Artificial Pulmonary Ventilation Research Articles

Perioperative use of erythrocyte-containing blood components in children during the first months of life

BACKGROUND: Anemia can be diagnosed before surgery, occur during surgical treatment, and develop and worsen in the postoperative period in children with surgical diseases. Anemia is associated with increased morbidity, severe complications, and even death after surgical treatment. AIM: This study aimed to determine the frequency and indications for transfusion of red blood cell-containing components in the perioperative period in children in the first months of life. MATERIALS AND METHODS: This cohort study included 187 children from the G.N. Speransky Children’s Hospital No. 9. The hemoglobin, hematocrit, and red blood cell levels were studied as well as the volume of intraoperative blood loss, hemodynamic parameters, the presence of hemorrhagic syndrome, and the use of adrenomimetics in the perioperative period. The stage of the perioperative (pre, intra, or post) period at which the transfusion of erythrocyte-containing components was conducted was recorded. Statistical data analysis was performed using the statistical computing environment R 4.3.0. RESULTS: The average age of the children at the time of surgery was 41 (16.5–63) days [5.9 (2.4–9) weeks]. Sixty-four (34.2%) children were in their first month of life, 72 (38.5%) in their second month, and 51 (27.3%) in their third month, and 76 (40.6%) children were premature. The surgeries were emergent and urgent in 102 (54.5%) children and planned in 85 (45.5). The hemoglobin, hematocrit, and erythrocyte levels at which erythrocyte-containing components were transfused were 82 (77–90) g/l, 25% (22%–28%), and 2.8 (2.3–3.0) × 1012/l, respectively. The volume of erythrocyte-containing components was 54.0 (32.9–74.4) ml (10–30 ml/kg/child’s body weight). The need for and duration of artificial pulmonary ventilation in the postoperative period were 31 (72.1%) cases and 48.5 (22.5–190) hours, respectively, in contrast to children who did not receive transfusions of red blood cell-containing components—57 (39.6%) cases and 40 (22–96) hours. The indication for transfusion was anemia of varying degrees; however, 74.4% of children received adrenergic agonists simultaneously with transfusion to stabilize hemodynamics: dopamine monotherapy in 23 (74.2%) and combinations of dopamine and norepinephrine in 8 (25.8%) at 10 (8–12) mcg/kg/min and 0.2 (0.15–0.4) mcg/kg/min, respectively. CONCLUSION: The frequency of use of red blood cell-containing components was 23%. Threshold values for transfusion of erythrocyte-containing components Hb, Ht, and erythrocytes were 82 (77–90) g/l, 25% (22%–28%), and 2.8 (2.3–3.0) × 1012/l, respectively.

The first experience of the combined use of nitric oxide and molecular hydrogen for cardiac surgery in high-risk patients

The purpose of the study was to evaluate the effectiveness of myocardial protection with a combined supply of nitric oxide (NO) (40 ppm) and hydrogen (1.2 ppm) into the gas-air mixture delivery line of the cardiopulmonary bypass (CPB) machine during the entire period of CPB.Methods. The study included patients (n = 91) who had cardiac surgery under cardiopulmonary bypass and pharmacological cold cardioplegia. Patients were randomized into 3 groups. The Group 1 (n = 30) was control. Groups 2 (n = 28) and 3 (n = 33) received an isolated supply of NO (40 ppm) and a combined supply of NO (40 ppm) and hydrogen (1.2 ppm) into the extracorporeal IR circuit, respectively. During the postoperative period, clinical and functional indicators were studied (dynamics of myocardial contractile function according to ultrasound data); duration of artificial pulmonary ventilation (ALV); stay in the intensive care unit; hospital stay; mortality; level of marker of myocardial injury – troponin I (cTnI). Myocardial injury index (MII) was calculated to assess the degree of injury.Results. It was found that the level of cTnI in the postoperative period increased statistically significantly in all groups but was statistically significantly lower in Groups 2 and 3 compared to Group 1 at the end of the surgery and 12 and 24 hours after the surgery. Also, level of cTnI was statistically significantly lower in Group 3 at all stages of the study compared to Group 1 and after 12, 24 and 48 hours compared to Group 2. Statistically significantly lower MII values were revealed at all stages of the postoperative period in Group 3 compared with Groups 1 and 2. Changes in indicators of myocardial contractile function suggest an earlier and more complete recovery in Groups 2 and 3 (the changes were statistically significantly higher than that in Group 1). In Groups 2 and 3, the incidence of acute heart failure was statistically significantly lower (p = 0.046) compared to Group 1, according to Fisher’s exact test. There were no statistically significant differences in the incidence of acute respiratory and multiple organ failure in Groups 2 and 3 compared to Group 1. Also, patients of Groups 2 and 3 did not experience any complications in the early postoperative period. In Group 3, there was a statistically significant decrease in the duration of mechanical ventilation and stay in the intensive care unit after surgery compared to Group 2.Conclusion. Isolated supply of NO into the IR circuit has an additional cardioprotective effect, which is confirmed by statistically lower levels of troponin I and smaller changes in the indicators of myocardial contractile function during the postoperative period compared to standard technology. A more pronounced protective effect on the myocardium was shown with the combined supply of NO and molecular hydrogen to the IR circuit as seen by statistically lower levels of troponin I and MII in the postoperative period compared with the isolated supply of NO.

The Complex CPAP and Oxygen Therapies and Quality of Life in Alzheimer Patients

AbstractBackgroundCPAP, as a method of artificial pulmonary ventilation by constant positive pressure, improves oxygen supply to organs and tissues, including the cells of the cerebral cortex. This effect increases when CPAP and oxygen therapy are combined.MethodWe followed 11 female patients, ages 65 to 75, with Alzheimer’s disease. They were treated for Alzheimer’s disease according to accepted standards. All of them had COVID‐19, and in the rehabilitation program, they were prescribed CPAP therapy in combination with oxygen therapy, which was performed at night when the patients were sleeping, for one month. When they went to bed at a fixed time, a helmet was put on their heads, which allowed them to perform CPAP and oxygen therapy in their sleep. One patient could not get used to sleeping in the helmet, so she was treated differently and was excluded from our study. We also changed the oxygen content of the air in the helmet every three days. The patients themselves also filled out a Quality of Life Rating Scale every two weeks.ResultAfter the sessions, the patients subjectively evaluated their condition as being more rested, stronger, and able and willing to do something. Objectively, there were no improvements in patients' activity during the first two weeks of therapy. Already, after a week of therapy, a fixed bedtime led to better sleep. Also, the best effect was observed when the concentration of oxygen in the supplied air was between 35 and 40 percent. After one month of therapy, patients rated their health as good on the Quality of Life Rating Scale, whereas at the beginning of therapy, they rated their health as poor. After one month of therapy hedonic was evaluated as having joy in life, as opposed to a lack of joy in life, at the beginning of therapy. Also, all the patients themselves associated these changes with the CPAP and oxygen therapy.ConclusionComplex CPAP and oxygen therapy can be recommended as part of a comprehensive therapy for Alzheimer’s disease to improve their quality of life.

ANALYSIS OF THE EFFECTIVENESS OF PATHOGENETIC PHARMACOTHERAPY FOR SPINAL MUSCULAR ATROPHY IN CHILDREN IN THE CHUVASH REPUBLIC

Since 2020, pathogenetic pharmacotherapy of spinal muscular atrophy in children has been introduced into use in the Chuvash Republic. To date, the results of more than two years of using Nusinersen and Risdiplam have been accumulated. The aim of the study was to generalize the experience of pathogenetic pharmacotherapy for spinal muscular atrophy with an assessment of the factors determining its effectiveness in children in the Chuvash Republic. Materials and methods. A retrospective analysis of medical records of 15 inpatient patients with spinal muscular atrophy who were treated in the settings of the neuropsychiatric department of the Republican Children's Clinical Hospital under the Health Ministry of Chuvashia for the period from 2020 to May 2023 was carried out. The effectiveness of therapy was evaluated using clinical scales for assessing motor functions recommended for patients with spinal muscular atrophy. Study results. In the group of patients with severe manifestations (type I spinal muscular atrophy), clinical improvements in motor functions during treatment were observed in 50%, there was no positive dynamics in 30%, deterioration was registered in 20%. Attention should be paid to the fact that at the early start of therapy (up to 6 months after the disease manifestation), at least a slight increase in motor functions was observed in 100% of patients. On the other hand, the effectiveness of Nusinersen and/ or Risdiplam was observed in none of the patients with type I or II spinal muscular atrophy at late therapy, but these patients also repeatedly observed deterioration of motor functions. During the period of observing the children, even when the facts of improvement in motor function in points were established, swallowing disorders and respiratory failure often progressed, which required probe feeding and continued artificial pulmonary ventilation. At this, no facts of developing undesirable adverse reactions to medications were noted. Conclusions. The analysis of pharmacotherapy with Nusinersen and Risdiplam in children with spinal muscular atrophy in the Chuvash Republic indicates a better effect of pathogenetic therapy at its early onset and a lower initial severity of the disease. It should be noted that there was no significant improvement in the quality of life in any of the cases. In addition, in order to effectively use these drugs, objective methods should be developed to assess the survival of motor neurons and the quality of life, as well as to recommend the timing of pathogenetic therapy initiation.

The Role of Acute Rehabilitation during the COVID-19 Pandemic: A Retrospective Study in the Czech Republic.

In this retrospective study, we used data from the hospital information system (HIS) to evaluate the influence of the COVID-19 pandemic on rehabilitation care at the University Hospital of Ostrava (UHO). From March 2020 to December 2021, 5173 COVID-19 cases were hospitalized at UHO. Cases within individual groups and categories are shown in a flowchart. The average patient age was 64.9 ± 16.9 years. The mean BMI value was 30.6 ± 6.8 in the rehabilitated group, which was significantly higher compared to that among the non-rehabilitated cases 29.1 ± 6.9 (p < 0.001). Among the admitted patients, 16.6% required artificial pulmonary ventilation (APV), 1.8% extracorporeal membrane oxygenation (ECMO), and 11.9% high-flow oxygenation (HF). The days of rehabilitation ranged from 1-102 days. Among all rehabilitated patients, 92.0% (n = 1302) had a hospitalization duration ranging from 1-15 days and 8.0% (n = 114) longer than 15 days. Overall, rehabilitation care plays an important role in providing exercise, mobilization, and rehabilitation interventions to survivors of critical illness associated with COVID-19, enabling the early and functional return to home, and it must, therefore, be integrated into the clinical care of patients with COVID-19.

Intensive therapy and anesthesia for diffuse phlegmon of the neck and maxillofacial region, complicated by respiratory disorders and mediastinitis

The peculiarities of intensive therapy in 5 patients with Dupuytrens phlegmons complicated by mediastinitis and respiratory distresses are considered. The prolonged artificial pulmonary ventilation in the positive pressure regime in the expiration end of prevents not only respiratory insufficiency but phlegmon propagation from lower neck parts into the chest, as well as improves mediastinum drainage.

Вплив волемічної підтримки збалансованими кристалоїдними розчинами на динаміку периферійних набряків у постраждалих з тяжкою черепно-мозковою травмою

Актуальність теми. Інфузійна терапія є невід’ємною частиною інтенсивної терапії постраждалих з тяжкою черепно-мозковою травмою (ЧМТ), однак ефективність інфузійно-трансфузійної терапії багато в чому залежить від цілеспрямованого обґрунтування її програми, характеристик інфузійних розчинів, їх фармакологічних властивостей і фармакокінетики. На даному етапі інтенсивної терапії вибір розчину для проведення волемічної підтримки у постраждалих із тяжкою черепно-мозковою травмою залишається дискутабельним. Мета дослідження: оптимізувати методику проведення волемічної підтримки у постраждалих із тяжкою черепно-мозковою травмою з метою зменшення вираженості набрякового синдрому. Матеріали та методи. Обстежено 60 постраждалих із тяжкою ЧМТ віком від 18 до 65 років, з рівнем свідомості 5–11 балів за шкалою коми Глазго при надходженні та через 12 годин після проведення первинної ресусцитації та тяжкістю стану за шкалою APACHE II 21,0 ± 2,7 бала, які були поділені на дві групи: контроль та дослідження. Постраждалим у групі контролю волемічна підтримка проводилась розчином NaCl 0,9% за загальноприйнятою методикою. У групі дослідження волемічна підтримка проводилась збалансованим кристалоїдним розчином. В обох групах моніторувались показники збільшення товщини масиву тканин у фронтальній ділянці, на тилі стопи та окружності над променево-зап’ястковим суглобом. Результати. За даними нашого дослідження, у постраждалих, волемічна підтримка яким здійснювалась збалансованим кристалоїдним розчином, набряковий синдром був менш вираженим, також у групі дослідження спостерігається регресування набрякового синдрому на 8–9-й добі лікування, на той час як у групі контролю набряки зберігаються впродовж усіх 10 діб лікування. Висновки. Встановлено, що застосування для волемічної підтримки збалансованого кристалоїдного розчину суттєво зменшило вираженість набрякового синдрому у постраждалих із тяжкою черепно-мозковою травмою впродовж перших 10 діб лікування, дозволило ліквідувати набряковий синдром до 9–10-ї доби лікування, що, у свою чергу, дозволяє покращити параметри зовнішнього дихання, зменшити кількість ускладнень з боку дихальної системи, тривалість проведення штучної вентиляції легень, а відповідно і перебування у відділенні інтенсивної терапії та термінів лікування.

Modification of preoperative preparation as a guarantee of improvement of perioperative treatment in elderly and senile patients

Objective. Estimation of the changes efficacy in preoperative preparation of elderly and senile patients as a guarantee for improvement of treatment in perioperative period.&#x0D; Materials and methods. Into the investigation were included 153 patients, suffering an acute cholecystitis on background of biliary calculous disease. Into the control group 89 (58.2 %) patients were included, who were treated in accordance to the standards and clinical protocols, while into the main one - 64 (41.8%) patients, in whom preoperative preparation was modified in accordance to algorithm.&#x0D; Results. The patients’ state in admittance to the hospital in a control group was scored in (30.8 ± 5.2) points, and in the main - in (31.6 ± 5.7) points (U = 2684.00, p =0.5437). All the patients were operated in an urgent order. Application of algorithm of preoperative preparation in elderly and senile patients was followed by improvement in their general state in early postoperative period, estimated in accordance to the P-POSSUM scale: in the main group this index have constituted (28.2 ± 4.6) points, and in a control one - (31.1 ± 7.8) points (U = 2219.00, p = 0.0201). As well, the reduction of duration of the artificial pulmonary ventilation was guaranteed: in a control group - 80.00 (70.00; 120.00) min, while in the main one – 63.00 (52.50; 75.00) min (U = 1316, p &lt; 0.0001).&#x0D; Conclusion. Modified preoperative preparation, more frequent performance of miniinvasive operative interventions and eale activisation of the patients have shortened in them a stationary stay: to (10.9 ± 2.5) days in a control group, while (8.3± 2.3) days – in the main one (U = 1745.50, p &amp;lt; 0.0001).

Hemorrhagic Risks of Percutaneous Dilated Tracheotomy in Thrombocytopenia

The objective: to assess the incidence and influence of platelets level on the hemorrhagic complications during percutaneous dilated tracheotomy (PDT) in patients with thrombocytopenia.Subjects and Methods. The study included 85 consecutive patients with varying degrees of thrombocytopenia at the stages of hematopoietic stem cell transplantation. The control group included 56 patients who underwent classical tracheotomy. The study group included 29 patients who underwent PDT (Griggs method). The operations were performed for prolonged artificial pulmonary ventilation. When the platelets level was below 20 × 109/L, platelet concentrate transfusion was performed before the operation.Results. The incidence of hemorrhagic complications in patients with thrombocytopenia during PDT was 13.8% (95% CI 9.13–18.45%). In open tracheotomy, the bleeding rate was 3.8% (95% CI 2.65–4.49%). These results are comparable to the incidence of hemorrhagic complications in patients with normal platelet counts. The influence of the platelet level on the presence of hemorrhagic complications in both groups was not established.Conclusion. Thrombocytopenia is not a contraindication to performing PDT. However, platelet concentrate transfusion should be performed in patients with platelet counts less than 20 × 109/L. An experienced team of anesthesiologists and endoscopists can reduce the incidence of other complications.

Mortality Prediction in Patients with Severe Acute Kidney Injury Requiring Renal Replacement Therapy.

Background and Objective: Acute kidney injury (AKI) remains a serious health condition around the world, and is related to high morbidity, mortality, longer hospitalization duration and worse long-term outcomes. The aim of our study was to estimate the significant related factors for poor outcomes of patients with severe AKI requiring renal replacement therapy (RRT). Materials and Methods: We retrospectively analyzed data from patients (n = 573) with severe AKI requiring RRT within a 5-year period and analyzed the outcomes on discharge from the hospital. We also compared the clinical data of the surviving and non-surviving patients and examined possible related factors for poor patient outcomes. Logistic regression was used to analyze the odds ratio for patient mortality and its related factors. Results: In 32.5% (n = 186) of the patients, the renal function improved and RRT was stopped, 51.7% (n = 296) of the patients died, and 15.9% (n = 91) of the patients remained dialysis-dependent on the day of discharge from the hospital. During the period of 5 years, the outcomes of the investigated patients did not change statistically significantly. Administration of vasopressors, aminoglycosides, sepsis, pulmonary edema, oliguria, artificial pulmonary ventilation (APV), patient age ≥ 65 y, renal cause of AKI, AKI after cardiac surgery, a combination of two or more RRT methods, dysfunction of three or more organs, systolic blood pressure (BP) ≤ 120 mmHg, diastolic BP ≤ 65 mmHg, and Sequential Organ Failure Assessment (SOFA) score on the day of the first RRT procedure ≥ 7.5 were related factors for lethal patient outcome. Conclusions: The mortality rate among patients with severe AKI requiring RRT is very high—52%. Patient death was significantly predicted by the causes of AKI (sepsis, cardiac surgery), clinical course (oliguria, pulmonary edema, hypotension, acidosis, lesion of other organs) and the need for a continuous renal replacement therapy.

Pathogenetic bases of the use of antifibrotic therapy with Bovhyaluronidazum azoximerum in patients with new coronavirus infection COVID-19

One of the most likely and serious complications of the novel coronavirus infection (COVID-19) is pneumofibrosis, which can negatively affect the duration and quality of life of patients who have suffered from this disease. The appearance of fibrotic changes in COVID-19 is due to a number of pathological processes that occur in the lungs after the pathogen, the SARS- CoV-2 virus, enters there. First of all, an inflammatory response is triggered, which is mediated by macrophages and granulocytes, due to which the synthesis of pro-inflammatory cytokines, incl. IL-1, TNF, which are potent inducers of hyaluronic acid synthetase. There is a decrease in the content of fibrinolysis activators in the pulmonary endothelium, which contributes to the accumulation of fibrin in the vessels of the lungs. Fibrin can escape into the interstitial space and cause the formation of sclerosing alveolitis. The increasing defeat of pneumocytes favors the release of fibrin into the lumen of the alveoli, which causes the formation of hyaline membranes. The regulation of the fibrotic process involves immunocompetent cells, primarily CD4 + T-lymphocytes, which are capable of producing cytokines, chemokines and growth factors, and these, in turn, stimulate the proliferation and differentiation of fibroblasts, as well as their production of collagen. The more severe forms of infectious process can lead to the greater risk of developing fibrotic changes. Risk factors are a large area of lung damage, the use of artificial pulmonary ventilation, ARDS, fibrosis in anamnesis. An additional role in the pathomorphogenesis of pneumofibrosis is played by smoking, external inhalation effects (inhalation of organic and inorganic dust), gastroesophageal reflux, type II diabetes mellitus, genetic factors (familial idiopathic pulmonary fibrosis). The pathogenetic features of COVID-19 require administration of anti-fibrotic treatment. Bovhyaluronidazum azoximerum, a drug that is a conjugate of the proteolytic enzyme hyaluronidase, is considered as an antifibrotic agent. The treatment regimens with this drug recommended in the period of convalescence for patients who have undergone COVID-19 are given.

The effectiveness of volume guarantee ventilation in newborns

Background. An important goal of treating respiratory disorders in newborns during the first stage of perinatal care is effective and safe pulmonary ventilation, enabling the administration of surfactant therapy, reducing alveolar dead space, and providing adequate gas exchange.&#x0D; Objective. The aim of this study is to improve the quality of newborns respiratory therapy using double pressure and volume control at the first stage of perinatal care.&#x0D; Materials and methods. The study involved newborns from week 27 to week 42 gestation with respiratory failure requiring invasive pulmonary ventilation. The ventilation mode was evaluated with pressure control and volume guarantee option compared with routine pressure ventilation. For the comparative characteristic of the compared ventilation methods, we used targets, such as the duration of artificial pulmonary ventilation, reduction of FiO2, dynamics of venous blood lactate, peak and average pressure in the respiratory tract, dynamics of lung compliance, and the development of complications.&#x0D; Results and conclusions. Given the heterogeneity of lung damage in newborns, the use of the guaranteed volume option reduced the duration of mechanical ventilation, the development frequency of IVH, and the frequency of surfactant use.

Effect of Inhaled Nitrogen Oxide on the Plasma Concentration of Cytokines and Endogenous Nitrogen Oxide

Rationale. The nitrogen oxide molecule (NO) is a fundamental factor of the anti-infectious resistance of an organism. Research objective. To evaluate the effectiveness and safety of the prevention of sepsis by the inhalation of nitrogen oxide (iNO) in newborns with respiratory pathology on artificial pulmonary ventilation. Methods. Controlled, randomized, blind clinical trial included 97 newborns with respiratory pathology for artificial pulmonary ventilation. Patients received standard intensive therapy. The main group (n=44) received inhaled nitrogen oxide. The control group (n=53) did not receive inhaled nitrogen oxide. On Days 1, 3, and 20, the plasma concentrations of IL-1ß, IL-6, IL-8, TNF-α, G-CSF, s-Fas, FGF, and nitrogen oxide were measured by capture ELISA. Results. Inhaled nitrogen oxide as a part of intensive care decreased the rate of sepsis development, the duration of mechanical ventilation, and the period of hospitalization. It provided a tendency towards a decrease in the rate of lethal outcomes and reduced cytokine aggression. Conclusions. Inhaled nitrogen oxide in standard intensive care effectively and safely prevented the development of sepsis in newborns with respiratory pathology on artificial lung ventilation. A decrease in the concentration of pro-inflammatory cytokines, including IL-6, against the background of nitrogen oxide inhalation, confirmed the possibility of using inhaled nitrogen oxide as a therapy for COVID-19.

Pregnancy in a Woman with a Congenital Type of Nemaline Myopathy

<i>Introduction</i>: Congenital nemaline myopathy is a genetically heterogeneous disease caused by gene defects in a number of genes: nebulin (2q21-22) alpha-tropomysin (1q21-23), alpha-actin (1q42) and others. Nemaline myopathy can be inherited as an autosomal recessive or dominant trait. <i>Case report</i>: We present a case of the first pregnancy in a woman with a congenital type of nemaline myopathy, with a severe pulmonary involvement, in the Czech Republic. <i>Course of pregnancy</i>: The woman got spontaneously pregnant less than two months after a respiratory failure, when she had to be tracheostomized, remained dependent on portable ventilator support. The patient strictly refused artificial abortion recommended to her. Until the 22^nd gestational week she was stabilized in terms of ventilation and received health care at home. Subsequently, she was repeatedly admitted to the hospital for lung infection to ICU of the Department of Intensive Care. The fetus was developing proportionately, without signs of muscle hypotonia, but after the 23^rd g.w. was diagnosed with slightly progressive polyhydramnios. <i>Childbirth</i>: It was decided to schedule termination of the pregnancy by a caesarean section for the 30^th g.w., during the interval of the patient´s relatively satisfactory clinical respiratory and mental stabilization. A boy was born (1120g) and was transferred to the NICU. The newborn required artificial pulmonary ventilation, from the 3^rd day he was extubated, with intermittent use of nasal CPAP until the 9^th day. <i>Results</i>: The baby prospered, tolerated food and showed no signs of muscle hypotonia. A postoperative course of the mother went without any complications. On the 8^th postoperative day she was discharged from the hospital, ventilator-dependent and with tracheostomy in place. <i>Conclusion</i>: Pregnancy in women with a congenital type of nemaline myopathy with a severe lung involvement is a challenge for physicians. Based on the course of pregnancy it is necessary to decide when its termination will be safe for both the mother and the fetus. The care of the patient requires a multidisciplinary approach.

Значение респираторной поддержки в формировании бронхолегочной дисплазии у глубоко недоношенных детей с функционирующим артериальным протоком

Objective of the Review: To analyse the available information on the potential impact from respiratory support on bronchopulmonary dysplasia (BPD) development in extremely premature children with functional ductus arteriosus. Key Points. In recent decade, the problem of premature children has become very acute as a result of introduction of the new live birth criteria. The most common complication of a premature birth is BPD because of the morphofunctional immaturity of an extremely premature child. BPD is diagnosed in approximately 20% of newborns with the gestational age (GA) of less than 30 weeks and body weight of less than 1,500g; and in over 40% of newborns with GA of less than 28 weeks. Children with extremely low body weight (500–999g) and low body weight (1,000–1,499g) at birth have BPD in 35–80%, and 7–30% of cases, respectively. One problem aggravating the condition of premature children is a haemodynamically functional patent ductus arteriosus (PDA), the prevalence of which is in inverse relation to GA. Conclusion. The studies demonstrate the correlation between PDA and BPD development. The impact of artificial pulmonary ventilation on the haemodynamical significance of PDA and BPD development needs further evaluation. Keywords: premature children, bronchopulmonary dysplasia, respiratory support, patent ductus arteriosus.

Acute methadone poisoning in children: diagnosis and treatment

Methadone poisoning is one of the most common causes of unfavorable outcomes in children.The objective is to identify specific parameters of the course and intensive care for methadone poisoning in children.Subjects and methods. 30 children were examined. The average age made 16 (15‒17) years. The duration of treatment in ICU was 3 (1.5‒4.0) days.Results. The most frequent clinical manifestations of methadone poisoning included coma (40%), acute respiratory failure (70%), low body temperature (57%), and myosis (100%). By the admission, the oxygenation index was 4.5 r.u. 37% of patients had pronounced lactate acidosis. On day 1, the volemic support made 143 (124‒165)% of the estimated fluid demand. 21 (70%) children needed artificial pulmonary ventilation. The negative correlation was established between treatment duration in ICU, Glasgow coma scale (R = -0.41; p &lt; 0.05), Glasgow-Pittsburgh coma scale (R = -0.52; p &lt; 0.05) and urea concentration in blood within the first 24 hours (R = 0.44; p &lt; 0.05).Conclusion. The main criteria determining the severity of the state of patients with acute methadone poisoning include the level of depression of consciousness, the presence of acute respiratory and renal failure.

Анализ развития стернальной инфекции у кардиохирургических больных

A clinical study including 68 patients of a cardiac profile who developed sternal infection in the postoperative period was conducted. Patients were divided into two groups: 1 group – 42 patients with a sternal infection of soft tissues and the 2nd group – the 26th patient with a sternal infection of a breast. The received results were processed statistically. The received data confirmed that patients of both groups had an accompanying pathology: diabetes mellitus and chronic obstructive diseases of lungs. The risk factor for infection development during sternotomy were an average duration of operation that in the 1st group was 280,9 minutes and in the 2nd group the operation duration was 270,4 minutes. Another risk factor was duration of use of the device of artificial blood-flow; cardiac support was used for 24nd group. A prolonged artificial pulmonary ventilation was used in 39 (92,9 %) patients of the 1st group and 22 (84,6 %) patients of the 2nd group.

Results of the randomized comparative study of second-generation supraglottic airways in orbital osteosynthesis

The objective:to assess and compare supraglottic airways of LMA-Supreme and i-gel during orbital osteosynthesis.Subjects and methods.91 patients were included into the study. All of them underwent osteosynthesis of the orbit. The patients were randomly divided into two groups. LMA-Supreme group included 42 patients, while i-gel group included 49 patients.Results.The parameters of hemodynamics, gas exchange, and artificial pulmonary ventilation (APV) did not basically differ between the groups at different stages of the study. The oropharyngeal leak pressure differed between the groups at the end of surgery and made (Me – median, Q1and Q3– upper and lower quartiles): 28.0 (22.0; 30.0) and 21.0 (19.0; 27.0) mm WG the LMA-Supreme and i-gel groups, respectively;p= 0.021. A significant difference was observed in the insertion time of supraglottic airways (Me is the median, Q1and Q3are the upper and lower quartiles): 27.5 (19.3; 36.5) sec. for LMA-Supreme and 15.0 (13.8; 25.0) sec. – for i-gel;p= 0.001. When inserting the LMA-Supreme duct in 33 (78.6%) patients, jaw thrust maneuver, extension of the neck, etc. were required; while in the i-gel group, similar maneuvers were necessary in 18 (36.7%) patients;p&lt; 0.001. The number of postoperative complications was minimal in both groups.Conclusion.Both supraglottic airways can be used with equal efficacy in osteosynthesis of the orbit. At the same time, the i-gel duct has an advantage over the LMA-Supreme in speed and simplicity of insertion. The LMA-Supreme had greater leak pressure at the end of surgery, which might be an advantage in patients requiring greater peak inspiratory pressure to provide effective APV.

Cerebral protection from ischaemia during carotid endarterectomy

The purpose of this study was to assess efficacy of cerebral protection during carotid endarterectomy by means of controlled systemic hypertension in patients presenting with various levels of retrograde pressure in the internal carotid artery. The study enrolled a total of 150 patients subjected to carotid endarterectomy. The operation was carried out under general anaesthesia with artificial pulmonary ventilation and was accompanied by haemodynamic monitoring with invasive control of arterial pressure, as well as primary and additional correction of central haemodynamics. Cerebral perfusion was assessed by measuring retrograde pressure in the internal carotid artery. The retrograde pressure index was calculated, according to which the patients were subdivided into three groups: those with values less than 30, with values from 30 to 39, and with values of 40 and more. Controlled systemic arterial hypertension was used as cerebral protection during the period of cross-clamping of the internal carotid artery, with phenylephrine and norepinephrine administered for this purpose. The parameters of central haemodynamics, time intervals of the operation, and the duration of internal carotid artery cross-clamping in the groups did not statistically differ (p>0.05). A statistically significant difference was revealed in the level of systolic arterial pressure necessary for cerebral protection (p<0.05). There were no cerebral circulation impairments, myocardial infarctions, nor lethal outcomes. A conclusion was drawn that individualized correction of central haemodynamics ensured a sufficient level of collateral compensation of the cerebral blood flow, thus making it possible to refuse from using intraluminal shunts.

COVID-19 PANDEMIC AND CHALLENGES IT POSES TO OTORHINOLARYNGOLOGISTS

As doctors, we all have a shared responsibility in terms of COVID-19. At first glance, ENT specialists are not classed as the so-called “front line” medical workers but have a key role to play and these needs to be addressed. In response to the pressures on the Health Care System, the medical care provided by otorhinolaryngologists has been limited. Irrespective of the imposed work limitations, patients will still need to be provided with the specific care, which requires us to find the best solutions for work stations and wards. In addition, measures should be put in place to avoid compromising surgical activity (especially emergency procedures), deriving from a combination of factors, including staff sickness, problems with the supply of medical equipment, the use of operating theaters, anesthesiological teams, etc. An increased number of performed tracheostomies are expected in positive COVID-19 patients who need artificial pulmonary ventilation. The purpose of this paper is to address all these issues, based on current and accessible information, and propose measures and procedures for otorhinolaryngologists in the context of the COVID-19 pandemic for different patient groups. Simultaneously, recommendations are made to protect the doctors and their teams, as well as to reconfigure the medical operations in the new conditions.