Treatment of hemodynamic disorders in patients with alcohol withdrawal syndrome

FEDERAL MEDICAL RESEARCH CENTRE OF PSYCHIATRY AND NARCOLOGY

OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

NATIONAL SCIENTIFIC CENTER OF NARCOLOGY
OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
LLC "AKELA-N"

Treatment of hemodynamic disorders in patients with alcohol withdrawal syndrome

It is well known that alcohol withdrawal is accompanied by an adaptive response (stress), which is accompanied by an increase in the load on the heart and can lead to a rapid progression in heart failure due to a decrease in the compensatory capabilities of the cardiovascular system.

One of the most modern drugs that positively affect the adaptive capabilities of the body is inert xenon gas. Xenon inhibits acetylcholine receptors and potentiates glycine receptors, which explains its anxiolytic effect and ability to relax smooth muscle. Xenon also affects the state of the peripheral nervous system, suppressing to a lesser extent the parasympathetic, and to a greater extent, sympathetic neurotransmission, which suggests it to be relatively vagotonic.

To evaluate the therapeutic efficacy of xenon against hemodynamic disorders in patients with alcohol withdrawal syndrome (AWS) a study on 226 patients who were diagnosed with alcohol withdrawal syndrome was conducted. Among them, 80 patients with a reduced cardiac index (CI) according to bioimpedancemetry data (using the SIMONA 111 integrated monitoring system) were selected.

Patients of both groups received the following therapy: infusion therapy with polyionic solutions for fluid replacement, thiamine, tofizopam, metadoxine, phenazepam.

In addition to the above drugs, patients of the main group (Xe) were prescribed xenon therapy procedures - once a day for 5 days. The control group (BT) patients underwent similar procedures, during which they breathed oxygen-enriched air (50-70%).

Before and in 30 minutes after each procedure, indicators of cardiac output and a pulse index of peripheral vascular resistance (PIPVR) were measured in patients of both groups.

At the beginning of the study, a decrease in cardiac output was observed in patients of both groups, which was compensated by an increase in HR and an increase in vascular tone (an increase in PIPVR). At the same time, mean arterial pressure remained moderately elevated or At the same time, mean arterial pressure remained moderately elevated or kept within the physiological range (80-95 mm Hg), which indicates the limitation of the compensatory possibilities of the heart.

Fig.8. The typical trends in cardiac index after inhalation of xenon-oxygen mixture are presented

Inhalation of xenon-oxygen mixture was accompanied by a significant increase in CI, with its further gradual decrease during the day. In the control group, the CI did not change after the procedures.

Figure 9 presents a comparison of the trends in CI in the main and control groups before the procedure of inhalation of the respiratory mixture on the 1st and 5th days of the AWS. The diagram shows, that in both groups CI gradually increased, remaining below the age norm. In the main group, the trends were better, but the differences were not statistically significant. 

Fig. 9. Trends in cardiac index after inhalation of xenon-oxygen mixture

Fig.10. Trends in the pulse index of peripheral vascular resistance after xenon inhalation

Here one can see that the initially high vascular resistance decreased significantly after xenon therapy, which was especially noticeable on the 2nd, 3rd and 4th days of therapy, allowing the heart to work with a lesser load. During the day after the procedure, an increase in PIPVR was observed. In the control group, there was no effect after inhalation.

Figure 11 presents a comparison of the trends in PIPVR in the main and the control groups before the procedure of inhalation of the respiratory mixture on the1st and 5th days of AWS. The diagram clearly shows that the effect of xenon inhalation gradually accumulated and, on the 5th day, PIPVR was significantly lower in the main group.

Fig. 11. Comparison of trends in PIPVR

The effect of xenon inhalation clinically manifested as persistent improvement in the patient's condition in the form of anxiety reduction, hyperhidrosis, tachycardia, chills / fever, algic disorders, nausea. A positive effect was observed within 1.5-4 hours after the procedure, and then abstinence disorders gradually recurred. In addition, each subsequent procedure was accompanied by a deeper and longer-lasting effect.

No adverse events were detected during xenon therapy. Xenon at a therapeutic concentration did not depress consciousness, most patients after the procedures noted subjectively pleasant sensations

Fig.12 presents a comparison of trends in the severity of abstinence disorders in the main and control groups before the inhalation procedure of the respiratory mixture from the 1st till the 5th day of the AWS.

As it can be seen from the diagram, atypical trend of withdrawal disorders with a gradual, almost linear decrease was observed in the main group, while in the control group the trend in withdrawal disorders was typical, with a peak of severity of violations on 3rd day with its further slow decrease.

Fig.12. Comparison of trends in abstinence disorders.

Conclusions

 Thus, we can state that xenon is able to increase the myocardial work capacity under stress caused by the development of AWS. This significantly reduces vascular resistance, resulting in reduced load on the myocardium and increased blood flow.

These effects make xenon therapy the method of choice for treating patients with AWS and decreased myocardial contractility. Standard approaches to the treatment of such patients can not only fail to improve their state, but also can lead to its serious deterioration.

All inotropic drugs (cardiac glycosides, sympathomimetics) increase myocardial oxygen demand and can provoke ischemic disorders, while xenon due to its negative chronotropic and positive inotropic effects, along with cytoprotective properties in condition of hypoxia, reduces vascular tone, and increases peripheral blood flow.