Procalcitonin is an important marker used in the clinical practice for sepsis diagnostics. However the increase of its concentration can be registered in the early post-traumatic period with no obvious nidus of infection. Goal: to clarify the value of procalcitonin as a biomarker in those with concurrent trauma. Methods. 76 those injured were examined and divided into subgroups depending on the severity of trauma (ISS < 20 and ISS > 20 scores) and outcome (favorable, unfavorable, with infectious complications and no infectious complications). The changes in procalcitonin level in the subgroups were compared with intensity of the systemic response to the injury through changes in IL-6, IL-8, IL-10, CD14, HLA-DR, secretory immunoglobulin A. Blood was collected upon admission to hospital, in 12 hours, on the 1st, 3rd, 7th and 10th days. Results. It has been found out that in case of concurrent trauma the procalcitonin level in blood increased immediately and it was especially intensively expressed in severe trauma (ISS > 20 scores). During first 24 hours it was tens times above the normal and it remained above the normal during the post-traumatic period. And these changes were not related to a generalized infection. During all period of follow up the changes in procalcitonin level coincided with changes in the systemic inflammatory response and anti-inflammatory and pro-inflammatory cytokines though with a certain delay. Procalcitonin level did not increase repeatedly every time as nidus of infection manifested, it occurred more often in those with lethal outcome. High procalcitonin level in the acute post-traumatic period indicated higher chances of septic complications development on the 7-10th day. Conclusion. Along with the role of procalcitonin as an infection marker, changes in its concentration in the early post-traumatic period can be considered as a laboratory sign of the intensity of systemic response to the injury.

The retrospective study was conducted aimed at the detection of risk factors of myocardial infection in elderly and senile patients after hip arthroplasty. Materials and methods. 303 elderly and senile patients (older than 65 years old) with subcapital fracture and consequent hip arthroplasty were enrolled into the study. Logistic regression equations were used for assessment of prognostic value of signs of myocardial infraction development. Results. In the early post-operative period myocardial infraction developed in 12 cases (3.9%). The following controlable and uncontrolable risk factors were detected in elderly and senile patients, most significant are presented first: cardial risk as per K.A. Eagle score – 2 scores and more, acute post-operative anemia with hemoglobin level below 95 g/l and type of anesthesia. The indicator integrating these three rates had the highest prognostic value.

 

Non-invasive respiratory support by continuous positive airway pressure (CPAP) is the most common management technique of the respiratory distress syndrome in newborns. Goal: to evaluate efficiency of non-invasive respiratory support by CPAP in mature newborns depending on the start of therapy. Materials and methods. 39 newborns were enrolled into the study. Depending on the start of respiratory support infants were divided into 2 groups: Group 1 (n = 14) – therapy was started during the first 10 minutes after birth, Group 2 (n = 25) – therapy was started after transfer to Newborns Intensive Care Department. Results. Group 1 had lower rates of SpO2 intermediately after birth and higher rates of oxygen and carbon dioxide tension in blood. In Group 2 the correlation (r = 0.559; p < 0.05) has been found between the number of disorders of the newborn and duration of stay in Newborns Intensive Care Department . No significant differences in the outcome were found between the groups. Conclusion: The start of the non-invasive respiratory support during first 30 minutes after the birth results in the positive clinical effect and favorable impact on the outcome of the disease.

 

At present levels of air pollution with inhalation anesthetics and disinfectants in operating rooms as well as protection from their unfavorable effect on health and professional activities of the surgical personnel are underexplored. Goal of the study: to evaluate the efficiency of ORUB-3-5-KRONT air recirculator and irradiator for air cleansing from inhalation anesthetics and other organic compounds in operating rooms when using disposable air carbon filters of FUS-KRONT. Materials and methods. During the main stages of anesthesia and operation the content of sevoflurane, inhalation anesthetic and disinfectant of DeziceptI OP for treatment of surgical field was tested during 31 surgeries during operation of the wall mounted air recirculator-irradiators and without them (control group). Kolion 1B gas analyzer was used for online monitoring of the organic compounds concentration in the air of the operating room. Results. Comparative analysis has proved that during all stages of general inhalation anesthesia and surgery the sevoflurate concentration was 2.0-3.5 fold higher with no protection used compared to operation of air recirculator and it was above the ultimate permissible concentrations as per international standards. Treatment of surgical field by an antiseptic caused the up to 10-fold increase of organic substances in the air. The concentration of disinfectants reduced by 90% 2.5 times faster under operation of air recirculators compared to spontaneous cleansing. Conclusion: ORUB-3-5-KRONT air recirculator and irradiator equipped by disposable air carbon filters of FUS-KRONT reduces the content of sevoflurane in the air of operating rooms during anesthesia and surgical operation down to recommended ultimate permissible concentrations and provides fast cleansing of the air in the operating room from organic substances after treatment of the surgical field by an antiseptic.

 

Goal: to develop the intensive care programme aimed at the rational reduction of blood transfusions in those with massive hemorrhage of the very severe degree. Materials. Specific course of traumatic disease was analyzed in 112 patients with multiple traumas and acute massive hemorrhage of the very severe degree. Retrospective group 1 included 52 patients, prospective groups 2 and 3 – 39 and 21 patients respectively. Management tactics did not differ principally but for the therapy purposefully aimed at the rational reduction of transfusion of erythrocyte preparations. Results. Using differential management tactics for coagulopathy during acute period of wound disease in those with massive hemorrhage of the very severe degree aimed at the rational reduction of blood transfusions is accompanied by the tendency of lower severity of wound disease in general. Conclusion: In order to reduce the volume of blood transfusions during traumatic shock in those injured it is feasible to use preparations containing key coagulation factors. Rational reduction of blood transfusion volume is accompanied by the tendency of the better treatment results in such patients in general.

 

Postoperative delirium is being actively discussed by anesthesiologists for a long period of time. This article has been written due to new guidelines on prevention and management of this disorder compiled by the group of experts under umbrella of European Society of Anaesthesiology. Comparing this edition with the previous recommendations of American Society of Anesthesiologists the authors attempt to follow the evolution of doctors' views (anesthesiologists and intensive care physicians) on the discussed issue.

 

Delirium in the intensive care ward is actively being discussed by anesthesiologists for a long period of time. However at present there are fairly scarce evidences on the efficiency of various techniques of prevention and management of this disorder. Goal of the research: to assess the impact of inhalation sedation on the intensity and duration of sepsis-associated delirium in the intensive care ward of the surgical hospital. Methods. The one-centered, prospective, randomized comparative study was conducted in order to assess the efficiency of inhalation sedation in the patients with sepsis-associated delirium. Propofol was used for the intravenous sedation in the control group. 187 adult patients, admitted to the intensive care ward of Vorokhobov City Clinical Hospital no. 67, were included into the study. Results. Inhalation sedation reduced the delirium duration compared to intravenous use of propofol: delirium was fully managed on the 5th day in the group where sevorane was used [4; 7], while in the group where propofol was used delirium lasted for 7 days [6; 8] (p = 0.03). The study did not detect any effect of inhalation sedation on the intensity of oxidative stress (level of oxidized peptides in the blood plasma of the patients) and degree of neuronal damage (differences between groups are not significant, p = 0.37). No differences were recorded in the value of procalcitonin and SOFA score at any stage of the study. Conclusion. The frequency of delirium in the mixed population of sepsis patients makes 27.9%. Use of inhalation sedation with sevoflurane compared to intravenous administration of propofol reduces the duration of delirium therapy from 7 to 5 days.

 

Goal: to assess behavior and cognitive functions of rats after certain aggressive impact imitating anesthesia with sevoflurane and surgery in the clinical practice. Methods. Male rats of Wistar stock (n = 20) were used to assess the long term behavioral effect of continuous (6 hours) of action of sevoflurane and abdomen surgery. For anesthesia induction 8 volumes of % sevoflurane in the air flow (2 l/min) were used, for anesthetic support it was 4 volumes of % and 1 l/min. During surgery the rat was placed on the heated operating table and the mask was used for anesthesia; laparotomy was performed; nestis was isolated and irritated for 10 seconds by massage done by the forefinger and thumb. After that the loop was placed into the abdomen and the wound was sutured layer by layer. Then in accordance with previously compiled protocol on simulation of postoperative cognitive disorders in the rats the following behavioral tests were performed in order to evaluate the degree of post-anesthetic depression – motion and exploratory activity, social behavior, novel object recognition, specific behavior and learning under acute stress and avoidance response, forced swimming, and sexual behavior. Spray rats (n = 8) were used as standard opponents for social behavior tests, and hormone-stimulated female rats (n = 15) were used for sexual behavior tests. Results. The results showed that long-term action of sevoflurane vapor and abdomen surgery caused behavioral changes in rats compared to animals from the control group in the number of tests: they are not able to recognize novel objects and slower repeat extrapolational deliverance response in 24 hours and 7 days after its conditioning. Sevoflurane made no significant impact on motion and exploratory activities in novel circumstances, duration of immobilization during forced swimming test, social and sexual behavior of male rats. Conclusions. Continuous action of sevoflurane and abdomen surgery causes cognitive deficiency in male rats, however the profile of changes is different from the one observed under the action of halothane.

 

Atrial fibrillation is one of the most frequent complications occurring after cardiac surgery. This problem became especially crucial for the last decade due to brisk growth in cardiac surgery and surgeries in the patients with high risks. Post-operative atrial fibrillation confidently increases the risk of mortality and associated complications. This disease is diagnosed first of all by ECG tests. At present in order to detect atrial fibrillation early European Heart Rhythm Association (EHRA) recommends using technologies of continuous rhythm monitoring - implanted cardiac monitors. Currently there are two main approaches to management of postoperative atrial fibrillation. These are the strategies of rhythm monitoring and heart rate monitoring supplemented anti-thrombotic therapy. A wide range of drugs is used for anti-thrombotic therapy in the patients undergoing cardiac surgery. Effective management of post-operative atrial fibrillation in those undergoing cardiac surgery is to consider clinical status of the patient, concurrent diseases and risk of stroke and hemorrhage.

 

The frequency of sudden cardiac death remains still high, globally every year 3 mln. people suddenly die. During last thirty years it has been possible to prevent sudden cardiac death by using implantable cardioverter-defibrillators. For all this time the number of large clinical trials has been conducted confirming the improved survival when using implantable cardioverter-defibrillators. The last edition of Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death was presented by European Society of Cardiology in 2015. However there are a lot of unsolved problems first of all related to indications for implantation of cardioverter-defibrillators. This review analyzes the existing evidences and depicts the current use of implantable cardioverter-defibrillators in the clinical practice.

 

Trauma is one leading cause of death in young patients under 45 years old and it occupies the third pace among causes of general mortality for the whole population. Nosocomial infections (first of all ventilator-associated pneumonia) account for mortality in this group of patients in 5 days after trauma. The article describes risk factors, causative agents, pathologic physiology and specific features of diagnostics of nosocomial pneumonia in those with multiple traumas. Special attention is paid to immune response of the host to multiple trauma and related issues on using polymorphism of genes controlling production of certain cytokines in order to improve diagnostics and prognosis of the course and outcome of nosocomial pneumonia in this group of patients.