Artificial Lung Ventilation Research Articles

Опыт выполнения респираторной поддержки у пострадавших с тяжелыми травмами в ходе проведения санитарно-авиационной эвакуации вертолетами легкого класса

The aim of the study was to determine the optimal types of respiratory support for acute respiratory failure in patients with severe trauma during medical evacuation by light-class helicopters. Materials and research methods. The materials of the study are the data on the performance of respiratory support in patients with various types of trauma and acute respiratory failure for 2016-2021, contained in the automated information-analytical system “Disaster Medicine of Moscow” of the State Budget Institution “Moscow Territorial Scientific and Practical Center for Disaster Medicine of the Moscow City Health Department”. When performing the study, historical, statistical and analytical methods were used. Study results and their analysis. The results of the analysis showed: – proportion of victims with various traumas received in the emergency situations in Moscow constitutes 31,9% of all sanitary losses in emergencies. Of them 12.9% were in an extremely severe and serious condition, including 1.1% who needed artificial lung ventilation and tracheal intubation; – severe acute respiratory distress requiring ventilation and tracheal intubation was caused in 49.7% of cases by polytrauma, in 38.4 cases — by isolated trauma, in 8.7 cases — by thermal trauma, and in 3.2% of cases — by combined trauma. The indications and peculiarities of artificial ventilation with tracheal intubation in patients with various traumas to be medically evacuated by a light-class ambulance helicopter have been determined.

Complications and Mortality after CABG Surgery in Patients with Reduced Ejection Fraction

Coronary artery bypass grafting (CABG) is a complex, high-tech surgical intervention. Its success depends not only on the skill and experience of the surgeon but equally on the coherence of work and professionalism of all services involved in the operation. Severe left ventricular (LV) dysfunction after heart surgery is one of the main causes of cardiogenic shock, which is characterized by a local transient reduction of myocardial contractility (“stunned” myocardium) and/or significant cell damage caused by ischemia. In this state, systemic metabolic disorders often occur: increased concentration of free fatty acids, lactic acidosis, hypoxemia, and increased catecholamine content. General approaches to determining the risk of CABG surgery have not been definitively established. In addition, the data concerning the choice of optimal tactics in patients with a reduced ejection fraction (EF) are still limited. Relatively high early operative mortality in patients with reduced left ventricular EF requires further serious study.
 The aim. To determine the dominant complications and causes of fatal cases in patients with reduced LV contractility after CABG surgery.
 Materials and methods. The study included 210 patients with EF of 35% or less, who underwent CABG at the National Amosov Institute of Cardiovascular Surgery in the period from 01/01/2015 to 12/31/2021. Among them were 190 men (90.5%) and 20 women (9.5%). The age of the patients ranged from 29 to 83 years (61.1±8.9). Most patients underwent revascularization of three or more arteries.
 Results and discussion. In the group of patients with EF 35-30% in the postoperative period, acute heart failure (HF) occurred in 5 (3.8%) cases, respiratory failure (RF) was observed in 3 (2.3%) cases, renal failure in 3 (2.3%) cases, central nervous system (CNS) complications in 5 (3.8%). At the same time, along with the decrease in EF, the frequency of postoperative complications increased. In patients with EF below 24%, the frequency of postoperative complications increased significantly: acute HF was noted in 3 (15%) cases, RF in 5 (25%) cases, renal failure in 2 (10%) cases, CNS complications were noted in 0 (0%) cases. The duration of artificial lung ventilation increased significantly to 24.9±27.7 hours, the length of stay in the intensive care unit increased to 12.8±8 days, and the total length of stay of the patient in the hospital to 20.2±11.7 days.
 Conclusion. Based on the data we received, we concluded that: in patients with reduced LV myocardial contractility, such complications as HF, RF and renal failure, CNS complications most often occur; in addition, their frequency is higher than that in patients with preserved EF and increases with its decrease; one of the most frequent and life-threatening complications in this group of patients was acute HF; the use of intra-aortic balloon pump allows to avoid or improve treatment of HF and, at the same time, to increase survival in patients with reduced LV contractility.

Budesonid as a means of intraoperative lung protection during coronary bypassing in patients with concomitant chronic obstructive pulmonary disease and coronary heart disease: a pilot study

Lung protection during surgeries with artificial circulation (AC) is a vital task in clinical medicine.The aim. Evaluation of the effectiveness of intraoperative administration of nebulized budesonide for correcting the volume status of the lungs and oxygen transport in patients with concomitant coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD) during coronary artery bypass grafting (CABG) with artificial circulation (AC).Methods. The pilot clinical study included 40 patients with concomitant CHD and COPD who were admitted for scheduled CABG with AC. The first groups consisted of 20 patients who underwent low-volume artificial lung ventilation (AVL) with inhalation of nebulized budesonide in the process of AC; the second group consisted of 20 patients who underwent AC according to a routine technique with AVL off. Lung volemic status parameters were recorded by transpulmonary thermodilution using the Pulsion PiCCO in three stages: before the onset of AC, after its completion and one day after AC.Results. It was established that after withdrawal from AC, indices of extravascular water in the lungs (IEWL) decreased by 23% in the first group and increased by 24% in the second group. After the completion of AC and a day after it, IEWL significantly decreased in patients receiving budesonide and increased with a maximum rise at the second stage of the study in the second group. The index of oxygen delivery and utilization over time was within the reference range in all patients. The index of oxygen consumption did not reach the physiologically normal lower limit. The maximum level of pulmonary bypass blood fraction (16 and 12%, respectively) and a significant decrease in oxygenation index (240 – 290 c. u.) were recorded in this cohort of patients at the 2nd and 3rd stages of the study. The duration of postoperative ventilation was significantly longer in the second group, while the duration of in-hospital treatment did not differ significantly before the groups.Conclusion. The protective effects of the combination of aerosol therapy with budesonide and low-volume AVL were manifested by a decrease in the permeability of the pulmonary capillaries, the volume of IEWL, an improvement in the oxygenating function of the lungs, a decrease in the number of respiratory complications and the postoperative duration of AVL.

Specific Changes in Hemostasis System Parameters during Extracorporeal Membrane Oxygenation in Patients with a Novel Coronavirus Infection

Extracorporeal membrane oxygenation (ECMO) is a method that makes it possible to compensate for critical changes caused by acute respiratory failure, with the ineffectiveness of treatment with rigid modes of artificial lung ventilation (ventilator) in patients with acute respiratory distress syndrome in intensive care units. The search for the optimal state of the hemostasis system is one of the main tasks in the treatment of critical patients in ECMO conditions.The objective: to study changes in hemostatic parameters in patients with COVID-19 undergoing ECMO and determine the need for their correction.Subjects and Methods. According to the inclusion and exclusion criteria, 100 patients were included in the study: 72 men and 28 women aged 26 to 75 years old, the median age made 55 years [47; 60]. VV-ECMO was performed in all observations. In 100% of cases, the cause of respiratory failure which required VV-ECMO was COVID-19-associated pneumonia.Results. 49 episodes of hemorrhagic complications and 76 episodes of thrombotic complications were recorded from the 1st to the 7th day from the moment of ECMO initiation. We found that the chance of developing thrombosis decreased by an average of 0.3% with an increase in the activity of antithrombin-3 by 1%. A statistically significant association of thrombosis risk was also found for prothrombin and prothrombin time.Conclusion. During the first 7 days of ECMO, patients with COVID-19 demonstrate the increase in APTT, prothrombin time and a decrease in the number of platelets, prothrombin activity, and fibrinogen concentration. The risk of thrombosis in this group of patients significantly decreases with the increasing activity of antithrombin-3 and prothrombin and increases with rising need of the higher dose of unfractionated heparin. The tactics of restrictive anticoagulant therapy when using unfractionated heparin can be taken into account as a way to reduce the risk of thrombosis and requires further research.

Cognitive impairment in patients with coronavirus infection

The pathogenesis of the development of cognitive impairment (CI) associated with the SARS-CoV-2 virus is complex and includes the direct neurotoxic effect of the virus, vascular, disimmune factors, artificial lung ventilation, and adverse psychological consequences of social isolation. The relationship between CI and SARS-CoV-2 infection appears to be two-way: patients with premorbid CI have a higher risk of infection, severe illness, and death; on the other hand, past infection with SARS-CoV-2 may stimulate the clinical onset and progression of CI, including Alzheimer's disease. For the treatment of severe CI after COVID-19, memantine (akatinol memantine) is recommended.

ПРЕДИКТОРЫ ПОТРЕБНОСТИ В ИСКУССТВЕННОЙ ВЕНТИЛЯЦИИ ЛЕГКИХ У НЕДОНОШЕННЫХ НОВОРОЖДЕННЫХ ДЕТЕЙ ПОСЛЕ МАЛОИНВАЗИВНОГО ВВЕДЕНИЯ БЕРАКТАНТА

The purpose of the study was to predict the ineffectiveness of the first injection of Beractant by a minimally invasive method in the first 6 hours of life and the use of artificial lung ventilation (ALV) in premature newborns with a gestational age (GA) of less than 32 weeks with respiratory distress syndrome (RDS) at the age of 72 hours of life. Materials and methods of the research: a multicenter, retrospective, cohort study was carried out. Nine perinatal centers from different Russia regions took part in the research from July 1, 2019 till June 30, 2020. A total of 102 premature newborns at the GA of less than 32 weeks participated in the survey. The 100 mg/kg Beractant was used in the first and repeated injections of surfactant. The first injection was allowed at the age of not later than 6 hours of life. The authors have studied the methods of injection by a thin catheter represented by the term less invasive surfactant administration (LISA) or through an endotracheal tube using INSURE method, which consists of an intubation-surfactant-extubation sequence. The two comparison groups of patients were formed. Group 1 of 69 children “without ALV”: after the introduction of Beractant the patients had needed non-invasive respiratory support (non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP)). Group 2 of 33 children “with ALV”: needed intubation trachea and invasive ALV during the first 72 hours of life. Results: both groups did not differ statistically significantly in terms of gender, GA, body weight and length at birth, as well as in the APGAR score. The statistically significant differences were found in the duration of the anhydrous interval (Me [Q1; Q3] in children “without ALV” 72.0 [27.0; 95.0] hours versus 15.0 [6.8; 59.2] hours in children “with ALV,” p=0.035) and by the level of C-Reactive Protein (CRP) in the blood: the median (Me) maximum value in children “without ALV” was 8.0 [7.4; 10.0] mg/l versus 19.45 [11.2; 28.7] mg/l in in children “with ALV.” The risk of transfer to ALV in those children who were injected with Beractant using INSURE was 3,625 [1,137; 11,552] times higher than in those who were administered using LISA. Conclusion: the predictors for ALV in the first 72 hours of life in premature newborns with GA of less than 32 weeks are a short anhydrous period and a high level of CRP in the child's blood. The use of the INSURE method in comparison with LISA adds about 3.6 times higher risk of need for the ALV in patients with RDS in the first 72 hours of life (in the selection described in the article).

Difficulty in diagnosing and treating a child with multisystem inflammatory syndrome: a Case report

This clinical observation is an example to show the complexity of diagnosing and treating children with SARS-CoV-2-associated multisystem inflammatory syndrome.
 A 17-year-old patient who had a mild form of COVID-19 two weeks ago had a fever again and felt severe abdominal pain, and his general condition deteriorated rapidly. Moreover, on the fifth day from the onset of the disease, a child from the district hospital was admitted to the Ivano-Matreninsky Childrens Hospital in critical condition. Due to peritoneal symptoms, a diagnostic laparoscopy was performed to exclude acute surgical diseases which revealed mesadenitis and hydroperitoneum. Subsequently, the patient had a prolonged fever, severe multiple organ failure developed, including myocarditis with damage to the conduction system of the heart and a marked decrease in the left ventricular ejection fraction, bilateral pneumonia, hydroperitoneum and hydrothorax, acute kidney injury, lymphopenia, thrombocytopenia, coagulopathy, increased markers of inflammation. Non-invasive artificial lung ventilation was performed for 3 d. On day 10, an atrial temporary pacing system was installed, removed 11 d after heart rhythm normalization, and the pleural cavity was drained due to spontaneous pneumothorax. There was a gradual positive trend in respiratory status, the state of the cardiovascular system, normalization of laboratory parameters, and a decrease in inflammation markers. The patient was discharged from the hospital in a satisfactory condition on day 39.
 This clinical case demonstrates a severe course of childhood inflammatory, multisystem syndrome with multiple organ failure. The peculiarities of the case include the severity of abdominal pain syndrome, requiring laparoscopy, impaired cardiac activity, and requiring a pacemaker for 11 days.

Transportability of newborns at the stage of pre-transport evaluation

with the necessary resources and technology to improve the level and quality of care remains one of the most important tasks of emergency neonatology. Deterioration on the road may be due to suboptimal stabilization, the severity of the patient's condition, and the transportation procedure itself. Assessment of transportability is one of the most important tasks in the pre-transport preparation phase. Materials and Methods. The cohort study included data from 604 resuscitation team visits. According to the tactical decision, the subgroups of the transportable (n = 497) and non-transportable (n = 46) patients were singled out. The anamnesis data, scores according to the KSHONN, NTISS, TRIPS threat scales, the volume of intensive care, pre-transport preparation, and the outcome of the hospital stage were analyzed. Results. Non-transportable patients had significantly higher scores on the examined threatometric scales. The need for high-frequency artificial lung ventilation was associated with patient nontransportability with a risk ratio of 10.1 [6.72 to 15.18], and dopamine and adrenaline infusion increased the likelihood of nontransportability with risk ratios of 5.85 [3.44 to 9.95] and 11.38 [8.09 to 16.01], respectively. The need for correction of intensive care is associated with nontransportability with a risk ratio of 3.44 [2.29 to 5.17]. The group of nontransportable patients was characterized by significantly higher mortality, 7-day mortality, frequency of late neonatal sepsis, and longer duration of ventilatory ventilation and intensive care. Discussion. The group of patients considered untransportable at the stage of pre-transport preparation is characterized by high morbidity, the need for intensive care, and the need to correct therapy, which is regarded by the transport team as an additional risk. Conclusion. Non-transportable patients are characterized by a significantly higher need for intensive care and amount of pre-transport preparation, high morbidity and mortality

Comparative analysis of intraoperative lung protection technologies in patients having cardiorespiratory comorbidity during coronary bypass surgery with artificial circulation

Objective: Comparative analysis of the effect of budesonide and low-volume artificial lung ventilation (ALV) on pulmonary volemia, oxygen transport and respiratory biomechanics in patients having cardio-respiratory comorbidity during сoronary artery bypass graft (CABG) with artificial blood circulation (ABC).Methods: The clinical study included 50 patients having cardiorespiratory comorbidity with a median age of 66 years who were admitted to the clinic of the Far Eastern Federal University for planned CABG in conditions of ABC. The patients were divided into 2 groups by random sampling method. The first group consisted of 25 patients who underwent low-volume artificial lung ventilation (ALV) with inhalation of nebulized budesonide during ABC; the second – 25 patients underwent isolated low-volume ALV during ABC. The study was carried out in three stages: before the start of ABC, after its completion and a day after CABG. Extravascular lung water index (ELWI) and pulmonary vascular permeability index (PVPI) were registered using method of transpulmonary thermodilution. Oxygen transport indicators were determined: oxygen delivery index (DO2I) and oxygen consumption index (VO2I), pulmonary blood bypass fraction (Qs/Qt), oxygenation index (OI).Results: After turning off ABC in the first group, the ELWI decreased by 23%, in the second group it declined by 8%. Among patients treated with budesonide, PVPI significantly decreased after providing ABC. However among patients of the second group it remained unchanged. DO2I remained in the reference range among all patients. However VO2I was below it with a minimum value in the second group after ABC stopping. In this cohort the level of Qs/Qt was significantly higher, and OI was lower than in patients of the first group. The resistance of the lung tissue decreased on the background of an increase in its compliance among patients who received budesonide immediately after ABC and 2 hours after it. In the second group there was opposite dynamics of these indicators.Conclusions:The combination of low-volume ALV and inhalation of nebulized budesonide during ABC stabilizes the volemic status of the lungs, improves their oxygenating function and respiratory biomechanics in the postperfusion and early postoperative periods of CABG.

Analysis of risk factors of developing infections associated with medical care among maternity and newborn babies

BACKGROUND: In modern conditions of the development of healthcare and humanity as a whole, the prevention of healthcare associated infections is one of the global world problems.
 Identification of risk factors for the development of infections associated with the provision of medical care in patients in various types of medical organizations is an integral part of epidemiological surveillance.
 To determine the health index of a nation, it is enough to indicate the level of infectious morbidity, in the formation of which healthcare associated infections plays an important role. Currently, the attention of medical workers of various specialties is attracted to this problem: hygienists, health care organizers, microbiologists, epidemiologists, and heads of nursing staff.
 AIM of this study was to identify possible risk factors for the development of healthcare associated infections in puerperas and newborns in the perinatal center in Makhachkala.
 MATERIALS AND METHODS: The retrospective, observational, single-center, continuous study was conducted based on the data of birth histories and individual maps of the development of newborns. The main group consisted of 125 puerperas and newborns with signs of HL. The diagnosis was confirmed by positive results of bacteriological examination of puerperas and newborns. The sanitary and hygienic background of the hospital was determined by samples of swabs from the surfaces of equipment, inventory, medical products, underwear and bed linen, dishes, hands of staff and puerperas.
 RESULTS: It has been established that possible risk factors for the development of infections associated with the provision of medical care in newborns and maternity hospitals include the carrying of hospital ecovars of microorganisms in workers of all categories; contamination by conditionally pathogenic microorganisms of various surfaces of the hospital environment, equipment, tools, inventory; invasive medical and diagnostic interventions (vascular catheterization, urinary tract, endoscopic studies, transfusions, punctures, injections), artificial lung ventilation, artificial feeding, etc. The multiplicity and duration of procedures are important.
 CONCLUSIONS: Strengthening control over the epidemiological safety of medical care using the risk assessment of hospital infections, as well as strengthening microbiological monitoring of circulating strains of topical pathogens are leading in the prevention of infections associated with the provision of medical care.

The Role of Dexmedetomidine in the Structure of Anesthesia for Hip and Knee Arthroplastyс Surgery in Patients with Diabetes

Hip and knee arthroplasty (HKA) is a surgical procedure when damaged parts of the joint are replaced with artificial ones that replicate the shape of a normal joint and restore its function. Every year more than 1.5 million endoprosthetic operations are performed in the world. Replacement of a damaged joint allows patients to return to the normal life, freeing from pain and limited mobility. However, one of the common diseases that negatively affect the results of these operations is diabetes mellitus (DM). The aim of the study: to determine the efficacy and safety of the combined multimodal low opioid anesthesia with dexmedetomidine sedation in patients with diabetes undergoing HKA surgery. Materials and methods. The study included 45 patients who underwent HKA surgery. Patients were divided into three groups according to the scheme of anesthesia. In patients of the 1st group (n = 15) multicomponent low-flow anesthesia with artificial lung ventilation was performed, in the patients of the 2nd group (n = 15) spinal anesthesia was used, in the 3rd group (n = 15) – combined spinal – epidural anesthesia with dexmedetomidine sedation. The groups of patients were identical in anthropometric and gender characteristics, duration of surgery and anesthesia, baseline somatic status. Statistical analysis was performed using the IBM SPSS Statistics suite (SPSS v.16.0). Results. The course of anesthesia in patients in all groups was satisfactory, but patients in group 3 were less likely to experience hyperdynamic reactions (tachycardia and hypotension), postoperative nausea and vomiting (PONV). Only one patient from group 3 required ondansetron for the treatment of PONV against 3 and 2 patients from groups 1 and 2, respectively (p <0.05). Conclusions. Any of the proposed techniques can be used for anesthesia during hip and knee arthroplasty, but the best results have been obtained with combined spinal-epidural anesthesia with dexmedetomidine sedation. In addition, the use of dexmedetomidine can significantly reduce the use of opioids diring the intraoperative and postoperative period.

PERINATAL OUTCOMES IN WOMEN WITH COVID-19

COVID-19 pathogenesis has not been fully understood yet. However, the virus is known to enter the epithelial cells of the upper respiratory and gastrointestinal tracts, activating S-protein by angiotensin-converting enzyme 2. This process can significantly affect the pregnancy, childbirth and postpartum period.
 The aim of the study is to analyze the impact of COVID-19 on pregnancy course and outcomes.
 Materials and Methods. The authors retrospectively analyzed case histories and surgical protocols of 67 pregnant women with confirmed and suspected COVID-19, and neonatal records of 59 newborns who were in contact with COVID-19 patients.
 Results. Childbirth due to antenatal fetal death occurred in 13.4 % of cases, preterm births were observed in 15.5 %. Besides, 15.2 % of children were born prematurely by gestational age (the average rate for the Russian Federation is 8–11 %); invasive artificial lung ventilation was required in 3.4 % of newborns; primary neonatal resuscitation was performed in 18.6 % of cases. PCR examination of oropharyngeal swabs for SARS-CoV-2 detection did not confirm the presence of COVID-19 causative agents. Neonatal jaundice was diagnosed in 83.1 % of cases (the average rate for the Russian Federation is 60 %). Phototherapy (serum bilirubin >220 µmol/l, transcutaneous bilirubin index >200, Kramer scale score 3–4) was required in 77.5 % of such children (the average rate for Russia is 40–50 %).
 Conclusion. The conducted study indicates a significant impact of COVID-19 on pregnancy course and outcomes: the risks of preterm birth, antenatal fetus death, and the need for primary neonatal resuscitation also increase.

Surfactant therapy for pneumonia COVID-19 of obstetric patients

Introduction. Pregnant women may be at increased risk for severe COVID-19 illness. Pregnant women are more likely to be hospitalized at ICU, needed the mechanical ventilation compared to nonpregnant women of childbearing age. Building on the experience of the effective use of the exogenous surfactant for influenza A/H1N1 treatment of pregnant women with COVID-19, the surfactant therapy has also been included in the treatment.The objective. To evaluate the effectiveness of surfactant therapy in the integrated treatment of severe COVID-19 pneumonia of pregnant women and postpartum women.Materials and methods. The study included 135 pregnant and postpartum women with severe COVID-19 pneumonia. All of them received antiviral, anticoagulant, anticytokine and anti-inflammatory therapy. 68 patients (main group) with an initially more severe course of the disease and a greater degree of lung damage (p = 0.026) received inhalations with Surfactant-BL, 67 patients (control group) did not receive the surfactant therapy. Patients received Surfactant-BL through a mesh-nebulizer at a dose of 75 mg 2 times a day for 3–5 days.Result. Patients of the main group showed decreasing risks of requiring the noninvasive ventilation (27.9% vs. 52.2%, р = 0.014) and artificial lung ventilation (2.9% vs. 11.9%, p = 0.047), the length of stay in the intensive care unit (ICU) was reduced (10.6 vs. 13.1 inpatient days, р = 0.045). Сomplications such as pneumomediastinum and pneumothorax occurred less frequently in the surfactant therapy group (24.2% vs. 52.4%, p = 0.037) with a high extent of lung damage (CT-3–4). With early surfactant therapy in the standard oxygen therapy stage or high-flow oxygenation, gas exchange indicators were restored faster, thus avoiding mechanical ventilation and has reduced the duration of intensive care (р = 0.004) and prevented deaths.Conclusion. The use of surfactant therapy for pneumonia associated with COVID-19 in pregnant and postpartum women against the background of ongoing complex therapy helps to prevent further lung damage, reduce the mechanical ventilation risk and improve oxygenation earlier, especially with early start of surfactant therapy.

Possible impact of the coronavirus on pregnancy outcome

Due to the peculiarities of their immune status, pregnant women, like the elderly, are at risk for the severe course of the novel coronavirus infection COVID-19. Immunosuppression and other physiological changes during pregnancy contribute to a high susceptibility to respiratory pathogens and can cause severe pneumonia at different gestational ages, which can lead to intensive care hospitalization and the need for artificial lung ventilation. The initial timing of the gestational period is fundamental in the development of the fetal organs, and the immune system is especially sensitive at this stage, which significantly affects the course of the infectious process. The clinical manifestations of the course of the disease identified in pregnant women with confirmed SARS-CoV-2 infection are similar in principle to those in non-pregnant women with COVID-19 pneumonia. Laboratory tests usually show a decrease in the level of leukocytes and lymphocytes, mild thrombocytopenia, and an increase in liver function test indicators. A general practitioner who provides dynamic monitoring of pregnant women at the site needs to be alert in terms of a possible severe course of the new coronavirus infection during pregnancy and take maximum measures to limit possible contacts of a pregnant woman in order to prevent her infection

Safety of adaptive ventilation modes ISV and PSV when weaning the patient from a respirator

Introduction.Currently there are no reports or recommendations concerning the ventilator weaning process. Appliance of the intellectual adaptive ventilation mode (iSV) represented in indigenous Russian unit ALV ZISLINE МV200 К 1.19 («Triton» Yekaterinburg) is highly potential. It provides minute ventilation target volume regardless of spontaneous patient’s respiratory activity and controls the pressure-support ventilation level (PSV) after each ventilatory cycle. Object was to increase safety of a patient’s spontaneous breathing adaptation period after longtime artificial lung ventilation.Materials and methods.Using the continuous sampling method we’ve surveyed 46 patients at the ages from 34 to 81 y.o. (median is 65.5 y.o.) being under prolonged artificial lung ventilation treatment at ICU from 5 to 28 full days. The groups are divided into 2 depending on the assisted respiration method for spontaneous breathing adaptation. In the 1st group (n = 25) the PSV mode was used for the purpose of spontaneous breathing adaptation. In the 2nd group (n = 21) the iSV mode was employed. The safety of conducting artificial lung ventilation was estimated by the dynamic of the arterial CO2 level, arterial oxygen saturation, pressure-support value, oxygen and energy intake value and a 24-hour fluid balance.Results.The comparison study of the metabolic indicants showed a higher rate of estimated energy requirement in the PSV mode authentically different by 3-5 full days, positive fluid balance conditioned by positive airway pressure and certain fluid retention which confirms more active respiratory load in the PSV mode. In the iSV mode from the 3rd till the 5th full day there’s negative fluid balance. By the 7th-10th full day it becomes slightly positive which proves electrolyte and fluid balance stabilization.Discussion.Most of the studies related to the study of the advantages of one or another method of auxiliary ventilation used the success of weaning as the primary indicator. In our study, we focused on the main respiratory indicators and the adequacy of ventilation when using auxiliary modes, as well as metabolic costs. In our study, we noted a decrease in the number of days spent by patients in IUC when using the iSV mode compared with the use of the PSV mode. We have determined a significant reduction in the estimated energy demand when using the adaptive ventilation mode compared to the pressure support mode, regardless of the PS level, as well as an increase in VO2 and VCO2.Conclusion.Thus, the iSV mode is believed to be more physiological than the PSV as it not only makes less demands on the respiratory system but it also allows to stabilize a patient's fluid balance during recovery after his/her critical condition.

Розрахунок параметрів функціональної системи дихання для оптимізації вибору режимів штучної вентиляції легенів

Різноманітні процеси, що відбуваються в організмі, є керованими, тобто їхній стан визначається в залежності від конкретного впливу на них керуючої сторони. При цьому природним є намагання вибрати оптимальний керуючий вплив, найкращий у порівнянні з іншими можливими способами керування. Зрозуміло, що живому організму для оптимізації вибору керуючого впливу необхідно здійснити імітацію на математичній моделі, яка дозволила б у режимі реального часу імітувати збурення і прогнозувати функціональний стан організму внаслідок цих збурень. Це стосується, зокрема, прогнозування реакції функціональних систем організму при вірусному захворюванні. У роботі узагальнено математичну модель функціональної системи дихання, яка враховувала б різний характер руху повітря в повітроносних шляхах (ламінарний, турбулентний, змішаний). Складовими частинами моделі є моделі транспортування респіраторних газів у повітроносних шляхах, альвеолярному просторі, крові легеневих капілярів, артеріальній крові, крові тканинних капілярів, тканинах і змішаній венозній крові та самоорганізації системи дихання та кровообігу. Запропонована обчислювальна процедура може бути застосована з урахуванням масиву індивідуальних даних для вибору режимів штучної вентиляції легенів у разі важкого перебігу COVID-19.

To the possibility of detecting the "coronary theft" syndrome in small laboratory animals

The purpose of the study. There are investigation of the possibility of using the laser Doppler flowmetry method to assess blood microcirculation and analyze the mechanisms of its regulation in conditionally intact and ischemic myocardium in small laboratory animals (rats) to identify the "coronary theft" syndrome. Materials and methods. The experiments were carried out on white mongrel anesthetized (urethane 1300 mg/kg /b) male rats weighing 200-250 g. 28 days after the reproduction of an experimental myocardial infarction in an open chest and artificial lung ventilation, the microcirculation level was assessed in conditionally intact and ischemic areas of the myocardium by laser Doppler flowmetry. Using spectral wavelet analysis, the amplitudes of microcirculation oscillations normalized to the total perfusion associated with various regulation mechanisms were determined. Results. It was found that the microcirculation level is significantly lower in the ischemic zone of the myocardium compared with the conditionally intact one (17.3±2.8 and 30.3±1.3 per. units, respectively, p = 0.006, n = 8). Spectral wavelet analysis showed that in the ischemic injury zone, in comparison with the conditionally intact myocardium, the amplitudes of microcirculation oscillations normalized to the general level of microcirculation increase for all regulatory mechanisms. Conclusion. The laser Doppler flowmetry method can be used to assess the intensity of microcirculation in conditionally intact and ischemic myocardium. Using this method makes it possible to identify the "coronary theft" syndrome in experiments on small experimental animals.

Obesity and covid-19 — signs of convergence of two pandemiсs. Guidelines to fight obesity based on the principles of «ROOTS»

The COVID-19 pandemic is a challenging problem of the present. Another essential problem causing serious health consequences is the global obesity epidemy. Our article notes the importance of studying the combinations and correlations of mentioned pandemic processes. We analyzed scientific reports of co-presence of obesity, diabetes and coronavirus infection. According to the analyzed data combination of COVID-19 with obesity and diabetes leads to the higher rate of the hospitalisation. These patients more often required the transfer to the intensive care unit and artificial lung ventilation. Our review contains scientific observations of the first reported cases of higher mortality rate of obese and diabetic patients during the period of previous influenza pandemics (including H1N1). The results of the 2020 year shows that the outcomes of coronavirus infection with underlying obesity much more threatening and harmfull. In our article, we present the correlation of the average body mass and mortality rate index in different countries (according to the WHO and the World Obesity Federation). Comparative results in the Central Asia countries are given as well. The paper analyzes the suggestions for obesity policy and advocacy provided by World Obesity Federation in “ROOTS: A framework for action”. The conclusions marks the importance of implementing the proposed measures against obesity during a pandemic and in the post-COVID era.

Вплив якісних та кількісних змін поповнення крововтрати на прояви синдрому поліорганної недостатності при політравмі

У роботі наведені результати аналізу 53 історій хвороб постраждалих із політравмою мирного та воєнного часу, яким проводили поповнення крововтрати за ліберальною стратегією, та обстеження 16 постраждалих, яким застосовували рестриктивну стратегію поповнення крововтрати. Обмеження інфузійно-трансфузійної терапії до 70 мл/кг не знизило її протишокового ефекту і в той же час дозволило зменшити позитивний водний баланс, скоротити тривалість вазопресорної підтримки та штучної вентиляції легень, зменшити кількість пневмоній та інших ускладнень, уникнути різких коливань гемоглобіну, гематокриту та загального білка в 1-шу добу, знизити кількість повторних трансфузій, зменшити летальність.

Кардіопротективні властивості торакальної паравертебральної блокади в гострому періоді закритої торакальної травми різного ступеня тяжкості

Вступ. Адекватність аналгезії при тяжкій закритій торакальній травмі (ЗТТ) забезпечується регіонарними методами знеболювання, одним із яких є торакальна паравертебральна блокада (ТПБ), яка вже довела свою ефективність. Проте не наведені дослідження впливу ТПБ на перебіг саме ушкодження серця після ЗТТ. Мета. Виявлення впливу ТПБ, проведеної в гострому періоді ЗТТ, на перебіг первинних і вторинних травматичних ушкоджень серця. Матеріали та методи. Контрольоване проспективне нерандомізоване дослідження засновано на аналізі лікування 82 постраждалих із ЗТТ: 70 (85,4 %) чоловіків, 12 (14,6 %) жінок, віком 53 (45, 65) роки. Групи сформовані за тяжкістю ЗТТ, де у підгрупах («a», «b») порівнювалася ефективність системної аналгезії (нестероїдні протизапальні засоби (НПЗЗ) та опіоїд) і ТПБ, проведеної у гострому періоді й надалі упродовж 4–5 діб. 1-ша групa — Injury Severity Score (ISS) — 16,0 ± 4,4 бала, APACHE II — 11,7 ± 3,6; 2-га група — ISS — 17,1 ± 3,9 бала, APACHE II — 13,8 ± 4,1; 3-тя група — ISS — 18,5 ± 4,9 бала, APACHE II — 14,5 ± 2,3. Результати. ЗТТ (ISS — 18 (14, 20) балів) із контузійним ушкодженням легенів І і ІІ ступеня у 62 (76 %) постраждалих (у 22 % виявлено на 1-шу добу, у 79 % — на 2-гу — 3-тю добу) ускладнювалася струсом чи забоєм серця до 70 % спостережень, післятравматичною міокардіо­дистрофією у ранньому та відновлювальному періодах — майже в усіх постраждалих. На електрокардіограмі (ЕКГ) — субендокардіальні та субепікардіальні зміни, пробіжки тахікардії, екстрасистоли, неспецифічні зміни кінцевої частки шлуночкового комплексу, ознаки інфаркту міокарда травматичного походження, а також і ІІ типу через крововтрату (у 2 пацієнтів). Не виявлено різниці ЕКГ-ознак між гемодинамічно стабільними і нестабільними пацієнтами. Застосування НПЗЗ та опіоїду (n = 43, підгрупи «а») достатньою мірою не усувало біль і гіпоксемію, зберігався периферичний вазоспазм (загальний периферичний судинний опір (ЗПСО) — 1987 ± 159 дин/с · см2), тахікардія (86 ± 13 уд · хв–1), зменшення роботи серця (серцевий індекс (СІ) — 2,71 ± 0,27 л/м2 · хв). Застосування ТПБ (n = 39, підгрупи «b») одразу знижувало біль на 68 ± 7 %, забезпечувало ліпше SрО2 95,6 ± 1,7 % проти 94,1 ± 1,5 % та РаО2/FіО2 340 ± 25 проти 312 ± 50 у підгрупах «а», що поєднувалось зі зменшенням тахікардії (80 ± 7 уд · хв–1) та периферичного судинного опору (ЗПСО — 1692 ± 157 дин/с · см2; p = 0,01) при одночасному сприятливому збільшенні продуктивності серцевої діяльності (СІ — 3,1 ± 0,17 л/м2 · хв). На 5-ту добу на фоні ТПБ РаО2/FiО2 був вищий, ніж у підгрупах «а» — 380 ± 28 % проти 362 ± 27 %; SрО2 — 96,8 ± 0,7 % проти 95,1 ± 1,1 % (p = 0,02). Висновки. ТПБ, проведена одразу в гострому періоді ЗТТ через усунення болю і гіпоксемії, має кардіопротекторну дію, що виявляється в антиаритмічному та протиішемічному ефектах, запобігаючи ускладненому перебігу струсу чи забою серця, зменшуючи прояви первинної і вторинної посттравматичної міокардіодистрофії.