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Пандемія коронавірусної хвороби, що супроводжується широким розповсюдженням захворювання, високим рівнем летальності, безпрецедентним навантаженням на системи охорони здоров'я, спонукає науковців та лікарів до пошуку ефективних заходів лікування та профілактики COVID-19. В умовах відсутності етіологічного лікування, основним методом терапії є симптоматичний підхід. Одним з необхідних компонентів лікування пацієнтів з COVID-19, які перебувають у ВІТ, є адекватна нутритивна терапія. Загальні принципи клінічного харчування загалом такі ж, як і для основної популяції пацієнтів ВІТ з поліморбідністю, з особливим акцентом на безпеку медичного персоналу. В статті наводиться огляд літературних даних з питань нутритивної підтримки пацієнтів з COVID-19, які потребують інтенсивної терапії.

Introduction. Lung cancer occupy an advanced place among malignant neoplasms. It is more common in men aged 30 to 74 years. Almost all lung cancer patients need surgical treatment. Pulmonary dysfunction is caused by impaired evacuation of bronchial secretions, and the diaphragm dysfunction due to the pain. Postoperative pain is one of the main reasons for the development of complications. There are many methods of postoperative pain control, but the search for a better method is still ongoing.Objective. Improve results of perioperative analgesia in patients undergoing thoracotomy by choosing the optimal method of analgesia.Маterials and methods. 45 patients with lung cancer who underwent thoracotomy. Patients were randomized into 4 groups. Group A: according to the concept of pre-emptive analgesia, patients received 1000 mg of paracetamol intravenously 1 hour before incision, 50 mg of dexketoprofen intravenously and epidural analgesia: 40 mg of 2% lidocaine solution when placing a venous catheter, in the postoperative period - 2 mg / ml (3-7 ml / h) of ropivacaine. Group B: epidural analgesia: 40 mg of 2% lidocaine solution when placing a venous catheter, in the postoperative - 2 mg / ml (3-7 ml / h) ropivacaine. Group C: according to the concept of pre-emptive analgesia, patients received 1000 mg of paracetamol intravenously 1 hour before incision and of 50 mg of dexketoprofen intravenously. Group D: Without pre-emptive analgesia and epidural analgesia. The severity of the pain syndrome was assessed using a numerical rating scale (NRS) after 3, 6, 12, 24 and 32 hours.Results and discussion. No statistically significant differences were observed in the subgroups by age, body weight, duration of surgery and blood loss (p> 0.05). Patients in group A did not require additional morphine analgesia and reported lower pain intensity using NRS. After 32 hours, the data were significantly different from groups B, C, and D (p <0.05). There was no significant difference between groups B and C in the assessment of the NRS (p <0.05), but in the group C only one patient required additional morphine analgesia.Conclusion. The effectiveness of the combination of pre-emptive analgesia and epidural analgesia indicates sufficient level of analgesia in patients after lung surgery. A multimodal approach to perioperative analgesia for patients undergoing thoracic surgery without epidural analgesia reduces opioid use compared to epidural analgesia alone.

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Resume. The issue of open visits to intensive care units is currently a topical, acute and ambiguous issue. In Ukraine, it is actively discussed in the media, social networks, the medical community. Appropriate working groups of the Ministry of Health are being set up to optimize the regulatory framework on this issue.The article reviews the literature on the problems of open visits of adult patients undergoing treatment in the intensive care unit. Opinions on this issue are quite contradictory. On the one hand, there is a position that the stay of relatives in the ICU 24/7 improves the results of treatment, creating a more comfortable psychological atmosphere for the patient. On the other hand, and this approach prevails, a number of studies indicate an increase in the number of bacterial complications in patients with unlimited visits, complication of working conditions of medical staff, which leads to a deterioration in treatment outcomes in general.Public organization «Association of Anesthesiologists of Ukraine» conducted an online survey among anesthesiologists - members of the association for find out the opinion of Ukrainian experts about open visits to ICU’s patients. Most of the anesthesiologists surveyed are inclined to a limited visitation regime.