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Background: 
High-flow nasal cannulae (HFNC) create positive oropharyngeal airway pressure but it is unclear how their use affects lung volume. Electrical impedance tomography (EIT) allows assessment of changes in lung volume by measuring changes in lung impedance. Primary objectives were to investigate the effects of HFNC on airway pressure (Paw) and end-expiratory lung volume (EELV), and to identify any correlation between the two. Secondary objectives were to investigate the effects of HFNC on respiratory rate (RR), dyspnoea, tidal volume and oxygenation; and the interaction between body mass index (BMI) and EELV.

Methods: 
Twenty patients prescribed HFNC post-cardiac surgery were investigated. Impedance measures, Paw, PaO2/FiO2 ratio, RR and modified Borg scores were recorded first on low flow oxygen (nasal cannula or Hudson face mask) and then on HFNC.

Results: A strong and significant correlation existed between Paw and end-expiratory lung impedance (EELI) (r=0.7, p<0.001). Compared with low flow oxygen, HFNC significantly increased EELI by 25.6% (95% CI 24.3, 26.9) and Paw by 3.0 cmH2O (95% CI 2.4, 3.7). RR reduced by 3.4 breaths per minute (95% CI 1.7, 5.2) with HFNC use, tidal impedance variation increased by 10.5% (95% CI 6.1, 18.3) and PaO2/FiO2 ratio improved by 30.6 mmHg (95% CI 17.9, 43.3). HFNC improved subjective dyspnoea scoring (p=0.023). Increases in EELI were significantly influenced by BMI, with larger increases associated with higher BMIs (p<0.001).

Conclusions: 
This study suggests that HFNC improve dyspnoea and oxygenation by increasing both EELV and tidal volume, and are most beneficial in patients with higher BMIs.

Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients

Modern concepts of pain mechanisms

BACKGROUND: The use of lidocaine in the scheme of multimodal anesthesia in order to reduce doses of opioids in comparison with traditional anesthesia and the possibility of influencing various links in the pathogenesis of pain is a promising direction in modern cardioanesthesiology. 
AIM: This study evaluates the effectiveness of intravenous infusion of lidocaine as a component of multimodal analgesia and its effect on the postoperative period in children under one year of age after surgical correction of congenital heart defects. 
MATERIALS AND METHODS: The prospective comparative study included 81 cardiac surgery patients aged 0 to 1 year. All patients underwent open cardiac surgery by a cardiopulmonary bypass from January 2019 to April 2021. The patients were divided into two groups: the first (n = 40) included patients receiving intravenous lidocaine as a component of multimodal analgesia in the postoperative period, and the second, control (n = 41) patients who were not prescribed lidocaine. 
RESULTS: : In patients receiving lidocaine infusion, the need for opioids was significantly lower (p 0.001), which is also associated with a shorter mechanical ventilation time (p = 0.03). The cortisol levels and most laboratory parameters (the concentration of glucose, lactate, albumin, C-reactive protein, and the level of leukocytes and lymphocytes) in the two patient groups did not differ. Clinical indicators reflecting intestinal paresis development (the appearance of peristalsis, the onset of enteral nutrition, the rate of its increase, and the time when the patient receives the total amount of food only enterally) also did not differ between the groups. No side effects of lidocaine infusion were reported. There were no deceased patients in any of the study groups. 
CONCLUSIONS: Intravenous infusion of lidocaine as a component of multimodal analgesia after heart surgery in children has an additional opioid-saving effect and shortens the mechanical ventilation time. It is not accompanied by the development of side effects and does not affect the restoration of gastrointestinal functions.

Intravenous infusion of lidocaine as a component of multimodal analgesia in children under one year of age after cardiac surgery

A review of domestic and foreign literary sources on the problem of assessing pain syndrome (PS) in clinical practice was carried out. Chronic PS (CPS) poses a problem not only for the patient, but also for the attending physician, since it is more difficult to describe and evaluate in comparison with acute heart disease, and it is also more difficult to treat with pharmacotherapy. CPS is not a symptom of the underlying disease, but a separate complex symptom complex. PS remains one of the main problems in medicine; in connection with this, the development of new methods that allow an adequate assessment of the intensity of pain, taking into account the characteristics of a particular patient, is currently an urgent issue. All existing methods, from questionnaires to the latest instrumental methods for assessing pain, have certain advantages and disadvantages, but none of them can sufficiently fully objectify pain sensations. This indicates the importance of finding a solution to this problem – improving objective methods for assessing PS. 

The problem of pain syndrome in clinical practice

Adequate postoperative pain management remains a challenge. We discuss pathophysiology of pain after cardiac surgery and describe in detail multimodal and regional anesthesia, their advantages and disadvantages.

Analgesia in Patients After Coronary Artery Bypass Grafting

High flow oxygenation in acute respiratory distress syndrome: possibilities and perspectives

Непрерывный мониторинг гемоглобина методом пульсовой оксиметрии после кардиохирургических вмешательств

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High flow oxygenation in acute respiratory distress syndrome: possibilities and perspectives

Непрерывный мониторинг гемоглобина методом пульсовой оксиметрии после кардиохирургических вмешательств