Prolonged Artificial Ventilation Research Articles

THE ROLE OF BRONCHOSCOPY IN INTENSIVE CARE MEDICINE, CASE REPORT

Purpose. Airway maintenance, adequate ventilation, and pulmonary gas exchange are crucial for critically ill patients. The challenges of performing in intensive care patients often differ significantly from routine surgical procedures in the operating room. The aim of our study was to assess the effectiveness of bronchoscopic aspiration in improving respiratory function in a patient on prolonged artificial ventilation. Material/Methods. A 69-year-old male was admitted to the ICU six days after an open cystoprostatectomy, presenting with respiratory failure. Initial treatment included blind airway suctioning, nebulization, chest physiotherapy, and empirical antibiotics. Due to persistent atelectasis and respiratory failure, bronchoscopic aspiration was performed. A total of nine bronchoscopies with bronchoalveolar lavage (BAL) were conducted for aspiration and microbiological testing, guiding adjustments in antibiotic therapy. After 61 days in the ICU, the patient was transferred to the Department of Urology and later discharged. Results. Bronchoscopic aspiration significantly improved the patient's condition, with noticeable improvements after the first bronchoalveolar lavage (BAL). Pulmonary imaging on X-ray and blood oxygenation showed clear progress, with better lung function and enhanced ventilation parameters. These changes allowed for a reduction in oxygen concentration and improved gas exchange. After 61 days in the ICU, the patient was successfully transferred to the Department of Urology and later discharged in stable condition. Conclusions. Bronchoscopic aspiration is a highly effective method for improving ventilation and oxygenation in patients on prolonged mechanical ventilation. It plays a crucial role in managing airway obstructions atelectasis, and enhancing microbiological diagnostics.

The rs11385942 and rs657152 variants are not associated with COVID-19 severity and outcomes in patients treated with favipiravir and remdesivir

Background. There is a mounting evidence in the scientific literature that susceptibility to SARS-CoV-2 infection could vary. The severity of COVID-19 symptoms can range from asymptomatic to severe respiratory failure, requiring prolonged artificial ventilation. The underlying causes of this range of clinical manifestations remain unclear. Identification of the risk factors that may cause this variation in clinical symptoms is important for identifying the most susceptible populations at highest risk. This should help improve prevention measures, reduce hospitalizations, and decrease the mortality rate of the disease. Previously, an association has been found between the severity of COVID-19 and the genetic markers rs11385942 G>GA and rs657152 A>C.The aim. To assess the impact of carrying polymorphic markers rs11385942 G>GA and rs657152 A>C on the severity of COVID-19 in patients undergoing specific therapy. Materials and methods. A total of 240 patients hospitalized with a coronavirus infection were included in the study. All patients received therapy with favipiravir or remdesivir. The presence of the rs11385942 G>GA and rs657152 A>C variants was determined in all patients. The study compared the length of hospital stays, frequency of patient transfers to the intensive care unit (ICU), and frequency of clinical outcomes (recovery or death) among carriers of allelic variants of the markers under investigation.Results. There were no significant associations between the carriage of variants rs11385942 G>GA and rs657152 A>C and the duration of patients’ hospitalization, frequency of patient transfers to the ICU, and patient outcomes.Conclusion. The carriage of rs11385942 G>GA and rs657152 A>C variants did not affect the severity or type of clinical outcomes in patients with COVID-19.

Frequency of isolation of nosocomial pneumonia pathogens from the respiratory tract of cardiac surgery hospital patients who are under extended artificial lung ventilation and efficiency of oral cavity sanitation with chlorhexidine solution

Objective. To assess the frequency and degree of bacterial contamination of the respiratory tract in patients of cardiac surgery hospital, who are on prolonged mechanical ventilation, and to evaluate the efficiency of sanitation of the oral cavity with a solution of chlorhexidine. Materials and methods. A comparative analysis of the oral and tracheobronchial tract microbiota in operated patients of cardiac surgery hospital undergoing prolonged (4872 hours) artificial lung ventilation (ALV) was carried out. Microbiological assessment of the effectiveness of the oral cavity sanation with 0.1 % aqueous chlorhexidine solution is given. Results. The oral and tracheobronchial microbiota of cardiac surgery patients undergoing prolonged ALV are represented by gram-positive (S. epidermidis) and gram-negative (K. pneumoniae, P. aeruginosa, A. baumannii) microorganisms as well as Candida fungi. It was found out that the indices of the frequency and intensity of microbial isolation from the samples of the lower parts of the respiratory tract content were comparable with those of the oral cavity. The exception was S. epidermidis, the number of which in the lower airways compared to the upper ones was low. There was a statistically significant decrease in the intensity of microbial contamination of the oral cavity in patients on ALV after the sanation procedure with an aqueous chlorhexidine solution. Conclusions. Frequency and intensity indices of opportunistic microorganisms (K. pneumoniae, P. aeruginosa, A. inaumannii, Candida fungi) isolation from the oral cavity and lower respiratory tract in patients of cardiac surgical hospital under prolonged ALV have no statistically significant differences. The exception is S. epidermidis, whose numbers in the lower airways are low compared to the upper ones. The microbiological effectiveness of 0.1 % aqueous chlorhexidine solution in the process of sanitation of the oral cavity in patients on prolonged ALV has been established.

Distribution of thrombus predicts severe reperfusion pulmonary edema after pulmonary endarterectomy

ObjectivesPatients underwent pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to investigate the effect of thrombus distribution on the occurrence of severe reperfusion pulmonary edema (RPE) and identify specific parameters for predicting severe RPE. MethodsPatients with CTEPH who underwent PEA surgery were retrospectively analyzed. The thrombus in pulmonary arteries were evaluated through computed tomography pulmonary angiography. Based on presence of prolonged artificial ventilation, extracorporeal membrane oxygenation required, or perioperative death due to RPE, the patients were divided into the severe RPE and without severe RPE groups. Main resultsAmong the 77 patients (29 women), 16 (20.8%) patients developed severe RPE. The right major pulmonary artery (RPA) (0.64[0.58, 0.73] vs 0.58[0.49, 0.64]; p = 0.008) and pulmonary artery trunk (PAT) thrombus ratios (0.48[0.44, 0.61] vs 0.42[0.39, 0.50]; p = 0.009) (the PAT ratio is expressed as the sum of the right middle lobe clot burden and right lower lobe clot burden divided by the total clot burden multiplied by 100) of the severe RPE group was significantly higher than that of the without severe RPE group. Receiver operator characteristics curve identified a PAT ratio of 43.4% as the threshold with areas under the curve = 0.71(95%CI 0.582; 0.841) for the development of severe RPE (sensitivity 0.875, specificity 0.541). The logistic regression analysis demonstrated that age, period from symptom onset to PEA, NT-pro BNP, preoperative mPAP, preoperative PVR, RPA ratio, and PAT ratio were associated with the development of severe RPE. Multivariable logistic regression analysis revealed PAT ratio (odds ratio = 10.2; 95% confidence interval 1.87, 55.53, P = 0.007) and period from symptom onset to PEA (OR = 1.01; 95% CI = 1.00–1.02, P = 0.015) as independent risk factors for the development of severe RPE. ConclusionsThe thrombus distribution could be a key factor in the severity of RPE. PAT ratio and medical history could predict the development of severe RPE.

Senile asthenia as a predictor of the severity of the perioperative period in elderly and senile patients

The aim. To evaluate the effectiveness of the diagnosis of senile asthenia using the Edmonton Frail scale in emergency abdominal surgery and to determine its impact on the severity of the perioperative period. Materials and methods. The study included 81 patients with acute cholecystitis on the background of gallstone disease, who were assessed for senile asthenia using the Edmonton Frail scale. For the reliability of the obtained results, only patients who were urgently hospitalized to the surgical department with gynecology beds of the emergency hospital with clinical symptoms of acute cholecystitis were included. All patients received treatment in only one department and according to the standards and clinical protocols of this clinic. Based on the Edmonton Frail score, all patients were divided into two groups. The comparison group included 50 (61.7 %) patients who did not have senile asthenia. The main group included 31 (38.3 %) patients diagnosed with senile asthenia. Results. Surgical treatment in both groups was carried out on an urgent basis using total intravenous anesthesia with artificial lung ventilation. According to the type of surgical intervention in both groups, preference was given to minimally invasive methods. Laparoscopic cholecystectomy in the comparison group was performed in 49 (98.0 %) patients, and only one patient (2.0 %) was converted and operation continued from the mini-access. In the main group, all surgical interventions were performed by the laparoscopic method, U = 759.50, P = 0.8841. Analyzing the results of the duration parameters and the need for prolonged mechanical ventilation, it can be seen that it progressively increases in patients with asthenia: in the comparison group 61.50 (48.00; 75.00) minutes, and in the main 93.84 (60.00; 80.00), U = 513.50, P = 0.0112. Also, we noted that in patients with senile asthenia, the number of postoperative complications increases: in the comparison group, there were only 2 (4.0 %) postoperative complications, while in the main group – 7 (22.6 %), U = 556.00, Р = 0.0337. Summarizing the results, it can be seen that due to increase of the frequency of postoperative complications and increase of the need for prolonged artificial ventilation of the lungs, the length of hospital stay of patients with senile asthenia increased: in the comparison group it was 7.9 ± 2.2 days, and in the main group 9.7 ± 3.2 days, U = 530.50, P = 0.0177. Conclusions. In our opinion, the Edmonton Frail scale is effective in diagnosing the severity of senile asthenia in elderly and senile patients in emergency abdominal surgery due to its simplicity and speed of use. The overall severity of the condition, heart failure in patients with senile asthenia lead to increase in the duration of surgery and the total duration of artificial lung ventilation: in the comparison group 39.52 (30.00; 45.00) minutes, while in the main group 49.19 (35.00; 50.00) minutes, U = 482.50, P = 0.0046. The duration of mechanical ventilation also differed significantly, in the comparison group 61.50 (48.00; 75.00) minutes, and in the main – 93.84 (60.00; 80.00), U = 513.50, P = 0.0112. The severity of senile asthenia negatively affects the course of the perioperative period, the frequency of postoperative complications increases: 2 (4.0 %) patients in the comparison group, while in the main group of 7 (22.6 %) patients, U = 556.00, P = 0.0337 and, as a consequence, the duration of inpatient treatment increases: in the comparison group it was 7.9 ± 2.2 days, in the main – 9.7 ± 3.2, U = 530.50, P = 0.0177. Modification of the approaches to preoperative preparation and postoperative management of elderly and senile patients diagnosed with senile asthenia will reduce the frequency of postoperative complications and reduce the length of hospital stay.

Features of open respiratory tract care in patients undergoing prolonged artificial lung ventilation

A visual assessment of compliance with the requirements of epidemiological safety of 52 open-air respiratory tract care procedures in 8 operated adult patients undergoing long-term artificial lung ventilation in the department of anesthesiology and resuscitation of a cardiac hospital showed a high frequency of violations of the technology of these procedures. To optimize the care of the respiratory tract in such patients and improve epidemiological safety, an improved manipulation algorithm is proposed. The issue of the priority of rehabilitation of the tracheobronchial tree and upper respiratory tract requires further epidemiological and microbiological assessmen.

PO251 / #854 NONINVASIVE CLOSED LOOP DIAPHRAGM STIMULATION FOR VENTILATED ICU PATIENTS: E-POSTER VIEWING

Many COVID-19 patients need prolonged artificial ventilation. Skeletal muscle wastes rapidly when deprived of neural activation, and in ventilated patients the diaphragm muscle begins to atrophy within 24 hours (ventilator induced diaphragmatic dysfunction, VIDD). This profoundly weakens the diaphragm, complicating the weaning of the patient off the ventilator, and increasing the risk of complications such as bacterial pneumonia. 40% of the total duration of mechanical ventilation in ITU patients is accounted for by the weaning period, after the initial illness has resolved.

Paralytic Ileus after Prolonged Transient Hypocholinesterasemia Induced by Fenitrothion Poisoning

The patient was a 62-year-old woman who was found in an unconscious. She had paroxysmal atrial fibrillation, dyslipidemia and anxiety neurosis. On arrival, she was in a state of deep coma with hypotension and hypoxia. She underwent tracheal intubation and continuous infusion of noradrenalin. Her serum cholinesterase (butylcholinesterase) level was 2 IU/L. Organophosphate poisoning was suspected. On day three, she regained clear consciousness and accepted that she had intentionally ingested a bottle of fenitrothion with suicidal intent. On the 3rd day, her serum cholinesterase level decreased to 0 U/L, and remained at this level until the 7th day. Prolonged artificial ventilation was required due to weak respiration. On the 14th day, she presented shock, a deterioration of consciousness, a distended abdomen with the peritoneal stimulation sign. She was diagnosed with paralytic ileus with septic shock. Her general condition gradually improved with supportive therapy. At the end of treatment in our hospital, she barely could walk and feed for herself and was transferred to another hospital for rehabilitation. To our knowledge, this is the first reported case of delayed paralytic ileus after prolonged transient hypocholinesterasemia induced by fenitrothion poisoning, in which atropine was not used as treatment. Physicians should pay attention to the complication of paralytic ileus when a patient with organophosphate poisoning shows prolonged hypocholinesterasemia.

ANALYSIS OF THE FREQUENCY AND NATURE OF CONCOMITANT DISEASES AS A RISK FACTOR FOR COMPLICATIONS AND ADVERSE OUTCOME IN CORONARY ARTERY BYPASS GRAFTING IN ELDERLY AND SENILE PATIENTS

Abstract. Objective: to study the frequency of occurrence of concomitant pathology of the circulatory and respiratory system, digestive organs and urogenital system to improve the quality of prognosis of developing complications and adverse outcomes during coronary artery bypass grafting in elderly and senile patients with coronary heart disease, including taking into account gender differences. Materials and methods. 164 patients (70% - men), operated on a planned basis for coronary heart disease in the Altai Regional Clinical Hospital, were under observation. The average age of patients at the time of surgery was 58.7± 7.3 years. Coronary bypass surgery was performed according to indications in conditions of artificial circulation and pharmacoholodic cardioplegia. Results. The Charlson comorbidity index was 5.3 [4.4-5.9] points; in young and middle-aged patients 3.5 [3.0-4.3], in elderly and senile patients - 5.9 [4.9-6.3] (p=0.03). It correlated with the following surgical complications: heart failure that required inotropic support for more than 5 days (r=0.68); perioperative MI (r=0.61); acute cerebrovascular accident confirmed by computed tomography (r=0.52); cardiac arrhythmias (atrial fibrillation, paroxysmal ventricular tachycardia) (r=0.49); respiratory insufficiency, which led to prolonged artificial ventilation of the lungs for more than 5 days (r= 0.45). Conclusions: Comorbidity in CABG is characterized by a high risk of an unfavorable prognosis in elderly and senile patients (survival rate is less than 21% in the next 10 years). The presence of a significant frequency of both multi and comorbid diseases determines a high associated surgical and anesthetic risk, which must be taken into account at the stage of preoperative preparation in gerontological patients, requires additional examination, increased costs and mandatory medical correction.

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.

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.

Роль санаційної терапії носоглотки і ротової порожнини в профілактиці гнійних ускладнень верхніх дихальних шляхів у пацієнтів, які перебувають на тривалій штучній вентиляції

Вторинне бактеріальне запалення часто істотно ускладнює перебіг основного захворювання у пацієнтів, які перебувають у відділенні інтенсивної терапії. В останні роки все більша увага приділяється нозокоміальному синуситу як гнійно-септичному захворюванню носоглотки. Утруднення відтоку ексудату через супутній набряк та інфільтрацію слизової оболонки зменшує ймовірність одужання навіть при застосуванні адекватної антибактеріальної терапії, що забезпечує стерилізацію секрету синусів. Тому антибактеріальна терапія повинна поєднуватися з активним місцевим лікуванням. Використання 0,02% розчину декаметоксину в комплексі санаційної терапії носової порожнини, ротоглотки і лікуванні гнійних риносинуситів, ускладнених фарингітами, є ефективним методом боротьби з дисемінацією нозокоміальної інфекції, що дозволяє скоротити середні терміни перебування у відділеннях реанімації та інтенсивної терапії, зменшити строки застосування антибіотиків, і не виявило побічних ефектів. На відміну від стандартної схеми застосування в лікуванні гнійних риносинуситів і фарингітів хлоргексидинвмісних препаратів і фурациліну 0,02% розчин декаметоксину дозволяє одночасно зробити санацію носа, придаткових пазух і глотки, тому що не має токсичної дії на миготливий епітелій і не викликає алергічних реакцій.

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.

Rhinological tactics in the complex treatment of patients with severe combined cranio-facial trauma who are on mechanical ventilation

Introduction. In recent years, injuries ranked fourth among the main causes of death of the population after diseases of the cardiovascular system, malignant neoplasms and infectious diseases. The clinical course of associated injuries, as a rule, is characterized by a high number of complications, much more than in isolated injuries.Objective. Explore approaches to improving otorynolaryngological tactics from the standpoint of normalizing the functional state of the nasal mucosa, as well as increasing the effectiveness of treatment of patients with severe concomitant trauma on prolonged mechanical ventilation.Materials and methods. In the process of studying the problem of impaired mucociliary clearance of the nasal mucosa, the functional state of the mucous membrane in patients with severe concomitant head trauma undergoing prolonged artificial lung ventilation was analyzed. We studied the state of one of the most important mechanisms of sanitation and local protection of the respiratory tract - mucociliary clearance, which provides the necessary potential for barrier, cleansing and immune functions. A study was made of the thermal effect of the nasal cavity, pH + of the mucous membrane, the study of the frequency of beating of the cilia of the ciliated epithelium and the rate of mucociliary transportResults and discussion. The results of the study showed that the problem of post-traumatic and nosocomial sinusitis in patients with severe concomitant head trauma must be resolved as soon as possible, with the involvement of modern diagnostic and treatment methods, including the proposed method of artificial ventilation of the nose. The severity of the patient's condition, the severity of the injuries received excludes the use of advanced methods of surgical, otorhinolaryngological treatment.Conclusion. 12:30 PMThe use of minimally invasive methods of treatment, precision technical execution, including under endovideo control, polysinusotomy made it possible not to burden the condition of the victims and exclude iatrogenic damage that could entail irreversible changes in the body and condition of the victim.

Impact of anemia on outcomes in on-pump coronary artery bypass surgery patients.

Aim To study the contribution of preoperative anemia to the prognosis of adverse clinical events (mortality, complications, transfusion) in patients with ischemic heart disease (IHD) after myocardial revascularization in the conditions of artificial circulation.Material and methods This retrospective cohort study included 1 133 patients with IHD who had undergone isolated myocardial revascularization in the conditions of artificial circulation in 2019. The primary endpoints were mortality and a composite endpoint that included, in addition to mortality, cases of acute coronary syndrome, heart, respiratory and renal failure, neurological deficit, and infectious complications. The secondary endpoints were duration of artificial ventilation of more than 12 h, duration of stay in the resuscitation and intensive care unit (RICU) of more than one day, and duration of postoperative inpatient treatment of more than 7 days.Results Preoperative anemia was found in 196 (17.3 %) patients. The anemia was not associated with mortality but increased the risk of the composite endpoint, prolonged artificial ventilation, stay in RICU for more than one day, and red blood cell transfusion. Despite the absence of a relationship between red blood cell transfusion and mortality, the use of transfusion was associated with increased risks of the composite endpoint and prolonged stay in the RICU and hospital.Conclusion Preoperative anemia is a risk factor for adverse outcomes of myocardial revascularization in the conditions of artificial circulation. Timely treatment of preoperative anemia may improve outcomes of the treatment.

Early results of multiple coronary artery bypass grafting on arteries less than 1.5 mm in diameter

Abstract The widespread using of coronary artery (CA) stenting has led to the fact that nowadays coronary artery bypass grafting (CABG) is the method of choice for patients with multiple occlusions and diffuse lesions, who can be refused in surgery due to “small”, not specified in the guidelines, CA (diameter less than 1.5 mm). The use of microsurgical technique makes it possible to reconstruct small-caliber vessels, however, no detailed comparative data has been published yet. Aim To analyze the efficacy of CABG using microsurgical techniques for multiple CA bypass with arteries less than 1.5 mm and compare the results with coronary surgery of larger vessels in the early postoperative period. Methods We studied the early results of CABG in two groups of patients. The study group was represented by 100 patients with multiple coronary artery lesions with d<1.5 mm, who underwent control MSCT-shuntography in the postoperative period. We formed a control group of 100 patients who underwent CABG with a target artery d>1.5 mm. In all cases cardiopulmonary bypass and microsurgical technique were used. Results All patients underwent complete revascularization of CA, the average number of distal anastomoses was 4,3±0,5 in the study group versus 3.6±0,3 in the comparison group, p<0,001. Intraoperatively in the study group significantly more often performed complex anastomoses to arteries <1,5mm (47 patients vs 18, p<0,001), onlay-flap anastomoses (23 vs 1, p<0,001), single and multiple endarterectomies (19 vs 1, p<0,001). The need for long-term inotropic support (15 cases vs 13, p=0,684), as well as prolonged artificial lung ventilation (2 vs 3, p=0,651), in hospital stage was similar in both groups. Patients from the study group more often underwent reexploration for bleeding in the early postoperative period, which was explained by a large number of complex reconstructions and prolonged on pump time, nevertheless, the difference did not reach statistical significance (4 vs 2, p=0,407). Perioperative myocardial infarction (MI) were registered in 3 (3%) and 1 (1%) cases in the study and control groups, respectively, p=0,621. All patients in the study group underwent MSCT-shuntography in the early postoperative period, according to which 8 patients (8%) had occlusion of the autovenous coronary grafts to the CA<1.5mm and 4 patients (4%) - occlusion of the bypasses to CA>1.5 mm. Conclusion CABG in patients with coronary arteries less than 1.5 mm in diameter requires complex reconstructive techniques significantly more often. Nevertheless, in the early postoperative period, it is possible to achieve comparable results in the patient groups with and without CA<1,5mm in the anastomotic sites. Funding Acknowledgement Type of funding sources: None.

Determination of the level of condensate by recording the noise level in the respiratory circuit of mechanical ventilation devices

Abstract. The method of determining the accumulation of condensate by registering the noise level in the respiratory circuit of ventilators is substantiated. According to the proposed method, the condition and performance of the apparatus is monitored during artificial lung ventilation and oxygen therapy. With hardware ventilation, an increasing turbulent flow of a water or gas stream is formed in the respiratory circuit, accompanied by an increase in the noise effect and vibration. An increase in the level of acoustic noise from fluctuations in the accumulation of condensate in gaseous media was recorded by an instrument for objective measurement of sound level a sound level meter. Indicators of noise effects reached a higher level on the wet circuit (the presence of condensation droplets or accumulations of mucus) of the liquid compared with the indicators obtained on the dry breathing circuit. The difference in recorded noise levels reached 10 dB, and increased from 37,73 to 47,36 dB. Areas of the respiratory circuit with the greatest degree of narrowing of the lumen and critical accumulations of water condensate and mucus are a source of turbulence in the air flow and increased noise. In conditions of prolonged artificial ventilation of the lungs, the rate of humidified air-gas flow is constantly changing, especially with hardware modeling of the phases of inspiration and expiration, and an increase in temperature in the humidifier chamber. The proposed technique is designed to identify critical levels of water condensate in the apparatus breathing circuits by recording the intensity of the increase in noise level and choosing the rational mode of operation of medical equipment. Data on the emerging critical situation are displayed on the sound level meter screen and inform medical personnel about the need to rehabilitate the circuit of the artificial lung ventilation apparatus. The primary field of application is resuscitation and intensive care units, medical transport teams during in-hospital or inter-hospital transportation, and surgical operating rooms during inhalation anesthesia.

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.

КОРРЕКЦИЯ ЦЕРЕБРАЛЬНОЙ ОКСИГЕНАЦИИ С ЦЕЛЬЮ СНИЖЕНИЯ РАЗВИТИЯ ПОСЛЕОПЕРАЦИОННЫХ ОСЛОЖНЕНИЙ У КАРДИОХИРУРГИЧЕСКИХ ПАЦИЕНТОВ ВЫСОКОГО РИСКА

The imbalance between oxygen delivery and consumption in the brain can lead to unfavorable post-operative outcomes of cardiac surgery. The authors evaluated the effect of the protocol on management of cerebral oxygenation episodes during the post-operative period in the patients undergoing cardiac surgery and facing a high risk of complications. Subjects : Patients who underwent coronary bypass surgery and/or cardiac valve surgery with cardiopulmonary bypass, were randomly divided into two groups: the interventional group (n = 60), where a special protocol was used to manage desaturation episodes, and the control group (n = 60) where only blinded monitoring of cerebral oximetry was used. Within 30 days after surgery, the development of desaturation episodes during surgery was assessed as well as the occurrence of complications (myocardial infarction, brain damage of the 1st and 2nd types, infectious complications, prolonged artificial ventilation of the lungs, arrhythmia, repeated thoracotomy, acute renal damage) in both groups. Results . The duration and intensity of desaturation did not significantly differ between the groups. The composite outcome was observed in 41 (68.3%) patients in the intervention group and in 38 (63.3%) of them in the control group (p = 0.70), and no significant difference was found in the frequency of individual components of the composite outcome. It was found out that desaturation significantly affected the development of delirium (odds ratio 1.03, 95% confidence interval 1.01–1.05, p = 0.03, to reduce % of the area under saturation curve for the less than 60% of the absolute value per every 5 minutes). Conclusion . The cerebral oximetry correction protocol provided no effect on prevention of complications in high-risk patients undergoing cardiac surgery. However, the reduction of cerebral oximetry turned out to be significant to predict the development of post-operative delirium, and it noted the need to search for ways to manage oxygen imbalance during surgery.

ДИНАМИКА КОЛИЧЕСТВА ТРОМБОЦИТОВ В ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ У ДЕТЕЙ РАННЕГО ВОЗРАСТА С ВРОЖДЕННЫМИ ПОРОКАМИ СЕРДЦА

Цель исследования: выявить причины развития и определить влияние тромбоцитопении на течение послеоперационного периода у детей после хирургической коррекции врожденных пороков сердца в условиях искусственного кровообращения. Материалы и методы. Проведено сравнение течения раннего послеоперационного периода у детей с применением торакальной эпидуральной (ТЭА) анестезии (n = 68) и высокоопиоидной (ВВА) внутривенной анестезии (n = 84). Взаимосвязь между видом анестезии и результатами хирургического вмешательства оценивали по клинико-лабораторным характеристикам, в том числе по количеству тромбоцитов на 1, 2, 3 сутки и при выписке из стационара. Тромбоцитопенией считали количество тромбоцитов менее 150×109/л. Результаты. При использовании ТЭА уровень интраоперационной гликемии был ниже, а тромбоцитопения на 2 и 3 сутки после операции развивалась реже, чем при ВВА. При ишемии миокарда (ИМ) более 60 минут частота тромбоцитопении на 1 и 3 сутки после операции была выше, чем при ИМ менее 60 минут. Послеоперационная тромбоцитопения коррелировала с развитием дыхательной недостаточности и продленной ИВЛ. Количество тромбоцитов было достоверно ниже на 1 и 3 сутки после операций с выраженной интраоперационной сердечной недостаточностью. Заключение. Ранняя послеоперационная тромбоцитопения коррелирует с периоперационными осложнениями. Использование ТЭА коррелирует с меньшей выраженностью интраоперационной гипергликемии и ранним восстановлением количества тромбоцитов. The aim of study was to identify the reasons of thrombocytopenia development and to determine its effect on postoperative period in children after surgical correction of congenital heart diseases under cardiopulmonary bypass. Materials and methods. We compared 2 groups of children after surgery with thoracic epidural (TEA) anesthesia (n = 68) and high-opioid intravenous (HIA) anesthesia (n = 84) and assessed the relationship between the type of anesthesia and surgery results by clinical and laboratory characteristics, including the number of platelets on 1, 2, 3 days of postoperative period and at discharge from the hospital. Thrombocytopenia was the number of platelets less than 150×109/l. Results. With TEA usage the level of intraoperative glycemia was lower, and thrombocytopenia on 2 and 3 days after surgery developed less frequently than with HIA. Thrombocytopenia occurrence on days 1 and 3 after surgery was higher after myocardial ischemia (MI) for more than 60 minutes than with MI less than 60 minutes. Postoperative thrombocytopenia correlated with the development of respiratory failure and prolonged artificial lung ventilation. Platelets number was significantly lower on 1 and 3 days after operations with severe intraoperative heart failure. Conclusion. Early postoperative thrombocytopenia correlates with perioperative complications. TEA usage correlates with lesser severity of intraoperative hyperglycemia and early recovery of platelets count.