Clinical observation of a patient with hemangiomatosis involving skin, subcutaneous tissue, lung, stomach, intestinal, liver, kidney, spine

Aim. The work demonstrates a clinical case of an extremely rare pathology ‒ hemangiomatosis with damage to the skin, subcutaneous tissue, lungs, stomach, intestinal, liver, kidneys, and spine. Results. Patient L., born in 1994 with multiple hemangiomas. No heredity was observed for vascular tumors. In childhood, several large hemangiomas had to be surgically removed. She resorted to the Amur Regional Perinatal Center about her first pregnancy. There was a high risk of hemorrhagic complications due to damage to internal organs, primarily the lungs. Since there were multiple lesions of the vertebrae, it was decided not to use neuraxial methods of anesthesia. Total intravenous anesthesia and artificial ventilation of the lungs under the control of bronchoscopy were chosen by the method of anesthesia. Hemangiomatosis with lesions of internal organs was the indication for a Cesarean section. The operation took place without complications. The child was born healthy. Conclusion. In most cases, cosmetic defects are a significant problem of hemangiomatosis. However, in a number of situations, for example during pregnancy, there is a high risk of rupture of hemangiomas and the development of bleeding. In this case, the choice of the method of delivery and anesthesia depends on the location of the hemangiomas.

Restoration of heart and respiration in rats after cooling to a body temperature of 9-10°C

The study was carried out on male Wistar rats anesthetized by urethane. The rats were cooled in water until breathing stopped; after 5 minutes, mechanical ventilation of the lungs was started, which activated the work of the heart. The animals were not removed from the water, the heart rate decreased, the heart stopped at rectal temperature (Tr) 9,6±0,7°, in the esophagus (Te) 11,9±0,6°C. Then the rats were taken out of the water, a saline heating pad (38-40 °C) was applied to the chest area. As a result, the heart temperature increased, the heart rate began to rise; their own respiration appeared at Tp 18,6±0,8° and Te 21,6±0,9°C. It is concluded that the supply of oxygen to the heart and warming contribute to the restoration of its work, and the resumption of its own breathing. Key words: hypothermia, rat, artificial respiration, heart, respiration.

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.

Clinical case of longterm artifi cial ventilation of the lungs in a patient in a chronic vegetative state.

The article presents a clinical observation of long-term (18 years) artifi cial ventilation in a patient in a chronic vegetative state.

MATHEMATICAL MODEL FOR SELECTING RESPIRATORY MODES FOR ARTIFICIAL VENTILATION OF THE LUNGS

COVID-19 mainly affects the lower respiratory tract, and in 20 % of people infected with the SARS-CoV-2 virus, it penetrates deep into the lungs. At the same time, the patient's condition quickly becomes critical, and the most severe patients must be urgently placed in the intensive care unit and connected to artificial lung ventilation (IVL) devices. Artificial ventilation is necessary when the lungs can no longer breathe in enough oxygen and breathe out the carbon dioxide that has been collected in them. In this case, ventilators take over the functions of the respiratory system. The methods of carrying out artificial ventilation of the lungs require not only experimental, but also theoretical justification. For the study, it is proposed to apply a mathematical model of the functional respiratory system, in which the breathing process is represented as a controlled dynamic system and which allows predicting the gas exchange process in the lung structures in the dynamics of the respiratory cycle under various disturbing influences. To expand the area of applicability, the process features characteristic of the conditions under consideration are taken into account. It is proposed to supplement the model with equations that take into account the elasticity and resistance of pulmonary structures. Since the possibility of obtaining quantitative and qualitative characteristics of the process of mass transfer of gases with various types of artificial ventilation of the lungs is essential, equations are proposed to describe different types of pulmonary respiration. Implementation of the proposed model will allow obtaining results on the study of the process of dynamics of respiratory gases during artificial ventilation of the lungs, contributing to the solution of practical problems on the optimization of the parameters of technical devices for artificial ventilation. The subsequent combination of the proposed model with the model of the development of a viral disease can, in the presence of an array of individual data, be of significant assistance in choosing mechanical ventilation modes in a complicated course of a viral disease.

COVID-19 CHALLENGE, IN WHICH A THREE-YEAR-OLD GIRL WON

Since March 11, coronavirus infection has become an intercontinental problem – a pandemic has developed.Ukraine (until December 2019) ranks 17th in the world in the number of Covid-19 cases. Although according to statistics, the children are the least vulnerable group for coronavirus infection, unfortunately, severe and serious complications such as pneumonia, Kawasaki disease and Kawasaki-like syndrome, Multisystem inflammatory syndrome in children, toxic shock syndrome, myocarditis occur in children, too. As of the end of November, according to the Ministry of Health in Ukraine, 732,625 cases of coronavirus were laboratory- confirmed, including 13,720 children. According to the Lviv Regional Laboratory Center of the Ministry of Health, in the Lviv region since the beginning of the Covid-19 pandemic, among 46078 of all infected were about 5-6% of children. To analyze clinical, laboratory features of severe coronavirus infection complicated by bilateral pneumonia with acute respiratory distress syndrome (ARDS) in a three-year-old girl who was on V-V ECMO for one week and mechanical ventilation of the lungs for 28 days. The diagnosis was confirmed by detection of SARS-CoV-2 virus RNA by PCR, X-ray and ultrasound examination of the lungs. The disease had a dramatic course but a successful outcome. Life-threatening conditions associated with COVID-19 in children are much less common than in adult patients. However, in some cases, when critical hypoxemia is not eliminated by traditional methods of respiratory support, ECMO can become a life-saving technology and with its timely usage in pediatric patients.

Aspiration lipoid pneumonia in a child 1.5 years

Aspirated lipoid pneumonia is a rare lung disease, in which interstitial lesion with chronic respiratory failure is predominantly expressed. In the available literature, this pathology is described in the form of separate observations with an empirical selection of therapeutic measures. The appearance of lipophages in a bronchial aspirate is recognized as a pathognomonic sign of lipoid pneumonia. There is no etiological treatment of the disease. The effectiveness of intensive therapy, according to available sources, depends on the severity of respiratory failure and on the timing of the start of complex bronchodrainage therapy, and theoretically the most attractive is kinesitherapy. Only one observation describes the use of bronchial lavage with sequential separate intubation of the main bronchi. Hormone therapy is considered effective, but the physiological basis for its use is not presented. The published observation is characterized by a late start of treatment due to a long diagnostic search. The applied therapeutic measures are given and described in detail with an assessment of the expected and achieved practical benefits. It was shown that beneficial effects were due to the use of bronchodrainage therapy techniques, including the jet high-frequency artificial ventilation of the lungs. There are doubts about the appropriateness of the use of corticosteroids in this pathology.

FEATURES OF PERIOPERATIVE MANAGEMENT OF PATIENTS AT LAPAROSCOPIC ANTIREFLUX INTERVENTIONS

Aim. The analyzing current available literature on the problem of anesthesiology of antireflux interventions in patients with hernias of the esophageal aperture. Materials and methods. Biblosemantic, comparative and systems analysis. The suggested recommendations are based on the data of contemporary literature analysis, the results of randomized trials and meta-analyzes, devoted to the study of the problem of anesthesiology of antireflux surgery. Results and discussion. The analyzing the problems of anesthesia and analgesia in patients with hernias of the esophageal aperture, it is necessary following next concepts: general inhalation anesthesia in laparoscopic surgery, should be taking into account the technical features of surgery, as well as, the injection and diffusion of CO2 in tissue in time of carboperitoneum, in the same time, besides that to guarantee rapid awakening of the patient without residual sedation. The possibility of developing specific late complications, as well as, ruptures of the esophagus and stomach, pneumothorax makes adjustments in the tactics of the introduction in this category of patients in the perioperative period.The choice of anesthesia method is greatly determined the length of the post-anesthetic rehabilitation period, the stay of the patient with artificial ventilation of the lungs, the need and the length of stay in the intensive care unit. Conclusions. Ourday the question is still remain, which of the methods of inhalation anesthesia Low flow anesthesia or Minimal flow anesthesia is better, in the case of the requirements of comfort, patient’ safety and pharmacoeconomic feasibility.The principles of accelerated rehabilitation are possible not only if the surgical invasion is reduced, but also with the use of managed general anesthesia with adequate perioperative anesthesia.The operation of the patient in time is the best method of prevention of many early and delayed complications of the postoperative period. This provision has been validated by numerous clinical trials and is rarely take into account at present.The ideology of inhaled anesthesia involves not only sufficient control over the depth of anesthesia, but also predictability at the stage of anesthesia.