Search

One of the important features of patients in chronic critical illness is their need for prosthetics of vital functions. The provision of specialized medical care to all patients in need is impossible without resolving the issues of transportation to a specialized medical center. Inter-hospital transportation of resuscitated patients is one of the tasks of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology. The greatest difficulty is the transportation of patients with unstable hemodynamics. The transportation service created in the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology is engaged in the development of issues of safe transport, including this category of patients by attracting organizational resources, forming a specialized team and equipping it. Medical and diagnostic, additional assessment of the patients condition on the spot. This approach makes it possible to increase the efficiency of intensive care during transportation and to eliminate mortality in this category of patients during transportation. Our experience of inter- and intra-hospital transportation of resuscitation patients was widely discussed at conferences, congresses and today is used in the work of mobile resuscitation teams.

Background: Thanks to advances in emergency medical and surgical care, the number of patients experiencing acute critical illnesses is increasing. However, a group of patients in the so-called chronic critical illness (CCI) was formed. In this category of patients, the problem of treating decubital ulcers is relevant, since they are characterized by a combination of prolonged immobilization, severe protein catabolism, neuroendocrine and metabolic disorders, protein-energy malnutrition (PEN) and tissue trophic disorders. Aims: Analyze the correlation of the degree of regeneration of decubital ulcers according to the Bates-Jenson scale in the modification S.Y.R. in relation to indicators of the nutritional status of patients in the CCI after brain damage. Materials and methods: The study included 26 patients with pressure ulcers II, III, IV stage with PEN. To evaluate decubital ulcers, the adapted Bates-Jensen scale in the S.Y.R. modification was used. (with graphic model). The severity of PEN was evaluated by a complex of anthropometric (BMI, shoulder circumference, thickness of the skin-fat fold, circumference of the shoulder muscles) and laboratory (transferrin, absolute lymphocyte count) indicators. The dynamics of anthropometric indicators and the results of laboratory studies were separately considered. Results: As a result, it was found that the change in anthropometric data correlated with laboratory parameters and the healing rate of decubital ulcers in only 26.9% of cases. Moreover, this correlation between the dynamics of transferrin and the absolute number of lymphocytes with the regeneration of decubital ulcers was observed in all patients. The obtained results demonstrated a direct correlation between the dynamics of healing of pressure ulcers and changes in laboratory indicators of nutritional status (as opposed to anthropometry data) in patients who are in a CCI after brain damage. Conclusions: These findings provide an opportunity to review the weight of indicators in assessing the severity of protein-energy malnutrition, as well as introducing the rate of regeneration of a decubital ulcer in the presence of a patient into the assessment of the nutritional status.