Mechanical Ventilation Of Lungs Research Articles

The intricate physiology of veno-venous extracorporeal membrane oxygenation: an overview for clinicians.

During veno-venous extracorporeal membrane oxygenation (V-V ECMO), blood is drained from the central venous circulation to be oxygenated and decarbonated by an artificial lung. It is then reinfused into the right heart and pulmonary circulation where further gas-exchange occurs. Each of these steps is characterized by a peculiar physiology that this manuscript analyses, with the aim of providing bedside tools for clinical care: we begin by describing the factors that affect the efficiency of blood drainage, such as patient and cannulae position, fluid status, cardiac output and ventilatory strategies. We then dig into the complexity of extracorporeal gas-exchange, with particular reference to the effects of extracorporeal blood-flow (ECBF), fraction of delivered oxygen (FdO2) and sweep gas-flow (SGF) on oxygenation and decarbonation. Subsequently, we focus on the reinfusion of arterialized blood into the right heart, highlighting the effects on recirculation and, more importantly, on right ventricular function. The importance and challenges of haemodynamic monitoring during V-V ECMO are also analysed. Finally, we detail the interdependence between extracorporeal circulation, native lung function and mechanical ventilation in providing adequate arterial blood gases while allowing lung rest. In the absence of evidence-based strategies to care for this particular group of patients, clinical practice is underpinned by a sound knowledge of the intricate physiology of V-V ECMO.

Study of the spectrum and antibiotic sensitivity of the respiratory tract microbiota of newborns with infectious complications during long-term mechanical lung ventilation

determining the structure of leading microbial colonizers of the respiratory tract as potential causative agents of ventilator-associated pneumonia and their sensitivity to antibacterial drugs plays an important role in choosing effective tactics for etiotropic therapy of newborns. According to the data of scientific publications, the etiological structure of infectious complications associated with long-term respiratory support in newborns is known to have certain features. The spectrum of nosocomial microbial pathogens and their sensitivity to antimicrobial drugs are among them. The patients of early age are characterized by a number of peculiarities of anatomical and physiological characteristics and the qualitative and quantitative composition of the microbiota of the respiratory tract. In order to form ideas about the determining causative agents of VAP in newborns, it was advisable to conduct a microbiological study of the species composition of microorganisms associated with this infectious complication, as well as to determine their sensitivity to antibiotics recommended by the management protocols of the corresponding pathology. To study and solve this problem, it is necessary to study the spectrum and antibiotic sensitivity of the causative agents of VAP. A prospective study was conducted in 69 newborns with VAP (2020 - 2023), who were treated in the Neonatal Intensive Care Unit (NICU) of the Vinnytsia Regional Children's Clinical Hospital (VRCCH) and consisted in studying the composition of the microbiota and antibiotic sensitivity. We took into account opportunistic microorganisms that are not characteristic of this biotope of the respiratory tract of newborns who were diagnosed with VAP during long-term mechanical ventilation. As a result of the prospective analysis of the microbiological study of the microbiota of 69 newborns, 82 microorganisms - etiologically significant pathogens of VAP - were isolated and identified. Thus, according to the data of our bacteriological studies, 17 Gram-positive and 65 Gram-negative pathogens of VAP were isolated and identified in NICU VRCCH for 2020-2023. As a result of the study of antibiotic sensitivity of VAP pathogens in newborns, the following trends were observed. Low sensitivity of Acinetobacter baumannii to ceftazidime, aztreonam, imipinem, meropenem, amoxicillin, piperacillin, levofloxacin, ciprofloxacin was established. And sensitive to amikacin, gentamicin and cefoperazone-sulbactam. High rates of resistance of Pseudomonas aeruginosa to ceftazidime, doxycycline, imipinem, meropenem, gentamicin, piperacillin, levofloxacin, ciprofloxacin, ofloxacin were established. The best indicators of sensitivity of P. aeruginosa to amikacin, cefoperazone-sulbactam and tobramycin were found. According to the results of the sensitivity of K. pneumoniae to antibiotics, resistance to all antibiotics was established. The development of resistance of Staphylococcus aureus to azithromycin, norfloxacin, cefotaxime, benzylpenicillin has been established. The indicators of S. aureus sensitivity to amikacin, tetracycline and vancomycin turned out to be the best. We took into account opportunistic microorganisms that are not typical for this biotype of the airways of newborns who were diagnosed with VAP during long-term mechanical ventilation. The results of the study indicate the need to take into account the data of a microbiological study with the mandatory identification of isolated pathogens, their microbial load at the site of infection, determining their antibiotic sensitivity is of crucial importance in the selection of etiotropic treatment tactics for newborns with VAP.

Right anterior minithoracotomy with preservation of the vascular bundle for correction of congenital ventricular septal defects

Introduction Congenital VSDs require early correction to avoid serious complications. For many years, the gold standard was the median longitudinal sternotomy, but given the gross cosmetic effect, miniapproaches were developed, but right anterior mini-thoracotomies gained popularity. We modified the method of anterior right-sided minithorcatomy by preserving a. et v. mammaria interna and the purpose of the study was to evaluate its effectiveness.
 Material and Methods The design of the study was prospective with historical control. A total of 82 patients who underwent VSD correction were included in the study. All patients were divided into three groups: group 1 operated by median sternotomy (MS) – 15 patients; Group 2 operated by right anterior minithoracotomy (RAMT) – 38 patients; and the 3rd main group operated on by right antero-lateral thoracotomy (RLMT) with preservation of the artery and vein of the internal mammary artery - 29 patients.
 Results We revealed the older age in RAMT group. Cardio pulmonary bypasstime and total operation time were shorter in RLMT group, but the time of aortic cross-clamping is shorter than in RAMT group, but longer than in MS group. The length of the skin incision is also the shortest in RLMT group, which enhances the cosmetic effect. Also there were revealed a shorter mechanical lung ventilation time and ICU stay, moreover we observed reduced amount of drainages, as well as quick discharge home.
 Conclusion Therefore, improved and modificated right antero-lateral minithoracotomy method with preserving a et v mammaria interna is feasible, has a good cosmetic effect, and short hospitalization stay, but should perform with careful preparation of the entire cardiac team.
 Bangladesh Journal of Medical Science Vol. 23 No. 02 April’24 Page : 514-520

Extended period of ventilation before delayed cord clamping augments left-to-right shunting and decreases systemic perfusion at birth in preterm lambs.

Previous studies have suggested that an extended period of ventilation before delayed cord clamping (DCC) augments birth-related rises in pulmonary arterial (PA) blood flow. However, it is unknown whether this greater rise in PA flow is accompanied by increases in left ventricular (LV) output and systemic arterial perfusion or whether it reflects enhanced left-to-right shunting across the ductus arteriosus and/or foramen ovale (FO), with decreased systemic arterial perfusion. Using an established preterm lamb birth transition model, this study compared the effect of a short (∼40s, n=11), moderate (∼2min, n=11) or extended (∼5min, n=12) period of initial mechanical lung ventilation before DCC on flow probe-derived perinatal changes in PA flow, LV output, total systemic arterial blood flow, ductal shunting and FO shunting. The LV output was relatively stable during initial ventilation but increased after DCC, with similar responses in all groups. Systemic arterial flow patterns displayed only minor differences during brief and moderate periods of initial ventilation and were similar after DCC. However, an increase in PA flow was augmented with an extended initial ventilation (P < 0.001), owing to an earlier onset of left-to-right ductal and FO shunting (P < 0.001), and was accompanied by a pronounced reduction in total systemic arterial flow (P=0.005) that persisted for 4min after DCC (P ≤ 0.039). These findings suggest that, owing to increased left-to-right shunting and a greater reduction in systemic arterial perfusion, an extended period of ventilation before DCC does not result in greater perinatal circulatory benefits than shorter periods of initial ventilation in the birth transition. KEY POINTS: Previous studies suggest that an extended period of initial ventilation before delayed cord clamping (DCC) augments birth-related rises in pulmonary arterial (PA) blood flow. It is unknown whether this greater rise in PA flow is accompanied by an increased left ventricular output and systemic arterial perfusion or whether it reflects enhanced left-to-right shunting across the ductus arteriosus and/or foramen ovale, with decreased systemic arterial perfusion. Anaesthetized preterm fetal lambs instrumented with central arterial flow probes underwent a brief (∼40s), moderate (∼2min) or extended (∼5min) period of ventilation before DCC. Perinatal changes in left ventricular output were similar in all groups, but extended initial ventilation augmented both perinatal increases in PA flow, owing to earlier onset and greater left-to-right ductal and foramen ovale shunting, and perinatal reductions in total systemic arterial perfusion. Extended ventilation before DCC does not confer a greater perinatal circulatory benefit than shorter periods of initial ventilation.

Pericardial Effusion Predicts Clinical Outcomes in Patients with COVID-19: A Nationwide Multicenter Study

Rationale and objectivesThe prognostic role of pericardial effusion (PE) in Covid 19 is unclear. The aim of the present study was to estimate the prognostic role of pericardial effusion in patients with Covid 19 in a large multicentre setting. Materials and methodsThis retrospective study is a part of the German multicenter project RACOON (Radiological Cooperative Network of the Covid 19 pandemic). The acquired sample comprises 1197 patients, 363 (30.3%) women and 834 (69.7%) men. In every case, chest computed tomography was analyzed for PE. Data about 30-day mortality, need for mechanical ventilation and need for intensive care unit admission were collected. Data were evaluated by means of descriptive statistics. Group differences were calculated with Mann-Whitney test and Fisher exact test. Uni-and multivariable regression analyses were performed. ResultsOverall, 46.4% of the patients were admitted to intensive care unit (ICU), mechanical lung ventilation was performed in 26.6%, and 30-day mortality was 24%.PE was identified in 159 patients (13.3%). The presence of PE was associated with 30-day mortality: HR = 1.54, CI95% (1.05; 2.23), p=0.02 (univariable analysis), and HR = 1.60, CI95% (1.03; 2.48), p=0.03 (multivariable analysis). Furthermore, density of PE was associated with the need for intubation (OR = 1.02, CI95% (1.003; 1.05), p=0.03) and the need for ICU admission (OR = 1.03, CI95% (1.005; 1.05), p=0.01) in univariable regression analysis. The presence of PE was associated with 30-day mortality in male patients, HR=1.56, CI95%(1.01-2.43), p=0.04 (multivariable analysis). In female patients, none of PE values predicted clinical outcomes. ConclusionThe prevalence of PE in Covid 19 is 13.3%. PE is an independent predictor of 30-day mortality in male patients with Covid 19. In female patients, PE plays no predictive role.

SCAI Staging Application for Acute Myocardial Infarction-Related Cardiogenic Shock at a Single-Center Russian Registry.

To access the features of the course of myocardial infarction (MI) in patients with different stages of MI complicated by cardiogenic shock (MI CS) according to the SCAI scale. We retrospectively described the portrait of CS MI (n = 117) at different stages of SCAI from the hospital MI registry (n = 1253). Hospital mortality increased from stage to stage (p ≤ 0.001). Significant differences in biochemical parameters were found both for indicators characterizing intensive care measures, such as the presence of mechanical lung ventilation or an intra-aortic balloon pump, and for indicators of organ hypoperfusion such as lactate level, pHv (7.39 (7.36; 7.44) at stage A-B; 7.14 (7.06; 7.18) at stage E), creatinine, and glomerular filtration rate. Parameters related to MI characteristics, such as instrumental and laboratory data, anamnesis of ischemia, and performed treatment, did not differ between groups. Polynomial logistic regression showed that lactate level, mechanical ventilation, and monocyte count upon admission (1.15 (0.96; 1.23) at stage A-B; 0.78 (0.49; 0.94) at stage E, p = 0.005) correlated with CS severity. The characteristics of MI at different stages of SCAI do not have differences and do not determine the severity of shock. We revealed a high discriminatory potential of the pH level in predicting refractory shock. The value of monocytes at admission may be a promising predictor of the severity of MI CS. The question of the causes of heterogeneity of MI CS, taking into account the homogeneity of MI characteristics, remains open and promising.

Effect of same dose varying concentration poractant alfa on outcomes in preterm infants under 32 weeks of age

Introduction. We proposed a hypothesis that prognosis in preterm infants may be affected by concentration of the administered surfactant preparation able to determine its viscosity and, therefore, even distribution throughout the lungs.Aim: to assess an effect of poractant alfa (PA) administered at low (40 mg/mL) vs. standard (80 mg/mL) concentration without changing recommended dosage (200 mg/kg) on outcomes of preterm infants at gestational age (GA) under 32 weeks receiving various respiratory support.Materials and Methods. A prospective randomized controlled multicenter study was conducted. A total of 325 infants under 32 weeks of GA in five perinatal centers were randomized. The inclusion criteria were met by 264 patients: required respiratory therapy, had indications for surfactant administration at birth/within the first 30 minutes of life, and informed parental consent. Patients were excluded if they had no indications for surfactant preparations at the age of the first 30 minutes of life, had chromosomal and genetic abnormalities, congenital malformations, early neonatal sepsis, or gross deviations from the study protocol. Two groups were formed and compared: Low concentration (LC) group – PA concentration was 40 mg/mL (n = 111) and Standard concentration (SC) group (control) – PA concentration was 80 mg/mL (n = 153). Additionally, we compared two subgroups with surfactant preparation administered by minimally invasive methods in spontaneously breathing infants (using LISA – a less invasive method of introducing surfactant through a thin catheter or endotracheal tube): subgroup LC – PA concentration was 40 mg/mL (n = 27) and subgroup SC (control) – PA concentration was 80 mg/mL (n = 34).Results. It was found that development of pulmonary hemorrhages in LC and SC groups was significantly less common in infants who received PA at concentration of 40 mg/mL vs. 80 mg/mL: 3.6 (4/111) % vs. 13.1 (20/153) % (p = 0.008). While comparing subgroups with minimally invasive PA administration (LISA or endotracheal tube), we found that treatment with 40 mg/mL significantly decreased total respiratory therapy duration– 142 [70.0; 219.0] hours vs. 250 [141.0; 690.0] hours (p = 0.008), incidents of bronchopulmonary dysplasia – 4.0 (1/27) % vs. 29.0 (10/34) % (p = 0.009), length of stay in neonatal intensive care unit and hospital – 8.0 [7.5; 13.0] days vs. 14.0 [8.0; 33.75] days (p = 0.014) and 38.0 [26.5; 48.5] days vs. 50.5 [36.25; 62.5] days (p = 0.014), respectively.Conclusion. PA administered at concentration of 40 mg/mL without changing the recommended dose did not aggravate nursing of preterm infants at GA under 32 weeks. Minimally invasive PA administration at concentration of 40 mg/mL, lowered risk of bronchopulmonary dysplasia, and when used in infants on mechanical lung ventilation, it lowered a risk of pulmonary hemorrhage. All the discussed findings require to be further assessed in large prospective, multicenter, randomized studies in large patient cohort.

Effect of mechanical ventilation under intubation on respiratory tract change of bacterial count and alteration of bacterial flora

Background: The most common ‘second strike’ in mechanically ventilated patients is a pulmonary infection caused by the ease with which bacteria can invade and colonize the lungs due to mechanical ventilation. At the same time, metastasis of lower airway microbiota may have significant implications in developing intubation mechanical ventilation lung inflammation. Thus, we establish a rat model of tracheal intubation with mechanical ventilation and explore the effects of mechanical ventilation on lung injury and microbiological changes in rats. To provide a reference for preventing and treating bacterial flora imbalance and pulmonary infection injury caused by mechanical ventilation of tracheal intubation. Methods: Sprague-Dawley rats were randomly divided into Control, Mechanical ventilation under intubation (1, 3, 6 h) groups, and Spontaneously breathing under intubation (1, 3, 6 h). Lung histopathological injury scores were evaluated. 16SrDNA sequencing was performed to explore respiratory microbiota changes, especially, changes of bacterial count and alteration of bacterial flora. Results: Compared to groups C and SV, critical pathological changes in pulmonary lesions occurred in the MV group after 6 h (p < 0.05). The Alpha diversity and Beta diversity of lower respiratory tract microbiota in MV6, SV6, and C groups were statistically significant (p < 0.05). The main dominant bacterial phyla in the respiratory tract of rats were Proteobacteria, Firmicutes, Bacteroidetes, and Cyanobacteria. Acinetobacter radioresistens in group C was significant, Megaonas in group MV6 was significantly increased, and Parvibacter in group SV6 was significantly increased. Anaerobic, biofilm formation, and Gram-negative bacteria-related functional genes were altered during mechanical ventilation with endotracheal intubation. Conclusion: Mechanical ventilation under intubation may cause dysregulation of lower respiratory microbiota in rats.

Clinical case of a high-frequency mechanical lung ventilation atypical using in the treatment of an infant with congenital lung disease

A small number of controlled studies have been conducted using high-frequency mechanical lung ventilation (HFMLV) in the treatment process. In the literature, complications associated with the use of HFMLV, in particular, the development of air leak syndrome, are described. This technique is usually successfully used in the treatment of homogeneous and symmetrical lung tissue lesions.Every year, the number of congenital malformations in children that can be accompanied by inhomogeneous lesions of the lungs increases, accordingly, the number of clinical cases that do not correspond to the classic picture of the disease increases, so they cannot be treated according to unified clinical protocols.The objective of the article is to help choose optimal modes of mechanical lung ventilation in non-standard situations, which will make it possible to improve the course of the disease, reduce the number of complications and prevent hypoxic-ischemic damage to the central nervous system as a consequence of chronic or acute hypoxia, which is combined with the phenomena of secondary ischemia.A baby was hospitalized in the department of the National Children’s Specialized Hospital «Ohmatdyt» with the main diagnosis of «hypoplasia, dysplasia of the lung» and concomitant «broncho-pulmonary dysplasia that occurred in the perinatal period. The ductus arteriosus is open. Pulmonary hypertension? Anemia. Seizure syndrome. Primary immunodeficiency? Complication: respiratory failure 3, mixed type». After surgical intervention in the scope of an atypical lobectomy, the child was ventilated using strict parameters of mechanical lung ventilation, which was accompanied by a gradual deterioration of the general condition and the condition of the lungs, caused not only by a congenital malformation of the lungs, but also by immunodeficiency (of unknown etiology), anemia, convulsive syndrome and the presence polyresistant strains of bacteria in bacterial cultures of sputum. Against the background of surgical (mechanical) trauma to the lung tissue and the presence of a bacterial disease of the lung parenchyma with a concomitant complication in the form of a tension pneumothorax, HFMLV was used as a «therapy of despair», despite the limited amount of scientific data on the effectiveness of treatment of inhomogeneous lung tissue lesions using HFMLV. During the treatment, a complication in the form of pneumothorax occurred as expected. The use of constant adequate monitoring of respiratory functions and timely elimination of complications made it possible to stabilize the child’s condition: the need for oxygen decreased, the condition of the lung parenchyma improved, the positive dynamics of the disease made it possible to carry out gradual weaning from artificial lung ventilation and the transition to spontaneous effective breathing with minimal oxygen support.Therefore, HFMLV can be not only a «therapy of despair». With proper and timely use, it can help reduce the frequency of complications associated with mechanical ventilation of the lungs.It can also be used as a separate technique, if the dynamics of the disease can be predicted, provided that the hospital has expert class respiratory function monitoring and experienced specialists.

Sensory interventions to relieve dyspnoea in critically ill mechanically ventilated patients.

In critically ill patients receiving mechanical ventilation, dyspnoea is frequent, severe and associated with an increased risk of neuropsychological sequelae. We evaluated the efficacy of sensory interventions targeting the brain rather than the respiratory system to relieve dyspnoea in mechanically ventilated patients. Patients receiving mechanical ventilation for ≥48 h and reporting dyspnoea (unidimensional dyspnoea visual analogue scale (Dyspnoea-VAS)) first underwent increased pressure support and then, in random order, auditory stimulation (relaxing music versus pink noise) and air flux stimulation (facial versus lower limb). Treatment responses were assessed using Dyspnoea-VAS, the Multidimensional Dyspnea Profile and measures of the neural drive to breathe (airway occlusion pressure (P 0.1) and electromyography of inspiratory muscles). We included 46 patients (tracheotomy or intubation n=37; noninvasive ventilation n=9). Increasing pressure support decreased Dyspnoea-VAS by median 40 mm (p<0.001). Exposure to music decreased Dyspnoea-VAS compared with exposure to pink noise by median 40 mm (p<0.001). Exposure to facial air flux decreased Dyspnoea-VAS compared with limb air flux by median 30 mm (p<0.001). Increasing pressure support, but not music exposure and facial air flux, reduced P 0.1 by median 3.3 cmH2O (p<0.001). In mechanically ventilated patients, sensory interventions can modulate the processing of respiratory signals by the brain irrespective of the intensity of the neural drive to breathe. It should therefore be possible to alleviate dyspnoea without resorting to pharmacological interventions or having to infringe the constraints of mechanical ventilation lung protection strategies by increasing ventilatory support.

Features of Mechanical Lung Ventilation During Robot-Assisted Radical Prostatectomy in Patients with Different Body Mass Index

The aim of the study. To evaluate effects of carboxyperitoneum and steep Trendenburg position on respiratory biomechanics and gas exchange indicators in patients with different body mass index (BMI) during robotic-assisted radical prostatectomy (RRP). To develop an algorithm for choosing the optimal mechanical lung ventilation (MLV) regimen. Materials and methods. The study included 141 patients with verified prostate cancer who were candidates for RPR. Participants were divided into 2 groups based on BMI: group I included 88 patients with BMI30 kg/m2, group II — 53 patients with BMI30 kg/m2. Indicators of respiratory biomechanics and gas exchange during ventilation in various modes (Volume Controlled Ventilation (VCV), Pressure Controlled Ventilation (PCV), Pressure Controlled– Inverse Ratio Ventilation (PC-IRV) were analyzed in each group at 5 consecutive stages of the procedure.Results. The key parameters evidencing the effectiveness and safety of MLV during RRP procedure did not vary significantly under various ventilation regimens in the group of patients with a BMI30 kg/m2. Whilst in obese patients the use of VCV mode resulted in a significant increase of airway peak pressure (Ppeak) already at the stage of placing them into a steep Trendelenburg position (35°), thus endangering with the development of ventilator-induced lung injury. Increased Ppeak was also accompanied by the drop in oxygen saturation and significantly lower SpO₂ values, starting from the stage of applying carboxyperitoneum and until the end of surgical intervention.Conclusion. In non-obese patients, there’s no particular ventilator regimen that is crucial for achieving the safety and effectiveness of RRP anesthesia management, all regimens can be used. In patients with BMI30 kg/m2 PCV regimen and PC-IRV with inhalation/exhalation ratio of 1.5:1 can be considered as the optimal strategy for MLV during anesthesia for RRP surgery.

ALGORITHM OF A DIFFERENTIATED APPROACH TO MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN PREMATURE INFANTS

Introduction. Oxidative stress (OS) is recognized as a contributing factor to the development of persistent pulmonary hypertension (PPH) in premature infants. In the modern scientific literature, there is a lack of unequivocal recommendations for the management of PPH, considering the levels of OS, what determines the need for the development of a differentiated approach for management to infants with pulmonary hypertension.The aim of the study. To increase the efficacy of management of premature infants with persistent pulmonary hypertension with asphyxia and respiratory distress syndrome based on the development of the algorithm of a differentiated approach for management of pulmonary hypertension considering the levels of oxidative stress as determined by the urinary 8-hydroxy-2-deoxyguanosine (8-OHdG).Material and methods. Were analyzed the observations of 96 infants born prematurely at gestational age of 26/1–34/6 weeks: group I consisted of 50 infants with respiratory distress syndrome (RDS), group II - 50 infants with RDS associated with perinatal asphyxia. PPH was determined by echocardiography on the 1st and on the 3rd-5th day of life, and quantitative determination of the urinary 8-OHdG (ng/ml) was performed on 44 neonates on the 1st and in dynamics on the 3rd-5th day of life using enzyme-linked immunosorbent assay (ELISA). For comprehensive radiographic assessment of PPH, all infants received chest X-Ray with determination of Moore's, Schwedel's, and cardiothoracic indexes (CTI).Statistical analysis was performed using Microsoft Excel 2019 software. Under the conditions of normal distribution of quantities, parametric statistical methods were used to calculate the arithmetic mean (M) and the representativeness error of the mean (m). Using Fisher`s exact test (φ) we analyzed the quantitative parameters. Using the heterogeneous sequential Wald procedure, development of diagnostic criteria was performed. The essence of the procedure is to determine both diagnostic (DC), prognostic coefficients (PC) and diagnostic informativeness (I) of the investigated indicators. The minimum informativeness of the feature required for addition to the developed algorithm was considered I ≥ 0.25.The algorithm was developed on the basis of diagnostic coefficients of clinical and anamnestic data of the examined groups of children, echocardiographic criteria for the presence and determination of the degree of PPH, the dynamics of OS levels and their comparison with the indicators of a comprehensive radiological assessment of pulmonary hypertension in prematurely born infants with RDS and perinatal asphyxia in association with RDS in gestational age of 26-34 weeks.Design of a study was discussed and approved at a session of the Ethical commission of the Kharkiv Medical Academy of Postgraduate Education (Prot. № 5 from 18.12.2020). All parents gave an informed consent for examination of their children.The study was carried out in accordance to the plan of the research work of the Department of Neonatology of the Kharkiv Medical Academy of Postgraduate Education "Study of features of the course of oxidative stress diseases in newborns" (January 2022 - December 2024), state registration number 0122U000025.Results. Has been developed an algorithm of a differentiated approach to management of premature infants with RDS and asphyxia with PPH, the essence of which - is to improve and individualize the method of mechanical lung ventilation (MLV) for each individual case.Conclusions. For prematurely born infants at gestational age 26-34 weeks, is important to determine the level of the urinary 8-OHdG on the 1st and 3rd-5th days of life to decide the severity of OS. For management of newborns with PPH, in the case of an increase of the level of 8-OHdG by the 3rd-5th day of life, is recommended to increase the ventilator parameters; in the case of a decrease - diminish the ventilation parameters or extubate an infant.

Випадок мітохондріальної епізодичної міопатії (варіант без атрофії зорового нерва та оборотної лейкоенцефалопатії) у Прикарпатті

Mitochondrial episodic myopathy with/or without optic nerve atrophy and reversible leukoencephalopathy (MEOAL, OMIM 251900) belongs to rare primary mitochondrial myopathies, caused by nuclear genome DNA mutations with autosomal recessive inheritance. Purpose - to inform about the case of this current rare mitochondrial miopathy and encrease the knowledge of practical doctors in scope of diagnostics and treatment of the current orphan pathology Clinical case. In the clinical case being presented herein, the sick child had a severe course of the disease in the form of episodes of severe myopathy (during one of them there was a need for long-term mechanical lungventilation with the placement of a tracheostomy) in combination with severe metabolic crises. During crises, persistent keto- and lactic acidosis, a sharp increase in transaminases (alanine aminotransferase and aspartate aminotransferase) and creatine kinase in blood serum were observed. The patient did not have optic nerve atrophy or leukoencephalopathy. A similar course of the disease is described in the literature by different authors in only 3 cases. Molecular genetic analysis (Invitae laboratory, San Francisco) revealed 2 mutations of the FDX2 gene (the disease is associated with this gene) with uncertain pathogenic significance. Considering the presence of cardinal symptoms of MEOAL, this diagnosis was set to the patient, and therefore the detected mutations of the FDX2 gene should be considered as pathogenic. Conclusions. A thorough syndromic analysis of the phenotype together with a set of paraclinical examinations, including modern molecular genetic methods, made it possible to establish a clinical diagnosis of an extremely rare primary mitochondrial myopathy, which will contribute to further elucidation of relationships in the «genotype-phenotype» system and, possibly, reclassification of pathogenic genotypes in modern databases, as well as finding optimal approaches in treatment and rehabilitation of patients. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

ASSESSMENT OF PATIENTS READINESS FOR WEANING FROM THE RESPIRATOR AFTER MECHANICAL LUNG VENTILATION

Introduction. Approximately 20% of patients on mechanical lung ventilation (MLA) experience weaning difficulties. It is recommended to evaluate objective clinical criteria used to predict a patient's readiness of weaning from a respirator. Randomized trials have shown the effectiveness and safety of the spontaneous breathing test (SBT) with inspiratory pressure support as a weaning method. Currently, there are many predictors of ventilator weaning, including both clinical and sonographic criteria, such as rapid shallow breathing index (RSBI), diaphragm thickening fraction (DTf), and Diaphragmatic excursion (DE).&#x0D; Case description. Patient K., 87 years old, has a history of 3 acute ischemic strokes with signs of vascular dementia according to relatives. 3 weeks ago, she hit her head at home and lost consciousness. She was hospitalized in a medical institution, after drainage of subdural hematomas, she was under analgosedation. 26 hours after tracheal intubation, in the presence of clinical criteria, a SBT was performed with calculation of RSBI, DTf and DE. After evaluating the predictors of weaning from the respirator, a decision was made to extubate the patient. After weaning from the respirator, the general condition is satisfactory.&#x0D; Conclusions. Assessment of predictors of successful ventilator weaning is relevant in elderly patients with dementia, when assessment of mental status is difficult and the use of objective indicators helps in decision-making regarding ventilator weaning.

Фактори ризику та короткострокові наслідки відсутності або раннього припинення грудного вигодовування передчасно народжених дітей

Breastfeeding (BF) benefits all babies; it also benefits preterm infants, so it is crucial that mothers receive skilled and expanded lactation support. Purpose - to identify factors associated with the absence or early cessation of BF, to evaluate the short-term consequences of the absence of BF in preterm infants and to identify the relationship between feeding practices (BF vs formula feeding - FF) and adherence to preventive measures recommended for preterm children, related with food. Materials and methods. An anonymous online survey of parents (self-reported) of preterm infants was conducted using the Google Forms service. The study involved 390 children divided into two groups. The main group (MG) included 290 children who were on mechanical ventilation, and the control group (CG) included 70 children on BF. Results. Early termination of BF of a preterm baby or start from FF is associated with the following factors: maternal age under 18 or older than 38 years old (OR=3.47; 95% CI: 0.84-2.40), male gender of the child (OR=2.43; 95% CI: 1.41-4.18), birth from a multiple pregnancy (OR=1.94; 95% CI: 1.01-3.73), prolonged (more than 7 days) mechanical lung ventilation (OR=2.52; 95% CI: 1.36-4.66) and prolonged (more than 14 days) tube feeding of the child (OR=1.96; 95% CI: 1.14-3.36). Children of MG aged 6 months of adjusted age were significantly more likely to have delayed psychomotor development. Conclusions. When counseling parents on the nutrition of a child born pretermin the first year of life, it should be taken into account that in the absence of BF, parents start introducing the first complementary foods to the child later (р&lt;0.001), including those rich in iron (р=0.01), and parents of a BF child more often neglect the recommendations for adding iron and vitamin D (OR=2.09 vs OR=1.92). The lack of BF of preterm babies for at least the first 6 months of life is associated with an increased risk of developing atopic dermatitis and acute respiratory diseases in the first year of life (OR=2.14 and OR=2.24, respectively). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. No conflict of interests was declared by the authors.

Endobronchial surfactant administration in full-term newborn with respiratory distress syndrome

Neonatal respiratory distress syndrome is the leading cause of neonatal acute respiratory failure. Despite the successes achieved and the existing international recommendations, in some cases there is a severe course of this disease, which requires a personalized approach to the patient and intensive care measures.&#x0D; The article presents a case of successful treatment of acute respiratory distress syndrome in a full-term newborn complicated by pulmonary barotrauma using monobronchial administration of exogenous surfactant under X-ray control. In order to assess the course of the disease and the effectiveness of treatment, a retrospective analysis of medical documentation was carried out. From the first minutes of life, the child had respiratory disorders, which was the basis for non-invasive mechanical lung ventilation nCPAP (nasal continuous positive airway pressure). Progression of hypercapnia and hypoxemia was revealed over time, and therefore tracheal intubation was performed and convective mechanical ventilation was started with FiO2 = 1,0. Monobronchial administration of exogenous surfactant was a key element of the therapy that allowed to achieve stabilization of the condition and regression of gas exchange disorders with complete recovery of the patient.&#x0D; Monobronchial administration of surfactant in acute respiratory distress syndrome with heterogeneous lung involvement is an effective treatment option and can be used in clinical practice for refractory hypoxemia.

Comparison of mainstream (Capnostat 5) and a low-flow sidestream capnometer (Capnostream) in mechanically-ventilated rabbits anesthetized with a Bain coaxial breathing system.

Introduction: Measurement of end-tidal carbon dioxide (PE'CO2) provides continuous non-invasive estimation of arterial carbon dioxide partial pressure (PaCO2). Agreement can be affected by the high respiratory rates and shallow tidal volumes of rabbits, especially when anesthetizing with a non-rebreathing system and high fresh gas flows. Capnometer function may be improved by increasing tidal volume and decreasing respiratory rate with mechanical lung ventilation.

Sedacija kritično obolelih pacijenata u jedinicama intenzivnog lečenja - šta je novo?

Sedation of critically ill patients is a highly important therapeutic aspect in Intensive Care Units (ICUs). Numerous studies have demonstrated that a sedated (calm) patient compared to an unsedated (restless, agitated, delirious) one achieves better treatment outcomes, fewer complications, shorter duration of mechanical lung ventilation, reduced ICU stay, shorter hospitalization, and lower mortality. The fundamental rule is to first ensure analgesia, followed by sedation. Shallow sedation is recommended to maintain patient cooperation, while deep sedation should be avoided except in specific clinical situations such as severe brain trauma or acute respiratory distress syndrome. Monitoring sedation in the ICU is mandatory, and for this purpose, simple scales such as the Richmond Agitation Sedation Scale (RASS) or the Riker Sedation-Agitation Scale (RSAS) are recommended. There is a wide range of medications available, each with advantages for specific clinical situations, but generally, propofol and dexmedetomidine are most recommended and commonly used. Non-pharmacological measures and interventions should also not be disregarded and should be systematically employed whenever possible to reduce agitation occurrences in the ICU

Incidence and associated risk factors for systemic drug levels with inhaled aminoglycoside therapy.

To characterize the incidence of and risk factors for a detectable drug level (DDL) in patients that received inhaled aminoglycoside therapy. This retrospective, single-centre study included adult patients who received at least one dose of an inhaled aminoglycoside with a drug level during inpatient hospitalization. Patients were excluded if they received an aminoglycoside intravenously within 7 days or if the drug level was not drawn within 4 h of the next dose. A repeated measures logistic regression model evaluated the association between potential risk factors and a DDL. Among 286 drug levels, 88 (30.8%) drug levels were detectable. In multivariable analysis, cystic fibrosis (CF) (OR: 3.03; 95% CI: 1.10-8.35), chronic kidney disease (CKD) (OR: 4.25; 95% CI: 1.84-9.83), lung transplant recipient (OR: 3.08; 95% CI: 1.09-8.73), mechanical ventilation (OR: 2.99; 95% CI: 1.25-7.15) and tobramycin (OR: 5.26; 95% CI: 2.35-11.78) were associated with higher odds of a DDL. Among those with a DDL, inhaled aminoglycoside type and drug level concentration were not associated with acute kidney injury (P = 0.161). Among 286 drug levels identified among inpatients receiving inhaled aminoglycoside therapy, 88 (30.8%) unique drug levels were detectable. Based on the results of this study, periodic trough concentrations should be considered for patients receiving inhaled aminoglycoside therapy with CF, CKD, lung transplantation, mechanical ventilation or tobramycin.

Hemoadsorption in Patients with Various Types of Respiratory Support for Severe COVID-19

Study aim. To evaluate the efficacy of hemoadsorption in patients with severe COVID-19 on mechanical lung ventilation (MLV) and noninvasive respiratory support.Material and methods. We retrospectively analysed longitudinal clinical and laboratory parameters of 49 patients with severe coronavirus infection who were treated in the First Intensive care unit of Grodno University Hospital from September 2020 to November 2021 and underwent hemoadsorption using the Hemo-Proteasosorb sorbent. All patients were divided into two groups: Hemo-Proteasosorb + MLV (22 patients who underwent hemoadsorption while being on MLV) and Hemo-Proteasosorb without MLV (27 patients who had hemoadsorption while receiving the low- and high-flow oxygen therapy or noninvasive lung ventilation).Results. In the Hemo-Proteasosorb + MLV group a decrease in procalcitonin (PCT) (from 0.27 [0.12–2.08] down to 0.14 [0.05–1.77], P=0.027), C-reactive protein (CRP) (from 135.4 [10.6–303.0] down to 64.3 [1.2–147.0], P=0.003), fibrinogen (from 11.7 [4.9–19.49] to 8.2 [3.7–14.7], P=0.00004), and D-dimer (from 1432.0 [443.0–6390.0] to 1087.0 [415.0–3247.0], P=0.006) was seen on day 3 after the hemoadsorption session. The Hemo-Proteasosorb without MLV group also demonstrated a reduction in the levels of CRP (from 4 [10.6–303.0] to 64.3 [1.2–147.0], P=0.003), fibrinogen (from 11.7 [4.9–19.49] to 8.2 [3.7–14.7], P=0.00004), D-dimer (from 1432.0 [443.0–6390.0] to 1087.0 [415.0–3247.0], P=0.006) on day 3 after the hemoadsorption session. The Hemo-Proteasosorb without MLV group also showed a decrease in PCT (from 0.29 [0.14–21.25] to 0.14 [0.04–11.91], P=0.002), CRP (from 132.6 [30.7–183.0] to 28.55 [5.3–182.0], P=0.0002), fibrinogen (from 10.2 [4.41–15.5] to 6.5 [2.8–11.9], P=0.00005), D-dimer (from 1445.0 [365.0–4830.0] to 1049.0 [301.0–3302.0], P=0.005), while an increase in SpO₂/FiO₂ (from 238 [88–461] up to 320 [98–471], P=0.011) was registered. On days 5–7, positive changes in SpO₂/FiO₂ index (238 [88–461] vs 320 [96–471], P=0.0020) were observed in the Hemo-Proteasosorb without MLV group, as well as a trend toward further reduction in the levels of CRP (132.6 [30.7–183.0] vs 23.85 [2.2–200.0], P=0.0001) and fibrinogen (10.2 [4.41–15.5] to 5.11 [2.3–11.5], P=0.0017). The patients were assessed using the NEWS2 score at all the stages of the study. On days 2–3 of the study, a reduction in the mean NEWS2 score was noted in the Hemo-Proteasosorb + MLV group (8.0 [4.0–11.0] vs 6.0 [2.0–10.0], P=0.0002), whereas on days 5–7 its increase was seen vs stage 2 of the study with its values still lower than those prior to hemoadsorption (8.0 [4.0–11.0] vs 7.0 [2.0–9.0], P=0.011). On day 3 of treatment, in the Haemo-Proteasorb without MLV group we observed a decreased mean NEWS2 score (7.0 [3.0–9.0] vs 5.0 [1.0–9.0], P=0.00002), on days 5–7, this trend was still present (7.0 [3.0–9.0] vs 3.0 [1.0–8.0], P=0.00002).Conclusion. Hemoadsorption was beneficial for patients with severe COVID-19 during both oxygen therapy and mechanical ventilation due to decreased levels of inflammatory markers, hypercoagulation, and reduced NEWS2 scores.