Coronavirus infection caused by the SARS-CoV-2 virus is a multifaceted disease due to generalized vascular endothelial damage. Endothelial damage also underlies COVID-associated coagulopathy.The paper presents a case of coagulopathy causing myocardial infarction in a 43-year-old patient with no history of coronary disease. We have reviewed the available literature for the pathophysiological rationale of the assumed possibility of coronary thrombosis resulting from coagulopathy with the intact intima of the coronary arteries.Conclusion. The present observation of coronary thrombosis with radiographically intact coronary artery intima confirms the important role of coronavirus infection in triggering endothelial dysfunction. Currently, the most effective strategy for this type of coronary lesions is the use of anticoagulants and antiplatelet agents along with ECG, echocardiography and troponin level monitoring.
The clinical manifestation of shock is characterized by systemic circulatory disturbances andblood flow, hypoxic and metabolic disorders. The leading role in the pathogenesis of traumatic shock (the subtype of a hypovolemic shock), is assigned to the severity of the damaging effect, the time interval sufficient for the development of a pathophysiological response, mismatch between body tissue perfusion and the metabolic requirements, and impaired aerobic oxidation in tissues. The use of a comprehensive multicomponent intensive care strategy matching the pathophysiological changes is a difficult challenge for a critical care physician.The aim of the review is to demonstrate the specific features and sequence of events occurring in the body during the development of traumatic shock, the pattern of manifestations of clinical signs, and potential use of intensive therapy methods tailored to the pathophysiological responses in traumatic shock.Material. The information search was carried out in the PubMed and RSCI databases, among which 80 sources were finally selected, representing current therapeutic approaches, the results of scientific research and clinical guidelines related to the scope of this review.Results. The main stages of traumatic shock pathogenesis were reviewed. The basic patterns of cardiovascular and respiratory failure development were analyzed, the criteria of their severity were evaluated, and the complexity of the selection of intensive therapy was shown.Conclusion. Respiratory support, stabilization of cardiac and circulatory parameters and optimization of oxygen status are the most important components of treatment of patients with traumatic shock. Current methods of respiratory failure control allow to estimate promptly the severity of respiratory dysfunction, reveal the cause and correct existing disorders in an individualized way taking into account the better availability of mechanical ventilation. Replacement of circulating blood volume is aimed both at achieving hemodynamic effect and restoring the concentration of sources of oxygen carriers and plasma pro- and anticoagulant factors. The earliest and most comprehensive intensive therapy can improve the prognosis and outcome in patients with traumatic shock.
Pulmonary artery thromboembolia (PATE) is not a clinical entity as such, but a complication of different diseases and conditions leading to deep thrombosis in the low tension circulation system, right cardiac chambers or causing local thrombosis in the pulmonary artery system. PATE is characterized by complex pathogenesis of respiratory failure of varying severity, which makes it difficult to choose a respiratory support technique.Purpose of the overview: to show advantages of different respiratory support techniques and prospects of high-flux oxygen therapy with regard to PATE pathophysiology.82 sources were selected based on the principle of combining clinical and experimental data from papers published over the recent 5 years and earlier that are still relevant for medical practice.The overview presents the structure of main causes and prevalence of PATE and considers thrombogenesis stages and predominant manifestations of respiratory failure during PATE occurring due to inconsistency between pulmonary ventilation and perfusion. Review discusses five methods of respiratory therapy in PATE patients: low-flux and high-flux oxygen therapy, non-invasive and invasive artificial lung ventilation, extracorporeal blood oxygenation. Finally, the paper shows the efficacy and limitations of these methods.Conclusion. High-flux oxygen therapy seems to be the most effective and promising technique in PATE patients thanks to absence of adverse cardiohemodynamic consequences, subjective comfort for patients, and relation to minimal risks of secondary infectious complications.Nevertheless, the clinical experience accumulated is insufficient to make an absolute choice of one particular technique for respiratory support during PATE. It is necessary to continue investigating the clinical efficacy of high-flux oxygen therapy in the specific population of patients who experienced PATE.
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