Visually assisted respiratory rehabilitation of a patient with sequelae of intraventricular hemorrhage: a clinical case

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BACKGROUND

Long-term immobilization, post-intensive care syndrome, as well as the disorders of the physiological anatomic and topographic interrelations in patients with a history of acute cerebrovascular event of hemorrhagic type, brings forth the decrease of the rehabilitation potential, the level of physical activity and the increased risk of developing the concomitant diseases of the cardiorespiratory system, due to which, the rehabilitation of such patients is a combined problem, requiring the participation of the extended multidisciplinary rehabilitation team [1–3]. The cerebrovascular diseases, especially in young individuals, lead to the long period of incapacity of work and general incapacitation, while the presence of concomitant complications worsens the occupational prognosis. Within the structure of the acute cerebrovascular events, the percentage of the hemorrhagic type ones is approximately 20%, while the incapacitation level takes the first place among all the reasons of disability (3.2:10 000) [4, 5].

Restoring the functional activity is the aim of the multidisciplinary approach to rehabilitation of such patients, but for arranging the rehabilitation activities in the most favorable early period, the patient must be compensated in his somatic status [6–8]. The problematics of primary cardiorespiratory dysfunctions as the concomitant diseases, in particular, the unstable hemodynamics, the hospital-acquired pneumonia, is routinely faced by the primacy care physicians within the multiprofile in-patient hospital — the anesthesiologists-intensivists, the neurosurgeons and the pulmonologists [9]. In cases of severe respiratory distress, the mortality at the Resuscitation and Intensive Care units reaches 20–50% due to the inflammatory endotoxemia, the refractory hypoxia and the microcirculation crysis. The respiratory complications developing at the later rehabilitation period, include the development of the hypostatic pneumonia, the impaired mucociliary clearance, the development of purulent-septic foci, the atelectases, the cannula-associated endobronchitis, the weakness of the respiratory muscles and the development of respiratory failure with the incidence rate of 18–40% in case of brain infarctions and approximately 60% during the postoperative period of the non-traumatic intracerebral hemorrhages [10]. According to the data from various authors, such complications are an important factor leading to the increase in mortality and to the increase of the incapacitation degree, being responsible for the fatal outcomes in 5% of the patients surviving the acute period, and in 14% of the cases being the main cause of death [11–15]. Besides, such associated conditions in an extreme manner limit the physical activity, the general health status and the set of rehabilitation activities for the main disease [16].

The measures adopted for the purpose of improving the quality of life, for decreasing the respiratory insufficiency, for elevating the bronchodilation effect, for shortening the duration of involuntary immobilization and the total duration of hospitalization, as well as for increasing the survival rate, are the methods of respiratory rehabilitation. The research works on the rehabilitation of neurosurgery patients with respiratory complications describe only the specific methods of inhalation or physical therapy, not touching all the risk factors, which include the limited ventilation related to the increased volume of dead space; the impaired physiological gaseous exchange, the increase of the ventilation demands and the dysfunction of the peripheral muscles due to neurological disease [17, 18]. The complexity is also resulting from the fact that some invasive methods of respiratory support at the early rehabilitation period can themselves be the risk factor of developing additional complications, such as barotrauma, the volutrauma, the ventilator-associated pneumonia or the atelectasing of the lung, even in the settings of performing the manipulation in accordance with the strict recommendations due to the insufficient visual control over the respiratory function.

The significance of physical rehabilitation for the patients from the mentioned cohort is high and its is emphasized in the publications of the foreign authors, with this, the data on the problem of visual control of rehabilitation activities directly at the patient’s bed are sparse and need additional research [19, 20].

We have described the clinical case of respiratory rehabilitation of the patient with the consequences of the intracerebral hemorrhage by means of the imaging method of electrical impedance tomography.

CLINICAL CASE DESCRIPTION

Patient info

Case history. Male patient aged 20 years with a past history of cryptogenic non-traumatic intracranial hemorrhage; transported to the Neurosurgical In-patient Department for lavaging and for the endoscopic correction of the intraventricular hemorrhage with Arendt draining at the Kocher point on both sides. The evaluation of the degree of intensity of the intraventricular hemorrhages according to the D.A. Graeb scale was 10 points. Within the Resuscitation and Intensive Care Unit, during the postoperative period, the lower tracheostomy was performed.

The patient was receiving the in-patient treatment with the functional disorders expressed as the central tetraparesis, the bulbar syndrome and the impaired functions of the pelvic organs of the central type, due to which the trocar epicystostomy was performed. During the period of stay at the specialized department, the patient had an episode of hospital-acquired lower lobe pneumonia. According to the CT data, the lower lobe pneumonia was at the state of resolving, leaving the lower lobe fibroatelectasis.

The patient was discharged 3 months after the past cerebral accident in generally satisfactory status; referred for rehabilitation to the rehabilitation center under the LLC “Parus Medical Resort & SPA”. The patient was examined by the multidisciplinary team consisting of the physical and rehabilitation therapist, the anesthesiologist-intensivist, the exercise therapist, the physiotherapist, the neurologist, the pulmonologist, the medical logopedist-aphasiologist and the medical psychologist. The patient was admitted to the intensive therapy ward of the Medical Rehabilitation Department for the neurology profile patients. No active complaints were reported by the patient due to the presence of rough neurological deficit. No risk factors, pernicious habits or chronic diseases were reported before the moment of present disease, according to the oral information provided by the relatives and by the accompanying medical documentation.

Laboratory and instrumental diagnosis

On admission, the patient reacts to the examination, capable of following simple commands, not able to provide the productive contact due to the neurological deficit. The patient’s position in the bed is passive, he has signs of decreased nutrition, the tongue has a thick yellowish coating, normothermia is registered. The chest excursion is inhomogeneous. Unassisted breathing, superficial, via the tracheostoma; upon the sanitation, mucopurulent discharge was found in significant quantities. The pulmonary auscultation reveals the respiration that is weakened on both sides, weaker in the lower areas of the lungs. Saturation (SpO₂) — 96%. Breath rate — 18 breaths per minute. Central tetraparesis was diagnosed.

The patient underwent the set of diagnostic procedures for evaluating the cardiorespiratory system and including the radiological examination of the chest cavity organs, the laboratory diagnostics of the acid-base status of the arterial blood, the clinical hematology parameters and the tests to determine the levels of the main biochemical electrolytes, as well as the sanitation (therapeutic) fibrobronchoscopy. All the mentioned manipulations, as well as the therapeutic and the rehabilitation activities, were arranged under the visual monitoring using the method of electrical impedance tomography of the lungs (control of spatial distribution of the electrical impedance within the object based on the results of non-invasive electrical measurements).

Results of instrumental examination:

• rehabilitation routing scale: 5 points, major disorder of the vital processes, the patient is bed-bound and requires constant care;
• Barthel index (basic functional activity): 0 points, complete dependence;
• Rivermead mobility index: 0 points, sporadic movements during the day;
• Intracerebral Hemorrhage score (ICH score): 2 points;

Severity scale for the community-acquired pneumonia and for detecting the patients requiring intensive respiratory support (Systolic Blood Pressure, Multilobar Infiltrates, Albumin, Respiratory Rate, Tachycardia, Confusion, Oxygen, and pH, SMART-COP / modified variant of the SMTR-CO scale): 4 points, medium risk; severity scale for community-acquired pneumonia (Pneumonia Outcomes Research Team, PORT / Pneumonia Severity Index, PSI): 60 points, group II. Diagnosis — Z98.8: s/p lavaging and endoscopic treatment of intraventricular hemorrhage dated 24.12.24. Arendt draining at the Kocher point on the right side and on the left side. Intraventricular hemorrhage of unspecified etiology. Graeb 10. Central tetraparesis (in the right upper limb — proximally 4, 5 points, distally 3–4 points, in the left upper limb — minimal motions, in the lower limbs — 1–2 points), bulbar syndrome, impaired functions of the pelvic organs of the central type. Complications of the main disease: Hospital-acquired left-sided polysegmental pneumonia, convalescent. Bed sores of the sacrum. Lower tracheostomy on 05.01.25. Trocar epicystostomy on 26.02.25. N31.2: Flaccid neuropathic bladder, Trocar epicystostomy on 26.02.25. J18.9: Convalescent after the left-sided polysegmental in-hospital pneumonia (February 2025). Pneumofibrosis. L08.0: Pyoderma.

Therapy

Due to the presence of long-term involuntary immobilization and the absence of possibilities for changing the body position, the previous episode of pneumonia, the signs of fibroatelectases, the changes of the mucociliary clearance, the carriership of the tracheostomy cannula with the discharge colored grey-yellow with blood admixtures, the tube feeding, the body mass index being less than 16, the neuromuscular dysfunction of the central type, the neurological deficit — for the purpose of improving the functional outcome and the quality of life, the plan of individual measures of pulmonary rehabilitation of the patient included the following:

1. passive physical training with the aid of an instructor for providing the activity of the skeletal and the respiratory muscles: on a daily basis, twice daily in 20 min sessions;
2. positioning (supine and prone), verticalization at the verticalization bed: on a daily basis, three times daily according to the tolerability of exercises;
3. extrapulmonary vibratory percussion massage of chest cavity: on a daily basis, twice daily with sessions lasting 10 minutes, with the frequency of 30 kHz, No. 10;
4. intrapulmonary insufflation-aspiration with high-flow percussion via the tracheostomy tube: twice daily in 5 min sessions with a rate of 600 cycles per minute, No. 10;
5. inhalational therapy with alkaline solutions, respiratory therapy with helium-oxygen mixture: daily for 10 minutes, with a temperature of 65°С, after the sanitation of the tracheostomy tube, No. 10;
6. respiratory support with Positive End-Expiratory Pressure (PEEP): daily with sessions lasting 30 minutes, twice daily, PEEP 6, No. 10;
7. revision and sanitation of the tracheostomy tube: on a daily basis, three times daily, as soon as the tracheobronchial content accumulates;
8. instrumental physiotherapy for the skeletal and the respiratory muscles: electrotherapy of the muscles in the limbs with a current of 20 mA and with 15 min daily sessions; magnetotherapy applied to the diaphragm and to the lower regions of the lungs with the induction value of 0.8 Tesla and with sessions lasting 10 minutes per single field, daily.

In order to select the starting point, the main parameters of the patient were registered (table 1). For performing the primary assessment of the cardiorespiratory system functions, the patient was connected to the vital function monitors, as well as to the monitor of the electrical impedance tomography of the lungs. The vital functions are stable.

 

Table 1 The vital functions of the patient at the beginning and at the end of rehabilitation activities

Parameters	Day 1	Day 20
BR per minute	18	12
T, оС	37.0	36.5
Blood pH	7.3193	7.4212
paCO2, torr	50	41
SaO2, %	95	99
paO2, torr	80	96
Hb, g/l	101	121
К+, mmol/l	3.4	4.2
Na+, mmol/l	137	140
WBC, 109/l	11.37	7.31
RBC, 1012/l	4.12	4.46
PLT, 109/l	534	349

Note. On Day 1 of the rehabilitation activities, the patient had moderate tachypnea, subfebrile body temperature, subcompensated acidosis, moderate hypercapnia, moderate hypoxia, mild anemia, mild hypokalemia, moderate leukocytosis, moderate thrombocytosis; in 20 days of rehabilitation — normopnea, normothermia, normal acid-base balance, normal parameters of the hematology panel and of the blood biochemistry panel. BR — breath rate; Т — body temperature; pH — hydrogen ion concentration in the arterial blood; раСО₂/раO₂ — partial pressure of carbon dioxide/oxygen in arterial blood; SaO₂ — arterial oxygen saturation; Hb — hemoglobin (hematology panel); К⁺ — potassium in blood serum; Na⁺ — sodium in blood serum; WBC — leucocytes (hematology panel); RBC — Red blood cells (hematology panel); PLT — platelets (hematology panel).

 

The visualization has shown the presence of hypoventilation zones in the dorsal areas of the right lung, the uneven non-cyclic ventilation of both lungs. Other findings included the inhomogeneity of ventilation in all the regions of the lungs during the process of spontaneous respiration, as well as the relatively physiological perfusion with a tendency to hyperperfusion in the dorsal area of the left lung. There was also the decrease of the center of ventilation (CoV) by 38.66–45.66%, which corresponds to the development of dorsal atelectasis (Fig. 1).

 

Fig. 1. Record sheet of electrical impedance tomography of the lungs at the spontaneous breathing.

Here and in Fig. 3–6: I — four rows of tomography slices, corresponding to the moment registered every 10 respiration cycles; each slice is marked with the sequential letter of the Latin alphabet (A, B, C, D), the reference image is Ref-A, the row D corresponds to last sequence of respiratory cycles with spontaneous breathing.

Rows 1–2 — recorded patient data; rows 3–5 — reference record from a healthy volunteer: rows 1 and 3 — the distribution of ventilation in the regions of interest, rows 2 and 5 — the distribution of perfusion in the regions of interest, row 4 — comparative pulmonary resistance. The parameters of pulmonary resistance in the patient were not described in Figure due to the artifacts related to the disease, and due to the absence of artificial ventilation at the moment of recording.

1–4 — regions of interest (ROI): ROI 1 — ventral region of the right lung; ROI 2 — ventral region of the left lung; ROI 3 — dorsal region of the right lung; ROI 4 — dorsal region of the left lung; а–е — Clinical features.

Here and in Fig. 3–6: II — the table contains the numeric values of percentages of spontaneous breathing.

LPB ROI 1–4 — percentage of ventilation in the regions of interest, respectively; LPB Global — total percentage of ventilation (sum of percentages ROI 1–4);

HPB ROI 1–4 — percentage of perfusion in the regions of interest, respectively; HPB Global — total percentage of perfusion (sum of percentages); CoV — center of ventilation.

At the normal state, due to the anatomy of the lungs and of the heart projection, the percentages of ventilation were close to the following formula: ROI 1=25%, ROI 2=25%, ROI 3=25%, ROI 4=25%; the percentages of perfusion are close to the following formula: ROI 1=25%, ROI 2=15%, ROI 3=35%, ROI 4=25%; the percentages of CoV are close to the 50% levels (with its decrease corresponding to the development of an atelectasis in the part the lung, and the increase indicates the over-inflation of the part of the lung).

а — The black-colored silent zone that corresponds to the dorsal hypoventilation (6.06%, cm. Fig. 1) the right lung; б — The black-colored silent zone that corresponds to the periodical ventral (1.95–8.91%) and dorsal (3.43–0.68%) hypoventilation in the left lung; в — the intensity of the white color corresponds to local area of hyperperfusion (34.84–39/69%) in the left lung; г — the distribution of the normal ventilation in a healthy individual; д — the distribution of the normal pulmonary resistance between the respiratory cycles upon the deep induced respiration; е — the distribution of normal perfusion.

 

On day 3, the patient underwent the therapeutic fibrobronchoscopy via the tracheostomy tube. Under the cannula, on the mucosa of the trachea and partially within the lumens of major bronchi, a viscous suppurative content was observed, the mucosa is hyperemic, the vascular pattern is blurred, the surface is loose, and the changes correspond to the bilateral diffuse atrophic endobronchitis grade II (Fig. 2). Upon further visualization of the pulmonary tissue, the ventilation becomes more even, the key zone of hypoventilation was found in dorsal areas of the right lung, the correction of center of ventilation was carried out (Fig. 3).

 

Fig. 2. The status of bronchial tree after sanitation. The stages of visualization (the arrows are showing the pathologically modified regions): the swelling of the interbronchial septum (а); the hyperemia in the walls of the level 2–3 bronchi (b); sputum removed from the lumen of the level 4 bronchi (c).

 

Fig. 3. The recorded data from the electric impedance tomography of the lungs with the spontaneous breathing after the therapeutic fibrobronchoscopy (rehabilitation activities, day 3). The series of tomography slices is showing the restored ventilation at the ROI 1, 2, 4 and the hypoventilation in the ROI 3 with percentage ranging from 4.46% to 6.39%. The growth of the center of ventilation was observed — up to 42.13–46.28%.

 

For the purpose of solving the problem of the pathological bronchial secreted matter, the rehabilitation activities were arranged in the following order: (1) extrapulmonary percussion for the production of the contents from the alveoli and small bronchi, (2) intrapulmonary percussion, which deforms the thick sputum and replaces the effect of physiological expectoration, (3) removal of the collected secreted matter using the suction aspirator. With this background, the patient was receiving inhalation therapy with alkaline solutions and mucolytic drugs. In 2 hours after the procedures, the patient was receiving the rehabilitation using the physical and instrumental methods according to the developed plan for 10 days.

The intermediate assessment was arranged on the rehabilitation day 10. The mucociliary clearance in the patient has normalized, only trace quantities of the pathological secreted matter were found, the circulatory parameters and the vital functions were stable. The patient was successfully verticalized, now he can sit in the chair. The scheme was optimized with the addition of therapy with medical gases (helium-oxygen mixture). The visualization monitor was showing a much more homogeneous ventilation with the sufficient perfusion in both lungs, with slight hyperventilation in the ventral segments of the right lung and the decreased percentage of ventilation in the lower areas of the lungs (Fig. 4).

 

Fig. 4. The record sheet of the electrical impedance tomography of the lungs with the spontaneous breathing. The rehabilitation scheme was optimized with an addition of the medical gases therapy (helium-oxygen mixture, 10th day of rehabilitation activities): the findings include the positive dynamic changes (bilateral ventilation with relative hypoventilation on the dorsal areas of ROI 3–4).

 

The scheme was optimized once again by means of adding the PEEP respiratory therapy with the level titration and with selecting the 6 cm H₂O pressure. The visualization was showing the sufficient gaseous exchange in all the lung fields with an area of insignificant hypoventilation in the dorsal region of the left lung (Fig. 5).

 

Fig. 5. The record sheet of the electrical impedance tomography of the lungs with the spontaneous breathing after an addition of respiratory therapy (10th day of rehabilitation activities). Visualization of adjusting the level of Positive End-Expiratory Pressure. The upper row shows the uneven excessive ventilation with an increased level of Positive End-Expiratory Pressure supply, which is indicated by the uneven gradient and the contours of visualization; the lower row corresponds to the insufficient level of Positive End-Expiratory Pressure, which is indicated by the zones of hypoventilation colored black.

 

Follow-up and outcomes

During the process of follow-up, the respiratory cycles at rest, when compared to the initial evaluation, were showing the significantly higher quality, the homogeneous bilateral ventilation was shown, with this, the mathematical computation shows the positive dynamic changes after the conducted pulmonary rehabilitation. The final parameters of the patient were recorded on day 20 of rehabilitation activities (see table 1; Fig. 6).

 

Fig. 6. The record sheet of the electrical impedance tomography of the lungs with the spontaneous breathing (rehabilitation activities, day 20). The color differentiation from blue (the least) to white-colored (maximal) corresponds to the gas distribution in the pulmonary tissue. The images show the normal center of ventilation with a periodical exceeding the values from 49.5% to 58.87%, which corresponds to the variant from the absolute normal to subcompensated over-inflation of lung regions. Other findings include the percentage of the distribution of ventilation close to the normal levels (ROI 1=26%, ROI 2=26%, ROI 3=30%, ROI 4=17%), as well as the distribution of perfusion (ROI 1=22%, ROI 2=22%, ROI 3=35%, ROI 4=21%).

 

DISCUSSION

The clinical case represents an example of successful pulmonary rehabilitation of the patient after an episode of intracerebral hemorrhage with the complication expressed as the cardiorespiratory dysfunction under the visual assistance using the method of electrical impedance tomography of the lungs.

The electrical impedance tomography of the lungs is the functional method of visualization (imaging), in the real time mode allowing for observing the distribution of the respiratory capacities in the lungs, as well as the efficiency of their mechanical ventilation. The method is based on measuring the distribution of electrical impedance (complete resistance to current) in the biological tissues using the cross-sectional images of the chest cavity and the reconstruction of the tomography images based on these data. Unlike the structural methods (X-ray, computed tomography), the electrical impedance tomography reflects predominantly the dynamic changes of ventilation and perfusion at the real time mode [21, 22]. The lung tissue has a high specific resistance (low conductivity) at the expiratory phase (the air is the isolator) and it significantly decreases (increased conductivity) when inhaling due to the increase of the electrolyte volume (blood, interstitial fluid) and due to the decreased percentage of air in the alveoli. On the surface of the chest cavity of the patient, the belt of 16 electrodes is placed along the chest circumference. Through the pair of adjacent electrodes, a small and safe alternate current is applied (usually 1–5 mА, 50–100 kHz frequency). This current creates the gradient electric field inside the chest cavity. The other electrodes are measuring the differences of electrical potentials occurring on the body surface as a result of the current passing through the tissues with various impedance. The process is repeated cyclically, with this, the active pair of current electrodes is gradually switched all along the perimeter of the belt. The single complete cycle of measurements with 16 electrodes takes 104 independent current measurements [23, 24]. The application of the electrical impedance tomography of the lungs can be arranged round-the-clock without any consequences for the health of the patient [25].

The patient from the case provided by us corresponds to the average statistical data on the dynamic changes and the prognosis of complications after the conducted neurosurgical intervention. Despite the fact that, formally, the patient was compensated in terms of the respiratory system, and data from the clinical scales did not require the in-patient procedures, the conducted examination has allowed for suggesting the presence of significant functional respiratory disorders, directly affecting the outcome and the duration of the hospitalization of the patient. Positive dynamic changes include the stabilization of the somatic status of the patient; returning to the physiological respiration rate; the restoration of normothermia, the correction of the water-electrolyte balance, the blood acid-base status; the decrease in the number and the changes in the quality of the expectorated sputum and of the bronchial mucus; the absence of the dependence upon the methods of instrumental ventilation and oxygen support; the regress of the manifestations of respiratory failure. The practical meaning is also expressed by the decrease in the number of required sanitation procedures, by the decrease in the percentage of drug load and the care procedures. A significant role was played by the safety of conducted procedures: the visual control of the method of electrical impedance tomography has allowed for precisely evaluating the pulmonary ventilation, avoiding overinflation or atelectasing, for titering the respiratory support parameters, the number of medical gases inhalations, as well as for avoiding the bronchial obstruction with sputum, which was also spoken about by some authors applying the method of electrical impedance tomography in the intensive care [26]. Taking into consideration the stabilization of the status, the absence of the need in pulmonary ventilation or oxygen support, the patient was discharged with positive changes for further out-patient treatment at place of residence in the generally satisfactory status.

The presented variant of the bedside visualization allows for clearly demonstrating the status of the impaired respiratory function and its dynamic changes during the treatment process. During the rehabilitation course, the team was analyzing the biomechanics of the impaired functions, discussing the prognoses and the occurring challenges. We have achieved the result expressed as the successful restoration of the impaired function due to the visual control with the method of electrical impedance tomography, which was confirmed by the laboratory data, the instrumental diagnostics results as well as by the clinical examination.

CONCLUSION

The clinical case demonstrates the importance of bedside visualization using the method of electrical impedance tomography within the framework of the multidisciplinary approach, aimed at the rehabilitation of the neurological abnormalities in the patient presenting with the significantly impaired respiratory function. This method can be useful when managing not only the patients with post-intensive care syndrome with respiratory complications, but also the patients of the specialized Pulmonology In-patient Department.

ADDITIONAL INFORMATION

Author contributions: N.I. Kholodkov, scientific rationale, methodology, discussion of the study results, writing the article text, search and analytical work, examination of the patient, treatment of the patient; S.V. Sklyuev, examination of the patient, diagnosis of the patient, discussion and processing of the study results; S.A. Penner, examination of the patient, diagnosis of the patient, discussion and processing of the study results; D.A. Laivin, examination of the patient, discussion of the study results; T.A. Nikiforova, examination of the patient, management of the patient’s treatment; N.V. Stavitskaya, analysis of the material, work with the literature review. Thereby, all authors provided approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgments: The authors express their gratitude to the Deputy Director for Scientific Work of FSBI NNIIT for the month Ministry of Health of the Russian Federation to Dr. Dr. Schwartz Yakov Shmulevich for reviewing and initial proofreading of the manuscript; to the scientific secretary, PhD. Biol. sciences, leading researcher Natalia Tursunova, Federal State Budgetary Research Institute of the Ministry of Health of the Russian Federation, for editing, invaluable assistance in the design and final proofreading of the manuscript.

Consent for publication: The authors received the written informed voluntary consent of the patient’s legal representative (mother) to publish personal datapublished, including photographs (with the face covered), in a scientific journal, including its electronic version (date of signing 27.04.2025). The volume of published data has been agreed with the patient’s legal representative.

Funding source: The study had no sponsorship.

Disclosure of interests: The authors declare that they have no competing interests.

Statement of originality: The authors did not use previously published information (text, illustrations, data) while conducting this work.

Data availability statement: The editorial policy regarding data sharing does not apply to this work, data can be published as open access.

Generative AI: Generative AI technologies were not used for this article creation.

About the authors

Nikolai I. Kholodkov

Parus-Resort Sanatorium LLC; Novosibirsk Scientific Research Institute of Tuberculosis

Author for correspondence.
Email: horodoku@gmail.com
ORCID iD: 0000-0003-3685-2910
SPIN-code: 9115-6581

MD

Russian Federation, Novosibirsk; Novosibirsk

Sergey V. Sklyuev

Novosibirsk Scientific Research Institute of Tuberculosis

Email: elphyn@yandex.ru
ORCID iD: 0000-0001-8547-7067
SPIN-code: 7905-4240

MD, PhD

Russian Federation, Novosibirsk

Svetlana A. Penner

Parus-Resort Sanatorium LLC

Email: horodoku@gmail.com
ORCID iD: 0009-0009-7410-1131

MD

Russian Federation, Novosibirsk

Tatiana A. Nikiforova

Parus-Resort Sanatorium LLC

Email: tan.post@mail.ru
ORCID iD: 0000-0002-5891-0168
SPIN-code: 6681-1218

MD, PhD

Russian Federation, Novosibirsk

Dmitriy A. Laivin

Parus-Resort Sanatorium LLC

Email: medreb@parusresort.ru

MD, PhD

Russian Federation, Novosibirsk

Natalia V. Stavitskaya

Novosibirsk Scientific Research Institute of Tuberculosis

Email: director@nsk-niit.ru
ORCID iD: 0000-0003-2616-6693
SPIN-code: 8043-5182

MD, PhD

Russian Federation, Novosibirsk

References

Supplementary files