BACKGROUND. Ultrasound study significantly expanded the possibilities of bedside diagnosis in patients with respiratory failure. Using ultrasound, it is possible to determine the volume of lung damage in the form of collapsed alveoli and infiltration areas with preserved airness of the lung tissue. AIM OF STuDY To study the possibility of assessing the recruitment maneuver of the alveoli based on changes in the ultrasound signs of lung tissue damage.MATERIAL AND METHODS. A prospective study was performed in the Clinic of Anesthesiology and Resuscitation of S.M. Kirov Military Medical Academy. The study included 36 patients who were treated in the period from 2010 to 2017 with a duration of respiratory support of at least 48 hours and oxygenation index less than 300 mmHg. For 36 patients, 48 alveoli recruitment maneuvers were performed according to a step-by-step method under the control of dynamic compliance and average tidal volume. Ultrasound determined the type and extent of destruction of lung tissue by signs of infiltration and consolidation.RESULTS. In the studied patients, after carrying out a maneuver of recruitment of the alveoli, arterial blood oxygenation indices increased statistically significantly, PaCO2 level decreased, pulmonary tissue compliance improved, respiratory volume grew. All this confirmed the mobilization of the alveoli and improved lung ventilation. Ultrasonographic evaluation of lung tissue showed a significant decrease in the severity of the ultrasound sign of infiltration after recruitment maneuver from 46.5 (38; 57.5) to 37.5 (30.5; 49.5). However, recruitment had practically no effect on the volume of the consolidated area of lung tissue: the general consolidation index before (4 (3; 5)) and after (4 (3; 5)) the maneuver had no statistically significant differences.CONCLUSIONS. The pneumonia-affected consolidated lung tissue has a low recruitment potential and the volume of consolidation does not change with the growth of PEEP. After the recruitment maneuver, the number of B-lines decreases, indicating a decrease in infiltration and an increase in lung airness.Authors declare lack of the conflicts of interests.

Intrahospital transportation of critical patients is a frequent procedure in the practice of most medical organizations, which in some cases is accompanied by a number of adverse events up to the occurrence of critical incidents. In order to improve patient safety, the Federation of Anesthesiologists and Reanimatologists of Russia (FAR) initiated in 2022 the development of national guidelines for the intrahospital transportation of critically ill adult patients. The literature search was focused on meta-analyses and randomized controlled trials, but also included registries, non-randomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinion. Before publication, the guidelines were approved by the Presidium of the Board of the FAR. The guidelines are focused on the peculiarities of the organization of the process of intrahospital transportation, critical indicators of vital functions and their monitoring using methods for an objective assessment of the condition of patients. Special attention is paid to the need to form a specialized team and its training. For each recommendation, the level of evidence is presented. The guidelines were developed by experts in the field of anesthesiology and intensive care for anesthesiologists-reanimatologists and must be used as an evidence-based basis for making a decision to transport a particular critical patient by responsible health professional.

Organizational issues of the interdepartmental application of telemedicine technologies in the provision of medical care to patients are considered. The most significant provisions of the concept of interdepartmental application of telemedicine technologies in the organization and provision of medical care to patients in critical conditions are presented. In addition, data on telemedicine consultations on federal districts of the Russian Federation performed by the federal level of health care in 2017 are shown, the frequency of emergency telemedicine consultations is revealed depending on the disease profile of patients or the specialty of a consulting physician. Prospects for the further introduction of telemedicine technologies into daily practical activities and the possibility of their adaptation to crisis situations and military conflicts are substantiated. It has been established that in various natural disasters, accidents, catastrophes, terrorist acts and during military conflicts with a large number of victims, successful organization of medical care and medical evacuation is possible only when combined with the efforts of the Ministry of Health, the Ministry of Defense, the Ministry of internal affairs and the Ministry of the Russian Federation for Civil Defence, Emergencies and Elimination of Consequences of Natural Disasters. Thus, the adequate development of telemedicine systems will increase the level of their rational and effective interdepartmental use for the benefit of saving people as Russia’s human capital.

When penetrating into the cell, local anesthetics affect some structures and processes, in addition to blocking sodium channels, leading to the development of cell damage. The aim of the article was to study the damaging effect of bupivacaine on the sciatic nerve and biceps femoris in rats. The study is double-blind and placebo-controlled. We used 0.9% sodium chloride as the placebo. The studied concentrations of bupivacaine were 0.2%, 0.5%, 0.75%, and 1%. We performed perineural introduction of 0.2 ml into the sciatic nerve and administered 0.2 ml into the biceps femoris muscle under the ultrasound guidance. The samples were taken twice: 1 hour after administration, and over 14 days. Cell necrosis or apoptosis were not found in the muscle and nerve after the 0.9% sodium chloride administration; occasional inflammatory cells were detected. Introduction of all concentrations of bupivacaine induced damage and inflammatory infiltration of muscle tissue and neural structures compared with 0.9% sodium chloride solution. Dystrophic changes and neutrophilic infiltration were detected in nerve fibers. Perimuscular edema, apoptosis, polychromasia, necrosis, disappearance of cross-striation of muscles, clusters of inflammatory cells were found in the biceps femoris. Signs of damage and inflammatory infiltration decreased, but continued to persist over 14 days. The study showed the presence of neurotoxicity and myotoxicity of all concentrations of bupivacaine compared to a 0.9% sodium chloride solution. It was revealed that signs of damage and inflammatory infiltration persisted 14 days after the administration of bupivacaine.

Щеголев Алексей Валерианович доктор медицинских наук, профессор, начальник кафедры анестезиологии и реаниматологии ФГБВОУ ВО ВМА им. С.М. Кирова, ORCID: 0000-0001-6431-439X. Воробьев Владимир Сергеевич старший врач-специалист хирургического отделения (аэромобильное) ФГБУ ГВКГ военный клинический госпиталь им. акад. Н.Н. Бурденко Шустров Вячеслав Владимирович адъюнкт кафедры анестезиологии и реаниматологии ФГБВОУ ВО ФГБВОУ ВО ВМА им. С.М. Кирова, ORCID: 0000-0001-5144-3360. Лахин Роман Евгеньевич доктор медицинских наук, доцент, профессор кафедры анестезиологии и реаниматологии ФГБВОУ ВО ФГБВОУ ВО ВМА им. С.М. Кирова, ORCID: 0000-0001-6819-9691.BACKGROuND We report the experience of sanitary aviation evacuation of a patient with severe respiratory failure on the background of community-acquired pneumonia using mask non-invasive ventilation. The use of this method of ventilation of the lungs made it possible to avoid undesirable consequences arising from the transfer of the patient to artificial ventilation of the lungs and to transport him safely to a specialized medical institution in order to continue treatment. The described method of preparing a patient with respiratory failure before aviation transportation has shown its effectiveness during the flight and may be recommended for use by airmobile crews when carrying out long-distance evacuation Keywords: community-acquired pneumonia, aviation evacuation, non-invasive ventilation, functional transportability For citation Shchyogolev A.V., Vorobyov V.S., Shustrov V.V., Lakhin R.Y. Non-invasive ventilation during sanitary aircraft evacuation in a patient with severe community-acquired pneumonia.