MECHANICAL VENTILATION OF THE LUNGS WITH A TARGETED TIDAL VOLUME IN NEWBORNS AND INFANTS WITH VARIOUS LUNG DISEASES

The review presents and systematizes the current provisions on artificial lung ventilation (ALV) with a guaranteed or target tidal volume as the most effective and safe mode of ALV in neonatal practice. The application of this method of respiratory support is described. The authors present the main provisions on the optimal selection of the target tidal volume in various pathological conditions. The use of various modes of ALV in combination with a guaranteed tidal volume makes it possible to prevent or reduce the harmful impact of ALV in patients with acute and chronic lung pathology, in newborns and children in the first year of life.

Retrograde Tracheal Intubation: Indications, Stages, Technique

Retrograde tracheal intubation occupies an important place in modern clinical practice and experimental studies when performing artificial lung ventilation to maintain vital functions of the human and mammalian body. Retrograde tracheal intubation has a very rich history (more than 50 years), and during this time this method has been repeatedly modified and optimized. This article discusses the indications and contraindications, equipment, stages and techniques of retrograde tracheal intubation.

Use of early puncture-dilatational tracheostomy in case of transferring patients with acute cerebral circulation disorder and new coronavirus infection COVID-19 to artificial lung ventilation

Objective. To assess the use, safety and effectiveness of puncture-dilatational tracheostomy (PDT) performed immediately after the tracheal intubation in patients with cerebrovascular accident (CVA) and new coronavirus infection (NCI). Materials and methods. Patients with CVA and NCI treated at ICU underwent PDT using the Ultraperc kit according to the Ciaglia technique immediately after the tracheal intubation. Results. The results of treatment of 12 patients with CVA and 21 patients with NCI were investigated, the safety of manipulation, treatment results, and mortality in groups were evaluated. Conclusions. The puncture-dilatational tracheostomy, performed as early as possible, allows improving disease outcomes in CVA, facilitating patients care, and ensuring greater safety of patients and staff.

Successful treatment of severe calcium channel blocker poisoning: a clinical case

The article describes the successful experience of treating a female patient with severe poisoning by a mixture of drugs with a predominant cardiotoxic effect. The number of drugs taken was many times higher than the potentially lethal dose. Hemodynamics has been supported by vasopressors and inotropic drugs for a long time, antidotes, sorbents, detoxification agents were used. Due to inadequate spontaneous ventilation, the patient was on artificial lung ventilation for 24 days. After 26 days in the intensive care unit, she was transferred to the therapeutic department in a stable state and without neurological deficit. We believe that this material will be useful for intensive care physicians when providing emergency care to patients in such situations.

Development of an algorithm for selecting the required frequency of injected current for multi-frequency electrical impedance tomography for tasksrelated to preoperative monitoring of human lung function

This paper proposes an algorithm for selecting the required frequency of injected current for problems of personalized multi-frequency electricalimpedance tomography. The essence of the algorithm is to calculate the rate of change in the recorded difference of potentials for the assigned range of frequencies of injected current, followed by determining the frequency after which the rate of a change in potentials is minimal. Subsequently, the injection parameters are readjusted to the chosen frequency and the complete process of electricalimpedance tomography is started. The proposed solutions were studied on four subjects with different fat mass, defined by bioimpedance analysis. Thus, it seems possible to track the dynamics of a change in the lungs of a certain patient by visualizing the reconstructed conductivity field, taking into consideration its internal features. It was established that in the course of studying lungsby using the method of electricalimpedance tomography, it is necessary to take into account the frequency of injected current at an increase in percentage of fat mass. The results of the studies showing a change in the quality of imaging the breathing process at different frequencies of injected current (from 50 kHz to 400 kHz, with a pitch of 50 kHz) are presented. For the test participants with a fat weight of 7.6 kg, 23.3 kg, 15.2 kg and 37.3 kg, the injection frequency was determined as 150 kHz, 200 kHz, 200 kHz, and 350 kHz, respectively. The proposed algorithm enables visual monitoring of lung function and can be used in the problems of pre- and postoperative monitoring of respiratory function of patients. Its use is particularly relevant for patients connected to an apparatus of artificial lung ventilation.

Exogenous surfactant in the late respiratory phase of COVID-19

The article presents data on the course of inhalations with a native surfactant administered in two patients (66 and 53 years old) at the late respiratory phase of the new coronavirus infection of COVID-19 (the 22nd and the 19th days from the disease onset) who received non-invasive artificial lung ventilation.Subjects and methods. For inhalations, an AeroNeb™ micropump nebulizer was used; for one inhalation, 75 mg of surfactant-BL was dissolved in 5 ml of isotonic sodium chloride solution. The treatment course included 5 days with 2 inhalations a day.Results. In both patients, upon the end of this therapy with the native surfactant, regression of respiratory failure was noted, the level of respiratory support was reduced to insufflation with humidified oxygen, and rehabilitation measures were started with subsequent discharge from the hospital.

The impact of mobilization protocols on the length of postoperative hospitalization among cardiac surgery patients

The aim. To determine the impact of implementing the extra early mobilization protocol (EEM) on the length of intensive care unit (LICU) stay and postoperative unit (LPOU) stay and to assess the role of age, heart contractility, functional class and surgical outcomes. Materials and methods. Participants – adult patients of 2018–2019 with less than 24-hour artificial lung ventilation (ALV). The first group were treated according to the early mobilization protocol (EM, patients of 2018); the second group were treated according to the EEM protocol (patients of 2019). Design: a retrospective analysis. Settings: cardiosurgical unit. Interventions: the major difference is that the resources of patient mobilization team have expanded since 2019, namely it included a physical therapist, which made it possible to modify the EM protocol (standing on the 2 postoperative day (POD), activation with the help of medical staff, respiratory exercise) to the EEM protocol (standing on the 1 POD following consultation with an anesthesiologist, exercises with a physical therapist, respiratory exercise). The main outcomes: LICU, LPOU and total postoperative hospitalization (LTPO) (number of nights). Results. There were no differences between the EEM and EM groups in LICU (3 (2; 4) vs. 2 (2; 4); P = 0.182), LPOU (7 (6; 10) vs. 8 (6; 10); P = 0.118), LTPO (10 (8; 13) vs. 10 (9; 13); P = 0.308). Correlation analysis revealed absence, weak and very weak relations between the LICU, LPOU, LTPO indicators and other criteria, including age, ejection fraction, ALV. Conclusions. The effectiveness of the EEM protocol seems doubtful to reduce LICU, LPOU, and LTPO as compared to the EM protocol. The obtained results also raise the importance of physical therapist time management.

Intensive therapy of multiple fatty embolism of the microvascular bed of vital organs

The article presents a clinical case of successful treatment of a patient with polytrauma complicated by multiple fatty embolism. Complications were manifested in the form of a syndrome of multiple organ failure: cerebral, cardiovascular and respiratory failure. According to the protocols and recommendations for providing assistance to patients with polytrauma, the tactics of management and intensive therapy were determined, with the obligatory consideration of recommendations for the treatment of patients with fat embolism. The patient underwent neuroprotection, which included one of the modern drugs, such as celex, artificial lung ventilation, maintenance of hemodynamics by cardiovascular medications, correction of the water, electrolyte and acid-base balance with positive dynamics. Despite the difficulties of diagnosis and treatment, a high percentage of disability, complications and mortality, the difficulty of preventing complications, a favorable outcome for patients with associated trauma is possible. An interdisciplinary approach ensures the success of the treatment and rehabilitation of these patients.

Influence of long-term intravenous drug use on physiological indicators and morphological changes of internal organs in piglets

The article considers the state of physiological indicators and morphological changes of internal organs during the application of long-term non-inhalation narcosis in pigs of two groups while providing artificial lung ventilation.