Under conditions of wide increased resistance of pathogens of infectious complications to antimicrobial agents, a considerable attention is paid to the use of antiseptic drugs. The research of their ...antimicrobial efficacy remains valid for substantiation of the rational use. The purpose was to carry out a comparative study of the antimicrobial efficacy of medicinal antiseptic agents based on decamethoxine and povidone-iodine.
In the study there was examined antimicrobial activity of mentioned antiseptics against 682 clinical strains of microorganisms (A. baumannii, S. aureus, P. aeruginosa, Enterococcus spp., E. coli, Enterobacter spp., K. pneumoniae, Proteus spp.), isolated from patients with infectious complications. Minimum inhibitory and bactericidal concentrations of 1–2– 10 % iodine, 0.02 % decamethoxine (decasan) were determined. Antimicrobial efficacy of medicines, based on studied antiseptics was evaluated with the use of an index of antiseptic activity, calculated by means of commonly used methods.
The study revealed high bactericidal properties of decasan against clinical strains of S. aureus, Enterococcus spp., E. coli, K. pneumoniae and Enterobacter spp. The advantages of antimicrobial activity of decamethoxine-based antseptis (decasan, p < 0.001) were proved. Iodine has expressed antimicrobial properties against Enterococcus spp., S. aureus, A. baumannii, bacteria of the Enterobacteriаcеae family and P. aeruginosa. It is proven that the dissolution of povidone-iodine leads to the reduction of the antimicrobial efficacy of 2 % antiseptic solution. There was found inefficacy of 1 % povidone-iodine against infectious agents (p < 0.001).
Thus, the leading Gram-positive (S. aureus, Enterococci) and Gram-negative pathogens (Escherichia, Klebsiella, Enterobacteria, Acinetobacteria, Pseudomonas) have a sensitivity to iodine and to domestic preparation based on decamethoxin 0.02 % (decasan), with a definite advantage of the antimicrobial properties of the latter to Gram-positive and some Gram-negative microorganisms (p < 0.001).
Today surgical site infections (SSIs) remain the second among hospital acquired infections in Europe and the USA.
Staphylococcus aureus
as a pathogen of nosocomial infections occur more frequently in ...surgical hospitals. The work was aimed to establish the effect of local anesthetics against planktonic forms and biofilm-formation of
S. aureus
clinical strains and the relationship between the sensitivity of
S. aureus
strains to local anesthetics and antiseptics
in vitro
. The antimicrobial activity of local anesthetics (0.5%, bupivacaine, 2.0% lidocaine, 0.375% ropivacaine) and antiseptics (decamethoxine 0.02%, chlorhexidine 0.05%) against clinical strains of
S. aureus
was observed and studied their ability to produce biofilms. The antimicrobial effect of local anesthetics was lower compared to antiseptics, but we observed inhibition of growth and reproduction of
S. aureus
in their presence. The ropivacaine solution and the lidocaine solution demonstrated almost the same activity against the studied microorganism isolates. Along with this, bupivacaine solution had the highest activity against the studied microorganisms. The minimal inhibitory concentration of bupivacaine for
S. aureus
was 2.2 times lower than the minimal inhibitory concentration of lidocaine and 2.1 times lower than the minimal inhibitory concentration of ropivacaine significantly (
p
< 0.05). Scientific research on various aspects of the formation of bacterial biofilms is a relevant area that will change approaches to the prophylaxis and treatment of a number of infections, including SSIs.
The article analyses the state of the aviation industry in Ukraine during the first years of the Soviet regime in January-March 1918 and its policies in this sphere. The establishment of the Soviet ...regime in Ukraine during this period was the result of offensive actions by Bolshevyk and pro-Bolshevyk troops against the Ukrainian People’s Republic. Therefore, the Soviet regime had transient nature in Ukraine amidst the unfinished First World War. In these settings, it established a management system in the field of aviation, which was aimed at auditing and evacuating aviation property and personnel. The study found that the aviation industry in Ukraine functioned quite efficiently in general and was manageable despite the difficulties of the revolutionary times. In this work, the authors used archival documents, which were first introduced into circulation. The socio-economic and political conditions, this industry operated in, were taken as a basis for the analysis of the aviation industry status in Ukraine. During this period of the First World War, warfare on the Eastern Front had its final phase, and peace talks were held in Brest-Litovsk, in which delegations of the Ukrainian People’s Republic and the Soviet Russia took part. Since the conclusion of the armistice on December 10, 1917 between Soviet Russia and the countries of the Quadruple Alliance, a state of chaos has spread across the territory of Ukraine, which was associated with the mass movement of soldiers back from the front. Social chaos intensified as the Soviet authorities gained control over almost entire territory of the Ukrainian People’s Republic. However, some air force units were able to maintain their material base. The Soviet regime was able to audit their condition and restore control over the available resources in the aviation industry, however, the facts of theft of goods, which belonged to these air force units was also established. Attempts were made to form an effective management system of the aviation industry and its scheme started to be developed. However, due to the political situation, these attempts were in vain. As early as the beginning of March 1918, Bolshevyk troops have been losing ground of most of Ukraine to the UPR troops and their allies, i.e., the German-Austrian troops. The short period of attempts to build a management system of the aviation industry by the Soviet regime in extreme military-political conditions is quite interesting, as it demonstrates approaches to the effective management of the high-tech sphere in a difficult situation.
The use of medicated procedural sedation in ambulatory surgery and in intensive care units has become popular due to increased treatment options for the doctor and increased comfort for the patient. ...The purpose of this literature review is to highlight studies reporting the efficacy and safety of midazolam as a sedative in adults and children for procedural sedation.
Adequate perioperative pain relief is an integral part of anesthesia. Opioid analgesics occupy one of the key places in the purchase of acute and chronic pain in the world. The article presents ...current data on the clinical effectiveness of remifentanil, a derivative of fentanyl, which is a selective ultra-short-acting μ-opioid receptor agonist when used in the perioperative period for the treatment of acute and chronic pain. Comparisons of the therapeutic activity and physicochemical properties, pharmacokinetic and pharmacodynamic characteristics of remifentanil with other opioids (fentanyl, sufentanil, alfentanil) are provided. Its unique properties (eg, organ function-independent metabolism, non-accumulation, rapid onset of action, and short duration of action) distinguish it from other opioid agents. Remifentanil is at least as effective as comparator opioids such as fentanyl, sufentanil in relieving pain and sedating patients during the perioperative period. In addition, it provides rapid and predictable extubation and is associated with shorter duration of mechanical ventilation and shorter length of hospitalization than comparators in some studies. In addition, remifentanil is well tolerated in both adults and children. Thus, remifentanil is a desirable addition to currently available pharmacologic agents used to treat period pain in patients
Адекватне періопераційне знеболювання є невід’ємною частиною ведення анестезії. Опіоїдні анальгетики посідають одне з ключових місць у купіруванні гострого та хронічного болю у світі. Враховуючи велику кількість побічних дій та розвиток гіпералгезії/ толерантності до опіоїдних аналгетиків, нині розробляється багато методик безопіоїдної або малоопіоїдної анестезії. У статті наводяться сучасні дані клінічної ефективності реміфентанілу — похідного препарату від фентанілу, який є селективним агоністом μ-опіоїдних рецепторів ультракороткої дії при використанні у періопераційний період для лікування гострого та хронічного болю. Наводяться порівняння терапев тичної активності та фізико-хімічних властивостей, фармакокінетичних і фармакодинамічних особливостей реміфентанілу з іншими опіоїдами (фентанілом, суфентанілом, алфентанілом). Його унікальні властивості (наприклад, незалежний від функції органів метаболізм, відсутність накопичення, швидкий початок дії та короткочасна дія) відрізняють його від інших опіоїдних агентів. Реміфентаніл є принаймні таким само ефективним, як і опіоїди порівняння, такі як фентаніл, суфентаніл, щодо полегшення болю та седації у пацієнтів в періопераційний період. Крім того, він забезпечує швидку та передбачувану екстубацію, а також асоціюється з меншою тривалістю ШВЛ і скороченням тривалості госпіталізації, ніж препарати порівняння в деяких дослідженнях. Крім того, реміфентаніл загалом добре переноситься як дорослими, так і в дитячому віці. Таким чином, реміфентаніл є бажаним доповненням до наявних на даний момент фармакологічних засобів, які використовуються для лікування болю у пацієнтів в періопераційний період.
Although numerous clinical guidelines for pain management have been published over the past decade, inadequate pain relief remains a major public health problem. Currently, several methods of ...analgesia are available for the treatment of acute pain, including intravenous analgesia, epidural anesthesia, and oral administration of medications. However, the existing methods of analgesia still do not cover all the needs of proper analgesia, the search for new forms of release, methods of administration and methods of analgesia continues. Currently, non-invasive methods of analgesia are being actively implemented, which include a transdermal delivery system of analgesics (in particular, fentanyl hydrochloride), intranasal and inhalational analgesia, in which the delivery of analgesics is controlled by both the doctor and the patient. The purpose of this article is to review the inhaled analgesic methoxyflurane, which is administered by means of an individual inhaler and is used for the treatment of acute pain.
The use of medicated procedural sedation in ambulatory surgery and in intensive care units has become popular due to increased treatment options for the doctor and increased comfort for the patient. ...The purpose of this literature review is to highlight studies reporting the efficacy and safety of midazolam as a sedative in adults and children for procedural sedation.
Enhanced Recovery After Surgery (ERAS) protocols are increasingly used in the perioperative period around the world. The concept of goal-directed fluid therapy (GDT) is a key element of the ERAS ...protocols. Inadequate perioperative infusion therapy can lead to a number of complications, including the development of an infectious process, namely surgical site infections, pneumonia, urinary tract infections. Optimal infusion therapy is difficult to achieve with standard parameters (e.g., heart rate, blood pressure, central venous pressure), so there are various methods of monitoring central hemodynamics – from invasive, minimally invasive to non-invasive. The latter are increasingly used in clinical practice. The current evidence base shows that perioperative management, specifically the use of GDT guided by real-time, continuous hemodynamic monitoring, helps clinicians maintain a patient’s optimal fluid balance. The manuscript presents the analytical data, which describe the benefits and basic principles of perioperative targeted infusion therapy based on central hemodynamic parameters to reduce the risk of complications.
Introduction. Nosocomial infections are risk factors associated with in-hospital mortality. Among other factors, these infections are strongly associated with invasive devices. In pediatric patients, ...a central venous catheter (CVC) is one of the most common causes of catheter-related bloodstream infection (CRBSI).
Background. To investigate the effectiveness of antimicrobial chlorhexidine dressings compared with standard dressings in the prevention of central venous catheter-related bloodstream infections.
Methods. 20 children who were treated in the intensive care unit were randomly divided into two groups of 10: a group that used chlorhexidine dressings and a group that used standard dressings (comparison group). Patient care was carried out in accordance with asepsis and antisepsis rule. The primary outcomes were a comparative study of microbiological researches of peripheral blood blood culture and catheter blood sample. But the final results were cultures from the tip of the catheter (at least 5 cm) after removal of the catheter in case of clinical symptoms of KAIK or in case of planned removal of the catheter due to the lack of its further need.
Results. Catheter colonization occurred in 3 patients in the control group (3 %) and in 2 patients in the chlorhexidine dressing group (2 %). Catheter-related bloodstream infections occurred in 3 patients in the control group (3%), and in patients in the chlorhexidine group, no microorganisms were isolated by microbiological examination of the implantation sites (0 %). Although more patients in the comparison group had catheter-related bloodstream infections, the difference in infection rates between the two groups was insignificant (P = 0.07).
Conclusions. The use of chlorhexidine-impregnated dressings reduced the incidence of catheter-related bloodstream infections, contamination, colonization, and local catheter infection in the pediatric intensive care unit, but there was no significant difference compared with the use of standard dressings. This study needs further study in pediatric patients.
The aim of this study was to evaluate the hemodynamic protective effects of perioperative ventilation in pressure-controlled ventilation (PCV) and adaptive support ventilation (ASV) modes based on ...non-invasive hemodynamic monitoring indicators.
The study included 32 patients who were scheduled for planned open abdominal surgery. Depending on the chosen ventilation strategy, patients were included in two groups of PCV mode ventilation (n=14) and ASV mode ventilation (n=18). The hemodynamic effects of the ventilation strategies were assessed by estimated continuous cardiac output (esCCO) and cardiac index (esCCI).
Preoperative cardiac output (CO) was 6.1±1.3 L/min in group 1 patients and 6.3±0.8 L/min in group 2 patients, and preoperative cardiac index (CI) was 3.9±0.4 L/min/m2 in group 1 patients and 3.8±0.8 L/min/m2 in group 2 patients. The ejection fraction (EF) in group 1 subjects was 55.4%±0.3%; this rate was 56.5%±0.5% in group 2 subjects. Group 1 patients experienced a 14.7% CO decrease to 5.2±0.7 L/min, a 17.9% CI decrease to 3.2±0.6 L/min/m2 , and a 12.8% mean arterial pressure decrease to 82.3±9.4 mm Hg 30 minutes after the start of surgery. One hour after the start of surgery, the CO mean values of group 2 patients were lower than baseline by 7.9% and differed from the dynamics of patients in group 1, in whom CO was lower than baseline by 13.1%. At the end of the operation, the CO values were lower than baseline by 11.5% and 6.3% in patients of groups 1 and 2, respectively. Our data showed that the changes in EF during and after surgery correlated with CO indicators determined by the esCCO.
In our study, perioperative ventilation in ASV mode was more protective than PCV mode and was characterized by lower tidal volume (16.2%) and driving pressure (12.1%). Hemodynamically-controlled mechanical ventilation reduces the negative impact of cardiopulmonary interactions.
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