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The role of extraglottic devices in securing the airways on the battlefield was not be completely clear althought theirs routine use in operating theaters or pre-hospital care. Only in the last decade has their position in the field become clearer, and it seems that if we choose a specific group of wounded soldiers, it is become important devices to securing the airways. [ABSTRACT FROM AUTHOR]

Adequate oxygenation and maintaining the patent airway are one of the key factors for patient survival in prehospital care. The main difference against the operating room is the environment of the accident and experience with the qualification of the provider. Basic techniques include the use of manual maneuvers for opening the airway, bag-mask ventilation, and insertion of the oropharyngeal or nasopharyngeal airways. Advanced techniques involve the insertion of a supraglottic airway device and tracheal intubation. Surgical cricothyrotomy is indicated only in a small number of patients and in the battlefield medicine. Tracheal intubation still remains a method of choice when performed by experience provider, for the unconscious victims and resuscitation in out-of-hospital cardiac arrest. Special tools such as gum elastic bougie or videolaryngoscopes are employed to increase the success rate of out of hospital tracheal intubation. Supraglottic airway devices inserted in prehospital care include laryngeal mask airways, i-gel, and laryngeal tube. [ABSTRACT FROM AUTHOR]

Background: Diaphragm atrophy and dysfunction is a major problem among critically ill patients on mechanical ventilation. Ventilator-induced diaphragmatic dysfunction is thought to play a major role, resulting in a failure of weaning. Stimulation of the phrenic nerves and resulting diaphragm contraction could potentially prevent or treat this atrophy. The subject of this study is to determine the effectiveness of diaphragm stimulation in preventing atrophy by measuring changes in its thickness., Methods: A total of 12 patients in the intervention group and 10 patients in the control group were enrolled. Diaphragm thickness was measured by ultrasound in both groups at the beginning of study enrollment (hour 0), after 24 hours, and at study completion (hour 48). The obtained data were then statistically analyzed and both groups were compared., Results: The results showed that the baseline diaphragm thickness in the interventional group was (1.98 ± 0.52) mm and after 48 hours of phrenic nerve stimulation increased to (2.20 ± 0.45) mm (p=0.001). The baseline diaphragm thickness of (2.00 ± 0.33) mm decreased in the control group after 48 hours of mechanical ventilation to (1.72 ± 0.20) mm (p<0.001)., Conclusions: Our study demonstrates that induced contraction of the diaphragm by pacing the phrenic nerve not only reduces the rate of its atrophy during mechanical ventilation but also leads to an increase in its thickness - the main determinant of the muscle strength required for spontaneous ventilation and successful ventilator weaning., Trial Registration: The study was registered with ClinicalTrials.gov (18/06/2018, NCT03559933, https://clinicaltrials.gov/ct2/show/NCT03559933 )., (© 2021. The Author(s).)

Objectives: Maintaining diaphragm work using electrical stimulation during mechanical ventilation has been proposed to attenuate ventilator-induced diaphragm dysfunction. This study assessed the safety and feasibility of temporary percutaneous electrical phrenic nerve stimulation on user-specified inspiratory breaths while on mechanical ventilation., Design: Two-center, nonblinded, nonrandomized study., Setting: Hospital ICU., Patients: Twelve patients mechanically ventilated from 48 hours to an expected 7 days., Interventions: Leads were inserted to lie close to the phrenic nerve in the neck region using ultrasound guidance. Two initial patients had left-sided placement only with remaining patients undergoing bilateral lead placement. Percutaneous electrical phrenic nerve stimulation was used for six 2-hour sessions at 8-hour intervals over 48 hours., Measurements and Main Results: Data collected included lead deployment success, nerve conduction, ventilation variables, work of breathing, electrical stimulation variables, stimulation breath synchrony, and diaphragm thickness measured by ultrasound at baseline, 24, and 48 hours. Primary endpoints included ability to capture the left and/or right phrenic nerves and maintenance of work of breathing within defined limits for 80% of stimulated breaths. Lead insertion was successful in 21 of 22 attempts (95.5%). Analysis of 36,059 stimulated breaths from 10 patients with attempted bilateral lead placement demonstrated a mean inspiratory lag for phrenic nerve stimulation of 23.7 ms (p < 0.001 vs null hypothesis of <88ms). Work of breathing was maintained between 0.2 and 2.0 joules/L 96.8% of the time, exceeding the 80% target. Mean diaphragm thickness increased from baseline by 7.8% at 24 hours (p = 0.022) and 15.0% at 48 hours (p = 0.0001) for patients receiving bilateral stimulation after excluding one patient with pleural effusion. No serious device/procedure-related adverse events were reported., Conclusions: The present study demonstrated the ability to safely and successfully place percutaneous electrical phrenic nerve stimulation leads in patients on mechanical ventilation and the feasibility of using this approach to synchronize electrical stimulation with inspiration while maintaining work of breathing within defined limits.

Introduction: Although several techniques of laparoscopic left pancreatectomy have already been developed through experiments on animals and human patients, there is still insufficient information about their pathophysiological mechanisms, especially the impact on surgical stress., Method: In a group of 10 pigs, open left pancreatectomy was performed, and the other group of 10 pigs underwent laparoscopic left pancreatectomy. Postoperative stress was compared by determining serum levels of leukocytes, interleukin 1, 6 and CRP from peripheral venous blood collection. The blood was collected prior to incision, 1 and 2 hours after incision, 24 hours after the beginning of the procedure, and on the 7th postoperative day., Results: No statistically significant difference was found between open and laparoscopic left pancreatectomy in the measured values of leukocytes, IL-1 and 6 and CRP.Key words: laparoscopy - left pancreatectomy surgical stress response interleukin 1 interleukin 6.