Complicated injury of the cervical spine is accompanied by a violation of blood circulation. This condition requires maintaining adequate perfusion pressure in order to prevent secondary damage to the spinal cord and multiple organ failure. The authors did not evaluate the effect of the urgency of spinal decompression on the severity and duration of systemic hypotension in this category of patients previously, as well as the presence of a connection between systemic hypotension and the outcome of the injury. Objective. To determine the effect of early decompression of the spinal cord on the duration and characteristics of adrenomimetics use in the bundle of intensive care measures in the acute period of complicated injury to the cervical spine. Material and Methods. A retrospective analysis of the treatment outcomes in 27 patients with complicated ASIA A cervical spine injury was conducted. Two groups were identified: Group I included 13 patients operated on within the first eight hours from the moment of injury; and Group II - 14 patients operated on within the period from eight to 72 hours. The analyzed parameters were: age, hemodynamic parameters, severity of organ dysfunction, duration of hemodynamic support, neurological status, time spent in intensive care unit, and length of hospital stay. Central hemodynamic parameters were registered using the impedance cardiography technique. To assess organ dysfunction, the SOFA score was used. Results. Complicated injury of the cervical spine is accompanied by a decrease in systemic vascular resistance and cardiac index. Hemodynamic parameters and duration of hemodynamic support in groups were not statistically different. Statistically significant differences in the SOFA score between groups were obtained on the third and 10^th day of the follow-up. Neurogenic shock was recorded in 70.4 % of cases. Positive dynamics of neurological deficit was observed only in two (15.4 %) patients of Group I. Conclusion. The urgency of spinal decompression does not affect the duration of hemodynamic support, but reduces the severity of organ dysfunction and increases the risk of neurological disorder regression.

Objective. To evaluate the effectiveness of dalargin and polyoxidonium as neurovegetative protection components, when performing decompression and stabilization operations in patients in the late period of spine and spinal cord injury. Material and Methods. Perioperative parameters of central hemodynamics and stress hormone levels were analyzed in 68 patients operated on using technology of multi-stage treatment in one surgical session under three variants of general anesthesia with mechanical ventilation: sevoflurane, fentanyl, and rocuronium bromide in Group I (n = 23); sevoflurane, fentanyl, dalargin, and rocuronium bromide-in Group II (n = 21); and sevoflurane, fentanyl, polyoxidonium, and rocuronium bromide-in Group III (n = 24). Results. The duration of operation was: 385.7 ± 54.8 min in Group I, 391.5 ± 43.5 min in Group II, 399.2 ± 51.2 min in Group III, and blood loss was 1008.7 ± 89.2 ml, 968.3 ± 71.8 ml, 1001.4 ± 80.3 ml, respectively. Statistically significant differences in cardiac output parameter from initial values were recorded during anterior spinal fusion procedure and at the stage of spinal deformity correction. There were no significant differences in hemodynamics between the groups. The greatest deviations in stress hormone levels were recorded in Group I at stages of anterior spinal fusion, deformity correction, and on the first day after surgery. The level of endogenous intoxication in Group I corresponded to high severity, in Groups II and III-to moderate severity. The need for opioid analgesics was significantly lower in Groups II and III (p < 0.05). Conclusion. Inclusion of dalargin and polyoxidonium into the anesthesia program allows achieving a required level of anesthetic protection of patients during operation, while maintaining adequate reactivity of the patient's body defenses.

Objective. To study the etiological structure and antimicrobial resistance of hospital-acquired pneumonia pathogens in patients with complicated cervical spine injury. Materials and methods. A retrospective study included 418 bacterial isolates from sputum in 29 patients with hospital-acquired pneumonia who were treated in ICU during the period 2012-2013 and 2017-2018. Results. The most common pathogens from the lower respiratory tract, both in 2012-2013 and in 2017-2018 were Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae. The share of K. pneumoniae in 2017-2018 increased by 16.8 % (3.2 times more often), and the share of microorganisms of the Enterobacteriaceae - by 26.7 % (p < 0.001). The dynamic's analysis shows an increase in the resistance of hospital gram-negative pathogens of hospital-acquired pneumonia to the main antimicrobial classes and an increase of the frequency of extremely resistant pathogens in 2017-2018 P. aeruginosa by 19.9 % (p = 0.008), A. baumannii by 13.8 % (p = 0.189), K. pneumoniae by 66.7 % (p < 0.001). Conclusion. Gram-negative microorganisms are the leading pathogens of hospital-acquired pneumonia in patients with complicated cervical spine injury. An increase of the level of antibiotic resistance creates an unfavorable background regarding the effectiveness of antimicrobial therapy for hospital-acquired pneumonia in patients with a complicated cervical spine injury.

INTRODUCTION: In the literature, there are reported cases of myocardial infarction in young patients after strenuous physical activity, as well as without any evident connection with physical load. The most common causes of the acute coronary syndrome in young individuals are anomalies in the development of coronary arteries. The article is devoted to the description of a clinical case of acute myocardial infarction in the anterior septal region of the left ventricle in the perioperative period after surgery of spinal injury in a patient without severe somatic pathology. During the surgery, unstable hemodynamics was noted with the development of arterial hypotension, which required infusion of norepinephrine. On the basis of clinical, laboratory and instrumental examinations, in the postoperative period the diagnosis: “Q-positive myocardial infarction of the anterior septum” was made. Coronary angiography visualized the presence of an intramural passage in the middle segment of the anterior descending artery with up to 30% stenosis in systole. The resulting arterial hypotension at the operational stage, with the myocardial bridge in the anterior descending artery, was the cause of circulatory disorders in the anterior septal region with the development of myocardial infarction and a decrease in the pumping function of the heart with subsequent hemodynamic disorders. CONCLUSION: Myocardial muscle bridges are a common anomaly of coronary arteries, which is usually asymptomatic. Clinical manifestations, if present, are blurred and atypical. In certain conditions, the given anomaly may be the cause of development of the acute coronary syndrome, in young individuals as well, which shows reasonability of monitoring of ECG and of markers of myocardial infarction in the postoperative period.

Objective. To analyze the role of the functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support and to substantiate additional criteria for their readiness to transfer to spontaneous breathing.Material and Methods. The state of the diaphragm was assessed by ultrasound in 24 patients with spinal cord injury. The excursion of the diaphragm during quiet breathing, the excursion and thickness of the diaphragm during forced breathing, and the change in forced expiratory volume from the moment of admission till the end of mechanical ventilation were analyzed.Results. On the first day, on the background of mechanical ventilation, there was a significant decrease in the excursion and thickness of the diaphragm during forced breathing (p = 0.002; p = 0.008) which persisted up to 3 days (p < 0.001; p < 0.001); by the fifth day of mechanical ventilation, the indicators increased to the initial levels (p = 0.112; p = 0.433); and by the 10th day they exceeded the initial values (p < 0.001). When comparing the excursion and thickness of the diaphragm during the transfer of patients to spontaneous breathing with the data on their admission, a significant difference was obtained (p < 0.001; p < 0.001). The dynamics of forced expiratory volume indicators was similar to those of diaphragm excursion during forced breathing.Conclusion. A peculiarity of the functional state of the diaphragm in patients with cervical spinal cord injury in the acute period was a significant decrease in diaphragm excursion and the development of ventilator-induced diaphragm dysfunction (VIDD) associated with mechanical ventilation in replacement modes. The tactics of early tracheostomy and the use of auxiliary ventilation modes determined the absence of progression of VIDD during prolonged mechanical ventilation. The presence of a strong correlation between the diaphragm excursion during forced breathing and the forced expiratory volume allows concluding that these indicators can be additional objective criteria for the  readiness of patients with cervical SC injury to transfer to spontaneous breathing, since they reflect not only the functional state of the diaphragm, but also the state of the lung tissue.