Integrative monitoring of systemic hemodynamics and the oxygen-transport status and the choice of the intensive therapy tactics in patients, suffering an ischemic cerebral insult

Keywords: ischemic cerebral insult; integrative monitoring; targeted intensive therapy; the oxygen-transportation status

Abstract

Objective. To elaborate the intensive therapy tactic in patients, suffering ischemic cerebral insult (ICI) depending on changes in the systemic hemodynamics indices and the oxygen-transportation status.Маterials and methods. In 42 patients, suffering the ICI of middle severity, ageing 45 - 88 years old, the integrative monitoring of the neurological state severity, systemic hemodynamics indices and the oxygen-transportation status on background of targeted intensive therapy was conducted.

Results. In the patients, suffering initial hypoxemia, a hypokinetic heart index (HI) - (2,0±0,1) l×min-1×m-2 and the lowered systemic delivery of oxygen (DO2) - (356±21) ml×min-1×m-2were revealed. Prophylactic oxygenation is needed if the value of the oxygen content in arterial blood (SаO2) exceeds 95% and DO2 is lesser than 520 ml×min-1×m-2. Aiming the achievement of eukinetic values of the HI, correction of vascular spasm and antihypertensive therapy was conducted, using alpha-adrenoblocking agent (urapydil) up to stabilization of the DO2 indices on the level of 520-600 ml×min-1×m-2. In hyperoxidal state a hyperkinetic HI - (3.6±0.1) l×min-1×m-2 and a raised DO2 - (699±14) ml×min-1×m-2 were revealed. Prophylactic oxygenation is not indicated if the value of the SаO2 index exceeds 95% and DO2 exceeds 600 ml×min-1×m-2. Aiming to achieve eukinetic values of HI it is mandatory to conduct antihypertensive therapy, using therapy with аlpha-beta-аdrenoblocking agent (labetalol).

Conclusion. Targeted intensive therapy, oriented towards balance with general oxygenation of the organism tissues, normalizes the oxygen-transport homeostasis in shortest terms, what impacts the results of treatment in patients, suffering ICI, immediately.

Author Biographies

К. V. Serikov, Zaporozhye Medical Academy of Postgraduate Education

Serikov Konstantin V. PhD, Associate Professor
Department of Emergency Medicine.
Zaporizhzhia Medical Academy of Postgraduate Education
69096, g. Zaporizhzhia, Vintera boulevard 20.
Tel.: (061) 236-72-01
E-mail: serikov@ua.fm
https://orcid.org/0000-0003-3580-7624

L. М. Smirnova, Shalimov National Institute of Surgery and Transplantology, Kyiv

Smirnova Larysa M., Doctor of Medicine. Chief Scientist.
Shalimov National Institute of Surgery and Transplantology, Kyiv.
03087, 30, Geroyev Sevastopolya str., Kyiv, Ukraine.
Tel.: 497-13-74.
E-mail: SMLM@ua.fm
https://orcid.org/0000-0003-2697-5458

G. А. Shifrin, Zaporozhye State Medical University

Shifrin Gregory A. Doctor of Medicine, Professor.
Department of Medicine of Catastrophes, Military Medicine, Anesthesiology and Intensive Care.
Zaporizhzhia Medical University.
69035, Zaporizhzhia, Mayakovsky avenue 26.
Tel.: (061) 224-64-69
E-mail: SMLM@ua.fm
Doctor of Medicine, Professor.

V. I. Dariy, Zaporozhye Medical Academy of Postgraduate Education

Dariy Vladimir I.
Department of Nervous Diseases.
Zaporizhzhia Medical University.
69035, Zaporizhzhia, Mayakovsky avenue 26.
Tel.: (061) 234-35-41
E-mail: dariyvladymir@gmail.com
https://orcid.org/0000-0001-9074-6911

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Published
2019-06-27
How to Cite
SerikovК. V., SmirnovaL. М., ShifrinG. А., & Dariy, V. I. (2019). Integrative monitoring of systemic hemodynamics and the oxygen-transport status and the choice of the intensive therapy tactics in patients, suffering an ischemic cerebral insult. Klinicheskaia Khirurgiia, 86(6), 19-24. https://doi.org/10.26779/2522-1396.2019.06.19
Section
General Problems of Surgery