This is an analysis of cardiopulmonary resuscitation and intensive care of patients suff ering from the pandemic spread of the coronavirus COVID-19. High contagiousness of COVID-19, its asymptomatic or, on the contrary, severe course, diffi culties with early laboratory confi rmation of the diagnosis all leads to increased risks of staff infection, especially in the departments of anaesthesiology and intensive care (AIC). Therefore, a clear understanding of the algorithms of resuscitation procedures and principles of medical staff protection is critical. To fi ght the coronavirus disease (COVID-19), the practical experience based on the application of the protocol adopted by the Ministry of Health of Ukraine No 722 "Organization of Medical Care for Patients with Coronavirus Disease (COVID-19)" dated March 28, 2020, is described.
Background. Coronavirus disease (COVID-19) is the biggest challenge the whole modern world has faced. Physicians and scientists are trying to find a solution to this problem. That is why many guidelines for the management of patients with COVID-19 have been created recently and they are constantly updating because of new results of the latest studies. But it is noticeable that there is a lack of protocols for certain special groups of the population the management of which differs from the treatment of the general population. Such groups include children, pregnant and postpartum women, the elderly, and patients who need surgery. The purpose of our study is to evaluate the management of pregnant and postpartum women in the Municipal Non-Profit Enterprise “Lviv Clinical Emergency Care Hospital”. Materials and methods. From September 2020, at the premises of the Municipal Non-Profit Enterprise “Lviv Clinical Emergency Care Hospital”, treatment has been carried out for pregnant and postpartum women with COVID-19; three case reports are presented. Results. Unfortunately, the treatment does not always lead to positive outcomes, sometimes it can be fatal, as the course is often accompanied by bacterial complications on the background of immunosuppression. However, it was found that the best treatment regimen is still a combination of antibiotics, anticoagulants and hormones and excludes the widespread use of antiviral or antimalarial drugs. Continuous monitoring of vital functions and assessment of liver, kidney, and heart function is essential to prevent complications or detect them at an early stage. Conclusions. During treatment of pregnant women in the intensive care units, it is important to choose the right empirical therapy, think about delivery done in time and oxygen therapy, based on theoretical and practical principles of ventilation.
The main factor limiting the number of heart transplants in Ukraine is the small number of potential donors. In cases when the delivery time of the donor organ is more than 4 hours, the risks of the donor organ ischemic injury are multiplied. Transportation of the recipient to the location of the potential donor in such cases is a forced measure, as it increases the risk of adverse cardiovascular events in the recipient during transportation. Providing medical care to a recipient in such circumstances may be difficult. However, these measures are fully justified by the reduced risk of postoperative complications associated with the time of graft ischemia. The article describes a case of heart transplantation in the conditions of transporting the recipient to the donor. Heart transplantation was performed in a patient with NYHA functional class IV heart failure, refractory to conservative therapy. The postoperative period was uneventful. The time of cardiopulmonary bypass was 90 minutes, the total ischemia time was 180 minutes. On the 3rd day, the patient was transported to the specialized centre to continue treatment and rehabilitation. On the 21st day the patient was discharged in satisfactory condition for outpatient treatment. Key words: heart transplantation, cardiomyopathy, heart failure.
Today, heart transplantation is a gold standard treatment of the terminal chronic heart failure. Despite the constant improvement of the technique of this operation and the emergence of new protocols of immunosuppressive therapy, one of the main problems in the development of heart transplantation in Ukraine is a limited donor pool. The article presents a clinical case of successful orthotopic heart transplantation, followed by mitral valve repair in the early postoperative period. Our experience shows that mitral valve repair after orthotopic heart transplantation provides good results in the medium term, and this type of intervention can potentially expand the donor pool, thus increasing the number of heart transplants. Key words: chronic heart failure, heart transplantation, mitral valve repair.
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