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Background. The approach to the use of scales for assessing the level of consciousness, functional and general somatic status for rehabilitation and intensive care units is statistically and clinically insufficiently substantiated. Aims: development and substantiation of a typical scheme for the clinical use of scales of the level of consciousness, general somatic and functional status of patients with consequences of brain damage of various etiologies. Methods. A single-center prospective, retrospective study that included 118 patients on 20–50 days after traumatic brain injury, anoxic damage; consequences of acute cerebral circulatory disorders, and neurosurgical operations. In groups of patients who are in a coma, vegetative status, a state of minimal consciousness and a state of clear consciousness, the analysis of the statistical quality of clinical scales was carried out: scales of consciousness: the Glasgow Coma Scale (GCS); FOUR (Full Outline of UnResponsiveness); Coma Recovery Scale-Revised (CRS-R); the Glasgow Outcome Scale (GOS); the Extended Scale of the Glasgow Coma (Glasgow Outcome Scale Extended, GOSE); Rancho Los Amigos scale — scale of consciousness and interaction with the environment (the Rancho Los Amigos scale, RLAS); Functional status scales: DRS (the Disability Rating Scale); modified Rankin Scale mRS; Barthel Activities of Daily Living (ADL) Index; Functional Independence Measure (FIM); Karnovsky Index; Rivermead Mobility Index self-assessment of everyday life opportunities in Merton and Sutton (checklist self-maintenance Merton and Sutton community NHS trust); Scales of General somatic severity: assessment of multi-organ dysfunction on the APACHE II scale (Acute Physiology and Chronic Health Evaluation); APACHE IV scale; SAPS II scale (Simplified Acute Physiology Score); SOFA scale (Sequential Organ Failure Assessment). The functional state of the ANS was recorded using HRV parameters by recording 5-minute RR intervals of the electrocardiogram. Results. There are 4 groups of patients who are in a state of coma, vegetative status, a state of minimal consciousness and a state of clear consciousness. In 67 patients out of 118 examined (56.8%) after brain and brain damage as a result of TBI, anoxia, stroke, the parameters of ANS functional activity are in the zone of pathological (sympathetic/parasympathetic hyperactivity) values. Manifestations of sympathetic/parasympathetic hyperactivity is progressively reduced from the patients in a coma to patients in clear consciousness. Conclusions. Various scales of the level of consciousness, functional and general somatic severity of patients with the consequences of brain damage, objectively differ in clinical significance in the gradation of coma–vegetative status–minimal consciousness–clear consciousness.

Background. At the same time, the main effect of the use of this drug is the elimination of the autonomic nervous system dysfunction and sympatholysis. It seems important to search for a method of indications and selection of a dose of dexmedetomidine in intensive care. Aims — to improve the clinical effectiveness of the electrophysiological navigation of the prolonged use of dexmedetomidine in patients with brain pathology of various origins. Methods. The study included 83 patients 20–50 days after the traumatic brain injury, anoxic damage; consequences of acute disorders of cerebral. 37 patients comprised the 1st intervention group with a clinical course of dexmedetomidine (male — 28; female — 9; average age 49.6 ± 2.3 years) and 46 patients comprised the 2nd control group without pharmacological correction with dexmedetomidine (male — 23; female — 23, average age 51 ± 2.5 years). Criteria for the inclusion of prolonged infusion of the drug dexmedetomidine (Orion Pharma, Finland) are based on heart rate variability (HRV) indicators characteristic of sympathetic hyperactivity, the target task of titration of doses of dexmedetomidine served as the parameters for achieving normal HRV indicators, the appearance of parasympathetic hyperactivity served as the basis for reducing the dosage of the drug or stopping it of application. HRV parameters were recorded before dexmetomedine infusion-initially, on 1–3; 4–5; 9–10; 15–20 days of drug administration. Results. The starting dose of dexmedetomidine with sympathetic hyperactivity in patients was 0.12 to 0.24 μ g.kg –1 .hr –1 (average dose 0.16 ± 0.01; total 200 mg/day). According to digital data from HRV, the effective dose of dexmedetomidine ED50 was 0.26 ± 0.03 μ g.kg –1 .hr –1 (total daily 353.8 ± 35.1 μ g) and was achieved on day 9–10 using dexmedetomidine. Conclusions. The protective role of dexmedetomidine with correction of sympathetic hyperactivity based on electrophysiological navigation according to the HRV is reliable in the following indicators: The improvement of consciousness; a significant decrease in the incidence of distress lung syndrome; septic shock; mortality.

BACKGROUND: Long-term respiratory support is a severe disabling factor and is accompanied by a long stay of patients in intensive care units. AIMS: The analysis of the predictors of the success of disconnection from mechanical ventilation on the basis of clinical and diagnostic criteria in patients with brain damage of various etiologies. METHODS: The study included 53 patients (husband ― 28, women ― 25; cf. age 53.69 2.34) who are in 2019 with the consequences of traumatic brain injury (TBI) (n = 18; 33.9%); consequences of acute cerebrovascular accident (n = 24; 45.3%); the effects of anoxic brain damage (n = 3; 5.7%); consequences of subarachnoid hemorrhage (n = 8; 15.1%). RESULTS: The statistically significant predictor of recovery of spontaneous breathing in the 1st and 2nd groups of patients were preserved chemoreflex sensitivity (IPCS), the sensitivity and specificity of IPCS was 78.57% [95 % DI 49.295.26] and 83.3 % [95 % CI 62.695.26]. The index of peripheral chemoreflex sensitivity (IPCS) was calculated using the formula: IPCS = [RRe / RRi] [Vt(e) / Vt(i)] [VE(e) / VE(i)] [Vt(e) VE(i)], where IPCS is the index of peripheral chemoreflex sensitivity in l/min; RRi and RRe; Vt(i) and Vt(e); VE(e) and VE(i) ― respiratory rate (RR, breaths/min), tidal volume (Vt), minute ventilation (VE), (l/min) of the starting point ― (i) before carrying out a functional stress test and (e) ― during a functional test of normobaric hypoxia with SpO2 in the range of 9080 %. CONCLUSIONS: The most significant clinical parameters statistically reliably hampering the process of successful recovery of spontaneous breathing in addition to chemoreflex sensitivity are the presence of severe heart failure, pneumonia, autonomic dysfunction, level of consciousness, age, higher levels of inspiratory and expiratory pressure mounted on a respirator.

A review of the literature is devoted to the analysis of the role of the autonomic nervous system as the main regulator of the bodyʼs homeostasis in heterotopic (anoxia, craniocerebral trauma, cerebral circulation disorder) brain damage. First of all, clinical, pathophysiological definitions and methods of pharmacological correction of manifestations of sympathetic and parasympathetic hyperactivity (paroxysmal sympathetic hyperactivity — PSH, paroxysmal parasympathetic hyperactivity — PPH) are considered first. An important aspect of the review is the evaluation of publications devoted to the prevention and therapy of systemic inflammatory response and secondary neuroinflammation based on functional adaptive responses of the autonomic nervous system. The mechanisms of the so-called cholinergic anti-inflammatory pathway to systemic and local inflammatory reactions are discussed. The aspects of the influence of the norm and pathology of the autonomic nervous system on the metabolism and energy balance of the organism are described in detail. The prospects of normalizing the nutritional status through therapeutic effects on the structures of the autonomic nervous system located in the hypothalamic zones of the brain, changes in the regulatory influences of parasympathetic and sympathetic nerves, the innervating liver, intestine, and pancreas are estimated. The interactions of peripheral structures of the autonomic nervous system and microbiota are considered separately. The relationship is shown in detail and possible mechanisms of the functional status of the sympathetic or parasympathetic nervous system in muscular dystonia, respiratory insufficiency and veining are discussed from the point of view of evaluation and correction of the most important constant of autonomic instability in the form of peripheral chemoreceptor insufficiency.