Clinical Anesthesiology and Intensive Care

TACTICS OF MANAGEMENT OF A PATIENT WITH CORONAVIRUS INFECTION CAUSED BY SARS-COV-2, WITH SEVERE DAMAGE TO THE RESPIRATORY AND CARDIOVASCULAR SYSTEMS

A.L. Bobir, R.E. Sukhonos — Tue, 26 Apr 2022 00:00:00 +0300

A 32-year-old woman was admitted to the admission department with pain in the heart with irradiation in the left shoulder blade, shortness of breath, shortness of breath of a mixed nature. conducted instrumental (Computed Tomography (CT) of the chest (OGK), CT-angiography of the pulmonary artery, ultrasound, ECG), laboratory studies, based on clinical data and after differential diagnosis, were found: coronavirus infection caused by SARS-Cov-2. Outpatient bilateral polysegmental pneumonia. Bilateral hydrothorax. Pankardit. Pericarditis. Occlusion of subcutaneous veins of both lower extremities. According to the severity of the patient’s condition, she was hospitalized in the intensive care unit. Based on these and instrumental studies, as well as clinical indicators and the general condition of the patient, the tactics of laboratory therapy were determined, which noted a positive effect.

THE ANAESTHETIC MANAGEMENT OF A COMPROMISED AIRWAY SECONDARY TO LEMIERRE’S SYNDROME

D. Levy, K. Flower, T. Hinde, T. Ali, C. Vinall, A. Varvinskiy — Tue, 26 Apr 2022 00:00:00 +0300

Lemiere’s syndrome is a life-threatening soft tissue infection of the neck. We describe the anaesthetic management of a patient presenting with a compromised airway due to severe soft tissue swelling associated with Lemierre’s syndrome. In this case, preoperative computed tomography and nasal endoscopy delineated the anatomy. The otolaryngology team were prepared for an airway emergency. High flow humidified nasal oxygen maximised oxygenation during awake fibreoptic intubation and the time available for rescue tracheostomy if required.

SEVERE THROMBOTIC LESIONS ON THE BACKGROUND OF CORONAVIRUS INFECTION CAUSED BY SARS-COV-2

R.E. Sukhonos, A.L. Bobyr — Tue, 26 Apr 2022 00:00:00 +0300

Thrombotic complications are not uncommon in patients infected with COVID-19. According to Piazza et al., 2020, they were observed in 2.6% of patients hospitalized with mild and moderate forms of the disease, and in 35.3% of patients hospitalized with severe and extremely severe forms of the disease. This article presents the clinical case of a patient diagnosed with COVID-19. Polysegmental pneumonia. Multiple (segmental) mixed thrombosis of mesenteric vessels. Necrosis of the ileum and cecum. Necrosis of the right appendages of the uterus and right ovary. Pelvic abscess. Peritonitis. Sepsis. Multiple organ failure. Despite urgent surgery and intensive care in the perioperative and postoperative period, severe complications of coronavirus infection were fatal.

MODERN APPROACHES TO THE SUCCESSFUL TREATMENT OF COLORECTAL CANCER

A.A. Duzenko — Tue, 26 Apr 2022 00:00:00 +0300

The article presents the results of an analytical review of the prevalence of colorectal cancer in the world and in Ukraine, the incidence of which is growing everywhere. The analyzed data consider the main risk factors for the development of this dangerous disease and its complications. Shown modern approaches to the prevention of venous thromboembolic and hemorrhagic complications in the surgical treatment of patients with colorectal cancer. Attention is focused on the importance of an individualized approach in preventing the development of unfavorable outcomes of surgical treatment of patients with colorectal cancer.

THE EFFECT OF ELEVATED BODY MASS INDEX (BMI) ON THE LEVEL OF THROMBOSIS IN LAPAROSCOPIC MYOMECTOMY

T.O. Maksymets — Tue, 26 Apr 2022 00:00:00 +0300

Uterine fibroids are one of the most common diseases in gynaecological practice. Laparoscopic myomectomy is one of the main methods of surgical treatment of uterine fibroids in women of reproductive age. According to the WHO data, overweight is considered to be BMI 25 and above, BMI 30 and above means obesity. The association of obesity with Intravascular Thrombotic Complications (ITC) is confirmed by clinical data. To date, there is a fairly significant set of cloning, enzyme- linked immunosorbent assays for the assessment of the Aggregate State Blood Regulation (RASC) system, the results of which give only a very approximate description of haemostatic potential. Therefore, instrumental methods of assessing haemostasis are of particular importance. Low-Frequency Piezoelectric Thromboelastography (LPTEG) is the most effective method of Haemostatic Potential (HP), able to objectively display the vascular-platelet component, the coagulation link of the haemostasis system and fibrinolysis. This technology allows you to visualize the process of blood clotting, allows you to assess in real-time all phases of coagulation and quantify the intensity of procoagulant potential and anticoagulant potential. Objectives. To study the effect of elevated body mass index on the level of thrombosis for adequate complex thromboprophylaxis in patients in the perioperative period with laparoscopic myomectomy, using an instrumental method of diagnosis as a low-frequency piezoelectric hemiscosimeter. Materials and Methods. The results of surgical treatment of 60 patients with uterine fibroids who underwent laparoscopic myomectomy at MOTHER AND CHILD, Medical Centre; NEOMED 2007, LLC in Kyiv in 2019-2020 were studied. Patients were divided into 2 groups depending on the value of BMI. Group 1 (16 patients) included patients with BMI < 30 kg/m2. Group 2 (44 patients) included patients with BMI > 30 kg/m2. The state of the haemostatic system before surgery, as well as on the 1st and 5th days after surgery, was monitored by standard biochemical tests, as well as by an instrumental method for assessing the functional state of the components of the haemostatic and fibrinolysis system as a Low-Frequency Vibration Piezoelectric Hemoviscosimeter (LFVPH). Results. After evaluating standard biochemical tests for assessing haemostasis before surgery, on Day 1 and Day 5 after surgery, no existing or significant pathological changes were detected in all groups of patients. When assessing the functional status of the components of the haemostasis and fibrinolysis system with Mednord LFVPH before surgery in Group 1 (Control Group of Patients), there were no significant differences within normal limits. In Group 2, statistically significant (p < 0.05) deviations from the reference values of haemostasiogram in the direction of structural and chronometric hypercoagulation, increased thrombin activity, activation of vascular-platelet haemostasis, inhibition of the lytic activity of blood. On the first day after surgery, changes in the haemostasis system were observed in both groups of patients. In Group 1 of patients, there was a decrease in chronometric parameters and an increase in the structural parameters of LPTEG, but they did not exceed the reference values. In Group 2, there was a significant decrease (compared to preoperative indicators) in chronometric indicators, an increase in structural indicators of Maximum Amplitude (MA), as well as a significant increase in Constant Thrombin Activity (CTA), Intensity of Coagulation Drive (ICD), indicating an increase in thrombosis in this group of patients requiring thromboprophylaxis. After thromboprophylaxis, changes in the normocoagulation trend of Haemostatic Potential (HP) were observed in the Group 2 patients. Fibrinolytic activity of blood before surgery is within the lower reference values in Group 1, and there is suppression of the lytic activity of blood in Group 2. One day after surgery, on the background of antithrombotic therapy, the lytic activity of the blood is normalized. On the 5th day after surgery, a normocoagulation tendency of haemostatic potential was observed in all groups of patients. Conclusions. In patients with uterine fibroids with BMI> 30, using the Mednord ARP-01M hardware-software set, revealed the presence of thrombosis in the perioperative stage of laparoscopic myomectomy, as evidenced by significantly significant (p < 0.05) changes in the main indicators of haemoscosimetry. Standard screening methods for the study of the hemostasis system do not provide a rapid and adequate assessment of Haemostatic Potential (HP), the response of the ASBR system in response to surgery, and do not allow to fully assess the functional activity of the vascular-platelet coagulation and fibrinolysis. The use of low-frequency piezoelectric haemoviscosimetry allows to reliably and quickly assess the kinetics of thrombosis, from initial viscosity and aggregation to clot formation and fibrinolysis, as well as to detect haemocoagulation disorders in patients with uterine fibroids in the earliest stages of myocardial infarction. This allows timely and effective prevention and treatment of thrombohemorrhagic disorders in this group of patients.

TARGETED CEREBRAL PERFUSION IN NEONATAL INTENSIVE CARE

D. Surkov — Tue, 26 Apr 2022 00:00:00 +0300

NIRS signal decreasing reflects low oxygen delivery to the brain tissue but can’t answer if it been related to hypoxia or ischemia. Doppler evaluation of cerebral blood flow in anterior cerebral artery in addition to NIRS monitoring should be the method which will distinguish proper ischemia and help neonatologist to decide what to do aiming hemodynamic support and/or oxygen supply. Relations between NIRS, Doppler cerebral blood flow and hemodynamic parameters in six term babies with severe HIE were evaluated. Considering rSO2 more depends on circulatory sufficiency then FiO2 it is expedient to use such a definition as “oxygen price of saturation”. In that case using of Doppler estimation of cerebral blood flow pattern allows differing mixed hypoxia and cerebral ischemia aiming to choose proper ways of intensive care.

PERSONALIZED CORRECTION OF DISORDERS OF HEMOSTASIS SYSTEM IN PATIENTS WITH COVID-19 AT THE INPATIENT AND OUTPATIENT STAGES

Tue, 26 Apr 2022 00:00:00 +0300

The article describes violations of the hemostasis system in patients in the acute period of COVID-19 and at the stage of convalescence, as well as methods of targeted correction of the identified violations. Prevention of serious complications of COVID-19 infection requires complex assess of the hemostasis system and prompt correction of identified disorders. The method of piezothromboelastography (PTEG) allows for a comprehensive and informative assessment of the functional state of the hemostasis system and monitoring the effectiveness of therapy, both in the hospital and on an outpatient basis. For assessment of anticoagulant therapy authors used t3 and ICD (the intensity of coagulation drive) parameters of PTEG. Assessment of anti-platelet and vasoprotective therapy requires of control of t1 и CTA (a constant thrombin activity). And correction of fibrinolytic activity was evaluated through control of CIP (the clot intensity of the polymerization), t5, indicators. Monitoring of effectiveness and personal approach for correction of hemostasiological disorders allows decrease the risks of complications.

THE CONCEPT OF PREHABILITATION IN THORACIC SURGERY: A SYSTEMATIC LITERATURE REVIEW

I. Maxim — Tue, 26 Apr 2022 00:00:00 +0300

Introduction. Lung cancer is the most common type of cancer in the world, responsible for 13.0% of cases of all cancers. Surgery is the optimal treatment for operable lung cancer and increases the survival rate of these patients. However, as with any oncological surgery, complications are a substantial cause of morbidity and mortality. The prehabilitation program has been proposed as preoperative adjuvant therapy to circumvent the given consequences, but existing studies show controversial results. Purpose and task. In this article, we review the evolution of the evidence base for prehabilitation before lung resection, the potential components of such a program, and how these programs can be integrated into the surgical treatment plan for lung cancer and aim to identify the role of this program in elevating respiratory parameters and reducing patients’ postoperative complications. Material and methods. A search of the electronic databases was requested: PubMed, clinicaltrials.gov, rcpjournals.org for randomized clinical trials that investigated the effectiveness of the prehabilitation concept and its influence on functional parameters, postoperative complications, and patient’s quality of life. The primary endpoint was the ability of prehabilitation to increase the values of respiratory parameters of patients undergoing lung resections. The secondary parameters investigated were: postoperative complications, functional capacity assessed preand postoperatively, length of hospitalization, and cost of hospitalization. Results. Ten clinical trials (698 patients) were included in the review. The quality of the studies was assessed using Delphi criteria. The impact of the targeted program in improving the respiratory parameters of patients was analyzed in 10 out of 10 studies, the incidence of respiratory complications in 9 out of 10 studies and the duration of hospitalization in 5 out of 10 studies. The results obtained can be classified as controversial, depending on the type of study, the size of the lots and the duration, intensity and multidisciplinarity of the prehabilitation program. Conclusion. It is obvious that prehabilitation needs to be comprehensively integrated into medical practice because this is a lucid hope for cancer patients. However, there remains a clear need to assess the effectiveness of the prehabilitation program in specific populations.

THE CONCEPT OF PREHABILITATION AND ITS IMPACT IN SURGERY: A SYSTEMATIC LITERATURE REVIEW

I. Maxim — Tue, 26 Apr 2022 00:00:00 +0300

Introduction. An impressive number of patients who undergo surgery suffer from postoperative complications. This problem has become imperative, with a prevalence of about 30% among patients undergoing surgical treatment. The prehabilitation program has been proposed as preoperative adjuvant therapy in order to circumvent the given consequences, but existing studies show controversial results. Purpose and task. The systematic literature review aims to study the effectiveness of the concept of prehabilitation and its influence on the functional parameters, the postoperative complications, and the quality of life of patients. Material and methods. A search of the electronic databases was requested: PubMed, clinicaltrials.gov, rcpjournals.org for randomized clinical trials that investigated the effectiveness of the prehabilitation concept and its influence on functional parameters, postoperative complications, and patients’ quality of life. The primary outcome parameter was the ability of prehabilitation to prevent postoperative complications of patients undergoing major surgery. The secondary parameters investigated were: the functional capacity evaluated pre- and postoperatively, the length of hospital stay, the cost of hospitalization, and the quality of life after surgery. Results. The review included 10 clinical trials with a total of 939 patients. The studies’ quality was evaluated using Delphi criteria. In 10 of the 10 studies, the impact of the targeted program on reducing postoperative complications of patients was examined, as was the duration of hospitalization in 7 of the 10 studies, and respiratory parameters in 4 of the 10 studies. Conclusions. Large-scale, high-quality studies are required to confirm the early evidence’s promise and to determine the frequency, intensity, and duration of prehabilitation designed to accomplish optimal results.

SOME ASPECTS OF THE PATHOGENESIS OF THE HEMOSTASIS SYSTEM

I. Savytskyi, L. Karabut, V. Savytskyi, T. Alexandrina — Tue, 26 Apr 2022 00:00:00 +0300

The article considers the main modern theoretical concepts of the hemocoagulation system. Described in details not only the mechanisms of vascular-platelet and coagulation hemostasis, but also the main components of the anticoagulation system and fibrinolysis. Thus, the thrombogenesis system is a chain of complex cascade-complex enzymatic reactions that involve a many of cellular and humoral agents with subtle mechanisms of neuroendocrine regulation.