Pub Date : 2021-09-30DOI: 10.25284/2519-2078.3(96).2021.242151
A. Mazur, P. V. Gurin, R. Zatsarynnyy, O. Khomenko, V. Beleyovych, T. Domansky, N.YU. Ivanchenko
Introduction. Heart transplantation remains the only radical treatment for end-stage heart failure (HF). Liver and / or renal dysfunction is common in patients with HF, which is also exacerbated by the use of artificial circulation and immunosuppressive therapy, and leads to postoperative complications and mortality. Case description. Patient P., 49 years old, after orthotopic heart transplantation was admitted to the intensive care unit (ICU) with signs of multiple organ failure. Graft rejection syndrome was suspected, but was not confirmed after the detailed clinical and laboratory examinations and according to the myocardial biopsy. Because of severe renal and hepatic insufficiency, patient at the ICU started to receive hemodiaultrafiltration with a flow of 190 ml/min; ultrafiltration – 100 ml/h. The condition, that developed was due to the direct effect of tacrolimus as the patient had a critically high plasma concentration of this drug (> 30 ng / ml) after the standard recommended postoperative dose (0.2 mg / kg per day). According to the literature, the elimination of the tacrolimus is provided by the liver, with microsomal cytochrome P450 3A4. Thus, the patient most likely had a failure of hepatic metabolism. Conclusion: Because of the systemic toxicity of tacrolimus, it is important to monitor its concentration after the first dose. Diagnosis of metabolic disorders at an early stage will prevent further systemic toxicity of tacrolimus. Efferent methods at ICU are the important tools for the correction of hepatic and renal insufficiency throughout toxic effects of tacrolimus.
{"title":"СASE STUDY OF HEPATO-RENAL FAILURE IN A PATIENT AFTER ORTHOTOPIC HEART TRANSPLANTATION","authors":"A. Mazur, P. V. Gurin, R. Zatsarynnyy, O. Khomenko, V. Beleyovych, T. Domansky, N.YU. Ivanchenko","doi":"10.25284/2519-2078.3(96).2021.242151","DOIUrl":"https://doi.org/10.25284/2519-2078.3(96).2021.242151","url":null,"abstract":"Introduction. Heart transplantation remains the only radical treatment for end-stage heart failure (HF). Liver and / or renal dysfunction is common in patients with HF, which is also exacerbated by the use of artificial circulation and immunosuppressive therapy, and leads to postoperative complications and mortality.\u0000Case description. Patient P., 49 years old, after orthotopic heart transplantation was admitted to the intensive care unit (ICU) with signs of multiple organ failure. Graft rejection syndrome was suspected, but was not confirmed after the detailed clinical and laboratory examinations and according to the myocardial biopsy. Because of severe renal and hepatic insufficiency, patient at the ICU started to receive hemodiaultrafiltration with a flow of 190 ml/min; ultrafiltration – 100 ml/h. The condition, that developed was due to the direct effect of tacrolimus as the patient had a critically high plasma concentration of this drug (> 30 ng / ml) after the standard recommended postoperative dose (0.2 mg / kg per day). According to the literature, the elimination of the tacrolimus is provided by the liver, with microsomal cytochrome P450 3A4. Thus, the patient most likely had a failure of hepatic metabolism.\u0000Conclusion: Because of the systemic toxicity of tacrolimus, it is important to monitor its concentration after the first dose. Diagnosis of metabolic disorders at an early stage will prevent further systemic toxicity of tacrolimus. Efferent methods at ICU are the important tools for the correction of hepatic and renal insufficiency throughout toxic effects of tacrolimus.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"4 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84070490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-30DOI: 10.25284/2519-2078.3(96).2021.242142
K. Bielka, I. Kuchyn, N. Semenko
Patient safety in the operative and perioperative period is critically important. The consequences of anesthesia complications have a significant impact on long-term surgical outcomes, quality of life of patients, morbidity and mortality. The purpose of the study was to assess the implementation of the components of the Helsinki Declaration in the practice of Ukrainian hospitals. Materials and methods. The survey was conducted in March-June 2021 by filling out a standard Google form. The link to the survey was distributed on the official page of the Association of Anesthesiologists of Ukraine, through social networks Facebook and Instagram on the official pages of the Department of Surgery, Anesthesiology and Intensive Care of the Institute of Postgraduate Education of the Bogomolets National Medical University. A total of 174 respondents took part in the survey. According to the results, 79.3% of respondents are aware of the Helsinki Declaration on Patient Safety in Anesthesiology. Among the respondents, only 43% stated that the principles of the Helsinki Declaration had been implemented in their medical institutions, and 20.9% about plans to implement the principles in the near future. At the same time, in 36% of medical institutions the principles of the declaration are not used and their implementation is not planned. The Safe Surgery checklist is always used by 18.7% of respondents, sometimes by 18.7%, and 29.2% of respondents have never about a checklist. Only 47% of doctors have an airway table in the operating room, and only 30% document the inspection of equipment before anesthesia. Most physicians noted that they used protocols in their practice, but 10% said they mostly did not. Regarding the report of complications, only 46% of hospitals have a separate form (journal), most doctors only inform the head of complications orally. Measures to improve patient safety in medical institutions in 2012-2014 were implemented by 24.1% of respondents, in 2015-2017 by 19.1%, in 2018 – 10.6%, in 2019-2020 – 10,2% of respondents. Most of the respondents stated that the quality of the department’s work has improved and the level of patient safety has improved after the application of these principles in their work. The study showed that while significant positive steps are being taken to improve patient safety, there are still many challenges and opportunities for improvement.
{"title":"PATIENT SAFETY IN THE OPERATING ROOM: HELSINKI DECLARATION IMPLEMENTATION IN UKRAINE","authors":"K. Bielka, I. Kuchyn, N. Semenko","doi":"10.25284/2519-2078.3(96).2021.242142","DOIUrl":"https://doi.org/10.25284/2519-2078.3(96).2021.242142","url":null,"abstract":"Patient safety in the operative and perioperative period is critically important. The consequences of anesthesia complications have a significant impact on long-term surgical outcomes, quality of life of patients, morbidity and mortality.\u0000The purpose of the study was to assess the implementation of the components of the Helsinki Declaration in the practice of Ukrainian hospitals.\u0000Materials and methods. The survey was conducted in March-June 2021 by filling out a standard Google form. The link to the survey was distributed on the official page of the Association of Anesthesiologists of Ukraine, through social networks Facebook and Instagram on the official pages of the Department of Surgery, Anesthesiology and Intensive Care of the Institute of Postgraduate Education of the Bogomolets National Medical University. A total of 174 respondents took part in the survey.\u0000According to the results, 79.3% of respondents are aware of the Helsinki Declaration on Patient Safety in Anesthesiology. Among the respondents, only 43% stated that the principles of the Helsinki Declaration had been implemented in their medical institutions, and 20.9% about plans to implement the principles in the near future. At the same time, in 36% of medical institutions the principles of the declaration are not used and their implementation is not planned. The Safe Surgery checklist is always used by 18.7% of respondents, sometimes by 18.7%, and 29.2% of respondents have never about a checklist. Only 47% of doctors have an airway table in the operating room, and only 30% document the inspection of equipment before anesthesia. Most physicians noted that they used protocols in their practice, but 10% said they mostly did not. Regarding the report of complications, only 46% of hospitals have a separate form (journal), most doctors only inform the head of complications orally.\u0000Measures to improve patient safety in medical institutions in 2012-2014 were implemented by 24.1% of respondents, in 2015-2017 by 19.1%, in 2018 – 10.6%, in 2019-2020 – 10,2% of respondents. Most of the respondents stated that the quality of the department’s work has improved and the level of patient safety has improved after the application of these principles in their work.\u0000The study showed that while significant positive steps are being taken to improve patient safety, there are still many challenges and opportunities for improvement.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81702211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30DOI: 10.25284/2519-2078.2(95).2021.238325
R. А. Zatsarynnyi, A. V. Biliaev, A. Mazur, O. Khomenko
Abstract. In the following article it was evaluated the coagulopathy and/or hypotension incidence rate in patients with the liver extensive resection, who were treated with the thoracal epidural anesthesia and pain management (TEA). Materials and methods. There were enrolled 55 subjects whom the liver extensive resection with TEA both in the intraoperative, and post-operative period was performed at the following site: National Institute of Surgery and Transplantology of the NAMS of Ukraine named after A.A. Shalimov. Influence on the haemodynamics was evaluated on the basis of the mean blood pressure (MBP) decrease lower than 65 mm Hg and appearance of the necessity of vasoactive substances’ administration. We determined the coagulation system’s alteration on the basis of changes of the indicators related to the prothrombotic time (PTT), prothrombotic index (PTI) and international normalization ratio (INR). Vascular platelet hemostasis was evaluated on the basis of the platelets level dynamics. Result. 80% of the 55 subjects required administration of noradrenaline with the aim of the objective MBP control. Execution of the liver extensive resection was characterized by the verifiable decrease of the platelets in the early post-operative period, but this decrease was not clinically significant. It was observed the verifiable increase of the PTT starting from the intraoperative period at the 16,5% (р=0,0001) in comparison with the baseline values, which correlated with the change of PTI and INR.Execution of the liver extensive resection was characterized by the decrease of the blood coagulation properties in early post-operative period, and which led to the verifiable increase of the prothrombotic time, INR and decrease of PTI. Conclusion. Now therefore, the influence of the TEA on the systemic hemodynamics and coagulation system requires of the alternative safe pain management methods’ search for this subjects’ group.
摘要在接下来的文章中，我们评估了肝广泛切除术患者的凝血功能障碍和/或低血压发生率，这些患者接受了胸硬膜外麻醉和疼痛管理(TEA)。材料和方法。入选55例患者，术中及术后均在以下地点行TEA肝广泛切除术:以A.A. Shalimov命名的乌克兰NAMS国家外科与移植研究所。根据平均血压(MBP)降至65 mm Hg以下和血管活性物质使用必要性的出现来评估对血流动力学的影响。我们根据血栓形成前时间(PTT)、血栓形成前指数(PTI)和国际正常化比(INR)相关指标的变化来判断凝血系统的改变。根据血小板水平动态评价血管血小板止血情况。结果:55名受试者中有80%需要给予去甲肾上腺素以达到控制MBP的目的。肝广泛切除术的特点是术后早期血小板可证实减少，但这种减少在临床上并不显著。与基线值相比，可证实的PTT从术中开始增加了16.5% (r = 0.0001)，这与PTI和INR的变化相关。肝广泛切除术的特点是术后早期凝血性能下降，导致血栓形成前时间、INR和PTI明显增加。结论。因此，TEA对全身血流动力学和凝血系统的影响需要在该受试者组中寻找其他安全的疼痛管理方法。
{"title":"ROLE AND PROBLEMATICS OF THE EPIDURAL ANESTHESIA DURING EXTENSIVE LIVER RESECTIONS","authors":"R. А. Zatsarynnyi, A. V. Biliaev, A. Mazur, O. Khomenko","doi":"10.25284/2519-2078.2(95).2021.238325","DOIUrl":"https://doi.org/10.25284/2519-2078.2(95).2021.238325","url":null,"abstract":"Abstract. In the following article it was evaluated the coagulopathy and/or hypotension incidence rate in patients with the liver extensive resection, who were treated with the thoracal epidural anesthesia and pain management (TEA). Materials and methods. There were enrolled 55 subjects whom the liver extensive resection with TEA both in the intraoperative, and post-operative period was performed at the following site: National Institute of Surgery and Transplantology of the NAMS of Ukraine named after A.A. Shalimov. Influence on the haemodynamics was evaluated on the basis of the mean blood pressure (MBP) decrease lower than 65 mm Hg and appearance of the necessity of vasoactive substances’ administration. We determined the coagulation system’s alteration on the basis of changes of the indicators related to the prothrombotic time (PTT), prothrombotic index (PTI) and international normalization ratio (INR). Vascular platelet hemostasis was evaluated on the basis of the platelets level dynamics. Result. 80% of the 55 subjects required administration of noradrenaline with the aim of the objective MBP control. Execution of the liver extensive resection was characterized by the verifiable decrease of the platelets in the early post-operative period, but this decrease was not clinically significant. It was observed the verifiable increase of the PTT starting from the intraoperative period at the 16,5% (р=0,0001) in comparison with the baseline values, which correlated with the change of PTI and INR.Execution of the liver extensive resection was characterized by the decrease of the blood coagulation properties in early post-operative period, and which led to the verifiable increase of the prothrombotic time, INR and decrease of PTI. Conclusion. Now therefore, the influence of the TEA on the systemic hemodynamics and coagulation system requires of the alternative safe pain management methods’ search for this subjects’ group.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89421612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30DOI: 10.25284/2519-2078.2(95).2021.238295
U. Fesenko, V. Fesenko, I. Pavlenko, R. M. Verbovsky, O. V. Ivaniushko
Many different receptors, ion channels, are involved in the pathophysiology of pain, which can serve as targets for adjuvant drugs. Despite the advent of long-acting local anesthetics, the improvement of their pharmacokinetics, and the advanced regional anesthesia techniques, they do not fully meet the need for treatment of pain, especially chronic pain. In parallel with the increase in the anesthetic power of local anesthetics, the risk of their systemic toxicity increases. All this justifies the use of adjuvants in regional anesthesia, which is quite logical from the point of view of multimodal analgesia. In this article the authors present a review of current literature data on the use of adjuvants in regional anesthesia. The mechanisms of action, doses, and ways of administration of adjuvant drugs are described.
{"title":"ADJUVANTS IN REGIONAL ANAESTHESIA","authors":"U. Fesenko, V. Fesenko, I. Pavlenko, R. M. Verbovsky, O. V. Ivaniushko","doi":"10.25284/2519-2078.2(95).2021.238295","DOIUrl":"https://doi.org/10.25284/2519-2078.2(95).2021.238295","url":null,"abstract":"Many different receptors, ion channels, are involved in the pathophysiology of pain, which can serve as targets for adjuvant drugs. Despite the advent of long-acting local anesthetics, the improvement of their pharmacokinetics, and the advanced regional anesthesia techniques, they do not fully meet the need for treatment of pain, especially chronic pain. In parallel with the increase in the anesthetic power of local anesthetics, the risk of their systemic toxicity increases. All this justifies the use of adjuvants in regional anesthesia, which is quite logical from the point of view of multimodal analgesia. In this article the authors present a review of current literature data on the use of adjuvants in regional anesthesia. The mechanisms of action, doses, and ways of administration of adjuvant drugs are described.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"17 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88581487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30DOI: 10.25284/2519-2078.2(95).2021.238315
I. Pavlenko, O. V. Ivaniushko
Introduction. In the system of higher education, at the postgraduate level of specialist training, the formation of a doctor as a highly qualified specialist is possible only with the formed motivational and value attitude in his professional development. One of the current areas of research is to study the motivation of doctors, analysis of life values and needs underlying the work be have our, identify factors that motivate and demotivate, study their working conditions and search for motivational factors. The process of motivation includes the creation of readiness for action, the choice of direction (goals), means and methods of action, place and time of action, assessment of the probability of success, the formation of confidence in the correctness and necessity of action. The following factors take part in the process of motivation: needs, motives, worldview, peculiarities of character and self-positioning, physical and mental abilities, functional and emotional states, experiences, knowledge about the environment and forecast of its changes. Goal. Identify the main motivating factors that contributed to the choice of interns in the specialty «Anaesthesiology». Employees of the Department of Anesthesiology and Intensive Care FPDO LNMU named after Danil Galitsky conducted an anonymous survey of 72 interns who are trained in the specialty «Anesthesiology». In the questionnaires it was proposed to assess 12 motivational factors for doctors-interns to choose a specialty, which are grouped into 4 blocks. Results and discussion. Analyzing the results of the study, it can be argued that the popularity and prestige of the specialty «Anaesthesiology» is the leading motive for most interns. Motivational factors are a conscious internal motivation of the intern to actively choose a professional activity, and in fact, the results of our study show that most respondents have a high level of professional orientation, and motivational factors serve as an indicator of the intern’s willingness and willingness to work. The analysis of personal data showed that the motivation of the choice of respondents is focused on professional and medical values and motivation of the individual to carry out medical activities and the realisation of their own motives. Conclusions. The choice of interns in the specialty «Anaesthesiology» is due to a complex combination of different motivational factors, the formation of which is laid down during training at clinical departments. Most respondents have a high level of professional orientation, which will lead to further self-realisation in the chosen specialty.
{"title":"MOTIVATIVE FACTORS OF CHOICE OF SPECIALTY «ANAESTHESIOLOGY» BY INTERNAL DOCTORS","authors":"I. Pavlenko, O. V. Ivaniushko","doi":"10.25284/2519-2078.2(95).2021.238315","DOIUrl":"https://doi.org/10.25284/2519-2078.2(95).2021.238315","url":null,"abstract":"Introduction. In the system of higher education, at the postgraduate level of specialist training, the formation of a doctor as a highly qualified specialist is possible only with the formed motivational and value attitude in his professional development. One of the current areas of research is to study the motivation of doctors, analysis of life values and needs underlying the work be have our, identify factors that motivate and demotivate, study their working conditions and search for motivational factors. The process of motivation includes the creation of readiness for action, the choice of direction (goals), means and methods of action, place and time of action, assessment of the probability of success, the formation of confidence in the correctness and necessity of action. The following factors take part in the process of motivation: needs, motives, worldview, peculiarities of character and self-positioning, physical and mental abilities, functional and emotional states, experiences, knowledge about the environment and forecast of its changes. \u0000Goal. Identify the main motivating factors that contributed to the choice of interns in the specialty «Anaesthesiology». Employees of the Department of Anesthesiology and Intensive Care FPDO LNMU named after Danil Galitsky conducted an anonymous survey of 72 interns who are trained in the specialty «Anesthesiology». In the questionnaires it was proposed to assess 12 motivational factors for doctors-interns to choose a specialty, which are grouped into 4 blocks. \u0000Results and discussion. Analyzing the results of the study, it can be argued that the popularity and prestige of the specialty «Anaesthesiology» is the leading motive for most interns. Motivational factors are a conscious internal motivation of the intern to actively choose a professional activity, and in fact, the results of our study show that most respondents have a high level of professional orientation, and motivational factors serve as an indicator of the intern’s willingness and willingness to work. The analysis of personal data showed that the motivation of the choice of respondents is focused on professional and medical values and motivation of the individual to carry out medical activities and the realisation of their own motives. \u0000Conclusions. The choice of interns in the specialty «Anaesthesiology» is due to a complex combination of different motivational factors, the formation of which is laid down during training at clinical departments. Most respondents have a high level of professional orientation, which will lead to further self-realisation in the chosen specialty.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"287 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80315602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30DOI: 10.25284/2519-2078.2(95).2021.238306
I. Kuchyn, D. Govsieiev, K. Bielka, A. Romanenko
The problem of a labor pain is becoming very important for health care because insufficient analgesia for women during childbirth affects the quality of medical care. The complexity of the use in the system and approaches to providing care to citizens in Ukraine, and at the local level – the interaction of the obstetrician with the women, anaesthetist and also the technical capabilities of public maternity hospitals [1]. For the last decade, epidural analgesia has been the «golden» method in labor analgesia. We searched numerous meta-analyzes about pain management during labor and delivery in the United States, they prefer epidural analgesia in 80-90% of women, while in the UK - 36% [2, 3]. Statistics from around the world indicate a relationship between pain relief and income levels, so in high-income countries, (HICs) women are more likely to be anesthetized during childbirth than in South Africa or Asia [4]. Although childbirth is a physiological and natural process, it needs pain relief. Nowadays a woman’s desire is a sufficient indication for labor analgesia, and this is her right [5]. The problem is to choose a pharmacological and / or non-pharmacological method of analgesia for a particular woman, which will be best for the parturient. It should be noted that there is a separate group of women who choose to give birth at home to reduce the «aggression» of medical staff against women and her child, but they have a higher incidence of complications and increased mortality [6]. «Homebirth» in maternity hospitals helps to solve this problem. A comprehensive questionnaire was created among seven state maternity hospitals in Kyiv to identify the current situation with the provision of maternity care and to analyze the main issues of labor analgesia in Kyiv.
{"title":"LABOR ANALGESIA IN KIEV (UKRAINE)","authors":"I. Kuchyn, D. Govsieiev, K. Bielka, A. Romanenko","doi":"10.25284/2519-2078.2(95).2021.238306","DOIUrl":"https://doi.org/10.25284/2519-2078.2(95).2021.238306","url":null,"abstract":"The problem of a labor pain is becoming very important for health care because insufficient analgesia for women during childbirth affects the quality of medical care. The complexity of the use in the system and approaches to providing care to citizens in Ukraine, and at the local level – the interaction of the obstetrician with the women, anaesthetist and also the technical capabilities of public maternity hospitals [1]. \u0000For the last decade, epidural analgesia has been the «golden» method in labor analgesia. We searched numerous meta-analyzes about pain management during labor and delivery in the United States, they prefer epidural analgesia in 80-90% of women, while in the UK - 36% [2, 3]. \u0000Statistics from around the world indicate a relationship between pain relief and income levels, so in high-income countries, (HICs) women are more likely to be anesthetized during childbirth than in South Africa or Asia [4]. \u0000Although childbirth is a physiological and natural process, it needs pain relief. Nowadays a woman’s desire is a sufficient indication for labor analgesia, and this is her right [5]. The problem is to choose a pharmacological and / or non-pharmacological method of analgesia for a particular woman, which will be best for the parturient. \u0000It should be noted that there is a separate group of women who choose to give birth at home to reduce the «aggression» of medical staff against women and her child, but they have a higher incidence of complications and increased mortality [6]. «Homebirth» in maternity hospitals helps to solve this problem. \u0000A comprehensive questionnaire was created among seven state maternity hospitals in Kyiv to identify the current situation with the provision of maternity care and to analyze the main issues of labor analgesia in Kyiv.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"119 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76357382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30DOI: 10.25284/2519-2078.2(95).2021.238313
S. Dubrov, Y. Zaikin, S. Cherniaiev, T. Baranovska, M. Denysiuk, S. O. Sereda
Introduction. Most hospitalized patients with COVID-19, both in medical institutions in Ukraine and in other countries, are unreasonably receiving antibacterial drugs, despite the fact that secondary bacterial infections in patients with COVID-19 are extremely rare, as evi-denced by numerous scientific studies (from 3 up to 10% among hospitalized patients).The goal of the work. Conduct a retrospective analysis of the frequency of use and justification of the prescription of antibacterial drugs in hospitalized patients with COVID-19 in two medical institutions in the city of Kyiv.Materials and methods. A retrospective study of 240 medical records of an inpatient (form 003 / y), randomly selected, hospitalized with a diagnosis of COVID-19 from September 2020 to April 2021, who were hospitalized in two communal medical institutions in the city of Kyiv.Results and discussion. The number of patients who received antibacterial drugs in the CUE KCCH №17 (antibacterial drugs were prescribed by concilium and only if there was a reasonable suspicion or confirmation of a bacterial infection) was 20 out of 120 (16.7%), while in the compared institution the frequency of prescription of antibacterial drugs accounted for 117 patients out of 120 analyzed cases (97.5%). The average length of stay of a patient on inpatient treatment in the two compared institutions had no statistically significant differences and was 11.2 ± 6.0 days in patients with the CUE KCCH №17, and 12.3 ± 4.6 days in patients from the control institution (р>0.05). The mortality rate did not differ between patients treated in both hospitals.Conclusions. After analyzing the results of the study, it can be concluded that the routine prescription of antibacterial drugs without available indications does not have the advantage of improving the quality of treatment for patients with COVID-19, does not reduce the duration of inpatient treatment and the mortality rate, does not prevent the risk of secondary bacterial infection in hospitalized patients. however, it leads to a significant increase in the cost of treating a case of the disease and leads to an increase in the resistance of hospital microorganisms to antibacterial drugs.
{"title":"A RETROSPECTIVE ANALYSIS OF THE FREQUENCY OF ANTIBIOTIC USE IN HOSPITALIZED PATIENTS WITH COVID-19","authors":"S. Dubrov, Y. Zaikin, S. Cherniaiev, T. Baranovska, M. Denysiuk, S. O. Sereda","doi":"10.25284/2519-2078.2(95).2021.238313","DOIUrl":"https://doi.org/10.25284/2519-2078.2(95).2021.238313","url":null,"abstract":"Introduction. Most hospitalized patients with COVID-19, both in medical institutions in Ukraine and in other countries, are unreasonably receiving antibacterial drugs, despite the fact that secondary bacterial infections in patients with COVID-19 are extremely rare, as evi-denced by numerous scientific studies (from 3 up to 10% among hospitalized patients).The goal of the work. Conduct a retrospective analysis of the frequency of use and justification of the prescription of antibacterial drugs in hospitalized patients with COVID-19 in two medical institutions in the city of Kyiv.Materials and methods. A retrospective study of 240 medical records of an inpatient (form 003 / y), randomly selected, hospitalized with a diagnosis of COVID-19 from September 2020 to April 2021, who were hospitalized in two communal medical institutions in the city of Kyiv.Results and discussion. The number of patients who received antibacterial drugs in the CUE KCCH №17 (antibacterial drugs were prescribed by concilium and only if there was a reasonable suspicion or confirmation of a bacterial infection) was 20 out of 120 (16.7%), while in the compared institution the frequency of prescription of antibacterial drugs accounted for 117 patients out of 120 analyzed cases (97.5%). The average length of stay of a patient on inpatient treatment in the two compared institutions had no statistically significant differences and was 11.2 ± 6.0 days in patients with the CUE KCCH №17, and 12.3 ± 4.6 days in patients from the control institution (р>0.05). The mortality rate did not differ between patients treated in both hospitals.Conclusions. After analyzing the results of the study, it can be concluded that the routine prescription of antibacterial drugs without available indications does not have the advantage of improving the quality of treatment for patients with COVID-19, does not reduce the duration of inpatient treatment and the mortality rate, does not prevent the risk of secondary bacterial infection in hospitalized patients. however, it leads to a significant increase in the cost of treating a case of the disease and leads to an increase in the resistance of hospital microorganisms to antibacterial drugs.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90285253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30DOI: 10.25284/2519-2078.2(95).2021.238302
S. Tarasenko, S. Dubrov, G. Suslov
The clinical manifestations of disseminated intravascular coagulation syndrome (DIC) depend on the predominance of the sum of the vectors of hypercoagulation and hyperfibrinolysis and are strongly associated with the underlying disease, against which DIC is formed. The issue of understanding the complex pathogenesis, timely diagnosis of overt DIC and early manifestations of DIC remain an urgent challenge for intensive care physicians and leading specialized societies to study the problems of hemostasis and thrombus formation. This review of the literature analyzes the pathways of DIC development, the current state of the possibility of using diagnostic markers to detect DIC, especially in sepsis. The diagnosis of sepsis-induced coagulopathy against the background of the development of multiple organ failure is highlighted as a separate issue. Diagnostic scales are presented in the form of comparative tables for a more convenient perception of information, memorization and further implementation in clinical practice.
{"title":"DIAGNOSTIC CRITERIA FOR DISSEMINATED INTRAVASCULAR COAGULATION SYNDROME AND SEPSIS-INDUCED COAGULOPATHY","authors":"S. Tarasenko, S. Dubrov, G. Suslov","doi":"10.25284/2519-2078.2(95).2021.238302","DOIUrl":"https://doi.org/10.25284/2519-2078.2(95).2021.238302","url":null,"abstract":"The clinical manifestations of disseminated intravascular coagulation syndrome (DIC) depend on the predominance of the sum of the vectors of hypercoagulation and hyperfibrinolysis and are strongly associated with the underlying disease, against which DIC is formed. The issue of understanding the complex pathogenesis, timely diagnosis of overt DIC and early manifestations of DIC remain an urgent challenge for intensive care physicians and leading specialized societies to study the problems of hemostasis and thrombus formation. This review of the literature analyzes the pathways of DIC development, the current state of the possibility of using diagnostic markers to detect DIC, especially in sepsis. The diagnosis of sepsis-induced coagulopathy against the background of the development of multiple organ failure is highlighted as a separate issue. Diagnostic scales are presented in the form of comparative tables for a more convenient perception of information, memorization and further implementation in clinical practice.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"27 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76792986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30DOI: 10.25284/2519-2078.2(95).2021.238331
О. V. Yemyashev, I. Malysh, S. Dubrov, L. Zgrzheblovska, O. Loskutov, O. Havrylenko
Resume. The issue of open visits to intensive care units is currently a topical, acute and ambiguous issue. In Ukraine, it is actively discussed in the media, social networks, the medical community. Appropriate working groups of the Ministry of Health are being set up to optimize the regulatory framework on this issue.The article reviews the literature on the problems of open visits of adult patients undergoing treatment in the intensive care unit. Opinions on this issue are quite contradictory. On the one hand, there is a position that the stay of relatives in the ICU 24/7 improves the results of treatment, creating a more comfortable psychological atmosphere for the patient. On the other hand, and this approach prevails, a number of studies indicate an increase in the number of bacterial complications in patients with unlimited visits, complication of working conditions of medical staff, which leads to a deterioration in treatment outcomes in general.Public organization «Association of Anesthesiologists of Ukraine» conducted an online survey among anesthesiologists - members of the association for find out the opinion of Ukrainian experts about open visits to ICU’s patients. Most of the anesthesiologists surveyed are inclined to a limited visitation regime.
{"title":"OPEN REGIME OF INTENSIVE CARE UNITS PATIENT VISITS: EXPERTS OPINION","authors":"О. V. Yemyashev, I. Malysh, S. Dubrov, L. Zgrzheblovska, O. Loskutov, O. Havrylenko","doi":"10.25284/2519-2078.2(95).2021.238331","DOIUrl":"https://doi.org/10.25284/2519-2078.2(95).2021.238331","url":null,"abstract":"Resume. The issue of open visits to intensive care units is currently a topical, acute and ambiguous issue. In Ukraine, it is actively discussed in the media, social networks, the medical community. Appropriate working groups of the Ministry of Health are being set up to optimize the regulatory framework on this issue.The article reviews the literature on the problems of open visits of adult patients undergoing treatment in the intensive care unit. Opinions on this issue are quite contradictory. On the one hand, there is a position that the stay of relatives in the ICU 24/7 improves the results of treatment, creating a more comfortable psychological atmosphere for the patient. On the other hand, and this approach prevails, a number of studies indicate an increase in the number of bacterial complications in patients with unlimited visits, complication of working conditions of medical staff, which leads to a deterioration in treatment outcomes in general.Public organization «Association of Anesthesiologists of Ukraine» conducted an online survey among anesthesiologists - members of the association for find out the opinion of Ukrainian experts about open visits to ICU’s patients. Most of the anesthesiologists surveyed are inclined to a limited visitation regime.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"16 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73039349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30DOI: 10.25284/2519-2078.2(95).2021.238291
O. Loskutov, I. Kuchynska, S. Nedashkivskyi, O. Demchenko
Mortality among patients with severe pneumonia and / or acute respiratory distress syndrome (ARDS) due to COVID-19 infection, who underwent mechanical ventilation (MV), is characterized by a fairly high frequency. However, despite the large number of patients receiving appropriate treatment, the question of choosing the optimal ventilation parameters remains poorly understood. In our article, we reviewed the available literature data on the indications for mechanical ventilation, parameters of MV, the need for prone-positioning of patients with ARDS caused by COVID-19 infection in intensive care units to identify unresolved issues.Despite the large number of publications about respiratory support in patients with severe coronavirus infection, there are only general principles regarding the indications for switching to invasive ventilation. Most authors identified the following clinical situations: progression of hypoxemia and / or respiratory failure but with constant oxygen support with increasing percentage of oxygen in the respiratory mixture, use of high-flow cannula or non-invasive ventilation for 1 hour without improvement; persistent hypercapnia, multiorgan failure, coma, high risk of aspiration, hemodynamic instability.According to most of the studies analyzed, the main components of the ventilation strategy should be based on the principles of pulmonary protective ventilation and include the use of low tidal volumes (Vt = 4-8 ml / kg of ideal body weight) and ventilation with plateau pressure Pplat <30 cm H2O (plateau pressure - air pressure measured after an inspiratory pause of 0.5 s). At the same time, many authors recommend using prone position and high levels of positive end-expiratory pressure (PEEP) compared to low levels in patients with ARDS on the background of COVID-19.The approach to invasive mechanical ventilation in ARDS caused by SARS-CoV-2 still requires further research and answers to a number of questions.
因COVID-19感染而发生严重肺炎和/或急性呼吸窘迫综合征(ARDS)并接受机械通气(MV)的患者的死亡率具有相当高的频率。然而，尽管大量患者接受了适当的治疗，但选择最佳通气参数的问题仍然知之甚少。在我们的文章中，我们回顾了现有的文献资料，包括机械通气的适应症、MV参数、重症监护病房COVID-19感染的ARDS患者需要俯卧位等，以找出尚未解决的问题。尽管有大量关于严重冠状病毒感染患者呼吸支持的出版物，但对于切换到有创通气的适应症，只有一般原则。大多数作者确定了以下临床情况:低氧血症和/或呼吸衰竭进展，但持续供氧支持，呼吸混合物中氧气的百分比增加，使用高流量插管或无创通气1小时无改善;持续性高碳酸血症，多器官功能衰竭，昏迷，高危误吸，血流动力学不稳定。根据分析的大多数研究，通气策略的主要组成部分应以肺保护性通气原则为基础，包括使用低潮气量(Vt = 4-8 ml / kg理想体重)和平台压力Pplat <30 cm H2O(平台压力-吸气暂停0.5 s后测量的空气压力)的通气。许多作者建议在COVID-19背景下的ARDS患者使用俯卧位和高水平的呼气末正压(PEEP)，而不是低水平。SARS-CoV-2所致急性呼吸窘迫综合征(ARDS)的有创机械通气方法仍需进一步研究和解答一些问题。
{"title":"ASPECTS OF INVASIVE MECHANICAL VENTILATION IN PATIENTS WITH ARDS CAUSED BY COVID-19","authors":"O. Loskutov, I. Kuchynska, S. Nedashkivskyi, O. Demchenko","doi":"10.25284/2519-2078.2(95).2021.238291","DOIUrl":"https://doi.org/10.25284/2519-2078.2(95).2021.238291","url":null,"abstract":"Mortality among patients with severe pneumonia and / or acute respiratory distress syndrome (ARDS) due to COVID-19 infection, who underwent mechanical ventilation (MV), is characterized by a fairly high frequency. However, despite the large number of patients receiving appropriate treatment, the question of choosing the optimal ventilation parameters remains poorly understood. In our article, we reviewed the available literature data on the indications for mechanical ventilation, parameters of MV, the need for prone-positioning of patients with ARDS caused by COVID-19 infection in intensive care units to identify unresolved issues.Despite the large number of publications about respiratory support in patients with severe coronavirus infection, there are only general principles regarding the indications for switching to invasive ventilation. Most authors identified the following clinical situations: progression of hypoxemia and / or respiratory failure but with constant oxygen support with increasing percentage of oxygen in the respiratory mixture, use of high-flow cannula or non-invasive ventilation for 1 hour without improvement; persistent hypercapnia, multiorgan failure, coma, high risk of aspiration, hemodynamic instability.According to most of the studies analyzed, the main components of the ventilation strategy should be based on the principles of pulmonary protective ventilation and include the use of low tidal volumes (Vt = 4-8 ml / kg of ideal body weight) and ventilation with plateau pressure Pplat <30 cm H2O (plateau pressure - air pressure measured after an inspiratory pause of 0.5 s). At the same time, many authors recommend using prone position and high levels of positive end-expiratory pressure (PEEP) compared to low levels in patients with ARDS on the background of COVID-19.The approach to invasive mechanical ventilation in ARDS caused by SARS-CoV-2 still requires further research and answers to a number of questions.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"79 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82301132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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