Search

With a traditional approach to treatment of hypoxemic respiratory failure, it is believed that SpO2 reduction below 88-90% during oxygen therapy requires emergency care including invasive mechanical ventilation. However, the manifestations of hypoxemic respiratory failure in COVID-19 patients have certain features that have led to the change in the traditional respiratory support procedure. The therapeutic goals of respiratory support in this category of patients require clarification.The objective: in patients with COVID-19, to study the relationship of transcutaneous saturation values with clinical indicators that characterize ARF, the state of acid-base balance and blood gas composition.Subjects and methods. A multicenter prospective observational study included 90 COVID-19 patients treated in ICU whose transcutaneous saturation (SpO2) values were below 93% despite treatment. Depending on the degree of impaired oxygenation, patients underwent oxygen therapy through a mask or nasal cannula, high-flow oxygenation or non-invasive ventilation, while it was not always possible to achieve the target values of oxygenation parameters. The patients were divided into the following groups: Group 1 ‒ SpO2 above 93%, Group 2 ‒ SpO2 within 93–90%, Group 3 ‒ SpO2 within 85–89%, Group 4‒ SpO2 within 80–84%, Group 5 ‒ SpO2 within 75–79%, and Group 6 – below 75%.Results. It was revealed that during ARF management by noninvasive methods, different values of transcutaneous saturation and corresponding changes in the acid-base balance (ABB) and blood gas composition were determined When transcutaneous saturation (SpO2) decreased to 85%, there was a corresponding moderate decrease in PaO2 while no metabolic changes occurred. As a rule, there were no obvious clinical signs of respiratory failure (silent hypoxia). In patients with SpO2 reduction down 80–85%, clinical signs of respiratory failure (dyspnea, tachypnea, agitation) and, as a rule, a moderate increase in PаCO2 with the development of respiratory acidosis and compensatory metabolic alkalosis were noted. When SpO2 decreased down to 75–79%, arterial hypoxemia was usually accompanied by moderate hypercapnia and the development of decompensated mixed acidosis and venous desaturation as well as increased lactate levels. With transcutaneous saturation going below 74%, these changes were even more pronounced and were observed in all patients of this group.Conclusion. The revealed changes are mostly consistent with generally accepted ideas about the relationship between values of transcutaneous saturation and blood gas composition and parameters of blood ABB in the case of ARF. Reduction of transcutaneous saturation down to 85% not accompanied by pronounced clinical signs of respiratory failure (dyspnea, tachypnea, agitation), development of acidosis and venous desaturation, and the elevated lactate level can be regarded as relatively safe.

Changes in the state of health of people of the older generation may not invest in age-sex ratios and reduce sanogenetic mechanism that determines the structure of the disease. With the help of sample population technique, using a representative, stratified sampling and analytical discussion we studied indicators of physical development and the characteristics of the disease in adults 45-59 years old according to the medical records for the years 2015-2016 in the city of Novosibirsk. Content of the study was data from the official statistical registration forms (N 025/u-04, N 025-12, N 131/a) of 300 patients 45-59 years. The analysis showed that the portion of individuals of the older age group with standard indicators such as body build, blood pressure, heart rate and respiratory movements, recognized in the Russian Federation made from 13.7 to 26.3 %. While adults of this age, with asthenic and hypersthenic body type, made respectively 28.3 and 56.3 %. The share of contingent having bradycardia accounted for 26.0 %, tachycardia - 52.3 %. The proportion of persons with low and high blood pressure level was 11.3 and 75.0 %, respectively. Patients with bradypnea were determined in 24.4 %, with tachypnea - 49.3 %. Among adults of 45-59 years, the most common disorders were noninflammatory diseases of female genital organs, diseases of male genital organs and dorsopathies. The contingent prevailed with a mild (55.0%) and severe (40.0%) degrees of severity of the disease, requiring a health check-up. The revealed changes in the health of the older generation will determine the relevance of diagnostic, curative and preventive measures taking into account regional peculiarities.

Цель. Аналитическая оценка физического состояния организма и здоровья у лиц 18-29 лет по данным медицинской документации за 2015-2016 гг. в Новосибирске. Методы. С помощью методики выборочной совокупности с применением репрезентативности, рандомизации, стратометрического отбора, аналитического обсуждения изучали показатели физического развития, характеристики патологии, группы здоровья. Материалом исследования служила информация из официальных статистических учётных форм (№025/у-04, №025-12/у, №131/у) 250 пациентов в возрасте 18-29 лет. Результаты. Стандартные показатели типа телосложения, уровня артериального давления, частоты сердечных сокращений и дыхательных движений, принятые в Российской Федерации, зарегистрированы в 34,4-78,4% случаев. Взрослых астенического и гиперстенического типа телосложения отмечено соответственно 42,8 и 22,9%. Доля контингента, имеющего брадикардию, составляла 8,4%, тахикардию - 21,6%. Удельный вес лиц с пониженным и повышенным уровнем артериального давления был по 21,6%. Пациентов с брадипноэ не зафиксировано, у 21,6% контингента установлено тахипноэ. Среди взрослых 18-29 лет наиболее распространены невоспалительные болезни женских половых органов, заболевания мужских половых органов и острые респираторные инфекции верхних дыхательных путей. Только у 19,2-21,6% контингента отсутствовали заболевания. Вместе с тем 48,4-50,0% лиц имели хроническую патологию лёгкой степени тяжести, нуждались в диспансерном контроле и дополнительном обследовании. У 30,0-50,0% контингента документировано острое заболевание средней степени тяжести, установлен высокий суммарный риск развития хронической патологии и требовался диспансерный осмотр. Вывод. Выявленные отклонения от российских возрастных норм в здоровье могут стать основой для разработки вариантов стандарта комплексной оценки здоровья взрослого контингента по возрасту и региону.