Bìlʹ, znebolûvannâ ì ìntensivna terapìâ最新文献

{"title":"PECULIARITIES OF PAIN MANAGEMENT IN PATIENTS WITH GUNSHOT WOUNDS IN MEDICAL AND NURSING TEAMS","authors":"YU.L. KUCHYN, G POSTERNAK, D.O. GOVSEEV","doi":"10.25284/2519-2078.3(104).2023.287872","DOIUrl":"https://doi.org/10.25284/2519-2078.3(104).2023.287872","url":null,"abstract":"Summary. During the Anti-Terrorist Operation/Joint Forces Operation in eastern Ukraine, gunshot wounds account for about 74% of the casualties. Such injuries are accompanied by high intensity pain. At the stage of treatment in medical and nursing teams, effective pain management is important, because in the long term, more than 70% of these patients suffer from chronic pain. Therefore, studying the features of pain management at this stage of treatment can play an important role in improving the results of their treatment.&#x0D; Objective. To study the peculiarities of pain treatment in patients after gunshot wounds at the stage of treatment in medical and nursing teams.&#x0D; Methods. Study of patients with gunshot and mine-blast wounds. A visual analog scale was used to study the intensity of pain. The results of the study were analyzed using the EZR v.1.35 package (R statistical software version 3.4.3, R Foundation for Statistical Computing, Vienna, Austria). The Shapiro-Wilk, Mann-Whitney, Friedman, and Bonferroni correction criteria were used.&#x0D; Results. The results of the study of 769 patients after gunshot wounds indicate that: 1) upon admission to the nursing teams (before anesthesia), the VAS pain intensity in group 1 was statistically different from group 2 (p<0.001) – in group 2, this indicator was higher; 2) the dynamics of VAS pain intensity during 2 days of observation shows no difference between the observation groups: 1 day – p=0.636, 2 days – p=0.465; 3) intervals between analgesia during the 1st day indicate a statistically significant difference between the groups (p=0.001), and on the 2nd day of observation no such difference was observed (p=0.818).&#x0D; Conclusion. At the time of admission to the medical and nursing team, the pain intensity according to the VAS was 7-8 points, which meets the criteria for high intensity. This intensity of pain is likely to affect the chronicization of pain in the future. The number of injured anatomical areas of the body is important for determining the tactics of pain treatment in patients with gunshot wounds, because the intervals between the administration of painkillers indicate that those patients who were injured in 3 or more anatomical areas of the body more often needed the administration of painkillers.","PeriodicalId":487491,"journal":{"name":"Bìlʹ, znebolûvannâ ì ìntensivna terapìâ","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135786269","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}

{"title":"MULTIMODAL LOW-OPIOID GENERAL ANESTHESIA FOR ELECTIVE CAESAREAN SECTION","authors":"A. PADALKO, D. DZIUBA","doi":"10.25284/2519-2078.3(104).2023.287873","DOIUrl":"https://doi.org/10.25284/2519-2078.3(104).2023.287873","url":null,"abstract":"Introduction: The frequency of general anaesthesia during caesarean section is up to 15 %. The main disadvantages of general anaesthesia during caesarean section are: a high percentage of consciousness during surgery and a pronounced hemodynamic reaction to surgical trauma. The most dangerous part of this surgical intervention is the period before the birth of a child.&#x0D; Purpose: To compare the \"routine\" technique of total intravenous anaesthesia with artificial lung ventilation for elective caesarean section and multimodal low-opioid general anaesthesia.&#x0D; Materials and methods: Our study is based on an examination of 60 patients. All patients were divided into 2 groups. The first group is a \"routine\" method of general anaesthesia, the second group is multimodal low-opioid general anaesthesia. Intravenous forms of medical drugs were used as adjuvants: paracetamol (1000 mg), clonidine (100 μg), 30 minutes before surgery and intravenous infusion of lidocaine (after the childbirth). Perioperative monitoring and treatment were based on the recommendations of the Enhanced Recovery After Caesarean Section and the American Association of Anaesthesiologists, the bispectral index and determination of the stress-induced substances (glucose, cortisol) blood levels were added. The newborns were evaluated with the Apgar scale and umbilical venous blood gas analysis was carried out. In the postoperative period, the intensity of pain, the time of patient activation and transfer from the intensive care unit were evaluated. The two-sided Student's t-test was used for statistical data processing (p value = 0.001; t &gt; ± 3,466).&#x0D; Results: The obtained data showed the presence of statistically significant differences between the two groups: mean blood pressure (t = 18.25); heart rate (t = 9.2); bispectral index (t = 5.9); assessment of newborns with the Apgar scale at 1 minute (t = - 4.2); parameters of umbilical venous blood gas analysis (t = - 6,5); glucose (t = 14.5); cortisol (t = 26,2); patient activation time (t = 8.12); the time of transferring from the intensive care unit (t = 8.67); pain assessment on a numerical rating scale (t = 13.4); using of opioids intraoperatively (t = 9.9); using of intravenous anaesthetics (t = 5.25); using of opioids after surgery (t = 8.78). Better indicators were determined in the multimodal low-opioid general anaesthesia group.&#x0D; Conclusions: Based on the obtained results, the multimodal low-opioid general anaesthesia has reasonable (statistically significant) advantages over the \"routine\" technique of total intravenous anaesthesia with artificial lung ventilation for elective caesarean section.","PeriodicalId":487491,"journal":{"name":"Bìlʹ, znebolûvannâ ì ìntensivna terapìâ","volume":"9 17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135786632","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}

{"title":"ERECTOR SPINE PLANE BLOCK WITH GENERAL ANAESTHESIA COMPARED WITH GENERAL ANAESTHESIA WITHOUT REGIONAL COMPONENT FOR SPINE SURGERY: PROSPECTIVE RANDOMIZED CONTROLLED TRIAL","authors":"M Barsa","doi":"10.25284/2519-2078.3(104).2023.287870","DOIUrl":"https://doi.org/10.25284/2519-2078.3(104).2023.287870","url":null,"abstract":"Background. Spine surgery is a complex and traumatic surgical intervention that require sufficient anaesthesia supplementation. Erector spine plane block (ESPB) is an effective method of reducing pain intensity, but there is insufficient data on its effect on hemodynamic parameters, blood loss and possible complications.&#x0D; Aim. Compare the impact of ESPB as a component of combined anaesthesia with general anaesthesia without regional component on amount of opiates, blood loss and infusion therapy intraoperatively, intensity of pain postoperatively, to study the consequence of the two methods of anaesthesia on hemodynamic parameters, the time of weaning from artificial ventilation and the duration of hospitalization.&#x0D; Materials and methods. 151 patients underwent spine surgery. Depending on the method of analgesia, patients were divided into two groups: group 1 – general anaesthesia with ESPB, group 2 – general anaesthesia alone. Primary outcomes: intensity of pain at rest and during movements after surgery 6, 12, 24, 36, 48 hours after surgery, duration of hospitalization, time of weaning from the ventilator. Secondary outcomes: amount of fentanyl used intraoperatively and morphine postoperatively, mean arterial pressure (MAP), heart rate (HR), blood loss, diuresis, and infusion therapy during surgery.&#x0D; Results. The intensity of pain at rest and during movement after surgery was significantly lower in group 1. The duration of hospitalization and ventilation was longer in group 2. The amount of opiates intra- and postoperatively was lower in group 1. HR, MBP, blood loss and infusion therapy were higher in group 2. Diuresis did not differ in both groups.&#x0D; Conclusion. ESPB as a component of combined anaesthesia reduces the intensity of pain at all stages of observation after surgery, decrease amount of opiates, duration of artificial ventilation and hospitalization. ESPB diminish HR and SBP, minimize blood loss and infusion therapy without affecting diuresis.","PeriodicalId":487491,"journal":{"name":"Bìlʹ, znebolûvannâ ì ìntensivna terapìâ","volume":"123 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135786633","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}

{"title":"PILOT STUDY OF ASSESSMENT OF CARDIAC OUTPUT USING THE PICCO METHOD AND THE INDIRECT FICK METHOD IN HEMADYNAMICALLY UNSTABLE PATIENTS WITH SEPSIS","authors":"O.E. SYDYUK, O.YU. KHOMENKO, R.A ZATSARYNNYI, M.F CHECHEL","doi":"10.25284/2519-2078.3(104).2023.287875","DOIUrl":"https://doi.org/10.25284/2519-2078.3(104).2023.287875","url":null,"abstract":"Background. Cardiac output (CO) is an indicator in the treatment of patients in critical condition. There are many methods for assessment CO, both invasive and non-invasive. All methods have their advantages and disadvantages, but the perfect method has not been found.&#x0D; Aim. Comparison of the assessment of СО by the PiCCO method and Fick's indirect method.&#x0D; Materials and methods. A pilot observational study was conducted on the basis of O.O. Shalimov National institute of surgery and transplantology. 12 results of CO measurement by the PiCCO method and CO calculation by the indirect Fick method in three patients were analysed. We analysed the results using the Excel descriptive statistics method, and also evaluated correlation in Excel.&#x0D; Results. The correlation coefficient of CO, estimated by more methods, r = 0.96, which showed the result of a high correlation of results. However, absolute values varied from 1.7 % to 19.9 %, which can be an acceptable error in conditions of limited resources. Correlation coefficient of cardiac index r = 0.98, and stroke volume index r = 0.98, which is also about high connection. Stroke volume correlation coefficient r = 0.64, which has a moderate connection. Variation in cardiac index and stroke volume vere within wide ranges (from 0.25 % to 27 % and from 1 % to 33 %, respectively).&#x0D; Conclusion. Cardiac output calculated by Fick's method in patients with sepsis and septic shock can be an alternative to CO determined by the PiCCO method in the case of limited resources.","PeriodicalId":487491,"journal":{"name":"Bìlʹ, znebolûvannâ ì ìntensivna terapìâ","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135786634","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}

{"title":"TRANSFUSION AND INFUSION THERAPY FOR MASSIVE BLOOD LOSS. PART 1, UNEXPECTED INTRAOPERATIVE HAEMORRHAGE","authors":"M.M PYLYPENKO, S.O. DUBROV","doi":"10.25284/2519-2078.3(104).2023.287869","DOIUrl":"https://doi.org/10.25284/2519-2078.3(104).2023.287869","url":null,"abstract":"Massive intraoperative bleeding has been one of the leading causes of mortality and morbidity in the perioperative period for many decades, and about a third of deaths occurred due to unexpected bleeding. Despite the widespread use of the terms massive haemorrhage (MH) and massive blood loss, their definition is still not fully agreed upon. The most widespread is the retrospective definition of MH, which is based on the number of units of blood transfused to the patient. The main manifestations of MH are the symptoms of severe haemorrhagic shock, that is, progressive overstrain of the sympathoadrenal system of the body, followed by a progressive decrease in blood pressure (BP) and cardiac output. In addition to massive haemorrhage, there are also such definition as severe bleeding, in which blood loss is about 20% of the volume of circulating blood. Severe bleeding can lead to the development of haemorrhagic shock in a particular category of patients.&#x0D; In cases where MH are planned (or at least severe bleeding), surgeons prepare to stop bleeding, and anaesthesiologists prepare to compensate of blood loss according to modern principles of hemostatic resuscitation. Over the past decade, in developed countries, scientists have developed and practitioners have widely implemented the principles of Patient Blood Management into clinical practice, which primarily consist of the preoperative diagnosis of anaemia and coagulation disorders and their compensation. Controlled (permissive) arterial hypotension is performed during surgery to reduce the planned MH. When MH occurs unexpectedly, surgeons are often not ready to quickly and effectively stop it, and anaesthesiologists have neither a sufficient supply of blood components and products nor a sufficient number of human resources to carry out balanced haemotransfusions in a fast and safe way. In such cases, it is very difficult for an anesthesiologist to perform full-fledged hemostatic resuscitation, so it is important to at least partially apply its basic principles. To do this, it is necessary to determine the rate of blood loss as early as possible, as well as to identify the main physiological disorders in the body, which will make it possible to establish diagnoses of hemorrhagic shock and MH. Timely establishment of the diagnosis of MH enables the practitioners to activate the massive transfusion protocol and receive a predetermined transfusion package from the blood bank. This package typically includes several packs of blood components, including red blood cells, plasma, platelets, and blood products such as cryoprecipitate, fibrinogen, and concentrates of other clotting factors. The system for ordering transfusion packages works only under the conditions when the massive transfusion protocols are created, agreed upon, approved and implemented in the clinical practice of the blood transfusion department of the medical institution in advance. It should be emphasized that the blood supply syst","PeriodicalId":487491,"journal":{"name":"Bìlʹ, znebolûvannâ ì ìntensivna terapìâ","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135786636","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}

{"title":"THE ROLE OF SIMULATION TRAINING FOR TEACHING (IN TEACHING) ANESTHESIOLOGIST INTERNS: A TWO-WAY SURVEY","authors":"K. BIELKA, YU. KUCHYN, G POSTERNAK, B. SAVCHENKO","doi":"10.25284/2519-2078.3(104).2023.287871","DOIUrl":"https://doi.org/10.25284/2519-2078.3(104).2023.287871","url":null,"abstract":"Resume. In the modern system of training intern anesthesiologists, simulation training is becoming an increasingly common tool for achieving educational goals. The simulation ensures the acquisition of professional competencies without the risk of harm to the patient and enables teachers to objectively assess the level of professional training of each intern. There is a growing need to review traditional approaches to the interaction between a teacher and an intern with the increasing use of simulation technologies.&#x0D; The purpose of the study was to determine the role of simulation training in the teaching of anesthesiologist interns.&#x0D; Materials and method. A prospective audit was conducted at the Department of Surgery, Anesthesiology and Intensive Care of the O.O. Bogomolets National Medical University in the period from April to June 2023. Interns of the 2nd year of training in 2023 in the speciality «Anesthesiology and intensive care» were trained in a 1-day simulation training «Critical incidents during anaesthesia\". We examine data (lower-level outcomes) assessing the role of simulation training on learning outcomes and willingness to work independently from the perspective of interns and faculty using an anonymous questionnaire at the end of the training.&#x0D; Results: the audit included 36 responses from interns and 10 from teachers. Many intern doctors noted an increase in their motivation to study, achievement of educational goals and correction of errors as a result of debriefing thanks to the conducted simulation training. Intern doctors noted that such training was very close to real conditions, it increased confidence in working with patients and readiness for emergencies, helped identify knowledge gaps and was more effective compared to traditional training (lectures, seminars). The results of the teachers' survey confirm the importance of simulation training as an effective means of training interns, which ensures the achievement of educational goals without risks for patients, accelerates the process of acquisition of competencies by learners, increases their motivation to study and objectively reflects the level of skills and knowledge of interns.&#x0D; Conclusions. Our research has proven that simulation training should be a mandatory component of the training program of the clinical internship in the speciality «Anesthesiology and intensive care» with an increase in their share in the training program of specialists. Creating conditions of mutual trust between interns and teachers is the key to the social mission of ensuring the quality of postgraduate education. Conducting a debriefing after working out each simulation scenario lays the foundation for the formation of critical thinking in future doctors and helps to avoid mistakes in real clinical practice.&#x0D; The role of systematic simulation training at the postgraduate level to improve outcomes in real clinical practice may be the subject of further research.","PeriodicalId":487491,"journal":{"name":"Bìlʹ, znebolûvannâ ì ìntensivna terapìâ","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135786631","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}

{"title":"MATERIALS OF THE UKRAINIAN ANESTHESIOLOGISTS CONGRESS, CAN 2023","authors":"","doi":"10.25284/2519-2078.3(104).2023.287876","DOIUrl":"https://doi.org/10.25284/2519-2078.3(104).2023.287876","url":null,"abstract":"","PeriodicalId":487491,"journal":{"name":"Bìlʹ, znebolûvannâ ì ìntensivna terapìâ","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135786635","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}