Background and Goal of Study: Fluid resuscitation is a critical component of early management in patients with septic shock. The 2021 Sepsis Surviving Campaign (SSC) guidelines recommend administering 30 mL/kg of balanced crystalloids within the first 3 hours of diagnosis. However, this standard approach does not fully align with the principles of personalized medicine.
This study aimed to investigate whether dynamic hemodynamic assessment methods can individualize fluid therapy during the early phase of septic shock.
UDC 616–089.5:253.1(477.63)
Abstract. This year, the Department of Anesthesiology and Intensive Care of the Danylo Halytsky Lviv National Medical University celebrates its 50th anniversary. The development of classical anesthesiology began almost two centuries ago with the invention of ether. At the beginning of this path, surgeons, dentists, obstetricians stood, who needed anesthesia in their daily practice. Classical anesthesiology as a profession and science is less than 100 years old. The anesthesiology community of the world remembers its titans, it is easy to find publications about their life and scientific way. It is important to popularize the great figures of Ukrainian history, especially during this historical period. Ivan Dmytrovych Tymchuk, who stood at the origins of teaching anesthesiology in 1965 within the Department of Thoracic Surgery, is one of such people. The emergence of the Department of Anesthesiology was
preceded by the selfless and long-term work of enthusiasts and highly qualified doctors with broad erudition. On January 28, 1975, the Department of Anesthesiology and Resuscitation of the Faculty of Postgraduate Education of the Lviv State Medical Institute was organized. The first head of the Department was professor Ivan Dmytrovych
Tymchuk. His enthusiasm and energy became the driving force behind the creation of the history of the Department, the training of anesthesiologists, and scientists. This article is dedicated to the bright memory of Ivan Dmytrovych, a talented scientist, teacher, organizer of the anesthesia service, patriot, and a man of a generous soul and extraordinary principles.
Keywords: anesthesiology and intensive care; history of the Department; anniversary
Однією з основних проблем у відділеннях анестезіології та інтенсивної терапії є дефіцит енергії у пацієнтів. З метою її вирі-шення критичним пацієнтам призначається парентеральне харчування, в складі якого містяться жирові емульсії. Відомо, що есенціальні жирні кислоти у складі жирових емульсій можуть проявляти як прозапальні (лінолева кислота), так і протиза-пальні (ліноленова кислота) ефекти. З метою зниження впливу на імунну систему рекомендується використання альтерна-тивних жирових емульсій, оскільки це може забезпечити кращі клінічні результати. Перше покоління жирових емульсій скла-далося з соєвої олії, проте було доведено, що вона може підвищувати ризик гнійно-септичних ускладнень. У складі жирових емульсій другого покоління з’явилися середньоланцюгові тригліцериди, метаболізм яких може призвести до ацидозу, тому їх використання обмежене, особливо, у пацієнтів з цукровим діабетом. Жирові емульсії третього покоління містять оливкову олію, яка знижує ризик тромбозу, вважається імунонейтральною та є менш чутливою до перекисного окислення ліпідів. До складу жирових емульсій четвертого покоління входить риб’ячий жир, який володіє протизапальними властивостями і може зменшити тривалість перебування пацієнтів у критичному стані. Найперспективніше застосовувати збалансовані жири, серед яких в Україні наявний СМОФліпід 20%. Доведено, що для хворих, які потребують парентерального харчування, жирові емульсії є невід’ємною його частиною, а хворим у критичному стані рекомендують використовувати жирові емульсії, які містять риб’ячий жир. Проте, перед призначенням рекомендовано оцінювати вихідний рівень тригліцеридів. Зважаючи на все вищесказане можна зробити висновок, що ліпіди забезпечують доставку жирних кислот, які впливають на важливі процеси організму, серед яких метаболізм, імунна відповідь, згортання крові. Альтернативні жирові емульсії можуть бути кращим джерелом енергії, проявляючи також антиоксидантний вплив та менше пригнічення імунітету.
UNITOne of the main problems in the departments of anesthesiology and intensive care is the lack of energy in patients. In order to solve it, parenteral nutrition, which contains fat emulsions is prescribed for critical patients. It is known that fat emulsions consist of essential fatty acids which can have both pro-inflammatory (linoleic acid) and anti-inflammatory (linolenic acid) effects. In order to reduce the impact on the immune system, the use of alternative fat emulsions is recommended, as this may provide better clinical results. The first generation of fat emulsions consisted of soybean oil, but it was proven that this oil can increase the risk of purulent-septic complications. Second-generation fat emulsions contain medium-chain triglycerides, the metabolism of which can lead to acidosis, so their use is limited, especially in patients with diabetes. Third-generation fat emulsions contain olive oil, which reduces the risk of thrombosis, is considered immunoneutral and less sensitive to lipid peroxidation. Fourth-generation fat emulsions contain fish oil, which has anti-inflammatory properties and can reduce the duration of patients staying in critical condition. The most promising is the usage of balanced fats, among which there is a 20% SMOFlipid available in Ukraine. For patients who require parenteral nutrition, fat emulsions are an integral part of it, and for critically ill patients fat emulsions containing fish oil are recommended. However, it is recommended to assess baseline triglycerides prior to administration. Thus, lipids provide the delivery of fatty acids that affect important body processes, including metabolism, immune response, blood clotting. Alternative fat emulsions can be a better source of energy, also showing antioxidant effects and less suppression of immune system.
Secondary post-traumatic and post-operative pain is a problem that is increasingly encountered by medical professionals in Ukraine today in the conditions of war. Chronic pain is an independent nosological unit, which is a severe complication of many performed surgical procedures. Сhronic pain as a result of surgical interventions occurs up to 10% of patients. It develops significantly often after amputations (50–85%), thoracotomies (5–65%), cardiosurgical interventions (30–55%), and chest surgeries (20–50%). Long-term post-operative pain is one of the primary, mostly unrecognized clinical problems.
It can be assumed that patients whose wounds do not heal in time have a predisposition to the development of secondary chronic pain. The long healing process of the wound surface is directly related to the following features: the wound microbiota, the resistance of microorganisms to antibiotics, the group of antibacterial agents chosen for treatment and the duration of exposure to the drug.
Understanding the interaction between microorganisms and the sensory systems of neurons can reveal more information for the putative pain mechanisms study.
In recent years, much attention has been paid to studying the concept of pain sensitization. Inflammation and nerve damage contribute to increased pain signaling, stimulating wound hyperalgesia. These processes can directly affect the formation of long-term post-operative pain.
Among the key problematic factors that contribute to the appearance of remote peripheral neuropathy, the duration of administration, increased dosage, and possible combinations of antimicrobial drugs should be highlighted, as well as the persistence and exacerbating of manifestations of local inflammation with the participation of resistant opportunistic bacteria that colonize the lesion and can directly produce metabolites vital activities, pathogenicity factors with pro-inflammatory properties. This allows us to assume a significant role of persistence in the primary lesion of antibiotic-resistant opportunistic bacteria, as well as antibiotic therapy as a delayed iatrogenic factor, as predictors of the formation of chronic pain syndrome in the wounded.