An interesting clinical case of viral pneumonia in a patient with diabetes mellitus is considered in the article. This case deserves attention of anesthesiologists, especially today, during the COVID-19 epidemic. An important role in timely diagnosis belongs to the CT scan, as the X-ray does not always diagnose viral pneumonia. In our case, we adhered to the principles of restrictive infusion therapy, early intubation, protective ventilation and early weaning of the patient from the respirator. The article describes the successful experience of using the ASV intelligent ventilation mode – from intubation to extubation. We recommend you to use ASV in patients with viral pneumonia to achieve protective ventilation, rapid weaning, and low risk of complications.
The ongoing conflict in Ukraine continues to generate many complex traumatic injuries and provides unique challenges to anaesthesiologists who provide medical care at various levels of medical evacuation. We report the successful use of an ultrasound-guided continuous erector spinae plane (ESP) block in a patient with severe posterolateral chest trauma. The acute perioperative outcome of the patient was improved with the ESP block, the main benefits being excellent analgesia and minimal postoperative morphine requirements without influencing the risk of bleeding and coagulopathy. We conclude that continuous ESP block can be utilized to provide excellent analgesia following massive thoracic trauma.It's ease of placement under ultrasound guidance and low risk of complications makes this technique particularly useful in war medicine. K E Y W O R D Scombat anesthesia, continuous peripheral nerve block, erector spinae plane block (ESP), postoperative regional anesthesia How to cite this article: Dmytriiev D, Dîrzu DS, Melnychenko M, Eichholz R. Erector spinae plane block for affective and safe analgesia in a patient with severe penetrating chest trauma caused by an explosion in the battlefield.
Introduction: Acute viral rhinitis is one of the most common pathologies among the population of the globe. Although, at first glance, this pathology seems simple and well-studied, but due to the high incidence, the load it creates on the health care system encourages in-depth study. Aims: To examine the dynamics of changes in quality of life and local levels of TNF-α and IL-1β in patients with acute viral rhinitis in different treatment regimens. Methodology: The prospective study included 84 patients with a confirmed diagnosis of acute viral rhinitis. In accordance with the purpose and objectives of the study, all patients on days 1, 5 and 10, in addition to routine studies, were determined by local levels of TNF-α and IL-1β, as well as to determine the quality of life. Results: In patients of the study group, only partial recovery of local levels of TNF-α and IL-1β and indicators of the physical component of quality of life was observed during 10 days of treatment. The emotional and functional components of quality of life in patients of this study were more correlated than with the physical component and local levels of proinflammatory cytokines, which are objective indicators of the activity of the inflammatory process. Complementing the traditional treatment regimen with 0.25% oxolin in the form of an ointment has reduced the duration of the disease, reduced the incidence of bacterial complications and improved the quality of life of patients with acute viral rhinitis in the short term. Conclusions: The dynamics of local levels of TNF-α and IL-1β reflects the nature of the inflammatory process in the nasal mucosa and clearly correlates with the physical component of quality of life.
Enhanced Recovery After Surgery (ERAS) protocols are increasingly used in the perioperative period around the world. The concept of goal-directed fluid therapy (GDT) is a key element of the ERAS protocols. Inadequate perioperative infusion therapy can lead to a number of complications, including the development of an infectious process, namely surgical site infections, pneumonia, urinary tract infections. Optimal infusion therapy is difficult to achieve with standard parameters (e.g., heart rate, blood pressure, central venous pressure), so there are various methods of monitoring central hemodynamics – from invasive, minimally invasive to non-invasive. The latter are increasingly used in clinical practice. The current evidence base shows that perioperative management, specifically the use of GDT guided by real-time, continuous hemodynamic monitoring, helps clinicians maintain a patient’s optimal fluid balance. The manuscript presents the analytical data, which describe the benefits and basic principles of perioperative targeted infusion therapy based on central hemodynamic parameters to reduce the risk of complications.
Background:The aim of this study was to evaluate the hemodynamic protective effects of perioperative ventilation in pressure-controlled ventilation (PCV) and adaptive support ventilation (ASV) modes based on non-invasive hemodynamic monitoring indicators. Methods: The study included 32 patients who were scheduled for planned open abdominal surgery. Depending on the chosen ventilation strategy, patients were included in two groups of PCV mode ventilation (n=14) and ASV mode ventilation (n=18). The hemodynamic effects of the ventilation strategies were assessed by estimated continuous cardiac output (esCCO) and cardiac index (esCCI). Results: Preoperative cardiac output (CO) was 6.1±1.3 L/min in group 1 patients and 6.3±0.8 L/min in group 2 patients, and preoperative cardiac index (CI) was 3.9±0.4 L/min/m 2 in group 1 patients and 3.8±0.8 L/min/m 2 in group 2 patients. The ejection fraction (EF) in group 1 subjects was 55.4%±0.3%; this rate was 56.5%±0.5% in group 2 subjects. Group 1 patients experienced a 14.7% CO decrease to 5.2±0.7 L/min, a 17.9% CI decrease to 3.2±0.6 L/min/m 2 , and a 12.8% mean arterial pressure decrease to 82.3±9.4 mm Hg 30 minutes after the start of surgery. One hour after the start of surgery, the CO mean values of group 2 patients were lower than baseline by 7.9% and differed from the dynamics of patients in group 1, in whom CO was lower than baseline by 13.1%. At the end of the operation, the CO values were lower than baseline by 11.5% and 6.3% in patients of groups 1 and 2, respectively. Our data showed that the changes in EF during and after surgery correlated with CO indicators determined by the esCCO. Conclusions: In our study, perioperative ventilation in ASV mode was more protective than PCV mode and was characterized by lower tidal volume (16.2%) and driving pressure (12.1%). Hemodynamically-controlled mechanical ventilation reduces the negative impact of cardiopulmonary interactions.
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