Hemorrhagic Risks of Percutaneous Dilated Tracheotomy in Thrombocytopenia

The objective: to assess the incidence and influence of platelets level on the hemorrhagic complications during percutaneous dilated tracheotomy (PDT) in patients with thrombocytopenia.Subjects and Methods. The study included 85 consecutive patients with varying degrees of thrombocytopenia at the stages of hematopoietic stem cell transplantation. The control group included 56 patients who underwent classical tracheotomy. The study group included 29 patients who underwent PDT (Griggs method). The operations were performed for prolonged artificial pulmonary ventilation. When the platelets level was below 20 × 109/L, platelet concentrate transfusion was performed before the operation.Results. The incidence of hemorrhagic complications in patients with thrombocytopenia during PDT was 13.8% (95% CI 9.13–18.45%). In open tracheotomy, the bleeding rate was 3.8% (95% CI 2.65–4.49%). These results are comparable to the incidence of hemorrhagic complications in patients with normal platelet counts. The influence of the platelet level on the presence of hemorrhagic complications in both groups was not established.Conclusion. Thrombocytopenia is not a contraindication to performing PDT. However, platelet concentrate transfusion should be performed in patients with platelet counts less than 20 × 109/L. An experienced team of anesthesiologists and endoscopists can reduce the incidence of other complications.

The effectiveness of volume guarantee ventilation in newborns

Background. An important goal of treating respiratory disorders in newborns during the first stage of perinatal care is effective and safe pulmonary ventilation, enabling the administration of surfactant therapy, reducing alveolar dead space, and providing adequate gas exchange. Objective. The aim of this study is to improve the quality of newborns respiratory therapy using double pressure and volume control at the first stage of perinatal care. Materials and methods. The study involved newborns from week 27 to week 42 gestation with respiratory failure requiring invasive pulmonary ventilation. The ventilation mode was evaluated with pressure control and volume guarantee option compared with routine pressure ventilation. For the comparative characteristic of the compared ventilation methods, we used targets, such as the duration of artificial pulmonary ventilation, reduction of FiO2, dynamics of venous blood lactate, peak and average pressure in the respiratory tract, dynamics of lung compliance, and the development of complications. Results and conclusions. Given the heterogeneity of lung damage in newborns, the use of the guaranteed volume option reduced the duration of mechanical ventilation, the development frequency of IVH, and the frequency of surfactant use.

Acute methadone poisoning in children: diagnosis and treatment

Methadone poisoning is one of the most common causes of unfavorable outcomes in children.The objective is to identify specific parameters of the course and intensive care for methadone poisoning in children.Subjects and methods. 30 children were examined. The average age made 16 (15‒17) years. The duration of treatment in ICU was 3 (1.5‒4.0) days.Results. The most frequent clinical manifestations of methadone poisoning included coma (40%), acute respiratory failure (70%), low body temperature (57%), and myosis (100%). By the admission, the oxygenation index was 4.5 r.u. 37% of patients had pronounced lactate acidosis. On day 1, the volemic support made 143 (124‒165)% of the estimated fluid demand. 21 (70%) children needed artificial pulmonary ventilation. The negative correlation was established between treatment duration in ICU, Glasgow coma scale (R = -0.41; p < 0.05), Glasgow-Pittsburgh coma scale (R = -0.52; p < 0.05) and urea concentration in blood within the first 24 hours (R = 0.44; p < 0.05).Conclusion. The main criteria determining the severity of the state of patients with acute methadone poisoning include the level of depression of consciousness, the presence of acute respiratory and renal failure.

Анализ развития стернальной инфекции у кардиохирургических больных

A clinical study including 68 patients of a cardiac profile who developed sternal infection in the postoperative period was conducted. Patients were divided into two groups: 1 group – 42 patients with a sternal infection of soft tissues and the 2nd group – the 26th patient with a sternal infection of a breast. The received results were processed statistically. The received data confirmed that patients of both groups had an accompanying pathology: diabetes mellitus and chronic obstructive diseases of lungs. The risk factor for infection development during sternotomy were an average duration of operation that in the 1st group was 280,9 minutes and in the 2nd group the operation duration was 270,4 minutes. Another risk factor was duration of use of the device of artificial blood-flow; cardiac support was used for 24nd group. A prolonged artificial pulmonary ventilation was used in 39 (92,9 %) patients of the 1st group and 22 (84,6 %) patients of the 2nd group.

Results of the randomized comparative study of second-generation supraglottic airways in orbital osteosynthesis

The objective: to assess and compare supraglottic airways of LMA-Supreme and i-gel during orbital osteosynthesis.Subjects and methods. 91 patients were included into the study. All of them underwent osteosynthesis of the orbit. The patients were randomly divided into two groups. LMA-Supreme group included 42 patients, while i-gel group included 49 patients.Results. The parameters of hemodynamics, gas exchange, and artificial pulmonary ventilation (APV) did not basically differ between the groups at different stages of the study. The oropharyngeal leak pressure differed between the groups at the end of surgery and made (Me – median, Q1 and Q3 – upper and lower quartiles): 28.0 (22.0; 30.0) and 21.0 (19.0; 27.0) mm WG the LMA-Supreme and i-gel groups, respectively; p = 0.021. A significant difference was observed in the insertion time of supraglottic airways (Me is the median, Q1 and Q3 are the upper and lower quartiles): 27.5 (19.3; 36.5) sec. for LMA-Supreme and 15.0 (13.8; 25.0) sec. – for i-gel; p = 0.001. When inserting the LMA-Supreme duct in 33 (78.6%) patients, jaw thrust maneuver, extension of the neck, etc. were required; while in the i-gel group, similar maneuvers were necessary in 18 (36.7%) patients; p < 0.001. The number of postoperative complications was minimal in both groups.Conclusion. Both supraglottic airways can be used with equal efficacy in osteosynthesis of the orbit. At the same time, the i-gel duct has an advantage over the LMA-Supreme in speed and simplicity of insertion. The LMA-Supreme had greater leak pressure at the end of surgery, which might be an advantage in patients requiring greater peak inspiratory pressure to provide effective APV.

COVID-19 PANDEMIC AND CHALLENGES IT POSES TO OTORHINOLARYNGOLOGISTS

As doctors, we all have a shared responsibility in terms of COVID-19. At first glance, ENT specialists are not classed as the so-called “front line” medical workers but have a key role to play and these needs to be addressed. In response to the pressures on the Health Care System, the medical care provided by otorhinolaryngologists has been limited. Irrespective of the imposed work limitations, patients will still need to be provided with the specific care, which requires us to find the best solutions for work stations and wards. In addition, measures should be put in place to avoid compromising surgical activity (especially emergency procedures), deriving from a combination of factors, including staff sickness, problems with the supply of medical equipment, the use of operating theaters, anesthesiological teams, etc. An increased number of performed tracheostomies are expected in positive COVID-19 patients who need artificial pulmonary ventilation. The purpose of this paper is to address all these issues, based on current and accessible information, and propose measures and procedures for otorhinolaryngologists in the context of the COVID-19 pandemic for different patient groups. Simultaneously, recommendations are made to protect the doctors and their teams, as well as to reconfigure the medical operations in the new conditions.