The objective: to evaluate the effect of high-flow oxygen and non-invasive ventilation on the mortality rate in adults with severe respiratory failure caused by the new coronavirus infection in the intensive care unit (ICU).Subjects and methods. A one-center retrospective study was conducted. Electronic medical files of patients treated in the ICU from April 1 to May 25, 2020, were analyzed. Totally, 101 medical files were selected, further, they were divided into two groups. Group 1 (n = 49) included patients who received oxygen insufflation, and should it fail, they received traditional artificial ventilation. No non-invasive respiratory therapy was used in this group. Group 2 (n = 52) included patients who received high-flow oxygen therapy and non-invasive ventilation. The mortality rate in the groups made a primary endpoint for assessing the impact of high-flow oxygen therapy and non-invasive ventilation. The following parameters were also analyzed: drug therapy, the number of patients in whom non-invasive techniques were used taking into account the frequency of cases when these techniques failed, and the number of patients in whom artificial ventilation was initiated.Results. In Group 2, non-invasive methods of respiratory therapy were used in 31 (60%) cases. High-flow oxygen therapy was used in 19 (36%) of them; in 13 cases this method allowed weaning them from the high flow. Non-invasive ventilation was used in 18 cases, in 12 patients it was used due to progressing severe respiratory failure during humidified oxygen insufflation, in 6 patients – after the failed high-flow oxygen therapy. In Group 1, 25 (51%) patients were intubated and transferred to artificial ventilation, in Group 2, 10 (19.2%) underwent the same. The lethal outcome was registered in 23 (47%) cases in Group 1, and in 10 (19.2%) in Group 2 (p = 0.004). Analysis of drug therapy in the groups revealed the difference in the prescription of pathogenetic therapy. Logistic regression demonstrated the effectiveness of the combination of tocilizumab + a glucocorticoid in reducing the frequency of lethal cases (p = 0.001).Conclusion. The use of non-invasive respiratory support in adults with severe respiratory failure caused by the new coronavirus infection combined with therapy by tocilizumab + a glucocorticoid can reduce the incidence of lethal cases.

The objective was to evaluate  the effectiveness of the erector  spinae plane block (ESP-block) as a component of perioperative analgesia in endovideosurgical  hernioplasty of inguinal hernias.Materials and methods. The study included 70 patients who underwent endovideosurgical plastic surgery of inguinal hernias. All patients randomly divided into the main (n=32) and control  (n=38) groups, were given general combined anesthesia. In the main group, it was supplemented with the ESP-block, which was performed with ropivacaine at the L1 level. Intraoperatively, fentanyl was used for analgesia. The indication for its introduction was an increase in the Surgical Pleth Index (SPI) of more than 50. In the early postoperative period, ketoprofen and tramadol were used for analgesia, which were administered with the development of moderate  and high intensity of the pain. The effectiveness of the ESP-block was evaluated by comparing the total doses of analgesic drugs that were required for analgesia during surgery and in the early postoperative period in patients of both groups.Results. In the main group, the total doses of fentanyl and ketoprofen were statistically significantly lower compared to the control group (p<0.01). After surgery, tramadol was used only in patients of the control  group. In some patients of the main group who required analgesia in the early postoperative  period (n=15), the pain syndrome  developed  only 12 hours after the end of the surgery. Their intraoperative need for fentanyl  did not differ from other patients of the main group (p>0.05).Conclusion. In endovideosurgical hernioplasty of inguinal hernias, the use of the ESP-block as part of multimodal analgesia contributes to achieving a good level of analgesia both intra- and in the early postoperative period.

Introduction. In patients with spontaneous breathing and respiratory failure, various methods of delivering the gas mixture to the respiratory tract have been developed. The use of high-flow oxygen therapy is alternative standard oxygen therapy. Objectives. Experimental study of the effects of high-flow oxygen therapy and evaluation of its clinical effectiveness in comparison with traditional oxygen therapy in patients with severe community-acquired pneumonia. Materials and methods. During the experimental stage of the study, the level of mean airway pressure was determined depending on the flow of the gas mixture using a lung model with parameters of biomechanics of respiration. During the clinical stage, a comparative analysis of the effectiveness of respiratory support in groups of patients with severe community-acquired pneumonia using high-flow and traditional oxygen therapy was carried out. Results. During experimental study, flow of gas mixture 30 l/min was determined, at which mean airway pressure registered on models of healthy lungs and lungs with modified respiratory biomechanics significantly increases. During the clinical phase of the study, a statistically significant decrease in the frequency of initiation of artificial (invasive and non-invasive) lung ventilation, an increase in oxygenation (saturation hemoglobin with oxygen, partial pressure oxygen in arterial blood) and partial pressure carbon dioxide with simultaneous decrease in respiratory rate. Conclusion. The value of gas flow over 30 l/min has significant effect on the recorded mean airway pressure calculated using models of lungs in experiment. However, clinical significance of this indicator is not clinically significant. The use of high-flow oxygen therapy in patients with severe community-acquired pneumonia in comparison with standard method reduces the frequency use of ventilation (invasive and non-invasive) with a significant increase in oxygenation indicators. This reduces hyperventilation, which is confirmed by a significant increase in partial pressure carbon dioxide and a decrease in respiratory rate.

Нейрогенный отек легких (НОЛ) является одним из осложнений острых заболеваний и травм головного мозга (ГМ) и сопровождается развитием тяжелой дыхательной недостаточности� Его возникновение связано с высоким уровнем летальности� Существует несколько теорий развития НОЛ� Наиболее современной и обсуждаемой среди них является теория «двойного удара»� В ее основе лежит повреждение легких за счет системной воспалительной реакции, источником медиаторов воспаления для которой становится глиальная ткань повре-жденного ГМ� Сходство патогенеза позволяет рассматривать НОЛ как одну из форм острого респираторного дистресс-синдрома (ОРДС)� Для его диагностики используются общие с ОРДС критерии, выявляемые на фоне острого повреждения ГМ и не имеющие связи с другими этиологическими факторами� Эффективных мер профилактики и лечения НОЛ в настоящее время не разработано� Ведущее место в его терапии занимает поддержание газообмена с помощью искусственной вентиляции легких, которую рекомендуется проводить в соответствии с принципами протективной вентиляции� При этом использование ее отдельных подходов возможно только в условиях нейромониторинга� Neurogenic pulmonary edema is one of the complications of acute cerebral diseases and traumas and it is accompanied by severe respiratory failure� It is associated with a high mortality level� There are several theories about neurogenic pulmonary edema development� The theory of the double hit is the most recent causing significant discussion� The theory is based on the pulmonary injury due to systemic inflammatory response when the glial tissue of the injured brain becomes the source of inflammatory mediators� A similar pathogenesis allows considering neurogenic pulmonary edema to be one of the forms of acute respiratory distress syndrome� It has diagnostic criteria common with acute respiratory distress syndrome, which are identified during acute cerebral injury and not associated with the other etiological factors� Currently, there are no effective prevention and treatment of neurogenic pulmonary edema� Support of respiratory exchange through artificial pulmonary ventilation is a major tool used for its management, which is recommended to be performed in compliance with protective ventilation principles� And some particular approaches of the preventive ventilation can be applied only with neuromonitoring� Key words: neurogenic pulmonary edema, acute respiratory distress syndrome, acute cerebral injury, protective pulmonary ventilation Дыхательная недостаточность является одним из наиболее часто развивающихся внечерепных осложнений различных острых заболеваний и травм головного мозга (ГМ)� Она возникает, по разным оценкам, у 81-83% пациентов с тяжелым повреждением центральной нервной системы (ЦНС) [33]� Ее развитие может существенным образом утяже-лять состояние пациента, негативно сказываться на течении основного заболевания и в ряде случаев ста-новиться самостоятельной клинической проблемой, требующей применения дополнительных средств и методов лечения� Наиболее частыми причинами дыхатель...