The objective: to evaluate the effect of high-flow oxygen and non-invasive ventilation on the mortality rate in adults with severe respiratory failure caused by the new coronavirus infection in the intensive care unit (ICU).Subjects and methods. A one-center retrospective study was conducted. Electronic medical files of patients treated in the ICU from April 1 to May 25, 2020, were analyzed. Totally, 101 medical files were selected, further, they were divided into two groups. Group 1 (n = 49) included patients who received oxygen insufflation, and should it fail, they received traditional artificial ventilation. No non-invasive respiratory therapy was used in this group. Group 2 (n = 52) included patients who received high-flow oxygen therapy and non-invasive ventilation. The mortality rate in the groups made a primary endpoint for assessing the impact of high-flow oxygen therapy and non-invasive ventilation. The following parameters were also analyzed: drug therapy, the number of patients in whom non-invasive techniques were used taking into account the frequency of cases when these techniques failed, and the number of patients in whom artificial ventilation was initiated.Results. In Group 2, non-invasive methods of respiratory therapy were used in 31 (60%) cases. High-flow oxygen therapy was used in 19 (36%) of them; in 13 cases this method allowed weaning them from the high flow. Non-invasive ventilation was used in 18 cases, in 12 patients it was used due to progressing severe respiratory failure during humidified oxygen insufflation, in 6 patients – after the failed high-flow oxygen therapy. In Group 1, 25 (51%) patients were intubated and transferred to artificial ventilation, in Group 2, 10 (19.2%) underwent the same. The lethal outcome was registered in 23 (47%) cases in Group 1, and in 10 (19.2%) in Group 2 (p = 0.004). Analysis of drug therapy in the groups revealed the difference in the prescription of pathogenetic therapy. Logistic regression demonstrated the effectiveness of the combination of tocilizumab + a glucocorticoid in reducing the frequency of lethal cases (p = 0.001).Conclusion. The use of non-invasive respiratory support in adults with severe respiratory failure caused by the new coronavirus infection combined with therapy by tocilizumab + a glucocorticoid can reduce the incidence of lethal cases.
Цель исследования: сравнить параметры гемодинамики, концентрацию севофлурана на выдохе, расход фентанила за время операции, интенсивность болевого синдрома при проведении общей комбинированной анестезии с использованием дексмедетомидина и без него� Материалы и методы: выполнено проспективное слепое рандомизированное исследование у пациенток онкогинекологического профиля с участием двух групп с применением дексмедетомидина и без него� Результаты. В исследуемых группах выявлены изменения гемодинамики, концентрации севофлурана на выдохе, расхода фентанила� Разницы в интенсивности болевого синдрома в исследуемых группах не обнаружено� Выводы. Концентрация севофлурана на выдохе, а также расход фентанила меньше в группе с использованием дексмедетомидина� Интенсивность болевого синдрома не отличалась в двух исследуемых группах� Ключевые слова: общая комбинированная анестезия, дексмедетомидин, агонисты α 2-адренорецепторов, анестезия у онкологических пациентов
Aim: to evaluate the effects of intravenous dexamethasone on postoperative analgesia in patients after arthroscopic knee joint surgery in conditions of peripheral regional blockade. Material and methods: 60 patients were included in the study, divided into 2 groups. In the first group, patients underwent peripheral regional blockade of the femoral and sciatic nerves with a 0.5% solution of levobupivacaine. In the second, the traditional peripheral regional blockade was supplemented by intravenous administration of 8 mg (0.4% - 2 ml) of dexamethasone immediately after catarrhization of the peripheral vein. Results: The duration of the sensory blockade in the group using dexamethasone was 25% greater than in the first group. In the postoperative period, patients who were intraoperatively injected with dexamethasone required 33% less additional anesthesia. The duration of motor blockade in the group with dexamethasone was 26.5% higher than in the patients of the first group. Conclusion: intravenous dexamethasone injection with levobupivacaine peripheral regional anesthesia with arthroscopic knee joint surgery, increases the duration of the sensory block and the duration of postoperative analgesia. The use of dexamethasone led to a decrease in the need for additional anesthesia in the early postoperative period.
evaluate the frequency of mistakes made without it and with its use. Materials and methods. The study included 32 residents of the first year of study in the specialty «Anesthesiology and Resuscitation», who had previously held theoretical lectures on the topic: «Organization of the workplace of an anesthesiologist». In the simulation center, the subjects were asked to prepare the anesthesiologist’s workplace. The trainees were divided into two groups. The1st group – performing the task without prior acquaintance with the checklist and the 2nd group – acquaintance with the checklist. The assessment was carried out by two teachers independently of each other using a checklist modified for objective assessment of the subjects. Results. In the 1st group, 8 (50 %) students coped with the task, in the 2nd group, in 15 cases (94 %), the task was successfully completed. Checking the availability of funds for tracheal intubation was successfully completed by trainees in both groups. At the same time, points were identified: a leak test and checking the correct functioning of the anesthetic-respiratory apparatus, which the subjects could not cope with, which required more detailed consideration, both in theoretical and practical classes of these issues. Conclusion. The use of the checklist: «Organization of the workplace of an anesthesiologist» allows to increase the effectiveness of training of residents and reduce the number of mistakes made.
It justifies the effectiveness of the use of high-fidelity simulation when training clinical ordinators on the difficult airway management After the theoretical course and obtaining practical skills of airway management, 26 1-st year clinical ordinators were divided into 2 equal groups. The members of the main group took part in each of 4 «difficult airways» scenarios with the use of a human-patient simulator with subsequent debriefing. Then, after 1, 3 and 6 months, the all ordinators from both groups passed one of the «difficult airways» scenarios with the performance assessment by checklists and the assessment of knowledge with multiple choice questions. In the main group, the high level of retained knowledge was revealed for 6 months (after 1 month - 86 points (81,3-91,2); after 6 months - 83,5 points (78,4-88,9); p>0,05). In the control group, the level of knowledge significantly decreased after 6 months (after 1 month - 82,2 points (75,4-89,2); after 6 months - 69 points (60,7-75, 2); p0,05). The control group showed a significant deterioration in the score assessment after 3 months, followed by its growth and the lack of difference between the groups after 6 months. The simulation-based difficult airways management training enhances the performance and retained theoretical knowledges and skills of trainees during simulated «difficult airways» clinical situations up to 6 months.
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