Novosti
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Year 2012 Vol. 20 No 3
ANESTHESIOLOGY-REANIMATOLOGY
A.V. MAROCHKOV, V.A. DUDKO, A.L. LIPNITSKY
QUALITY CONTROL OF SYNCHRONIZATION OF THE ARTIFICIAL LUNG VENTILATION AND PATIENT’S SPONTANEOUS BREATHING USING ELECTROENCEPHALOGRAPHIC MONITORING
ME “Mogilev regional hospital”
The Republic of Belarus
Objectives. To determinate the effectiveness of electroencephalogram-based control (EEG) according to Bispectral (BIS-index®) as the criterion of the adequate drug synchronization during the prolonged artificial lung ventilation (ALV).
Methods. 78 episodes of artificial lung ventilation were under analysis (ALV) in 12 patients with the syndrome of acute lung injury (ALI) who underwent ALV longer than 48 hours.
The registration of ALV regimen and parameters as well as the parameters of the respiration monitoring, the analysis data of the arterial and venous blood gases and acid-base state (ABS), the method of introduction and doses of the sedative preparations and analgesics was performed.
To assess the state of the central nervous system, bispectral index parameters (BIS-index) were registered. The evaluation of the patients’ state with Ramsey sedation scale was also carried out. All the analyzed episodes of ALV were divided into 4 groups: in the 1 group the psychotropic drugs were not administered, the 2 group – episodes of ALV with the use of narcotic analgesics, the 3 group – only sedatives preparations were used and the 4 group – both narcotic analgesics and sedatives were simultaneously used.
Results. It was established that higher values of BIS-index, an average of 89,1±10,6 were recorded in the 1 group of episodes of ALV. In the second group BIS-index decreased more significantly and amounted to an average of 75,0±16,1. In the third and fourth groups BIS-index was significantly different from the values in the first two groups; average values were 37,2±11,6 and 43,2±18,1, respectively. The reliable inverse correlation between the readings of BIS – monitoring and evaluation on Ramsey score scale was revealed. A clear direct correlation between the numerical values of the BIS-index and the volume of spontaneous breathing in the total volume of the minute lung ventilation was established. It was found out in the episodes of ALV demanding deep sedation, the significantly more severe disturbance of oxygenation and changes in the mechanical properties of the lung were registered in patients.
Conclusions. BIS – index is an objective criterion for effective drug synchronization during the prolonged ALV.
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212026, Respublika Belarus', g. Mogilev, ul. B.-Biruli, d.12, UZ “Mogilevskaia oblastnaia bol'nitsa“, reanimatsionno-anesteziologicheskoe otdelenie Tsentra serdechno-sosudistoi khirurgii,
e-mail: vladimirdudko@mail.ru,
Dudko Vladimir Aleksandrovich
Marochkov A.V., Doctor of medical sciences, Head of the Resuscitation and Anesthesia Department of ME "Mogilev Regional Hospital."
Dudko V.A., Head of the Resuscitation and Anesthesia Department of the Center of the Cardiovascular Surgery of ME "Mogilev Regional Hospital."
Lipnitski A.L., an Anesthesiologist-resuscitator of the Resuscitation and Anesthesia Department of ME "Mogilev Regional Hospital."
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