Abstract Book SRATI 2016

The 42nd Congress of the Romanian Society
of Anaesthesia and Intensive Care

The 10th Romanian-French Congress
Romanian Journal of
ANAESTHESIA
AND INTENSIVE CARE
Volume 23
supplement 1
May 2016
ISSN 2392-7518
The 8th Romanian-Israeli Symposium on

Updates in Anaesthesia and Intensive Care
The 15th Congress of Anaesthesia
and Intensive Care Nurses
The 3rd Symposium of the Romanian and Moldavian
Societies of Anaesthesia and Intensive Care
May 11th - 15th, 2016

International Conference Center
Sinaia, Romania
ROMANIAN JOURNAL OF
ANAESTHESIA AND INTENSIVE CARE
Volume 23, supplement 1, May 2016
SRATI 2016 Abstract Book

11 - 15 May 2016
International Conference Center
Sinaia, Romania
Editorial office:
Clinica ATI, Str. Croitorilor 19-21, Cluj-Napoca
Phone: 0264-433 969
Fax: 0264-433 335
E-mail: iacalovschi@hotmail.com, editor.jrati@gmail.com
ISSN: 2392-7518
The 42nd Congress of the Romanian Society

The 10th Romanian-French Congress
The 8th Romanian-Israeli Symposium
on Updates in Anaesthesia and
Intensive Care
The 15th Congress of Anaesthesia
and Intensive Care Nurses
The 3rd Symposium of the Romanian
and Moldavian Societies of Anaesthesia
and Intensive Care
SCIENTIFIC ABSTRACTS
Conferine Sesiuni Medici

Conferences Physicians sessions____________________________________________________
Ghidurile consiliului european de resuscitare 2015

2015 ERC resuscitation guidelines
Carmen Diana Cimpoeu
Universitatea de Medicin i Farmacie Gr. T. Popa, Unitatea Primire Urgene UPU-SMURD, Iai,
Romnia
Cunotinele i practica n resuscitarea cardiopulmonar evolueaz constant. Stopul cardiac este cea
mai mare urgen pentru care n octombrie 2015 au fost publicate noile ghiduri de resuscitare
cardiopulmonar (RCP) ale Consiliului European de Resuscitare, ca urmare a mbuntirii, pe baza
studiilor recente, a recomandrilor din octombrie 2010.
Prezentm cteva din noutile ghidului:
1. Dispecerii medicali de urgen au un rol important n diagnosticul precoce al opririi cardiace, n
oferirea indicaiilor de resuscitare la telefon i indicarea celui mai apropiat defibrilator automat
extern.
2. Sublinierea permanent a importanei ntreruperilor minime ale compresiunilor toracice de bun
calitate n cursul ALS, cu pauze foarte scurte pentru intervenii specifice, cum ar fi ntreruperea de 5
secunde pentru defibrilare.
3. Sublinierea importanei utilizrii padelelor autoadezive pentru defibrilare i a unei strategii de
defibrilare cu minimizarea pauzei pre-oc.
4. Introducerea unei noi seciuni de monitorizare n timpul ALS cu utilizarea undelor de capnografie
pentru confirmarea corectitudinii intubaiei traheale, a calitii resuscitrii i identificrii precoce a
rentoarcerii circulaiei spontane.
5. Transportul ctre spital cu manevre de RCP n curs al pacienilor selectai cu acces la laboratorul de
cateterism i realizarea interveniei coronarografiei percutane n timpul RCP.
6. Managementul intit al temperaturii postresuscitare rmne important, dar noua opiune este
temperatura central de 36C n locul recomandrilor anterioare de 32-34C.
7. Prognosticul este apreciat printr-o strategie multimodal, iar revenirea neurologic se va aprecia
dup o perioad suficient de timp.
The knowledge and practice in cardiopulmonary resuscitation is evolving constantly. The cardiorespiratory arrest is the most serious emergency, for which, in October 2015, the Cardio-pulmonary
Resuscitation Guidelines of the European Resuscitation Council (ERC) was issued, as a result of the
improved recommendations released in October 2010.
We present some new elements:
1. The emergency medical dispatcher plays an important role in the early diagnosis of cardiac arrest,
the provision of dispatcher-assisted CPR and the location and dispatch of an AED.
2. Continued emphasis on minimally interrupted high-quality chest compressions throughout any ALS
intervention: chest compressions are paused briefly only to enable specific interventions, minimising
interruptions in chest compressions for less than 5 s to attempt defibrillation.
3. Keeping the focus on the use of self-adhesive pads for defibrillation and a defibrillation strategy to
minimise the preshock pause.
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Centrul Internaional de Conferine International Conferece Center
Sinaia
Conferine Sesiuni Medici

Conferences Physicians sessions____________________________________________________
4. There is a new section on monitoring during ALS with an increased emphasis on the use of waveform
capnography to confirm and continually monitor tracheal tube placement, quality of CPR and to provide
an early indication of return of spontaneous circulation.
5. Transport with continuing CPR may be beneficial in selected patients where there is immediate
hospital access to the catheterisation laboratory and experience in percutaneous coronary intervention
(PCI) with ongoing CPR.
6. Targeted temperature management remains important but there is now an option to target a
temperature of 36C instead of the previously recommended 3234C.
7. Prognostication is now undertaken using a multimodal strategy and there is emphasis on allowing
sufficient time for neurological recovery.
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Conferine Sesiuni Asisteni

Conferences Nurses sessions____________________________________________________
Managementul anesteziei n Chimioterapia Hipertermic Intraperitoneal

Anaesthesia management in Hyperthermic Intraperitoneal Chemotherapy
Mariana Corina Haut (1), Ioana Grigora (2)
(1) Institutul Regional de Oncologie, Secia de Anestezie i Terapie Intensiv, Iai, Romnia
(2) Universitatea de Medicin i Farmacie Gr. T. Popa, Secia de Anestezie i Terapie Intensiv, Iai,
Romnia
Introducere: Intervenia CHIP - HIPEC este una dintre procedurile cele mai complexe din chirurgia
abdominal i presupune, n prim faz, ndeprtarea chirurgical a tuturor maselor tumorale
abdominale urmat, n faza a doua, de instilarea n abdomen a soluiei cu citostatic, la temperatur de
41-42 grade C, prin intermediul unui sistem de tubulaturi tip lavaj - drenaj i a unei pompe de circulaie
extracorporeal care recircul citostaticul, meninnd, n acelai timp, o temperatur constant de 41
- 42 grade C. Durata i complexitatea procedurii reprezint o provocare att pentru echipa de chirurgi,
ct i pentru cea de anestezie.
Obiective: Identificarea riscurilor intra i post-operatorii determinate de alterrile fizio-patologice
importante ce pot aprea n desfurarea acestei intervenii agresive precum i prezentarea msurilor
de meninere a statusului hemodinamic, hematologic, metabolic i respirator, din perspectiva
experienei clinicii noastre.
Material i metod: Pacienii ce fac obiectul analizei noastre sunt cei internai n IRO Iai, n perioada
noiembrie 2015 - februarie 2016, selectai pentru efectuarea interveniei CHIP - HIPEC. Au fost
nregistrate date privitoare la evoluia i complicaiile intra- i post-operatorii, la schimbrile
hemodinamice, metabolice, respiratorii, parametrii hematologici, biochimici, cantitatea de fluide
pierdute i nlocuirea lor.
Rezultate: CHIP - HIPEC este asociat cu pierderi mari de volum intravascular i tulburri metabolice i
respiratorii, tulburri ale coagulrii, inclusiv postoperator. Aceste dezechilibre impun adaptarea
continu a necesarului de fluide i a parametrilor respiratori. Cateterizarea peridural asigur o
analgezie suplimentar reducnd astfel necesarul de opioide administrate i durata ventilrii,
postoperator.
Concluzii: Vigilena i experiena echipei de anestezie, pregtirile temeinice preoperatorii sunt
fundamentale pentru meninerea unor parametri optimi n vederea asigurrii confortului i securitii
pacientului.
Introduction: CRS/ HIPEC is one of the most complex procedure in abdominal surgery and is comprised
of the surgical removal of all macroscopic tumour in the first phase, followed by the instillation of the
cytostatic solution into the abdominal cavity, at a temperature of 41 - 42 degrees C, through the inflow
and outflow tubes system connected to the hyperthermia pump. The duration and complexity of the
procedure represents a challenge for both the surgical and the anaesthesiology teams.
Objectives: Identifying intra and post-operative risks determined by the important pathophysiological
alterations that can occur during this aggressive intervention as well as presenting the procedures of
maintaining haemodynamic, haematological, metabolic and respiratory status, as revealed by our
experience.
Material and Methods: The patients included in our analysis were hospitalized during November 2015
- February 2016 and strictly selected for the CRS/HIPEC procedure. Data concerning perioperative and
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postoperative evolution, haemodynamic, metabolic and respiratory alterations, haematological and
biochemical parameters, fluid loss and replacement, was gathered and analysed.
Results: CRS/HIPEC is associated with large fluids loss, metabolic and respiratory alterations, and also
with disorders of the coagulation parameters, including postoperatively. This leads to a continuous
adaptation of the fluid requirement and respiratory parameters. Epidural cathetherisation insures
supplementary analgesia, reducing the opioid requirement and the duration of ventilation,
postoperatively.
Conclusion: The vigilance and experience of the anaesthesiology team, thorough preoperative
preparations are fundamental for maintaining optimal comfort and security for the patient.
Utilitatea sistemului informatic de eviden i gestiune a datelor ntr-o secie de anestezieterapie intensiv
The utility of an information system for data management in an anaesthesia and intensive
care unit
Luminia Popeanu, Ioana Grigora
Institutul Regional de Oncologie, Secia de Anestezie i Terapie Intensiv, Iai, Romnia
Introducere: Informatizarea sistemului sanitar romnesc a constat n implementarea i funcionarea
mai multor componente informatice. Sistemul electronic de management al datelor din spital, inclusiv
dosarul electronic al pacientului, prezint numeroase avantaje, dar i provocri pentru personalul
medical.
Obiective: Evaluarea avantajelor i limitelor sistemului informatic de management a datelor n Secia
ATI a Institutlui Regional de Oncologie Iai.
Material i metod: Au fost analizate procedurile care implic utilizarea sistemului informatic n Secia
ATI, limitele acestuia i msurile de mbuntire propuse.
Rezultate: Programul informatic al spitalului este utilizat de rutin pentru: evidena datelor despre
pacient (dosarul electronic), solicitarea explorrilor de laborator, programarea pentru investigaii
imagistice, obinerea rezultatelor, nregistrarea prescripiilor medicale, a gestiunii medicamentelor i
materialelor sanitare, a nregistrrii manevrelor i procedurilor medicale. De asemenea, se utilizeaz
pentru foaia de micare zilnic a pacienilor, ntocmirea fiei de alimentaie zilnic a pacienilor,
precum i numeroase rapoarte statistice privind activitatea seciilor.
Limitele i provocrile nregistrate n Secia ATI a IRO Iai privind utilizarea sistemului informatic au
constat n instruirea personalului privind utilizarea sistemului informatic, acceptarea lui, precum i
monitorizarea atent pentru sesizarea eventualelor disfunctionaliti i gsirea soluiilor optime
pentru rezolvarea acestora. n acest sens am propus urmtoarele msuri de mbuntire:
personalizarea parolelor de acces, acordarea de competene privind accesul la datele din sistem
conform nivelului profesional avut, mrirea vitezei de circulaie a datelor, precum i achiziionarea de
dispozitive externe de stocare a datelor.
Concluzii: Sistemul informatic de eviden i gestiune a datelor ntr-o Secie de Anestezie-Terapie
Intensiv este indispensabil, dar prezint numeroase limite i este susceptibil mbuntirilor care,
teoretic i ideal, ar trebui s fie la un click distan.
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Introduction: The health information system in Romania was based on the implementation of several
IT components. The hospital electronic data management system, including the electronic patient
record, has many advantages, but also challenges for the medical personnel.
Objectives: The evaluation of the benefits and the limits of data management system in the Anaesthesia
and Intensive Care Unit, Regional Institute of Oncology Iai.
Material and Methods: We analyzed the procedures involving the use of the information system, its
limitations and suggested improvements.
Results: The hospital data management system is routinely used for record of patient data (electronic
file), request of lab tests, programming for imaging tests, obtaining results, recording medical
prescriptions, management of medication and sanitary materials, registration of medical procedures.
The system is also used to record the daily patient movements, daily dietary records and numerous
statistical reports. The limits and challenges we encountered in the use of the information system
consisted of staff training on its use, grade of acceptance and the monitoring for detecting possible
malfunctions and finding optimal solutions to solve them. Thus, we proposed the following measures
to improve the system: customizing access passwords, granting access to data according to
professional level, increasing traffic speed data and the acquisition of external data storage devices.
Conclusions: The data management systems in Anaesthesia and Intensive Care Unit is essential, but
presents many limitations and is susceptible to improvements, that theoretically and ideally should be
"one click away".
Incompatibiliti ntre drogurile administrate intravenos n terapia intensiv: mecanisme,

diagnosticare i prevenie
Incompatibilities between drugs which are administered intravenous in the Intensive Care
Unit
Mirela Bidilic, N. Tnase, L. Ene, Flori Ciobanu, Cristina Gabriela Pascale, Gabriela Amoasei
Spitalul Universitar de Urgen Militar Central Dr. Carol Davila, Secia de Anestezie i Terapie
Intensiv, Bucureti, Romnia
Numeroase droguri administrate n terapie intensiv pot determina prin dizolvarea lor n aceeai
soluie de perfuzie, reacii cauzate de incompatibilitate fizic i chimic. Incompatibilitatea poate
presupune precipitare, reacii chimice, antagonism, denaturarea moleculelor biologice sau apariia de
compui gazoi. Dei se recomand ca n momentul administrrii soluia s fie inspectat pentru a fi
decelate eventualele precipitaii, modificri de culoare sau apariia turbiditii, nu orice
incompatibilitate poate fi obiectivat vizual.
Vom trece n revist principalele mecanisme ale incompatibilitii drogurilor intravenoase, cauzele
acestora, consecine (uneori severe) asupra pacientului i strategii de prevenie.
Pentru reducerea riscului asociat incompatibilitii drogurilor infuzate la pacientul de terapie intensive
am implementat n secia noastr utilizarea unui table bidimensional care conine recomandri de
dizolvare a fiecrui drog i compatibiliti ntre fiecare dintre droguri utilizate n mod uzual n secia
noastr.
In ICU there are many drugs which, by their mixing in the same infusate solution, may determine
incompatibility reactions, by chemical or physical mechanism. The incompatibility may appear as
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precipitation, chemical reactions, antagonism, decomposition of biological molecules or the
appearance of gaseous compounds.
Even though it is recommended the visual analysis of the admixture / carrier solution before its use in
order to determine the precipitation, the color modification or the appearance of turbidity, not every
incompatibility can be visually observed.
We will present you the main mechanisms of intravenous drugs incompatibilities, their causes and
consequences (sometimes severe) involving the patient and also some preventive strategies.
In order to reduce the risk associated with the intravenous drugs which are used in the ICU we have
implemented in our unit the using of a two dimensional chart which contains recommendations for
dissolving and compatibilities between every drug commonly used in our department.
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Prezentri orale Sesiuni Medici

Oral presentations Physicians sessions_________________________________________________
Proiecte educaionale de formare: modaliti alternative de finanare a sistemului medical

- Dezvoltarea competenelor n transplant
Educational projects: alternative ways to finance the medical system - Dezvoltarea
competenelor n transplant (Improving transplant development)
Dana Tomescu (1), Simona Dima (2), . Bubenek (3), Ioana Grinescu (4), Ruxandra Fota (5), Daniela
Ungureanu (5), B. Popescu (6), O. Chioncel (6), I. Popescu (2)
(1) Institutul Clinic Fundeni, Secia de Anestezie i Terapie Intensiv III, Bucureti, Romnia
(2) Institutul Clinic Fundeni, Centrul de Chirurgie General i Transplant Hepatic, Bucureti, Romnia
(3) Institutul de Urgen pentru Boli Cardiovasculare Prof. Dr. C.C. Iliescu, Secia de Anestezie i
Terapie Intensiv I, Bucureti, Romnia
(4) Spitalul Clinic de Urgen, Secia de Anestezie i Terapie Intensiv, Bucureti, Romnia
(5) Institutul Clinic Fundeni, Secia de Anestezie i Terapie Intensiv I, Bucureti, Romnia
(6) Institutul de Urgen pentru Boli Cardiovasculare Prof. Dr. C.C. Iliescu, Secia de Cardiologie,
Bucureti, Romnia
Introducere: Transplantul de organe i esuturi reprezint un subiect de ni al medicinei din Romnia.
Atragerea de fonduri alternative nsumnd 88.978.625 RON din Fondul Social European prin Programul
Operaional Sectorial Dezvoltarea Resurselor Umane a reprezentat posibilitatea finanrii i formrii
profesionale a peste 660 de medici i 1140 de asisteni n domenii de specialitate performante.
Material i metode: n cadrul proiectului POSDRU/186/3.2/S/155295 Dezvoltarea competenelor n
Transplant dou cursuri au fost dedicate profesionitilor din specialitatea A.T.I.: unul de insuficien
hepatic acut (C2) n cadrul cruia au fost instruii 33 de medici i 80 de asisteni medicali i unul de
identificare, declarare i management al donorului aflat n moarte cerebral (C12) n cadrul cruia au
fost instruii 77 medici i 140 de asisteni.
Rezultate: n cadrul Cursului C2, att medicii, ct i asistenii au fost instruii prin parcurgerea a 3
module viznd: diagnosticarea, etiologia i evaluarea iniial a pacientului cu iansuficien hepatic,
evaluarea, monitorizarea i managementul hemodinamic al acestuia i terapia specific a insuficienei
hepatice. Activitile practice au constat n utilizarea tehnicilor de epurare extrarenal i dializ
hepatic, monitoriarea hemodinamic avansat i monitorizarea ecocardiografic pe simulator. n
cadrul Cursului C12 participanii cu fost instruii privind conceptul de moarte cerebral, diagnosticul i
declararea acesteia i managementul donorului de organe. Participanii la curs au fost remunerai
lunar cu 3200 RON pentru medici i 2400 RON pentru asisteni, timp de 4 luni. De asemenea, acetia
au putut participa la 2 simpozioane i o conferin naional. n cadrul proiectului au fost editate un
tratat de chirurgie hepato-bilio-pancreatic i o monografie ce abordeaz insuficiena hepatic acut.
Concluzii: Obiectivele proiectului au fost ndeplinite prin certificarea a peste 100 de medici i 200 de
asisteni medicali privind managementul insuficienei hepatice acute i a donorului de organe.
Finanarea prin surse alternative a proiectelor educaionale reprezint o opiune viabil pentru
educarea personalului medical privind concepte i tehnici de ultim generaie.
Introduction: Organ and tissue transplantation represents an obscure topic in the Romanian medical
field. Attracting alternative founds (up to 88.978.625 RON) from the European Social Found through
the Sectoral Operational Programme Human Resources Development presented the opportunity of
training and financing over 660 doctors and 1140 nurses in the field of transplantation.
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Material and Methods: In the project POSDRU/186/3.2/S/155295 Improving transplant development
two courses were dedicated to specialists in the field of Anesthesia and Intensive Care: one on the topic
of acute liver failure (C2) in which 33 doctors and 80 nurses were trained and one on the topic of
identifying, diagnosing and management of brain dead donors (C12) in which 77 doctors and 140
nurses were trained.
Results: During the C2 Course both doctors and nurses were trained in regard to three topics: (1)
diagnosis, etiology and initial evaluation of acute liver failure, (2) advanced hemodynamic monitoring
and (3) management of patients with liver failure. Practical lessons consisted in applying renal
replacement therapy, hepatic dialysis, advanced hemodynamic monitoring and echocardiography.
During the C12 Course, the participants were trained in regard to the concept of brain death, identifying
and diagnosing brain death and management of organ donors. Participants received a monthly pay of
3200 RON for doctors and 2400 RON for nurses for 4 consecutive months. At the same time, all
participants could attend 2 symposiums and one national conference. The project financed the
publication of two medical textbooks: one regarding hepato-biliary and pancreatic surgery and one on
the topic of acute liver failure.
Conclusion: The projects objectives were fulfilled by certifying over 100 doctors and 200 nurses in the
management of acute liver failure and organ donation. Alternative financing of educational projects
represents a feasible option for the education of medical personal on state-of-the-art concepts and
technology.
Eficacitatea analgetic i sigurana lornoxicamului cu eliberare rapid n artroplastia total

de old
Analgesic efficacy and safety of lornoxicam quick-release formulation in total hip
arthroplasty
G. Porumbac (1), Simona Florescu Cionac (1), Ana Maria Munteanu (1), Denisa Mdlina Anastase (1),
Arabela Codrua Cocea (2), N. Mihailide (3), C. I. Stoica (3)
(1) Spitalul Clinic de Ortopedie-Traumatologie Foior, Secia de Anestezie i Terapie Intensiv,
Bucureti, Romnia
(2) Spitalul Clinic de Ortopedie-Traumatologie Foior, Secia de Anestezie i Terapie Intensiv I,
Bucureti, Romnia
(3) Spitalul Clinic de Ortopedie-Traumatologie Foior, Clinica de Ortopedie, Bucureti, Romnia
Obiectivul studiului: Antiinflamatoarele nonsteroidiene sunt recomandate n managementul durerii
acute postoperatorii. Scopul acestui studiu prospectiv randomizat a fost s evalueze eficacitatea
analgetic i sigurana administrrii de lornoxicam cu eliberare rapid n durerea postoperatorie la
pacienii cu artroplastie total primar de old.
Material i metod: Dup obinerea aprobrii comitetului de etic i a consimmntului informat, 110
pacieni programai pentru artroplastie total primar de old sub rahianestezie au fost randomizai n
2 grupuri: grupul lornoxicam a primit o tablet de lornoxicam de 8 mg la sfritul operaiei i ulterior
la 12 ore pn la 48 ore postoperator; grupul placebo a primit tablete placebo dup acelai protocol.
La prima cerere de calmant ambele grupuri au primit acelai protocol analgetic cu paracetamol 1 g iv
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la 8 ore; dup 15 minute, dac NRS se menine peste 3 s-a administrat morfin 0,1 mg/kg doz de
ncrcare, urmat de 2 mg iv repetat la 5 minute pn la NRS<3. Dup 2 ore, morfina s-a administrat
la cerere din doza total iv. Protocolul s-a aplicat 48 ore postoperator.
Rezultate: Cele 2 grupuri au fost similare din punct de vedere demografic i a duratei operaiei.
Pacienii din grupul lornoxicam au necesitat o cantitate mai mic de morfin semnificativ statistic la 24
i la 48 de ore i au avut o durat mai mare a analgeziei.
Concluzii: Administrarea iv de lornoxicam 8 mg la 12 ore n ziua operaiei i n prima zi postoperator
mbunteste analgezia i scade consumul de morfin la pacienii cu artroplastie total de old.
Objective: Non-steroidal anti-inflammatory drugs are recommended for postoperative pain
management. The aim of this prospective randomised study was to evaluate the analgesic efficacy and
safety of lornoxicam quick-release formulation in postoperative acute pain in total hip arthroplasty.
Material and Methods: After obtaining the ethical committee approval and informed consent, 110
patients undergoing elective hip replacement were randomised in 2 groups: lornoxicam group received
lornoxicam 8 mg iv at the end of surgery and then at 12 hours until 48 hours postoperatively; placebo
group received placebo pills after the same protocol. At the first analgetic request, both groups received
the same analgetic protocol with paracetamol 1g IV every 8 h for 48 h. If NRS was still over 3, morphine
was given as a loading bolus of 0.1 mg/kg IV supplemented with 2 mg IV every 5 minutes until NRS <3.
After 2 h morphine was administered SC of the total loading dose at request. This protocol was
applied until 48 h postoperatively.
Results: The two groups were similar in terms of demographic data and surgery duration. Patients in
the lornoxicam group required a statistically significant smaller amount of morphine at 24 and 48 hours
and had a longer duration of analgesia.
Conclusion: Intravenous administration of lornoxicam 8 mg every 12 hours the day of surgery and the
first postoperative day improves analgesia and reduces morphine consumption in patients with total
hip arthroplasty.
Beneficiul puls terapiei cu solumedrol n tratamentul bolii gref contra gazd

The benefits of pulse therapy with solumedrol in treatment of graft versus host disease
Ana Grigora (1), Iulia-Roxana Bold (1), Andreea Marcelica Frigioiu (1), Graiela Manga (1), Dana
Tomescu (2)
(1) Institutul Clinic Fundeni, Secia de Anestezie i Terapie Intensiv, Bucureti, Romnia
Introducere: Puls terapia cortizonic este utilizat, de obicei n afeciuni renale, inflamatorii i
autoimune, n doze i pe perioade diferite, n funcie de raportul risc - beneficiu.
Materiale i metode: Prezentm cazul clinic al unei paciente n vrst de 26 ani cunoscut cu Boala
Gref contra Gazd form pulmonar, hepatic, cutanat i ocular, secundar transplantului medular
(mai 2014) pentru Leucemie Acut Bifenotipic diagnosticat n 2013. Pacienta este admis n urgen,
n secia de Terapie Intensiv pentru insuficien respiratorie hipercapnic i encefalopatie
hipercapnic secundar.
Rezultate: La admisia n Terapie Intensiv, pacienta prezint stare general alterat, bradipnee,
manifestri succedate de emisie spontan de urin i com profund. Gazometria arterial relev:
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pH=7.13, pCO2=130 mmHg, pO2=49 mmHg, SpO2=75%. Pacienta este intubat orotraheal i ventilat
mecanic sub sedare i curarizare n infuzie continu. Pentru a mbunti oxigenarea i mecanica
respiratorie, se decide aezarea pacientei n prone position i recrutarea alveolar zilnic. Se
continu corticoterapia reprezentat de Solumedrol 100 mg iv/zi, iniiat pe secia de Hematologie. n
ziua 3 de Terapie Intensiv, se decide dublarea dozei de Solumedrol, iar n ziua 4, se instituie puls
terapia, administrat timp de 3 zile consecutiv. Tendina la hipercapnie se reduce progresiv,
stabilizndu-se la valori ale pCO2=55-70mmHg. Post puls terapie, se ncepe dezescaladarea
corticoterapiei, iar pacienta este sevrat de suportul ventilator.
Concluzii: Beneficiile oferite de prone position sunt ameliorarea net a oxigenrii i a mecanicii
ventilatorii, precum i limitarea atelectaziei i a leziunilor asociate ventilaiei. Supranumit the big
shot, puls terapia este preferat terapiei cu doze mici pe termen lung, deoarece administrarea pe
termen scurt are efect terapeutic mai mare i efect toxic cumulativ redus semnificativ.
Introduction: Cortizonic pulse therapy is usually used in renal, autoimmune and inflammatory disorders,
in different doses and periods, depending on the risk-benefit ratio.
Materials and Methods: We present the clinical case of a 26-year-old patient with pulmonary, hepatic,
cutaneous and ocular form of Graft versus Host Disease, due to bone marrow transplantation (May
2014) for Acute Biphenotypic Leukemia diagnosed in 2013. The patient is admitted in the Intensive Care
Unit for hypercapnic respiratory failure and secondary hypercapnic encephalopathy.
Results: At the intake in the Intensive Care, the patient presented impaired general condition,
bradypnoea, followed by the spontaneous emission of urine and deep coma. Arterial gazometria
reveals: pH = 7.13, pCO2 = 130 mmHg, pO2 = 49 mm Hg, SpO2 = 75%. The patient is intubated and
mechanically ventilated, under continuous infusion of sedation and curarization. In order to improve
oxygenation and respiratory mechanics, the patient was settled in "prone position" and daily alveolar
recruitment. Corticotherapy, represented by 100 mg IV Solumedrol/day, initiated on the Hematology
Department, is continued on the ICU. On the third day it is decided to double the dose of Solumedrol,
and in day 4 the pulse therapy is hereby established and administered for 3 consecutive days. The
tendency to hypercapnia is progressively reduced, establishing to the values of pCO2 = 55-70mmHg.
After pulse therapy, the corticotherapy is progressively reduced and the fan support is removed.
Conclusions: The benefits of the "prone position" are improving mechanical ventilation and
oxigenation, the limitation of the atelectasis and ventilation associated injuries. Dubbed "the big shot",
pulse therapy is preferred due to low-dose long-term therapy because short-term administration has a
higher response and toxic effects are significantly reduced.
SRATI 2016
11 - 15 mai / May
Sinaia

Poate avea claustrumul un rol n anestezie?

Could claustrum play a role in anaesthesia?
B. Pavel (1), Camelia Alexandra Acatrinei (1), Daniela Popa (2), F. Menardy (2), A. E. Roca (1), Ana
Maria Zgrean (1), L. Zgrean (1)
(1) Universitatea de Medicin i Farmacie Dr. Carol Davila, Disciplina de Fiziologie i Neurotiine,
Bucureti, Romnia
(2) Ecole Normale Superieure, Institut de Biologie, Paris, Frana
Obiectivul studiului: Dup ultimele date claustrumul pare a avea un rol de coordonare a structurilor
implicate n meninerea strii de contient, dar pn acum nu a fost investigat rolul acestuia n
anestezie.
n aceast cercetare am dorit s evalum efectul stimulrii claustrumului asupra profunzimii
anestezice.
Material i metode: n acest studiu au fost folosii 5 obolani Wistar care au fost anesteziai cu
isofluran, activitatea electric cortical (ECoG-electrocorticogram) fiind nregistrat pe toat durata
experimentului.
n timpul anesteziei claustrumul a fost stimulat cu ajutorul unui electrod timp de 200 de secunde (20
de stimuli).
Rezultate: n urma stimulrii claustrumului s-a obinut o aprofundare a anesteziei astfel nct a aprut
patternul de burst suppression. Aceast aprofundare a fost tranzitorie, durnd aproximativ 30 de
secunde, iar patternul de tip burst suppression a fost present preponderant la nivelul emisferei
stimulate.
Concluzii: Stimularea claustrumului induce o aprofundare a anesteziei, ns studii ulterioare sunt
necesare pentru a stabili cu claritate dac claustrumul joac un rol central n anestezie.
Introduction: Recent studies reveal that claustrum might play a role in coordinating the structures
involved in maintaining the state of consciousness, but its involvement in anaesthesia has not been
analyzed so far. The aim of the present study is to evaluate the effect of claustrum stimulation on the
depth of anaesthesia.
Materials and Methods: In this study, 5 Wistar rats were anaesthetized with isoflurane and the cortical
electrical activity (ECoG- electrocorticogram) was subsequently registered. During anaesthesia, an
electrode was used in order to stimulate the claustrum for 200 seconds (20 stimuli).
Results: Stimulation of the claustrum resulted in an increased depth of anaesthesia, revealed through
a burst suppression pattern on the ECoG. This deepening of anaesthesia was transitory and lasted for
30 seconds. The burst suppression pattern was noticed mainly in the stimulated cerebral hemisphere.
Conclusions: Claustrum stimulation leads to an increased depth of anaesthesia. Nevertheless, further
studies are required in order to analyze the role that claustrum plays during the process of general
anaesthesia.
SRATI 2016
11 - 15 mai / May
Sinaia

Endocardita asociat ngrijirilor medicale la pacientul oncologic. Experiena Clinicii ATI - IRO
Iai
Healthcare associated endocarditis in the oncologic patient. The experience of the Intensive
Care Unit, Regional Institute of Oncology Iasi
Angelica G, Andreea-Mihaela Vrnescu, Ioana Grigora
Introducere: Pacienii oncologici, i mai ales cei cu neutropenie postchimioterapie, sunt predispui la
infecii sistemice severe. Endocardita infecioas are impact pe mortalitate, durata spitalizrii i costul
tratamentului, iar diagnosticul este dificil i adesea incert.
Obiective: Identificarea particularitilor endocarditei asociate ngrijirilor medicale privind factorii de
risc, evoluia clinic, diagnosticul, tratamentul i prognosticul la pacienii oncologici.
Material i metod: Studiul retrospectiv a inclus toi pacienii cu endocardit infectioas internai n
Clinica ATI a Institutului Regional de Oncologie Iai n perioada 2012 - 2016. Diagnosticul clinic de
endocardit infecioas s-a bazat pe criteriile clinice Duke.
Rezultate: Din 18753 pacieni admii n secia ATI - IRO Iai n perioada mai 2012 - februarie 2016, am
identificat 15 pacieni cu diagnosticul de endocardit infecioas. Toi cei 15 pacieni aveau afeciuni
oncologice, din care 10 hemato-oncologice, iar 6 i aplazie medular postchimioterapie. 14 pacieni au
avut modificri ecocardiografice sugestive pentru endocardit, iar 9 pacieni au avut i hemoculturi
pozitive. Durata medie de internare n Terapie Intensiv a fost de 15 zile (3-52 zile). Mortalitatea a fost
de 9/15 (60%).
Concluzii: Endocardita infecioas are o frecven crescut la pacientul oncologic admis n TI,
complicnd evoluia i prognosticul bolii de baz. De aceea, n Clinica ATI IRO a devenit o rutin
cutarea sistematic a acestei complicaii la pacientul septic oncologic.
Cuvinte cheie: endocardit, sepsis, cancer, terapie intensiv
Introduction: The oncologic, and mainly neutropenic patients are susceptible to develop systemic severe
infections. Infective endocarditis impacts mortality, duration of hospitalization and costs. Frequently
the diagnosis is difficult and uncertain.
Objectives: Identification of particularities of healthcare associated endocarditis regarding risk factors,
clinical evolution and outcome, diagnosis and treatment in oncological patients.
Material and Methods: The retrospective study included all patients with infective endocarditis
admitted to Intensive Care Unit of Regional Institute of Oncology, Iai between 2012 and 2016. The
diagnosis was based on Duke clinical criteria.
Results: Out of 18753 patients admitted to ICU IRO Iai between May 2012 and February 2016, 15
patients had the diagnosis of infective endocarditis. All of them had cancer. 10 had hemato-oncological
diseases. 6 had also post-chemotheray medular aplasia. 14 patients had heart ultrasound findings
suggestive for endocarditis. 9 pacients has positive blood cultures. Mean ICU LOS was 15 day (3-52
days). Mortality was 60% (9/15).
Conclusions: Healthcare associated endocarditis has an increased frequency in ICU oncological
patients, complicating the evolution and prognosis of the underlying disease and it is frequently
underdiagnosed. Thus, according to our experience, the systematic search for it became routine in the
septic critically ill oncologic patient.
Keywords: endocarditis, sepsis, cancer, intensive care
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11 - 15 mai / May
Sinaia

Stenozele traheale benigne - etiopatogenie, metode terapeutice, prognostic

Benign tracheal stenosis - etiology, pathogeny, therapeutic methods, prognostic
Elena Vasiliu (1), Adelina Moise (2), C. Paleru (1), R. Stoica (3), D. Corneci (2)
(1) Institutul de Pneumoftiziologie Marius Nasta, Secia de Chirurgie Toracic, Bucureti, Romnia
(2) Spital Universitar de Urgen Elias, Secia de Anestezie i Terapie Intensiv, Bucureti, Romnia
(3) Institutul de Pneumoftiziologie Marius Nasta, Secia de Anestezie i Terapie Intensiv, Bucureti,
Romnia
Scopul studiului: Analiza retrospectiv a cauzelor stenozelor traheale benigne, a metodelor de
tratament aplicate i evaluarea rezultatelor obinute ntr-un centru specializat.
Material i metod: Studiu retrospectiv nerandomizat efectuat pe o perioad de 7 ani care a inclus 103
pacieni cu stenoze traheale benigne internai n Institutul Naional de Pneumologie ,,Prof. Marius
Nasta Bucureti n perioada 2008 - 2014. Au fost analizai urmtorii parametri: elementele de
diagnostic, cauzele stenozelor traheale benigne, rolul intubaiei oro-traheale i al traheostomiei,
metodele terapeutice abordate.
Rezultate: Stenozele traheale datorate balonaului sondei de intubaie sau traheostomiei reprezint
78,64% din cauze. Majoritatea pacienilor (52%) au avut un abord al cii aeriene prin sond
endotraheal sau canul de traheostomie timp de 2 - 4 sptmni (p=0,016), limitele fiind 6 - 103 zile.
26% din pacieni au avut acest abord mai mic de 2 sptmni. Durata de apariie a simptomelor dup
detubare a fost ntre 30 - 59 de zile - 44% i ntre 60 - 89 de zile -25% (p=0,0033). Stenozele datorate
traheostomiei au reprezentat 79% din cazuri (p=0,022). Rezultatele interveniilor chirurgicale au fost
considerate bune n 71% din cazuri (p=0,012), satisfctoare 8% i considerate eec 21% (traheostomie
definitiv).
Concluzii: Abordul cii aeriene furnizeaz majoritatea cazurilor de stenoz traheal benign.
Majoritatea cazurilor apar n sptmnile 3 - 4 de ventilaie mecanic invaziv, dar o proporie
important de pacieni (26%) au dezvoltat leziunea stenotic n sptmna a doua. Durata ntre
momentul detubrii i apariia simptomelor este variabil (1-3 luni). Rezultatele interveniilor
chirurgicale efectuate ntr-un centru specializat din Romnia au fost considerate bune i satisfctoare
n proporie de 79%.
Study objective: Retrospective analysis of the causes of benign tracheal stenosis, measures of treatment
and result overview in a specialized center.
Material and Methods: This retrospective nonrandomized study was conducted over a period of 7 years
and included 103 patients with benign tracheal stenosis admitted between 2008 and 2014 to the
National Institute of Respiratory Medicine Prof. Marius Nasta Bucharest. The following parameters
were measured: causes of benign tracheal stenosis, the role of endotracheal intubation and
tracheostomy, therapeutic measurements and patients outcome.
Results: Tracheal stenosis due to endotracheal cuff or tracheostomy represent 78,64% of all causes.
Most patients (52%) had an airways approach using endotracheal tube or tracheostomy for 2-4 weeks,
(p=0,016), with an interval of 6-103 days. 26% of the patients had an approach less than 2 weeks. The
amount of time between extubation and onset of symptoms was predominantly between 30 to 90 days
(p=0,0033). Stenosis due to tracheostomy were in 79% of cases (p=0,022). The outcome of the surgical
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procedures was considered good in 71% of cases (p=0,012), average in 8% and failure in 21% (definitive
tracheostomy).
Conclusions: Invasive airway management is the main cause of benign tracheal stenosis. The onset of
benign tracheal stenosis is mainly between weeks 3 to 4 of mechanical ventilation, but 26% of cases
developed stenosis during the second week. The amount of time between extubation and symptoms
onset is variable (1 - 3 months). The outcome of the surgical interventions in a specialized center in
Romania were considered good in 79% of the patients.
Evaluarea eficienei terapiei antibiotice empirice folosind colistin iv i inhalator n vap

Assessment of the efficacy of empirical antibiotic therapy using inhaled and intravenous
Colistin in ventilator associated pneumonia
S. Negoi (1), Daniela Brum (1), Oana chiopu (1), Mdlina Duu (1), D. Corneci (2)
(1) Spitalul Universitar de Urgen Elias, Secia de Anestezie i Terapie Intensiv, Bucureti, Romnia
(2) Spitalul Universitar de Urgen Elias, Secia de Anestezie i Terapie Intensiv I, Bucureti, Romnia
Obiectiv: Studiul propune evaluarea eficacitii i siguranei administrrii inhalatorii de Colistin,
asociat administrrii intravenoase, la pacienii cu pneumonie asociat ventilaiei mecanice (VAP)
cauzate de bacterii gram negative multirezistente (MDR).
Materiale i metode: Am efectuat un studiu retrospectiv observaional n Clinica ATI a Spitalului Elias
(ianuarie 2013 - iunie 2014) n care au fost inclui 75 de pacieni. Pacienii au primit antibioterapie
empiric difereniat: lotul A (32 pacieni) a primit antibioterapie conform ghidurilor, adaptat
specificitii florei microbiene locale, lotul B (21 pacieni) a primit asociat antibioterapiei empirice
Colistin intravenos, lotul C (22 pacienti) a primit asociat antibioterapiei empirice Colistin intravenos i
inhalator. S-au utilizat pentru diagnostic scorurile CPIS, APACHE II, probe microbiologice (secreiile
traheale sau lavajul bronhoalveolar). S-a urmrit: durata ventilaiei mecanice (VM), durata internrii n
Terapie Intensiv (TI), incidena recurenelor, ameliorarea indicilor, mortalitatea general.
Rezultate: S-a observat durata mai mic a internrii n TI a pacienilor din lotul A (11.1+/-1.4), reducerea
duratei VM (p0.05) n loturile B i C (13.85+/-0.75, respectiv, 14.45+/-0.69) comparativ cu lotul A
(17.9+/-1.4), o corelaie puternic (r=-0.81) ntre durata VM i durata tratamentului cu Colistin. S-au
constatat 2 cazuri de nefrotoxicitate datorate administrrii de Colistin, ns pacienii nu au necesitat
protezare renal. Nu s-au nregistrat efecte adverse neurologice.
Concluzii: n seciile TI cu inciden crescut a patologiei VAP asociat germenilor MDR Gram negativi,
adugarea de Colistin nc din faza terapiei antibiotice empirice poate fi util. Nu s-a putut demonstra
beneficiul administrrii inhalatorii de Colistin asociate celei intravenoase. Limitrile studiului sunt
legate caracterul unicentric i de numrul de pacieni.
Objective: Our study aims to evaluate the efficacy and safety of inhaled and intravenous administration
of Colistin in patients with ventilator-associated pneumonia (VAP) caused by gram negative multidrug
resistant bacteria (MDR).
Material and Methods: We conducted a retrospective, observational study in the ICU of Elias Hospital
(January 2013 - June 2014) having 75 patients enrolled. Patients received differentiated empirical
antibiotic therapy: group A (32 patients) received antibiotic therapy according to guidelines, adapted
to local specific microbial flora, group B (21 patients) received intravenous Colistin associated to
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empirical antibiotics, group C (22 patients) received intravenous and nebulized Colistin associated to
empirical antibiotherapy. We used for diagnosis the CPIS, APACHE II scores, microbiological samples
(tracheal secretions or bronchoalveolar lavage) and observed the length of the mechanical ventilation
(MV), ICU stay, incidence of recurrence, improvement of indices, overall mortality. Results: We noticed
a shorter ICU stay for patients in group A (11.1+/-1.4), reduced duration of MV (p0.05) in groups B
and C (13.85+/-0.75, respectively 14.45 +/-0.69) compared to group A (17.9 +/-1.4), strong correlation
(r=-0.81) between duration of MV and length of treatment with Colistin. We found 2 cases of
nephrotoxicity due to Colistin administration, but no renal replacement therapy was required. No
neurological side effects were noticed.
Conlusions: In ICUs with high incidence of VAP caused by Gram negative, MDR bacteria, administration
of Colistin associated to empirical antibiotic therapy could be useful. We could not prove the benefit of
nebulized Colistin administration. Study limitations are related to the single-center character and
number of patients.
Metod alternativ de oxigenare extracorporeal la un pacient cu arsuri majore i ards

Alternative method for extracorporeal oxygenation in a patient with major burns and ARDS
D. Corneci (1), Mdlina Duu (1), Liliana Florentina Velicu (1), Victoria Ioan (1), S. Negoi (2), Diada
Sinescu (1), Penelopia Marinescu (1)
(1) Spital Universitar de Urgen Elias, Secia de Anestezie i Terapie Intensiv, Bucureti, Romnia
(2) Spital Universitar de Urgen Elias, Secia de Anestezie i Terapie Intensiv I, Bucureti, Romnia
Metodele de eliminare extracorporeal a CO2 (ECCO2R) au indicaie limitat n ARDS, datele din
literatur fiind puine, mai ales n patologia complex a pacienilor cu arsuri majore.
Scopul studiului a fost de a evalua eficiena unei tehnici de eliminare extracorporeal a bioxidului de
carbon i oxigenare n cazul unui pacient cu arsuri majore i ARDS.
Material i metod: Dintr-un lot de 16 pacieni internai n Spitalul Universitar de Urgen Elias
Bucureti cu diagnosticul de arsuri cutanate i ale cilor aeriene n urma accidentului din clubul Colectiv
doi dintre acetia au dezvoltat ARDS care a impus asocierea de metode extracorporeale de eliminarea
a CO2 i oxigenare. n cazul unuia din pacieni cu diagnosticul de ARDS moderat ventilat mecanic
protectiv s-a utilizat dispozitivul Prismalung (membran iLA active Novalung + pomp Prismaflex)
ataat la kitul de hemodiafiltrare continu veno-venoas (CVVHDF), cu scopul de a elimina CO2 i de a
normaliza pH-ul (low-flow CO2 removal). Accesul vascular s-a efectuat la nivelul venei femurale cu
un cateter dublu lumen 13,5 Fr care ofer un debit superior cateterelor uzuale de dializ continu:
debit sanguin 250-500 ml/min, debit O2: 9 l/min. Metoda a fost utilizat n dou edine de 48 ore,
respectiv 72 ore.
Rezultate: Tehnica prezentat a permis normalizarea pH-ului i ameliorarea parametrilor ventilatori
prin eliminarea eficient a CO2 i ameliorarea oxigenrii: indicele de oxigenare (PaO2/FiO2) a evoluat
de la 120 la 224-238 n prima edin i de la 170 la 236-337 n cea de a doua edin, cu un interval de
laten de 6-12 ore.
Concluzii: Oxigenarea extracorporeal cu ajutorul dispozitivului Prismalung asociat tehnicii de
CVVHDF poate fi util la pacienii cu ARDS uor i moderat. Indicaia tehnicii la pacientul cu arsuri
majore i ARDS necesit studii suplimentare.
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The methods of extracorporeal elimination of CO2 have limited indication in ARDS patients, with few
reports in the literature, especially in patients with major burns.
The purpose of the study was to evaluate the efficiency of one method of extracorporeal elimination of
CO2 and oxygenation in the case of a patient with major burns and ARDS.
Material and Methods: From a lot of 16 patients admitted in Elias Emergency University Hospital having
burns to the skin and the airways following the accident at Colectiv club, two patients have developed
ARDS that imposed the association of extracorporeal methods of CO2 removal and oxygenation. In one
case with moderate ARDS and protective mechanical ventilation, it was used the Prismalung device
and Prismaflex pump attached to the CVVHDF kit (low-flow CO2 removal). The vascular access was
at the femoral vein level with a 13.5 Fr double-lumen catheter: blood flow 250-500 ml/min, O2-flow 9
l/min. The method was used in two sessions of 48 and 72 hours.
Result: The technique allowed us to normalize the pH and to improve ventilation parameters by the
effective removal of CO2, but also to ameliorate the oxygenation: hypoxemic index (PaO2/FiO2) has
evolved from 120 to 224-238 in the first session and from 170 to 236-337 in the second session, with a
latent period of 6-12 hours.
Conclusions: Extracorporeal oxygenation with Prismalung device in association with CVVHDF can be
useful in light and moderate ARDS. The indications of this technique in severe burns and ARDS patients
requires more studies.
Ventilaia mecanic asistat neural (NAVA) - prima experien romneasc

Neurally adjusted ventilatory assist (NAVA) - first Romanian experience
D. Corneci, A. Tu, Ioana Popescu Garotescu, Mdlina Duu, S. Negoi
Spitalul Universitar de Urgen Elias, Secia de Anestezie i Terapie Intensiv, Bucureti, Romnia
Scopul studiului a fost de a evalua avantajele i limitele utilizrii modului de ventilaie mecanic NAVA
n cadrul unei prime experiene la nivel naional.
Material i metod: Ventilaia mecanic asistat neural a fost utilizat pentru prima oar n cadrul
Clinicii ATI a Spitalului Universitar de Urgen Elias n iulie 2015, metoda fiind aplicat n cazul a cinci
pacieni. Au fost selectai doi pacieni cu ventilaia mecanic prelungit, weaning dificil i eec prin
utilizarea ventilaiei asistate n presiune i a trialurilor de respiraie spontan: pacient cu pneumonie
comunitar sever i acutizare a BPOC std. IV i pacient la care este confirmat tardiv boal neuromuscular sever.
Rezultate: n cazul pacientului cu BPOC s-a nregistrat un potenial de vrf Edi ntre 6 i 14 microV,
asistarea NAVA iniial a fost de 1,2 cm H2O/microV, ulterior sczndu-se progresiv pe parcursul a cinci
zile la 0,5 cm H2O/microV, nivel care a permis detubarea. Parametrii ventilatori: Psup iniial=18-22 cm
H2O, Psup de 10-12 cmH2O n ziua 5, MV 10-13 l/min, VT 350-450 ml i RR 25-35/min. Cea de-a doua
pacient a nregistrat nc din momentul iniierii NAVA poteniale Edi mici (2-3 microV) care nu au
permis continuarea n modul NAVA i care au fost explicate ulterior prin confirmarea bolii neuromusculare.
Concluzii: Modul NAVA realizeaz o sincronie mai bun i permite realizarea weaning-ului mai uor
dect n modurile convenionale n cazul pacientului cu BPOC, dar este limitat/contraindicat n cazul
bolilor neuro-musculare.
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The purpose of the study was to evaluate the advantages and limits of using mechanical ventilation
mode NAVA in a first experience at national level.
Material and Methods: Neural assisted mechanical ventilation was used for the first time in the ICU of
the Elias University Emergency Hospital in July 2015, the method being applied to five patients. Two
patients were selected for presentation, having prolonged mechanical ventilation and difficult weaning
by using pressure assisted ventilation and spontaneous breathing trials: patient with severe
community-acquired pneumonia and exacerbation of COPD stage IV and another patient who was
subsequently confirmed a severe neuromuscular disease.
Results: Values of 6-14 microVforpeak potential Edi was recorded for the patient with COPD, initial
assisting NAVA was 1.2 cm H2O/microV, thereafter decreasing progressively over five days to 0.5 cm
H2O/microV, which allowed extubation. Ventilation parameters was initial Psupp=18-22 cm H2O,
Psupp 10-12 cmH2O in day 5, MV 10-13 l/min, VT 350-450 ml and RR 25-35/min. The second patient
has made since the time of initiation NAVA small Edi potentials (2-3microV) that did not allow the
continuation on NAVA and they were explained later by confirming neuromuscular disease.
Conclusions: NAVA mode provides a better synchrony and allows weaning easier than conventional
modes in patients with COPD, but is limited/contraindicated in neuromuscular diseases.
Rolul screeningului epidemiologic n terapie intensiv

The role of epidemiological screening in the intensive care unit
D. Corneci (1), I. Dinu (1), Denisa Niu (1), Georgiana Popica (1), Oana Maria Tudorache (1), Maria Buzea
(2)
(2) Spitalul Universitar de Urgen Elias, Laborator Clinic Medical, Bucureti, Romnia
Scopul lucrrii este de a investiga prevalena colonizrii la internarea n TI, relaia dintre colonizarea
bacterian i infecia ulterioar, precum i rolul screeningului bacterian la admisia n TI.
Material i metod: Este un studiu retrospectiv realizat pe 480 de pacieni admii n secia de terapie
intensiv a Spitalului Universitar de Urgen Elias n perioada 1 martie 2015 - 1 ianuarie 2016. La acetia
s-a efectuat screening bacteriologic la admisie constnd n recoltare de exudat nazal/faringian,
tamponament rectal. De asemenea, s-a efectuat i screening de identificare a infeciilor (hemoculturi,
uroculturi, aspirat broho-alveolar), repetndu-se seriat la 7, 14 i 21 de zile. Au fost exclui din studiu
pacienii cu infecie i/sau culturi pozitive la internare.
Rezultate: Din totalul de 480 de pacieni nrolai la un numr de 152 (32%) s-a identificat cel puin o
colonizare pozitiv la admisie. 100 de pacieni (65%) au prezentat exudate nazale/faringiene pozitive
i 52 (35%) - tamponamente rectale pozitive. Germenii cei mai frecvent identificai au fost:
Staphylococcus aureus sensibil la methicilin, MRSA, Candida nonalbicans, Enterococcus faecium.
Dintre acetia doar un pacient (0,6%) a dezvoltat infecie nosocomial cu acelai microorganism, ceea
ce dovedete absena unei corelaii ntre portajul bacterian i dezvoltarea unei infecii nosocomiale
ulterioare (p<0,05). Din cei 328 de pacieni (68%) cu screening negativ la admisie, 98 (29,8%) au
dezvoltat o infecie nosocomial cu germeni MDR diferii de cei identificai prin screeningul iniial.
Concluzii: Nu exist o corelaie ntre colonizarea iniial i infeciile ulterioare. Rolul screeningului
epidemiologic la internarea ntr-o terapie intensiv multidisciplinar rmne a fi demonstrat, n
prezent nejustificndu-i costurile.
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The aim of this presentation is to investigate the prevalence of colonization at the moment of admission
in the ICU, the relationship between bacterial colonization and subsequent infection as well as bacterial
screening at the time of admission in the ICU.
Methodology: This is a retrospective study which was applied to 480 ICU patients from Eliass
Universitary Emergency Hospital between 1st of March 2015 and 1st of January 2016. We conducted
bacterial screening for this patients which consisted in nasal/pharyngeal exudate sampling, rectal
sampling. We also conducted a screening program for infections (blood and urine cultures, bronchoalveolar aspirate) and serially repeatedly them at 7, 14 and 21 days. We excluded from this study the
patients with positive cultures at the moment of admission in the ICU.
Results: At 152 (32%) patients out of a total number of 480 patients included in this study, we identified
at least one positive colonization at the moment of admission. 100 (65%) patients had positive cultures
after nasal/pharyngeal exudates sampling and 52 (35%) after rectal sampling. The next germs were
frequently identified: Staphylococcus aureus sensitive to meticilin, MRSA, Candida nonalbicans,
Enterococcus faecium. Out of all patients, only one developed a nosocomial infection with the same
microorganism, which proves the absence of a link between bacterial carriage and the development of
a subsequent infection (p<0.05). 98 (29,8%) out of 328 patients with negative screening at the moment
of admission, developed a nosocomial infection with MDR germs, others than the ones identified in the
inital screening.
Conclusions: There is not a link between the initial colonization and subsequent infections. The role of
epidemiological screening at the moment of admission in a multidisciplinary ICU still has to be proved,
actually, the financial costs cannot be entitled.
Indicatori de prognostic n sepsis; utilizarea modelului PIRO de descriere a sepsisului

Prognostic factors in sepsis; using PIRO model in describing sepsis
Mdlina Duu, R. Ivacu, G. Gorecky, D. Corneci
Spitalul Universitar de Urgen Elias, Secia de Anestezie i Terapie Intensiv, Bucureti, Romnia
Introducere: Modelul PIRO cuprinde: predispoziia i comorbiditile, natura i amploarea infeciei,
rspunsul gazdei i disfunciilor de organ rezultate. Obiectivul a constat n studierea diverilor factori
clinici cu impact asupra prognosticului la pacienii septici.
Material i metod: Studiul retrospectiv, timp de 2 ani, a inclus 152 de pacieni diagnosticai cu
sepsis/sepsis sever/oc septic n primele 24 de ore ale admisiei n terapie intensiv la care au fost
studiate variabile clinice. Rezultate: Vrsta medie a pacienilor de sex masculin care au supravieuit a
fost semnificativ mai mic (p=0.002) fa de cea a celor decedai: 61 fa de 71 de ani. Indexul de
comorbiditate Charlson a fost semnificativ mai mare pentru pacienii decedai (p=0.043). Mortalitatea
a fost mai ridicat n cazurile cu infecii nosocomiale. Incidena decesului a fost semnificativ statistic
mai mic pentru infecia localizat comparativ cu cea generalizat: 72% fa de 87% (p=0.044).
Mortalitatea a fost mult mai ridicat la cazurile de sepsis pulmonar i abdominal (78,1%, respectiv
73,9%), comparativ cu sepsisul urinar: 55,5%. Incidena decesului a crescut semnificativ cu numrul de
disfuncii de organ (p<0.001) i s-a asociat negativ cu lactatul la 48 de ore (p=0.044). Indicele de
hipoxemie<100 s-a corelat pozitiv cu rata decesului, iar valoarea>250 la 72 de ore s-a corelat cu
supravieuirea.
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Concluzii: Indexul Charlson constituie un bun indicator al riscului de deces ataat componentei P,
pentru componenta I extensia infeciei a fost cu valoare prognostic, numrul de organe cu disfuncie
la admisie i lactatul la 48 de ore pot fi indicatori de prognostic aparinnd componentei O n
construirea modelului PIRO.
Cuvinte cheie: sepsis, PIRO, Charlson Comorbidity Index, prognostic
Background: PIRO model is created based on preexisting comorbidity (predisposition) and the nature
and extent of infection, the characteristics of the host response and organ dysfunction results. The aim
of this study was to assess the impact of various clinical factors on prognosis in septic patients.
Material and Methods: 2 years retrospective study of all septic patients (n=152) admitted into ICU.
Variables associated with hospital mortality were studied. Results: The mean age of male survivors was
significantly lower (p=0.002) than that of dead males: 61 to 71 years. Charlson comorbidity index was
significantly higher in patients who died (p=0.043). Mortality cases of nosocomial acquired infections
were higher compared to that of community acquired. The incidence of death was lower at patients
with local infection (72% vs 87%.), the difference being statistically significant (p = 0.044). Mortality
rate was significantly higher in lung and abdominal sepsis cases (78.1% and 73.9%) compared to the
urinary sepsis: 55.5%. Death rate increased significantly with the number of organ dysfunction (p <
0.001) and decreased with lower blood lactate at 48 hours (p = 0.044). Hypoxemia index <100
correlated to death rate and hypoxemia index value > 250 measured at 72 hours is positive correlated
with survival.
Conclusions: For P component Charlson comorbidity index is a good risk prognostic factor. The
infections extension proved to be a good prognostic factor for I component. The number of organs
dysfunction at admission time and the amount of lactate at 48 hours may be indicators belonging to O
component.
Key words: sepsis, PIRO, Charlson Comorbidity Index, prognostic indicator.
Intubaia fibroscopic de la manechin la rutina zilnic- experien clinic

Fiberscopic intubation, from the mannequin to daily routine - clinical experience
Ileana Mitre (1), Andreea Bereschi (2), G. Lajtrik (2), C. Mitre (3)
(1) Universitatea de Medicin i Farmacie Iuliu Haieganu, Clinica de Chirurgie Maxilofacial, ClujNapoca, Romnia
(2) Universitatea de Medicin i Farmacie Iuliu Haieganu, Spitalul Clinic Judeean de Urgen, ClujNapoca, Romnia
(3) Universitatea de Medicin i Farmacie Iuliu Haieganu, Clinica de Chirurgie III, Cluj-Napoca,
Romnia
Intubaia fibroscopic reprezint gold standardul, fiind recomandat n toate ghidurile de
management al cii aeriene dificile.
n toate workshopurile de cale aerian este prezentat metoda de intubare fibroscopic. Dar oare este
att de uor de utilizat pe ct pare la prima vedere?
n lucrarea de fa prezentm un model de curb de nvare a fibroscopiei cilor aeriene superioare
pentru medicul anestezist fr experien clinic n fibroscopie. n studiu au fost cuprini 100 de
pacieni sedai i curarizai, majoritatea n clasa Mallampati 1 i 2. Cei 100 de pacieni au fost mprii
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n grupe de cte 10. n cazul intubaiei pe manechin, dup 3 ncercri, procentul de reuit a fost de
100%. n studiul nostru a fost necesar un numr 20 de pacieni pentru a realiza o reuit de 70%. Dup
aceasta, procentul de reuit a fost 90-100%. Curba de nvare n cazul intubaiei fibroscopice este
mult mai dificil dect la manechin. O latur important pentru nvarea intubaiei fibroscopice este
starea pacientului sedat i relaxat, cu cale aerian normal i care se poate intuba rapid clasic n cazul
eecului fibroscopiei. Intubaia fibroscopic este o metod eficient de management al cii aeriene
dificile care necesit o serioas experien clinic. Exerciiul pe simulator, dei necesar, nu este
suficient, experiena clinic contribuie la succesul metodei. Experiena clinic la pacientul preoxigenat,
sedat i curarizat la care ventilaia pe masc este posibil i la care se ncearc un numr limitat
manopere fibroscopice este cel preferat.
Fiberscopic intubation represents the gold standard in the case of difficult airways and its use is
recommended in all guidelines. It is presented in all difficult airways workshops. But is this an easy
practice, clinically? 100 patients were included in this study. The patients were sedated and curarised,
the majority being Mallampati 1 and 2. For analysis, the patients were grouped in 10 equal groups. In
mannequin intubation, the success rate of fiberoptic intubation was 100% after 3 attempts. In our study
of the first 20 patients, the success was 10%, after which the success rate gradually increased to 90100%. Fiberscopic intubation is more difficult in the case of real patients than in mannequins. It is
important for beginners to practice this type of intubation in a classic induction of anaesthesia in
patients with normal airways, as a precautionary measure, retaining the alternative of classic
intubation in case of insuccess with fiberscopic intubation. Fiberscopic intubation is an important skill
for managing the difficult airway. Mannequin simulation is necessary but not sufficient, clinical
experience being mandatory for success. It is recommended to do this in a sedated and curarised
patient.
Dexametazona administrat perineural n blocul de nerv femural dup reconstrucia de

ligament ncruciat anterior
Perineural dexamethasone administered in femoral nerve block after anterior cruciate
ligament reconstruction
Arabela Codrua Cocea (1), Simona Florescu Cionac (1), Denisa Mdlina Anastase (1), Ana Maria
Munteanu (1), G. Porumbac (2), . Mogo (3), C. I. Stoica (3)
Bucureti, Romnia
Bucureti, Romnia
Obiectivul studiului: Efectul dexametazonei administrate perineural, ca adjuvant n prelungirea duratei
analgeziei continu s fie dezbtut. Scopul acestui studiu prospectiv randomizat a fost de a evalua
efectul dexametazonei, admininistrat perineural n analgezia postoperatorie n blocul de nerv femural
pentru reconstrucia de ligament ncruciat anterior.
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Material i metod: Dup obinerea aprobrii comitetului de etic i a consimmntului informat, 40
de pacieni operai au fost randomizai n 2 loturi egale ca numr la care s-a efectuat bloc de nerv
femural dup regresia anesteziei spinale: lotul A l-a care s-a administrat ropivacain 0,5% 20 de ml i
xilin 1% 20 de ml; lotul B l-a care s-a administrat ropivacain 0,5% 20 de ml, xilin 1% 20 de ml i
dexametazon 4mg. La prima cerere de calmant ambele grupuri au primit acelai protocol analgetic cu
paracetamol 1g iv la 12 ore. Dup 15 minute, dac NRS se menine peste 3 s-a administrat morfin 0,1
mg/kg doz de ncrcare. Ulterior, la cerere, morfina s-a administrat sc din doza de ncrcare.
Eficacitatea a fost evaluat prin durata analgeziei postoperatorii, consumul de opioid, satisfacia
pacientului i efectele secundare neurologice la 24 ore i 21 zile postoperator.
Rezultate: La pacienii din lotul B durata analgeziei a fost mai prelungit semnificativ statistic i
jumtate nu au necesitat opioid. Nu au fost semnalate efecte neurotoxice postoperator.
Concluzii: Administrarea de dexametazon perineural n blocul de nerv femural dup reconstrucia de
ligament ncruciat anterior crete durata analgeziei, fr efecte neurotoxice semnalate la 21 zile
postoperator.
Objective: The effect of dexamethasone administered perineural as an adjuvant in prolonging analgesia
continues to be debated. The purpose of this randomized prospective study was to evaluate the effect
of perineural dexamethasone administration on postoperative analgesia in femoral nerve block for the
reconstruction of the anterior cruciate ligament.
Material and Methods: After the ethical committee approval and informed consent, 40 patients under
spinal anaesthesia were randomised in 2 groups: group A received ropivacaine 0,5% 20 ml and xiline
1% 20 ml; group B A received ropivacaine 0,5% 20 ml, xiline 1% 20 ml and dexamethasone 4 mg. At the
first analgetic request, both groups received the same analgetic protocol with paracetamol 1g IV every
8 h for 48 h. If NRS was still over 3, morphine was given as a loading bolus of 0.1 mg/kg IV followed at
request by SC of the total loading dose. Efficacy was evaluated by the duration of analgesia after
block, the total amount of morphine in the first 24 h postoperative, the patient satisfaction and the
neurological side effects.
Results: The two groups were similar in terms of demographic data and surgery duration. Efficacy was
evaluated by the duration of analgesia, the total amount of morphine in the first 24 h postoperative,
the patient satisfaction and the neurological side effects.
Conclusion: Administration of perineural dexamethasone in femoral nerve block after anterior cruciate
ligament reconstruction increases duration of analgesia without postoperative neurotoxic effects
recorded at 21 days postoperatively.
Managementul perioperator al unui pacient cu inr=10 cu ajutorul rotem

The management of a patient with an INR of 10 with the use of ROTEM
Alexandra Marcu (1), Graiela Manga (1), Ecaterina Scrltescu (2), Dana Tomescu (2), Gabriela Droc
(1)
Introducere: Testele clasice de coagulare (timpul de protrombin, timpul de tromboplastin parial
activat, INR) pot fi insuficiente n aprecierea statusului coagulant deoarece acestea detecteaz doar
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timpul de coagulare, spre deosebire de testele vsco-elastice (ROTEM) care detecteaz schimbrile n
toate fazele coagulrii i fibrinolizei. ROTEM msoar formarea, stabilizarea i eventuala liz a
cheagului, precum i funcia plachetar i polimerizarea fibrinei.
Materiale i metode: Prezentm un caz clinic al unui pacient n vrst de 84 ani cunoscut cu ICC NYHA
II, AVC ischemic n antecedente, boal Parkinson i neoplasm de rect inferior operat n 2002 care este
admis n urgen n secia de Terapie Intensiv a Institutului Clinic Fundeni n vederea interveniei
chirurgicale pentru ocluzie intestinal. S-au nregistrat datele perioperatorii, analizele de laborator i
evoluia postoperatorie.
Rezultate: La admisia n Terapie Intensiv pacientul prezenta stare general alterat, instabilitate
hemodinamic i un abdomen mrit de volum, dureros spontan i la palpare. Analizele standard artau
modificri ale coagulrii: INR=10, PT=81 sec, APTT= 64 sec. n schimb ROTEM arta un status
procoagulant (MCF, CFT, n limite normale). S-a intervenit chirurgical n urgen. S-a practicat
enterectomie segmentar i colectomie segmentar. Intervenia chirurgical a durat 240 minute,
sngerarea a fost minim, fr necesar transfuzional, suport vasopresor (NA) maxim 0,2g/kg/min.
Postoperator prezenta acelai status procoagulant pe ROTEM i semne de CID: factorii coagulrii <
10%, DDimeri>18000 g/dl, PDF intens pozitivi. S-a instituit heparinoterapie. Evoluia a fost una
pozitiv, cu normalizarea parametrilor coagulrii i transfer din Terapie Intensiv n ziua a 5-a
postoperator.
Concluzii: Spre deosebire de testele de coagulare standard, testele vsco-elastice sunt net superioare
n evaluarea statusului coagulant i permit o abordare terapeutic rapid i corect.
Introduction: The classical coagulation tests (the prothrombin time, the activated partial
thromboplastin time, INR) might be insufficient in determining the coagulation status because these
tests detect only the time of coagulation, whereas ROTEM detects all the changes in all the phases of
coagulation and fibrinolysis. ROTEM measures the formation, stabilization and eventual lysis of the
clot, and also the platelet function and the fibrin polymerization.
Materials and methods: We present the case of a patients of 84-year-old, known with cardiac failure
NYHA II class, with a history of ischemic stroke, Parkinson disease and a rectal cancer operated in 2002.
The patient was admitted in the ICU of Fundeni Clinical Institute with the intention of being operated
for intestinal occlusion.
Results: At the time of admission in the ICU, the patient had a bad condition, hemodynamic instability
and an abdomen increased in volume, painful spontaneously and on palpation. The standard tests
showed problems in coagulation: INR=10, PT= 81 sec, APTT= 64 sec. In the same time ROTEM showed
a procoagulant status (MCF, CFT, alpha angle with normal values). There was an emergency procedure
which included o segmental enterectomy and colectomy. The surgery lasted for 240 minutes, the
bleeding was minimal, without the need for transfusion, minimal vasopressor support (norepinephrine
- maximum 0.2 mcg/kg/min). The ROTEM showed the same status and signs of disseminated
intravascular coagulation: coagulation factors < 10%, D-dimer >18000 mcg/dl, strong increase of fibrin
degradation products. For the reasons above, we chose to treat the patient with Heparin. The outcome
was good and the patient left the ICU after 5 days.
Conclusions: Unlike the standard coagulation tests, the ROTEM has superior results in determining the
coagulation status and allow a better and quicker therapeutic approach.
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Extinderea anatomo-topografic a anesteziei rahidiene prin manipularea baricitii

substanei anestezice injectate i poziionarea pacientului
Anatomical and topographic extension of spinal anaesthesia by substances baricity
manipulation and patient positioning
M. Botea (1), L. Szilagyi (2), D. Botea (2)
(1) Spitalul Clinic Judeean de Urgen, Unitatea Primire Urgene, Oradea, Romnia
(2) Spitalul Clinic Judeean de Urgen, Secia de Anestezie i Terapie Intensiv, Oradea, Romnia
Tocmai pentru a veni n ntmpinarea provocrilor anesteziei, ne-am propus aceast tem cu studierea
siguranei i eficienei anesteziei rahidiene alturi de extinderea cefalic a blocului senzorial pentru
abordul tractului urinar superior (TUS) care dispune de aferene senzoriale vegetative care urc cranian
pn la segmentele medulare toracale superioare (T4-6). Dar adevrata provocare a constat n
abordarea opereiilor deschise pe rinichi la pacientul sub anestezie rahidian, discutnd de pacientul
cu rezerve cardio-respiratorii limitate unde tehnica anesteziei generale ar presupune riscuri prea mari.
Scopul studiului este evaluarea eficienei i a siguranei anesteziei intratecale indus cu combinaia
bupivacain-fentanyl n interveniile urologice cu invazivitate de grade diferite, de durat variabil i
cu extindere anatomo-topografic variat.
Aceast lucrare este un studiu prospectiv realizat pe un lot de 100 de pacieni, cu stare fizic ASA I-III,
propui pentru proceduri urologice. Interveniile aplicate grupului de studiu au fost un numr de 76
proceduri endoscopice (TURP, TURV, cistoscopie, ureteroscopie) i 24 operaii deschise (nefrectomie,
pielolitotomie, ureterolitotomie, prostatectomie transvezical, cura incontinenei urinare, cura
varicocelului i hidrocelului, orhiectomie).
Anestezicul local utilizat a fost bupivacaina 5 mg/ml. Au fost utilizate pentru studiu comparativ 2 forme
- hipobar 0,25% i hiperbar 0,5%. Opioidul utilizat n combinaie, a fost fentanyl, soluie 50 g/ml.
Pacienii au fost mprii randomizat n patru grupe egale a cte 25 de pacieni la care s-au aplicat
proceduri diferite de poziionare dup administrarea intratecal a combinaiei anestezice. Acest studiu
prezint n final o statistic a rezulatatelor, n urma a cror discuii, autorii trag 20 de concluzii practice.
Pe scurt, aceast tehnic anestezic IT naltcu bupivacain hipobar i fentanyl este reducerea dozei
de bupivacain, conferind o stabilitate hemodinamic mai bun i o mobilizare postoperatorie precoce
a pacienilor, fr afectarea calitii analgeziei i a funciei respiratorii. Poziionarea vertical a
pacientului permite extinderera anesteziei pn la segmentele medulare toracice superioare (T4).
Tehnica este eficient i bine tolerat de pacientul fragil, pluritarat, necesitnd operaii deschise pe
rinichi i ureter.
Just for accepting the anaesthesia challenges, we aimed to study the safety and efficiency of the spinal
anaesthesia, looking for cephalic spread of the sensorial block for approaching the urinary superior
system, which is having vegetative sensorial afferences going up towards the superior thoracic
medullary segments (T4-6). But the ultimate challenge is coming from the open surgeries on the kidney
to the patient under spinal anaesthesia; taking in consideration that patient with limited cardiac and
respiratory reserves, where the general anaesthesia technique is posing to high risks.
The study aim was the assessment of the procedures safety and efficiency of spinal anaesthesia using
a combination of bupivacaine and fentanyl in urologic interventions with various grades of invazivity,
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in short and long standing procedures and obviously with different extension of the involved
topographic anatomy.
This paper work is a prospective study including 100 patients, I-III ASA status, who underwent urologic
procedures. There were 76 endoscopic procedures (TURP; TURV, cystoscopy, uretheroscopy) and 24
opened surgeries (nephrectomy, pielolitotomy, uertherolitotomy, transvezical prostatectomy, urinary
incontinantion cure, varicocel and hidrocel cure, orhectomy).
The local anaesthetic used was bupivacaine 5 mg/ml on two different concentrations - hypobaric 0,25%
and hyperbaric 0,5% - for study comparation purposes. The opioid used in this combination was
fentanyl, 50 g/ml solution. The patients were randomized divide into 4 equal groups. After the
intratechal administration of the anaesthetic combination were applied different positioning
techniques. This study will be presenting a statistic data research. Debating discussions the authors are
able to pull out 20 practical conclusions. Shortly, the advantages of high level intrathecal anaesthesia
with hypobar bupivacaine and fentanyl are: is an effective and safe technique for endoscopic and open
urologic procedures; it is easy to perform, and is an inexpensive; fentanyl allows a decrease of
bupivacaine dose favourising early ambulation, improving the hemodynamic stability, preserving the
quality of analgesia and respiratory function; the vertical patient positioning allows the anaesthetic
spread to the upper thoracic medullary segments (T4); the technique is efficient, well tolerated by the
fragile patient with multiple comorbidities, undergoing open surgeries on kidney and ureter.
Colonizarea cu microorganisme a tegumentelor pacienilor internai n unitatea de terapie intensiv:
studiu experimental, descriptiv
Microorganisms colonization of different body sites of patients admitted to the ICU
M. Ambroci (1), Natalia Stoica (2), M. Badaneu (2), P. Trapeznicov (2), A. Beli (3)
(1) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Catedra de Anesteziologie
Nr. 1 Valeriu Ghereg, Chiinu, Republica Moldova
(2) Societatea de Anesteziologie i Reanimatologie a Republicii Moldova, Reanimare, Chiinu,
Republica Moldova
(3) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Catedra de Anesteziologie i
Reanimatologie nr. 1 Valeriu Ghereg, Chiinu, Republica Moldova
Introducere: Gradul de colonizare al tegumentelor cu microorganisme i fungi depinde de starea
sistemului imun, igiena personal, eventualele tratamente cu antibiotice sau de microambian.
Meninerea igienei bucale i cutanate reprezint un obiectiv de ngrijire major, n special n unitile
de terapie intensiv (UTI).
Scopul lucrrii: Cuantificarea gradului de colonizare a diferitor regiuni ale tegumentelor la pacienii de
diferit gravitate, internai n UTI, comparativ cu persoanele sntoase.
Material i metode: Studiu prospectiv, experimental. Aviz CEC pozitiv. Acord informat scris obinut.
nrolai 12 voluntari sntoi (VS), 47 pacieni ventilai pulmonar artificial (VPA-UTI) i 10 - neventilai
(NV-UTI), toi internai n UTI minim 48 de ore. Prelevate probe de pe palme (P), scapul (S), obraz (O),
torace (T), regiunea inghinal (I), utiliznd testerele microbiologice Mikrocount TPC/E (Schulke).
Rezultate interpretate dup 72 ore de incubare la 37C. Prezentat doar rata de colonizare 105.
Rezultate: VS vs. NV-UTI vs. PV-UTI: P (8% vs. 10% vs. 70%); S(0% vs. 30% vs. 43%); O(8% vs. 10% vs.
40%); T(0% vs. 10% vs. 34%); I(17% vs. 40% vs. 83%).
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Concluzii: Gradul de colonizare cu microorganisme al tegumentelor la pacienii internai n UTI este de
10-100 ori mai mare (proporional severitii) dect la persoanele sntoase, regiunile cele mai
populate fiind zona inghinal i palmele.
Cuvinte cheie: colonizare bacterian, igien tegumente, pacient critic.
Introduction: The degree of colonisation of the teguments with microorganisms and fungi depends on
the state of the imune system, personal hygiene, eventual treatments with antibiotics and on
microsphere.
Objective of the study: Quantification of the degree of colonization of different skin regions of patients
with different severity hospitalized in the ICU, compared with healthy individuals.
Materials and Methods: Prospective, experimental study. ECC approved. Written informed consent was
obtained. The study enrolled 12 healthy volunteers (HV), 47 patients on artificial pulmonary ventilation
(PV-ICU) and 10 patients with no artificial pulmonary ventilation (NV-ICU), all patients had a minimal
stay in the ICU of at least 48 hours. The following regions were sampled: hands (P), scapula (S), cheek
(C), thorax (T), inguinal region (I) using microbiological test Mikrocount TPC/E (Schulke). The results
were read after 72 hours of incubation at 37C. Only the rate of colonisation 105 was presented.
Results: HV vs. NPV-ICU vs. PV-ICU: P (8% vs. 10% vs. 70%); S(0% vs. 30% vs. 43%); O(8% vs. 10% vs.
40%); T(0% vs. 10% vs. 34%); I(17% vs. 40% vs. 83%).
Conclusions: The degree of skin colonization with microorganisms in patients hospitalized in the ICU is
10-100 times higher (proportional to the severity) than in healthy people, the most populated regions
being the inguinal region and hands.
Keywords: bacterial colonization, skin hygiene, critical patient.
Simularea medical din punctul de vedere al studenilor
Medical simulation from the students point of view
Orsolya Benedek (1), C. Moldovan (2), Nicoleta Bulz (3), Alexandra Lazr (4), M. Petrior (2), M. Veres
(5), L. Azamfirei (4), Sanda Maria Copotoiu (1), J. Szederjesi (1)
(1) Universitatea de Medicin i Farmacie, Disciplina Anestezie i Terapie Intensiv 1, Trgu Mure,
Romnia
(2) Universitatea de Medicin i Farmacie, Disciplina Simulare Aplicat n Medicin, Trgu Mure,
Romnia
(3) Universitatea de Medicin i Farmacie, Facultatea de Medicin General, Trgu Mure, Romnia
Romnia
(5) Spitalul Clinic Judeean de Urgen, Clinica de Anestezie i Terapie Intensiv, Trgu Mure, Romnia
Introducere: Simularea este o component important a educaiei medicale. Scop: Cuantificarea
gradului de satisfacie a studenilor legat de simularea medical.
Material i metod: Am efectuat un studiu prospectiv observaional utiliznd fomulare pentru
evaluarea activitii de simulare de ctre studeni n Centrul de Simulare i Abiliti Practice din cadrul
Universitii de Medicin i Farmacie Trgu Mure. Formularul a coninut 5 ntrebri cu rspuns
cantitativ (1 punct = minim i 5 puncte = maxim), respectiv 2 ntrebri cu rspuns liber, acesta fiind
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completat anonim. Am analizat datele obinute de la 498 studeni. Am comparat rspunsurile obinute
n anul universitar 2013/2014, respectiv 2014/2015 utiliznd GrapPad Prism 5.
Rezultate: n primul an 91.71% din studeni au evaluat gradul de interactivitate cu punctajul maxim
fr diferen semnificativ comparativ cu al doilea an, cnd 86.23% din studeni au acordat acest
punctaj (p=0.12). Comprehensivitatea temei abordate a fost evaluat maxim de ctre 81.35% din
studeni n primul an, respectiv 73.11% din studeni n al doilea an (p=0.005, <0.05). 88.60% studeni
au participat nemijlocit la simulare n primul an, 83.93% n al doilea (p=0.03, <0.05). n primul an
87.05% din studeni au considerat dotarea tehnic excelent, iar 91.48% au optat pentru punctajul
maxim, fr diferen semnificativ n al doilea an (p=0.07). n primul an 93.26% din studeni au
considerat simularea fiind foarte util din punct de vedere profesional, 95.08% din studeni au evaluat
utilitatea cu punctaj maxim n al doilea an (p=1.99).
Concluzii: Simularea n educaia medical este foarte apreciat de studeni.
Introduction: Simulation is an important component of medical education. Aim: To quantify the level of
satisfaction of students regarding medical simulation.
Material and Methods: We conducted a prospective observational study using questionnaires to
evaluate simulation related activities by students in the Center for Simulation and Practical Skills from
the University of Medicine and Pharmacy of Trgu Mures. The anonymous questionnaire contained 5
questions with quantitative answers (1 point = minimum, 5 points = maximum) and 2 questions with
free answers. We analyzed the data from 489 students. We compared the answers from 2013/2014
with those from 2014/2015 using GrapPad Prism 5.
Results: In the first year 91.71% of students considered the interactivity to be the best, without
significant difference compared to the second year, when 86.23% of them had the same opinion
(p=0.12). The comprehensiveness of the cases was evaluated with a maximum score by 81.35% of the
students in the first year and 73.11% in the second year (p=0.005, <0.05). 88.60% participated actively
in the first year, while 83.93% of them in the second year (p=0.03, <0.05). In the first year 87.05% of
the students considered the technical aspect to be excellent and 91.48% evaluated this with a maximum
score in the second year (p=0.07). In the first year 93.26% of students thought these activities to be
useful while 95.08% of students agreed in the second year (p=1.99).
Conclusions: Simulation in medical education is highly appreciated by students.
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Factorii de risc n dezvoltarea MODS la copii dup corecia chirurgical a tetralogiei Fallot
Risk factors in the development of MODS in children after surgical correction of Fallot
tetralogy
A. Botizatu (1), S. Ursul (1), Doriana Cojocaru (2), V. Guan (1), Corina Guium (3), Iana Cotorcea (4), V.
Cojocaru (1)
(1) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Clinica de Anesteziologie i
Terapie Intensiv, Chiinu, Republica Moldova
(2) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Catedra Anesteziologie i
Reanimatologie Nr.1, Chiinu, Republica Moldova
(3) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Departamentul de Reanimare
i Terapie Intensiv, Chiinu, Republica Moldova
(4) Spitalul Clinic Republican, Clinica de Anesteziologie i Terapie Intensiv, Chiinu, Republica
Moldova
Date generale: Noile tehnologii chirurgicale n corecia TF au dus n ultimul deceniu la scderea
mortalitii postoperatorii, unii pacieni nc se confrunt cu o morbiditate postoperatorie
semnificativ.
Obiective: Determinarea incidenei, letalitii i identificarea factorilor predispozani n dezvoltarea
MODS la pacienii supui coreciei chirurgicale a TF.
Material i metode: A fost realizat un studiu retrospectiv n perioada mai 2010 - decembrie 2015 care
a inclus toi copii operai pentru corecia tetralogiei Fallot. Au fost analizate datele demografice i
morfologice preoperatorii, intraoperatorii i postoperatorii. Parametrii disfunciei de organe au fost
evaluai prin prisma scorului p-MODS.
Rezultate: Au fost identificai 45 pacieni cu TF supui coreciei chirurgicale.Vrsta medie a grupului de
pacieni a constituit 1,6 ani, greutatea corporal medie 13,1 kg. La 15 pacieni (33,3%) s-au nregistrat
accese hipoxice. Nivelul SpO2 mediu a fost de 83,9 %. Durata medie a CEC a fost 142,6 minute. Indicele
mediu inotrop-vasoactiv s-a apreciat 12,4 puncte. n perioada postoperatorie, disfuncia respiratorie a
fost prezent la 24 (53,3%), disfuncia renal la 11 (24,4%), disfuncia hepatic la 23 (51,1%), disfuncia
hemostazic la 18 (40%) pacieni. La 19 (42,2%) pacieni s-a dezvoltat MODS, letalitatea a constituit
6,6%. Durata medie a ventilaiei artificiale pulmonare a constituit 38,2 ore, durata medie a aflrii n
terapia intensiv a constituit 5,6 zile.
Concluzii: Nivelul SpO2, gradul de stenoz a valvei AP, prezena acceselor cianotice, scorul inotrop
vasoactiv 10, durata CEC au constituit factori predispozani n dezvoltarea MODS. Aflarea n terapia
intensiv, durata ventilaiei pulmonare, a prevalat la pacienii din grupul MODS.
Background: New technologies in surgical correction of FT over the past decade has led to a decreased
postoperative mortality, some patients still facing significant postoperative morbidity.
Objectives: Establishing the incidence, identifying predisposing factors and lethality in the development
of MODS in patients undergoing surgical correction of FT.
Material and Methods: A retrospective study was conducted in the period of May 2010 - December
2015 that included all children which underwent surgical correction of Fallot tetralogy. Morphological,
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preoperative, intraoperative and postoperative demographic data were analyzed. Organ dysfunction
parameters were evaluated through p-MODS scoring.
Results: There were identified 45 patients with FT who underwent surgical correction. The average age
of the group was 1.6 years, the average body weight 13.1 kg. In 15 patients (33.3%) were emphasised
hypoxic accesses. SpO2 average level was 83.9%. The average duration of CBP was 142.6 minutes,
vasoactive inotropic average score was 12.4 points. Through the postoperative period, respiratory
dysfunction was present in 24 (53.3%) patients, renal dysfunction in 11 (24.4%) patients, liver
dysfunction in 23 (51.1%) patients, disorder of hemostasis in 18 (40%) patients. 19 (42.2%) patients had
developed MODS. The lethality was 6.6%. The average duration of artificial lung ventilation was 38.2
hours, average length of stay in the ICU was 5.6 days.
Conclusions: SpO2 level, degree of stenosis of the PA valve, presence of cyanotic accesses, vasoactive
inotropic score 10 and CPB duration, have been determined as predisposing factors in the
development of MODS. Length of ICU stay, length of pulmonary ventilation also prevaled in the group
of patients with MODS.
Timpul de ischemie cald - factor de risc asociat cu funcia ntrziat a grefei n transplantul
renal de la donator n moarte cerebral - experiena unui singur centru
Warm ischemia time - a risk factor associated with delayed graft function in deceased donor
renal transplants - a single center experience
Liliana Florena Domnior (1), Dorina Tacu (2), A. Preda (2), G. Ismail (3), Ruxandra Divan (1), C. Gngu
(2), Denise Daia (1), Iulia Mitroi (1), Ruxanda Tulbure (1)
(1) Institutul Clinic Fundeni, Secia de Anestezie i Terapie Intensiv II, Bucureti, Romnia
(2) Institutul Clinic Fundeni, Centrul pentru Uronefrologie i Transplant Renal, Bucureti, Romnia
(3) Institutul Clinic Fundeni, Centrul de Medicin Intern, Bucureti, Romnia
Obiectiv: Obiectivul studiului este analiza influenei timpului de ischemie cald (TIC), ca factor
individual, pentru funcia ntrziat a grefei (DGF - delayed graft function), precum i influena
simultan a timpilor de ischemie cald i rece (TIC i TIR) asociat cu DGF, la receptorul de gref renal
de la donator n moarte cerebral. DGF este definit ca necesitatea de dializ n prima sptmn
posttransplant renal.
Materiale i metode: Studiul prospectiv observaional a inclus o serie de 143 de transplante renale de
la donator n moarte cerebral, n perioada ianuarie 2014 i septembrie 2015. Lotul de pacieni a fost
divizat n 4 grupe raportate la timpul de ischemie cald i timpul de ischemie rece, astfel: grupul A cu
TIR 12 ore i TIC 35 min, grupul B cu TIR > 12 ore i TIC 35 min, grupul C cu TIR 12 ore i TIC > 35
min i grupul D cu TIR > 12 ore i TIC > 35 min.
Rezultate: DGF a fost observat la 21 de receptori de rinichi de la donatori n moarte cerebral (14,7%).
Parametrul urmrit, timpul de ischemie cald nu a fost asociat, ca factor individual, cu DGF. Totui
prelungirea simultan a timpilor de ischemie rece i cald a fost asociat cu DGF (p <0,001).
Concluzii: n studiul nostru, timpul de ischemie cald nu a fost asociat cu creterea riscului crescut de
DGF. Uneori, efectul simultan de prelungire a timpului de ischemie rece i a timpului de ischemie cald
poate genera DGF posttransplant.
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Objective: The aim of this study was to analyze the influence of warm ischemia for delayed graft
function (DGF) and to determine whether simultaneously prolonged CIT and WIT were associated with
DGF in recipients of kidneys from deceased donors in our center. DGF is defined as the requirement of
dialysis in the first week after kidney transplantation, delayed graft function occurring in 20% to 50%
of patients receiving a first cadaver graft.
Materials and Methods: This prospective observational study included a series of 143 consecutive
deceased donor renal transplants performed in our center between the 1st of January 2014 and the
30th of September 2015. We divided patients into 4 groups: group A, CIT < or =12 hrs and WIT < or =35
min; group B, CIT >12 hrs and WIT < or =35 min; group C, CIT < or =12 hrs and WIT >35 min; and group
D, CIT > 12 hrs and WIT >35 min.
Results: DGF occurred in 21 kidney recipients from deceased donors (14.7%). Prolonged warm ischemia
time was not associated with an increased risk of DGF. The simultaneously prolonged cold ischemia
time and warm ischemia time were associated with DGF (p<0.001), suggesting some cumulative effects
on postoperative renal graft function.
Conclusions: In our study, warm ischemia time was not associated with increased risk of DGF. However,
simultaneously prolonged cold ischemia time and warm ischemia time were associated with DGF.
103 zile de terapie intensiv - Poliradiculonevrit la un copil de 6 ani cu hemofilie B Prezentare de caz
103 days intensive care stay - Polyradiculoneuritis in a 6-year-old child with type B
hemophilia - Case report
Mara tefan (1), A. Dinca (2), Adriana Diaconu (3), H. Vultur (3), Alexandra Marcu (2), M. Popescu (1),
Dana Tomescu (1)
(3) Institutul Clinic Fundeni, Secia Pediatrie I, Bucureti, Romnia
V prezentm cazul unui copil de ase ani cu hemofile B cu debut rapid al slbiciunii proximale i distale
a membrelor i areflexie, cu febr i stop respirator n momentul prezentrii la spital. Este admis n
terapie intensiv cu suspiciunea de hematom cervical medular compresiv, supoziie infirmat de
imaginile tomografice. Provocrile pornesc nc din momentul abordului venos periferic datorit
nivelului redus de factor IX(4%). Sindromul Guillain-Barre este suspectat. Examinarea lichidului
cefalorahidian obinut prin puncie dural se consider a fi cu risc crescut i nu se practic. Conform
protocoalelor aflate n uz, este indicat terapia cu imunoglobuline intravenos sau plasma exchange.
Nu se observ ameliorare clinic dup administrarea imunoglobulinelor i se decide nceperea
edinelor de plasma exchange. Se efectueaz cinci edine.
Provocrile acestui caz au fost: multiple manevre invazive (inclusiv traheostomie chirurgical) pe
parcursul celor 103 zile de terapie intensiv, numeroase episoade infecioase cu ue rezistente
(Pseudomonas aeruginosa, Acinetobacter sp.), precum i weaningul dificil dup ventilaia mecanic
prelungit. Pacientul a fost transferat pe secia de pediatrie, respirnd spontan pe canula de
traheostom, cu ameliorarea funciei motorii.
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Considerm asocierea dintre hemofilia B i poliradiculonevrit o mare provocare pentru medicul de
terapie intensiv. Nu am gsit n literatura de specialitate alt caz care se prezinte cele dou boli
asociate.
We present the case of a 6-year-old child with type B hemophilia with rapid onset of proximal and distal
limb weakness and areflexia, with fever and respiratory arrest at hospital arrival. The patient was
admitted in intensive care unit with the suspicion of compressive hematoma in the cervical spine,
excluded after CT scan. The challenge began from the first intravenous line, every manoeuvre being
carefully weighed because of severe deficit of the IX factor level (4%). Guillain-Barr syndrome was
suspected. Examination of cerebral spinal fluid via dural puncture was considered to be at high risk.
According to local therapeutic protocols, intravenous immunoglobulin or therapeutic plasma exchange
were indicated. No clinical benefit was noted after intravenous immunoglobulin and five therapeutic
plasma exchange sessions were performed.
Challenges for this case were: multiple invasive manoeuvres (including surgical tracheostomy) in a 103day stay in intensive care unit, numerous episodes of infection with resistant microbial strains
(Pseudomonas aeruginosa, Acinetobacter sp.) and weaning from mechanical ventilation. The patient
was discharged to the pediatric ward with improvement in motor function, spontaneous breathing.
We consider the association between hemophilia B and polyradiculoneuritis a challenge for the
intensivist. We did not find any similar case in the literature with polyradiculoneuritis and type B
hemophilia.
Oxigenarea extracorporeal membranar n ARDS provocat de AH1N1 la pacienii cu

obezitate morbid
Extracorporeal membrane oxygenation in ARDS caused by AH1N1 in patients with morbid
obesity
V. Cojocaru (1), A. Botizatu (1), S. Ursul (1), Doriana Cojocaru (2), V. Guan (1), V. Maevschi (3), Corina
Guium (3), Iana Cotorcea (4)
(2) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Catedra de Anesteziologie i
Reanimatologie Nr. 1, Chiinu, Republica Moldova
Moldova
(4) Spitalul Clinic Republican, Clinicacde Anesteziologie i Terapie Intensiv, Chiinu, Republica
Moldova
Actualitate: Hipoxemia i hipercapnia prezent la pacienii cu ARDS de origine AH1N1 sunt 2 cauze
eseniale de inducere a MODS. La moment, ultima soluie pentru contracararea acestor fenomene este
ECMO.
Obiective: Evaluarea eficienei aplicrii ECMO la pacienii cu detres respiratorie provocat de gripa
A(H1N1) pe fundal de obezitate morbid.
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Material i metode: Prezentm 5 cazuri de grip AH1N1 complicat cu ARDS, evoluat cu MODS,
disfuncia a 3 i mai multe sisteme i organe pe fundal de obezitate morbid, IMC>40. Vrsta medie a
fost 61,7 ani. Pacienii au fost supui ECMO, cu aparatul CARDIOHELP System prin metoda VV-ECLS,
n perioada ianuarie - martie 2016. Criteriile de includere la ECMO au constituit: IO 70 mmHg; PaCO2
66 mmHg; suport VAP 4zile; presiunea Ppeak 30 mmbar/sec; PEEP > 8 mbarr i scorul de injurie
pulmonar acut, scorul Morey >3 puncte.
Msurile principale de evaluare: Particularitile clinice, gradul de distrucie pulmonar, caracteristicile
tehnice, durata ECMO, complicaiile i supravieuirea.
Rezultate: Din 5 pacieni supui ECMO au supraveuit 3 (60%) pacieni. Sevrajul de la ECMO s-a reuit
la a 10-a, a 12-a i a 11-a zi. Sevrajul de ventilator s-a efectuat la a 4-a, a 6-a i respectiv a 7-a zi. La
necropsie, la 2 pacieni decedai, s-a constatat fibrozarea avansat a esutului pulmonar, tromboza
microcirculaiei pulmonare, sindrom de CID decompensat.
Concluzii: ECMO poate reduce mortalitatea, inclusiv la pacienii cu obezitate morbid. Obezitatea
morbid nu prezint contraindicaie absolut pentru conectarea la ECMO.
Actuality: Hypoxemia and hypercapnia in patients with ARDS caused by influenza A(H1N1) are two
essential factors inducing MODS. ECMO is the last solution to counteract these phenomena at the
moment.
Objectives: Evaluating the effectiveness of applying ECMO in patients with respiratory distress
syndrome caused by influenza A(H1N1) in obese patients.
Material and Methods: We present 5 cases of AH1N1 influenza, evolved in ARDS, complicated with
MODS (dysfunction of 3 or more organ systems), in morbidly obese patients with a BMI> 40. The mean
age was 61.7 years. The patients underwent EMO, the device "CARDIOHELP System" using the method
VV-ECLS during the period of January - March 2016. Criteria for inclusion on ECMO were: OI 70 mmHg;
PaCO2 66 mmHg; ventilatory support 4 and 7 days, Ppeak pressure 30 mmbar/sec; PEEP> 8
mbar and acute lung injury: Morey score > 3 points.
The evaluation measures: Clinical features, the degree of pulmonary destruction, technical
characteristics, duration of ECMO, complications and survival.
Results: From 5 patients undergoing ECMO three patients (60%) survived. Weaning from ECMO was
managed at the 10th, 12th and 11th day. Weaning from the ventilator was performed at 4, 6 and
respectively 7 days. At necropsy, in 2 dead patients, it was found "advanced fibrosis of the lung tissue,
pulmonary microcirculatory thrombosis, uncompensated DIC syndrome".
Conclusions: ECMO can reduce mortality, including in patients with morbid obesity. Morbid obesity is
not an absolute contraindication for treatment with ECMO.
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Unele consideraii anestezice n chirurgia tumorilor de fos posterioar

Some anaesthetic considerations in the posterior fossa tumor surgery
Corina Guium (1), Iana Cotorcea (1), A. Botizatu (2), S. Ursul (2), Doriana Cojocaru (2), V. Guan (2), V.
Cojocaru (2)
Moldova
Materiale i metode: n studiu au fost incluse 2 loturi de pacieni: I lot - 26 pacieni crora li s-a
administrat anestezie combinat (i/v + pivot inhalator cu sevofluran); lotul II - 24 pacieni crora li s-a
administrat anestezie total intravenoas (propofol+fentanil).
Monitoring: TAs, TAd, TAm (invaziv), PVC, echilibru acidobazic, gazos (arter i ven periferic, bulbul
jugular), electrolitic, acidul lactic, diurezei orar, poteniale evocate.
Discuii: n lotul pacienilor cu anestezie inhalatorie s-a determinat o inciden nalt a depresiei
hemodinamice profunde (> 30%), cu o micorare a ratei metabolice cerebrale i a coeficientului de
extracie a O2 n creier. Tot aici s-a determinat: utilizarea dozelor mai mici de analgetice i
miorelaxante, trezire mai rapid, inciden mai sczut a greei i tremorului postoperator. S-a reuit
nregistrarea mai veridic a potenialelor evocate, datorit cantitii mici de miorelaxante utilizate. La
pacienii cu anestezie intravenoas s-a determinat o stabilitate hemodinamic, hemoragie
intraoperatorie nesemnificativ, ct i modificri nesemnificative a ratei metabolice cerebrale.
Concluzii: Tehnicile descrise pot fi utilizate pentru accesul chirurgical al fosei posterioare, dar numai n
condiii de monitorizare multimodal corespunztoare. Tehnica de anestezie inhalatorie, respectnd
farmacokinetica preparatelor, ar putea fi de preferat, din cauza evitrii riscurilor de supra-sau sub
dozare de medicamente anestezice, oferind o trezire mai rapid, cu o evaluarea neurologic imediat,
care este extrem de important.
Materials and Methods: The study included two groups of patients: Ist group - 26 patients receiving
combined anaesthesia (i / v + inhaled sevoflurane); IInd group - 24 patients who received intravenous
anaesthesia (propofol + fentanyl).
Monitoring: sBP, dBP, mBP (invasive), CVP, acid-base, gas (peripheral artery and vein, jugular bulb) and
electrolytic balances, lactic acid, hourly diuresis, neurology evoked potentials.
Discussion: In the group of patients with inhalation anaesthesia was determined a higher incidence of
hemodynamic depression (> 30%) with a decreased cerebral metabolic rate and a reduction of the
extraction coefficient of O2 in the brain. Also it was determined: use of lower doses of analgetics and
muscle relaxants, faster awakening, lower incidence of postoperative nausea and tremors. We
managed a more accurate recording of evoked potentials due to the small amount of muscle relaxant
used. In patients with intravenous anaesthesia was determined a more stable, less intraoperative
bleeding and minor changes of cerebral metabolic rate.
Conclusions: The described techniques can be used to access the posterior fossa for surgery, but only
under appropriate multimodal monitoring. Inhalational anaesthesia technique, respecting the
pharmacokinetics of the drugs, could be preferable due to avoiding the risks of over or under dosage of
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anaesthetic agents, providing a faster awakening with immediate neurological evaluation, which is
extremely important.
Implicarea analizei psihologice n procesul educaional folosind simulatoarele medicale

The implication of psychological analysis in the educational process using medical simulators
J. Szederjesi (1), Luminia Albert (2), C. Moldovan (2), Alexandra Lazr (3), Orsolya Benedek (1), Sanda
Maria Copotoiu (1), L. Azamfirei (3)
(1) Universitatea de Medicin i Farmacie, Disciplina Anestezie i Terapie Intensiv I, Trgu Mure,
Romnia
Romnia
(3) Universitatea de Medicin i Farmacie, Disciplina Anestezie i Terapie Intensiv II, Trgu Mure,
Romnia
Obiectivul studiului: Evaluarea satisfaciei studenilor privind activitatea educaional utiliznd
simulatoarele medicale.
Material i metode: n cadrul studiului propus a fost elaborat un chestionar de feedback, acoperind 5
mari categorii: autodezvoltarea personal, utilitatea exerciiului pe simulatoare, dezvoltarea
abilitilor de relaionare, actul pedagogic, dezvoltarea aptitudinilor de management propriu.
S-au completat i analizat un numr de 149 de chestionare de la studenii care au participat la sesiunile
de simulare.
Rezultate: La ntrebrile care vizeaz componenta de autodezvoltare personal, adic stpnirea mai
bun a contextului terapeutic, auto-eficacitatea, detaare n situaii criz, luarea deciziilor terapeutice,
rspunsurile afirmative ca utilitate reprezint n medie 41% din grupul total.
La categoria care urmrete utilitatea exerciiului pe simulator: nsuirea tehnicilor pn acum
considerate dificile, antrenarea deprinderilor/manevrelor, rspunsurile n procent de 60% subliniaz
aprecierea lucrrilor practice din cadrul Centrului de Simulare.
Rspunsurile pozitive privind relaionarea cu cadrele medicale din clinici, colegi, personal auxiliar au
fost transpuse ntr-un procentaj de 55%.
Cel mai mare punctaj procentual este obinut n cadrul categoriei privind procesul pedagogic, 76%
afirmativ pentru utilitatea predrii ntr-un cadru degajat, unde procesul de acumulare a informaiilor
se realizeaz mai uor.
La ntrebrile legate de dezvoltarea aptitudinilor manageriale, i anume organizarea etapelor medicale,
descoperirea resurselor proprii n anumite situaii medicale, formularea ipotezelor de lucru, rezultatele
afirmative n ceea ce privete utilitatea sunt n procentaj de 45%.
Concluzii: Analiza activitii pedagogice ne permite evaluarea obiectiv a calitii procesului
educaional i permite mbuntirea acestuia. Studenii apreciaz nivelul educaional oferit de
simulatoarele medicale.
The aim of the study: To evaluate student satisfaction regarding the educational process using medical
simulators.
Material and Methods: A questionnaire was developed for this study, which covered 5 large categories:
personal auto development, usefulness of simulation based exercises, development of bonding abilities,
educational process, and development of self-management aptitudes.
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A number of 149 questionnaires were filled and analysed by students who participated at simulation
sessions.
Results: The answer to questions regarding personal auto development, a better control of therapeutic
context, self-efficiency, detachment in crisis situations, making therapeutical decisions, the affirmative
answers represent 41% of the total group.
In the category regarding the usefulness of simulation exercises: learning techniques that were
considered difficult, training in skills/manoeuvres, 60% of the answers underline the appreciation of
practical activities in the Simulation Centre.
Positive answers regarding bonding with the medical staff, colleagues, auxiliary personnel, translated
into a percentage of 55%.
The highest percentage is obtained in the category regarding the educational process, 76% agree on
the usefulness of teaching in a more liberal environment, where the process of information gathering
is accomplished more easily.
To the questions about development of managerial skills, more precisely organising the stages of the
medical act, discovering own resources in certain medical situations, defining work hypotheses, the
positive results are registered in 45%.
Conclusions: Analysing the teaching activities allows us to objectively evaluate the quality of the
educational process and permits us to improve it. Students appreciate the level of education provided
by medical simulators.
Prezentare de caz: dublu abord spinal n cifoza Scheuermann fr transfuzie de snge

Case-Report: double spinal approach in Scheuermann kyphosis without blood transfusion
Denisa Mdlina Anastase (1), Ana Maria Munteanu (1), Simona Florescu Cionac (1), Arabela Codrua
Cocea (1), G. Porumbac (2), T. R. Ursu (3), A. Drghici (3), C. I. Stoica (3)
Bucureti, Romnia
Bucureti, Romnia
Corecia cifozei Scheuermann prin dublu abord este o intervenie ortopedic major asociat cu
necesitatea transfuziei de snge aproape obligatoriu att intra-, ct i postoperator. Tehnici care scad
necesarul transfuzional sunt: administrarea de acid tranexamic, hipotensiunea controlat, bureii cu
fibrin. Pe lng metodele farmacologice este necesar o metod care s se adreseze hemostazei, mai
ales n ortopedie,unde sngerarea este dintr-o tran de osteotomie. O astfel de metod este folosirea
intraoperatorie a unui dispozitiv special bipolar pe baz de radiofrecven i ser fiziologic care sigileaz
surs de sngerare la temperaturi mai joase (100C) dect electrocauterul clasic (200C).
Prezentm cazul unui tnr de 19 ani cu cifoz Scheuermann cu componen rotaional i cardiopatie
de nsoire care a fost operat n clinica noastr printr-un dublu abord: antero-lateral stng transtoracic
la nivelul coastei VII pentru discectomie multisegmentar (4 discuri intervertebrale) i posterior pentru
corecia diformitii prin multiple osteotomii (tip Ponte) i fixare cu instrumentaie segmentar T3-L3,
intervenia avnd o durat de 7 ore. Hemostaza a fost realizat cu Aquamantis. Hemoglobina de
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pornire a fost de 13,8g/dl. La 4 ore de la debutul interveniei Hb era de 11,7g/dl, iar la 24 ore
pstoperator 10,1g/dl. Evoluia postoperatorie a fost favorabil cu externare la 8 zile.
Chiar folosind metodele de prevenie convenionale, sngerarea medie ar fi fost de 1200 ml, care ar fi
necesitat 1-2 U MER. Aquamantis a permis o hemostaz intraoperatorie mai eficient. De asemenea,
riscul de complicaii postoperatorii e mai mic. Rezultatul nostru este conform cu datele publicate n
literatur.
Scheuermann kyphosis correction by double approach is a major orthopedic intervention associated
with blood transfusion almost mandatory both intra- and postoperatively. Techniques that decrease
transfusion requirements are: administration of tranexamic acid, controlled hypotension, fibrin
sponges. Besides pharmacological methods, it is necessary a technique that addresses to hemostasis,
especially in orthopedics where bleeding occurs in the area of the osteotomy. One such method is the
intraoperative use of a special device like bipolar radiofrequency and saline source device that seals the
bleeding at lower temperatures (100 C) than classically electrocautery (200 C).
We present the case of a 19-year-old patient with kyphosis Scheuermann with a rotational component
and accompanying cardiopathy who was operated in our clinic through a dual approach: antero-lateral
transthoracic left approach at the coast VII for multisegmentary discectomy (4 intervertebral discs) and
posterior approach for correction of deformity by multiple osteotomies (Ponte type) and fixation with
segmentary instrumentation between T3 to L3 with a surgery duration of 7 hours. Hemostasis was
achieved with Aquamantis. The starting hemoglobin was 13.8 g / dL. After 4 hours hemoglobin value
was 11.7g / dl and 24 hours after was 10.1g / dl. The postoperative evolution was favorable with
discharge after 8 days.
Even using conventional methods of prevention the bleeding would have been 1200 mL, which would
have required 1-2 U blood units. Aquamantis allowed an intraoperative hemostasis more effective.
Also, the risk of postoperative complications is lower. Our result is consistent with the literature data.
Incidente n anestezia extra bloc operator

Incidents in non-operating room anaesthesia
M. I. Tudoroiu (1), Mdlina Berbecel (1), Gabriela Droc (2)
Introducere: n cadrul Institutului Clinic Fundeni se pot efectua cu anestezie o gam variat de
proceduri i manevre extra bloc operator: gastroenterologice, imagistice i de radiologie
intervenional. Aceste proceduri sunt, de obicei, relativ sigure, iar complicaiile care pot aprea
tranzitorii. Obiectivele studiului sunt de a cuantifica aceste incidente i de a gsi eventualii factori ce
ar putea fi corectai.
Material i metode: A fost evaluat prospectiv un lot de 343 pacieni consecutivi n perioada noiembrie
2015 - februarie 2016. Toi pacienii au avut monitorizai parametrii vitali i au primit oxigen
suplimentar (3-4 l/min). Anestezia a fost realizat n general cu propofol i n anumite cazuri, n funcie
de procedur, cu fenthanyl, midazolam, atracurium i sevofluran. Au fost notate incidentele aprute
pe parcursul procedurii.
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Rezultate: Din cei 343 pacieni inclui n lot 153 sunt brbai i 190 femei, cu o vrst medie de 55 ani
(18-88). Durat medie a procedurii a fost 18 minute (3-150), iar doza medie de propofol 202 mg (0550). Au fcut bradicardie 30 pacieni (8,7%). Din acetia 5 primeau tratament beta blocant.
Bradicardia a aprut n general la pacienii care au efectuat colonoscopie i a fost de scurt durat,
probabil prin manevr vagala. La doi pacieni s-a ntrerupt procedura i s-a administrat 0,5 mg atropin.
Patru pacieni (1,16%) au fost hipotensivi, iar unul (0,29%) a prezentat un episod de scdere a saturaiei
n oxigen, fr complicaii ulterioare. Nu a existat o diferen semnificativ statistic ntre dozele de
propofol, durata procedurii la pacienii care au fcut colonoscopie i au prezentat bradicardie
comparativ cu cei care nu au avut bradicardie.
Concluzii: Cu o monitorizare adecvat a pacientului, incidentele n anestezia extra bloc operator sunt
rare i de obicei minore i tranzitorii.
Introduction: In the Fundeni Clinical Institute a wide range of procedures and maneuvers can be
performed with anaesthesia in non operating room: gastroenterological, imaging and interventional
radiology. These procedure are usually relatively safe and complications that can occur are transient.
The study objectives are to quantify these incidents and find potential factors that could be corrected.
Material and Methods: Between November 2015 and February 2016, 343 consecutive patients were
evaluated. All patients had been monitored for vital parameters and received supplemental oxygen (34 l / min). Anaesthesia was generally made with propofol and, in some cases, depending on the
procedure, with fenthanyl, midazolam, atracurium and sevofluran. Incidents that occurred during the
procedure were noted.
Results: Of the 343 patients included, 153 were men and 190 women with an average age of 55 years
(18 - 88). The average duration of the procedure was 18 minutes (3 - 150) and the mean dose of propofol
202 mg (0 - 550). 30 patients had bradycardia (8.7%) and 5 of them received beta blocant. Bradicardia
has generally occurred in patients who received colonoscopy and was of short duration, probably due
to vagal maneuver. For two patients the proceedings were interrupted and received 0.5 mg atropine.
Four patients (1.16%) were hypotensive and one (0.29%) presented an episode of decrease in oxygen
saturation, without further complications. There was no statistically significant difference between the
doses of propofol, procedure duration in patients who did colonoscopy and had bradycardia compared
with those who did not have bradycardia.
Conclusion: With appropriate patient monitoring, non-operating room anaesthesia incidents are rare
and usually minor and transient.
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Presepsin-procalcitonina-sofa
Presepsin-Procalcitonin-SOFA
Alida Moise (1), C. T. Guran (1), G. Stelea (1), Carmen-Iuliana Blescu-Arion (1), Natalia Mincu (2),
Adriana Mnescu (3), Dana-Mirela Lengyel (4), D. Dragomir (5)
(1) Spitalul de Urgen Prof. Dr. Dimitrie Gerota, Secia de Anestezie i Terapie Intensiv, Bucureti,
Romnia
(2) Spitalul de Urgen Prof. Dr. Dimitrie Gerota, Secia de Anestezie i Terapie Intensiv I, Bucureti,
Romnia
(3) Spitalul de Urgen Prof. Dr. Dimitrie Gerota, Laborator, Bucureti, Romnia
(4) Spitalul de Urgen Prof. Dr. Dimitrie Gerota, Secia de Farmacologie Clinic, Bucureti, Romnia
(5) Spitalul de Urgen Prof. Dr. Dimitrie Gerota, Secia de Cardiologie, Bucureti, Romnia
Obiective: Studiu prospectiv, observaional pentru a studia valoarea clinic a presepsinei n
diagnosticul sepsisului/SIRS, alturi de ali markeri consacrai.
Material i metod: Dup aprobarea n Comisia de Etic, am inclus n studiu 40 pacieni consecutivi,
suspectai de sepsis, pe parcursul a 6 luni, admii n secia de ATI a spitalului nostru, secie mixt. Am
imaginat un protocol pentru pacieni conform cruia am determinat la admisie presepsin (Point of
care methods - PATHFAST, Medience Corporation), procalcitonin (BRAHMS) i PCR (quantitative test,
nephelometry, Beckman Coulter), leucocite, fibrinogen, VSH i culturi. Atunci cnd a fost posibil am
repetat determinarea la 48 - 72h.
Rezultate: Valoarea limit a presepsinei pentru separarea sepsisului de SIRS noninfecios a fost aleas
din experiena seciei de 400pg/ml. Valoarea presepsinei pentru pacienii din studiu a fost de
1038,93=/-802,11pg/ml, iar pentru supravieuitori (N = 23) i decedai (N = 17), rezultatele obinute au
fost 787,22 745,18 and respectiv 1379,47 768,38 pg/ml (p = 0.018). Presepsina a fost comparat cu
procalcitonin, CRP, culturile pozitive (majoritatea din lichidul peritoneal, secreiile traheale, urin),
SOFA, Qsofa.
Concluzii: Presepsina poate fi folosit pentru diagnosticul sepsisului, cu valoare predictiv superioar
markerilor convenionali i culturilor ca i urmrirea n dinamic.
Referine: Xin Zhang, Dan Liu, You-Ning Liu, Rui Wang and Li-Xin Xie, The accuracy of presepsin (sCD14ST) for the diagnosis of sepsis in adults: a meta-analysis. Critical Care (2015) 19:323
Goal of Study: The clinical use of presepsin in separating sepsis and other causes of systemic
inflammatory response syndrome (SIRS) was studied and compared with procalcitonin (PCT) and CReactive Protein (CRP) in a prospective observational study.
Materials and Methods: After ethical approval, 40 consecutive suspected sepsis patients were enrolled
into the study for six months in a mixed ICU. Point of care methods - Presepsin (PATHFAST, Medience
Corporation), Procalcitonin (BRAHMS) and CRP levels (quantitative test, nephelometry, Beckman
Coulter) were measured in patients with suspected systemic bacterial infection. The ICU sepsis
protocole included leucocyte count, other inflammation markers and site cultures When it was possible,
Presepsin levels were reassessed in evolution at 72-96 hours.
Results: The cut-off value of presepsin for discrimination sepsis and non-infective SIRS was chosen to
be 400 pg/ml local experience). For our patients presepsin value was 1038,93+/-802,11pg/ml. For
survivers (N = 23) and non-survivers (N = 17), results showed 787,22 745,18 and respectively 1379,47
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768,38 pg/ml (p = 0.018). Presepsin levels was compared with procalcitonin, C-Reactive Protein,
positive cultures (majority of them being from peritoneal fluid, tracheal secretions, urine), SOFA, Qsofa.
Conclusion(s): Presepsin is useful for the diagnosis of sepsis, superior to conventional markers and blood
culture. Moreover, the serial determination of presepsin might be useful in predicting the evolution of
septic patients.
Presepsina versus procalcitonina ca i biomarker precoce al sepsisului dup intervenii

chirurgicale abdominale complexe
Presepsin versus procalcitonin as an early sepsis biomarker after large abdominal surgery
M. Veres (1), Orsolya Benedek (2), Monica Orlandea (1), A. Cioc (1), J. Szederjesi (2), Bianca Grigorescu
(3), Sanda Maria Copotoiu (2)
(2) Universitatea de Medicin i Farmacie, Disciplina Anestezie i Terapie Intensiv, Trgu Mure,
Romnia
(3) Universitatea de Medicin i Farmacie, Disciplina Fiziopatologie, Trgu Mure, Romnia
Infeciile grave n prezent sunt principalele cauze de mortalitate i morbiditate la pacienii critici
chirurgicali.
Scopul: Evaluarea puterii de predicie a presepsinei, a procalcitoninei (PCT) i a proteinei C reactive
(PCR) legat de dezvoltarea infeciei i mortalitii.
Material i metod: Am realizat un studiu observaional care a inclus un numr de 20 pacieni
chirurgicali. Au fost determinate valorile presepsinei preoperator, intraoperator la 1 i 3 ore, PCT i
PCR la intervale de 24, 48, 72 de ore postoperator. Au fost determinate valorile leucocitelor,
neutrofilelor, trombocitelor, a temperaturii periferice, scorurile de mortalitate APACHE II, SOFA, PPOSSUM. Pacienii au fost considerati septici dac au prezentat culturi bacteriene pozitive.
Rezultate: Presepsina la 24 de ore are o sensitivitate de 90% i o specificitate de 70% pentru infecie la
o valoare cut-off de 515 ng/ml. Valorile likelihood ratio i PPV la 24 de ore sunt de 3.0 i 87.5% cu o
probabilitate post-test de a dezvolta infecie de 75%. Odds ratio pentru pacienii cu presepsina pozitiv
este de 21. Presepsina la 1 or intraoperator se coreleaz semnificativ cu valoarea neutrofiliei
preoperatorii (p=0.004, r=0.619) i la 24 de ore (p=0.014, r=0.54). Presepsina nu se coreleaz cu valorile
PCT, PCR la 24,48 sau 72 de ore postoperator. Valorile cut-off la care presepsina a fost factor predictiv
pentru mortalitate au fost de 468 ng/ml la 48 de ore (AUC=0.846, p=0.013, 95%CI 0.65-1.00) i 736
ng/ml la 72 de ore (AUC=0.929, p=0.001, CI 95% 0.89-1.00).
Concluzii: Presepsina poate fi un biomarker de predicie al infeciei i mortalitii.
Severe infections can be the main cause of mortality and morbidity in critical surgical patients.
Aim: To evaluate the predictive power of presepsin, procalcitonin (PCT) and C reactive protein (PCR)
regarding infection and mortality.
Material and Method: We conducted an observational study which included 20 surgical patients. We
determined presepsin before surgery and during in the first and third hour. Presepsin, PCT and CRP
were monitored at 24, 48, 72 hours postoperatively. We assessed a total blood count, peripheral
temperature, mortality scores APACHE II, SOFA, P-POSSUM. The patients were considered septic if they
had positive bacteriological findings.
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Results: Presepsin at 24 hours has a sensitivity of 90% and a specificity of 70% for infection at a cut-off
value of 515 ng/ml. Likelihood ratio values and PPV at 24 hours are 3.0 and 87.5% with a probability
post-test of developing infection of 75%. Odds ratio for patients with positive presepsin is 21.
Intraoperative presepsin at 1 hour correlates significantly with the preoperative neutrophil count
(p=0.004, r=0.619) and at 24 hours (p=0.014, r=0.54). Presepsina does not correlate with the values of
postoperative PCT, CRPat 24, 48or 72 hours. Cut-off values at which presepsin was a predictive factor
for mortality were 468 ng/ml at 48 hours (AUC=0.846, p=0.013, 95%CI 0.65-1.00) and 736 ng/ml at 72
hours (AUC=0.929, p=0.001, CI 95% 0.89-1.00).
Conclusions: Presepsin can be used as predictive biomarker for infection and mortality.
Ventilaia non-invaziv prelungit n ARDS sever

Case report - why intubate when you can ventilate?
Alida Moise (1), C. T. Guran (1), G. Stelea (1), Carmen-Iuliana Blescu-Arion (1), Natalia Mincu (1),
Cristina Gic (2), Iulia Blaa (2), Luminia Rotaru (3)
(1) Spitalul de Urgen Prof. Dr. Dimitrie Gerota, Secia de Anestezie i Terapie Intensiv, Bucureti,
Romnia
(2) Spitalul de Urgen Prof. Dr. Dimitrie Gerota, Secia de Pneumologie, Bucureti, Romnia
(3) Spitalul de Urgen Prof. Dr. Dimitrie Gerota, Secia de Cardiologie, Bucureti, Romnia
V prezentm pacienta VC, 53 de ani, BMI 24, cunoscut cu HTA std I, sechele AVC, fumtoare care sa internat pentru pneumonie de lob inferior stng. Se iniiaz tratament antibiotic conform scorului
Carmelli, aerosoli, simptomatice. Evoluie nefavorabil cu admisie la 4 zile n ATI a unei paciente
contient, cooperant, cu diagnosticul de insuficien respiratorie acut hipoxemic sever - ARDS
stadiu 3, clasificare Berlin (PaO2/FiO2=78,5). Aspect CT de sticl mat omogen n lobii medii i
superiori. Se instituie NIV pe masc oro-nazal/full-face cu ameliorarea raportului PaO2/FiO2=100 la
16h. Se continu NIV pe diverse tipuri de device-uri, cu parametrii de suport ventilator relativ constani
(Pinsp 11-15, PEEP5-8, FiO2 45-65 cu meninerea unor saturaii ntre 88 i 94%), alternnd cu
oxigenoterapie pe masc simpl. Pacienta a primit tratament complex, inclusiv terapie antibiotic cu
spectru larg i bronhodilatatoare, susinere nutritiv-metabolic. Dup 15 zile n care s-a obinut doar
ameliorarea raportului PaO2/FiO2=124, pacienta, dei contient, cooperant, devine extrem de
anxioas, polipneic i nu mai permite pauze n NIV. Din ziua 22 se constat o ameliorare semnificativ
a raportului PaO2/FiO2=174-212, asociat cu o cretere a PaCO2= 54,9-85mmHg, pentru care s-au
instituit i perioade de BIPAP-NIV nocturn. Din ziua 27 se renun la modul BIPAP, se reintroduc
perioade de oxigenoterapie pe masc simpl cu durat progresiv crescande. Evoluie favorabil, cu
externare n ziua 36, cu indicaie de oxigenoterapie i NIV-CPAP la domiciliu.
Female patient, aged 53, BMI = 24, smoker, hypertensive, known with ischemic stroke sechelae,
presents in Pneumology for inferior left lobe pneumonia. Antibiotics are initiated based on Carmelli
score, as well as bronchodilators and symptomatic treatment. The evolution is in aggravation, with
admission in ICU for acute severe hypoxemic failure - ARDS stage III (Berlin classification
PaO2/FiO2=78.5). Oro-nasal/full face mask NIV is initiated, with improvement of hypoxemy score of
100 at 16 hours. NIV is continuated on a full range of devices (masks, helmets) with constant ventilatory
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support (Pinsp 11-15, PEEP5-8, FiO2 45-65) for SpO2 88-94%, in alternance with facial mask
oxygenotherapy.
Thoracic CT scan reveals bilateral alveolo-interstitial images in inferior and middle lobes. Complex
treatment - large specter antibiotherapy, bronhodilators, nutrition and metabolic support is continued.
After 15 days of moderate amelioration of hypoxemy score (PaO2/FiO2=124), patient becomes
extremely anxious, polypneic, agitated, which motivated quasi continuous NIV.
On day 22 a significant amelioration of PaO2/FiO2 of 174-212, with moderate to severe hypercapnia
(PaCO2= 54.9 - 85 mmHg) motivates introduction o nocturnal non invasive BIPAP.
On day 27 BIPAP is no longer needed, with increasingly longer periods of mask oxygenotherapy
between NIV. Improvement continues, patient is discharged in day 36, with recommendation of
oxygenotherapy and CPAP-NIV at home.
Hemofiltrarea cu filtru pentru eliminarea ciytokinelor tip cytosorb - analiz retrospectiv

Hemofiltration with haemoadsorbtion device cytosorb - retrospective analisys
Mihaela Blaj (1), Mihaela Damian (1), A. I. Ciumanghel (1), C. Ponea (1), Oana Apopei (1), Denisa Purice
(1), Tania Patrichi (1), Marta Chiricu (2)
(1) Spitalul Clinic Universitar de Urgene Sf. Spiridon, Secia de Anestezie i Terapie Intensiv, Iai,
Romnia
(2) Spitalul Clinic Universitar de Urgene Sf. Spiridon, Secia de Anestezie i Terapie Intensiv II, Iai,
Romnia
n terapia intensiv a pacientului critic cu sindrom de rspuns inflamator sistemic sever, un loc special
l ocup hemofiltrarea cu filtre pentru eliminarea mediatorilor inflamatori (TNF, IL-1, IL-6, IL-10).
Obiective: Analiz retrospectiv a hemofiltrrii cu CytoSorb n Clinica ATI din Spitalul Judeean de
Urgene Sf. Spiridon Iai.
Material i metod: Am evaluat retrospectiv indicaiile hemofiltrrii cu CytoSorb, evoluia clinic
siparaclinic a sindromului inflamator dup aplicarea terapiei, precum i supravieuirea la externare.
Rezultate: Hemofiltrarea cu CytoSorb s-a aplicat n perioada 2014 - 2016 la 24 pacieni critici, cu vrsta
medie de 48,52 +/-34 ani, cu urmtoarele patologii: oc septic, politraum, ARDS, pancreatit acut
sever, insuficien hepatic; la admisie scorul APACHE II mediu a fost de 28,12+/-54. Dup utilizarea
acestei terapii, concomitent cu tratamentul specific, evoluia s-a ameliorat, s-a redus necesarul de
suport vasopresor, s-a constatat stabilizarea hemodinamic i s-a redus nivelul markerilor inflamatori
de tip protein C reactiv, procalcitonin i presepsin. Dup hemofiltrarea cu Cytosorb scorul APACHE
II a sczut la 22,35+/-26. Mortalitatea n lotul evaluat a fost de 62,25%(15 din 24 pacieni).
Concluzii: Hemofiltrarea cu CytoSorb a fost utilizat la pacieni critici tineri cu sindrom inflamator sever.
S-a remarcat o ameliorare semnificativ pe termen scurt dup aceast terapie. Mortalitatea crescut
s-a datorat controlului inadecvat al patologiei de baz.
Hemofiltration with haemoadsorbtion filter CytoSorb that removeS proinflammatory cytokines is an
important adjuvant treatment in critically ill patients with strong inflammatory syndrome.
Objective: Retrospective analysis of haemofiltration with CytoSorb in the Intensive Care Unite in St.
Spiridon Hospital Iai.
Material and Methods: We retrospectively reviewed the indications of haemofiltration with CytoSorb,
the clinical and paraclinicaly evolution of inflammatory syndrome after therapy, and survival to hospital
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discharge.
Results: Haemofiltration with CytoSorb was applied during the period 2014 - 2016 to 24 critically ill
patients, average age of 48.52 +/- 34 years, with the following pathologies: septic shock, ARDS, acute
severe pancreatitis, liver failure, sever trauma. At admission APACHE II score was 28.12 average +/- 54.
After using this therapy, along with specific treatment, the evolution improved, it reduced the need for
vasopressor support, it was found to stabilize the hemodynamics and the level of biomarkers (C-reactive
protein type, procalcitonin and presepsina) was reduced. After Cytosorb haemofiltration APACHE II
score decreased to 22,35 +/- 26. Mortality was 62.25% (15 of 24 patients).
Conclusions: Haemofiltration with CytoSorb has been used in patients with sever inflammatory
syndrome. It has been noticed a significant improvement in the short term after this therapy. Increased
mortality was due to inadequate control of the underlying pathology.
Hipotiroidia sever - cauz de stop cardiac - prezentare de caz

Severe hypothyridia - a cause of cardiac arrest - case report
Mihaela Blaj, Mihaela Damian, G. Tudose
Spitalul Clinic Universitar de Urgene Sf. Spiridon, Secia de Anestezie i Terapie Intensiv, Iai,
Romnia
Mixedemul este o cauz rar de stop cardiac. Mortalitate asociat stopului cardio-respirator secundar
mixedemului poate ajunge, conform studiilor, pn la 60%.
Prezentm cazul unei paciente n vrst de 43 de ani, tiroidectomizat n antecedente i ulterior
neglijat terapeutic,obezitate morbid, admis n urgen n secia ATI a Spitalului Judeean de Urgene
Sf. Spiridon Iai dup stop cardio-respirator resuscitat. Investigaiile paraclinice i imagistice relev
tamponada cardiac drept cauz a opririi cardiace. S-a practicat pericardioceteza ghidat ecografic.
Postresuscitare, evoluia pacientei este lent favorabil sub tratament complex: ventilaie mecanic,
pericardiocentez, suport vasopresor i inotrop, terapie de substituie tiroidian i corticoterapie.
Sevrarea de pe ventilaie mecanic a fost dificil, cu necesar de suport ventilator non-invaziv
intermitent, n condiiile unei afectri pulmonare cronice secundare obezitii, dar cu ameliorarea
progresiv a statusului neurologic. Dup 39 de zile de internare n TI pacienta este transferat la
Spitalul de Pneumoftiziologie pentru stabilirea oportunitii unei ventilaii non-invazive la domiciliu.
Mixedemul poate reprezenta o cauz de stop cardio-respirator la pacienii care se prezint cu alterarea
statusului neurologic i hipotermie. Instituirea prompt a tratamentului corect i terapia substitutiv
tiroidian poate aduce o scdere a mortalitii asociate acestei situaii clinice.
Myxedema is a rare cause of cardiac arrest. Mortality associated with cardio-respiratory arrest
secondary myxedema can reach up to 60% according to studies.
We present a 43-year-old patient, with thyroidectomy history and subsequently neglected therapeutic,
morbidly obese, admitted in emergency in the Intensive Care Unit of the "St. Spiridon" Emergency
Hospital, Iai, resuscitated after cardiac arrest. Laboratory investigations and imaging reveals cardiac
tamponade as the cause of cardiac arrest. It was practiced ultrasound guided pericardiocentesis.
Post-resuscitation evolution is slow favourable, under treatment with mechanical ventilation,
pericardiocentisis, vasopressor and inotropic support, thyroid replacement therapy and corticosteroids.
Wining on mechanical ventilation was difficult; non-invasive intermittent ventilator support was
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applied for long time. There was a progressive improvement of the neurological status. After 39 days
of hospitalization the patient is transferred to the Pneumology Hospital to determine whether a noninvasive ventilation at home is possible.
Myxedema can be a cause of cardiac arrest in patients presenting with neurological alterations and
hypothermia. Establishing fair and prompt treatment and thyroid replacement therapy can bring a
decrease in mortality associated with this clinical situation.
Rolul tehnicii substitutive pulmonare tip Novalung (ILA) n tratamentul insuficienei

respiratorii din status asthmaticus - prezentare de caz
The place of extracorporeal ventilation devices - Novalung(ILA) in the management of acute
lung failure in status asthmaticus - case presentation
Oana Marinescu, Angela Popa, Oana Avram, Ioana Grinescu
Spitalul Clinic de Urgen, Secia de Anestezie i Terapie Intensiv, Bucureti, Romnia
Novalung ILA este o membran ventilator care permite, prin simpla difuziune, schimburile de O2
i CO2; a fost folosit la pacieni cu insuficien respiratorie sever prin ARDS, pneumonie, traum
toracic, intervenii de chirurgie toracic.
Am folosit Novalung-ILA la un pacient n vrst de 26 de ani, cu stare de ru astmatic stadiul IV, cu
dispnee sever, tahicardie cu hipontensiune, status neurologic alterat. EAB: acidoz respiratorie
sever, hipercapnie; CT- leziuni de barotraum-pneumomediastin, pneumotorax.
S-a instituit intubaie oro-traheal cu ventilaie mecanic de urgen. S-au montat tuburi de dren
pleural bilateral.
Este admis n ATI, unde se administreaz tratament medicamentos specific maximal: Beta 2-stimulant,
Beta 2- nonselectiv, anticolinergice, corticoizi, teofilin. Se continu ventilaie mecanic sub
analgosedare profund i curarizare, conform protocoalelor A.T.I.; se instituie suport vasopresor.
Evoluia este sever, cu meninerea acidozei metabolice severe, hipercapniei, ventilaie mecanic
dificil cu valori crescute ale presiunilor inspiratorii i agravarea hiperinflatiei pulmonare.
Se decide instituirea terapiei cu Novalung-ILA prin dublu cateter arterio-venos femural. n orele
urmtoare, PaCo2 se normalizeaz, pacientul putnd fi ventilat permisiv cu reducerea auto-PEEP-ului,
a volumului de air-trapping, iar administrarea de vasopresor este oprit 6 ore mai trziu.
Am utilizat Novalung-ILA timp de 4 zile, pacientul a necesitat intubaie oro-traheal protectiv i
ventilaie asistat pn la 2 sptmni.
n concluzie, tehnicile substitutive pulmonare tip Novalung pot reprezenta o soluie salvatoare n
insuficiena respiratorie acut sever, neresponsiv la terapie medicamentoas maximal i ventilaie
mecanic i fac posibil atingerea unor noi dimensiuni n conceptul de ventilaie protectiv.
Novalung - ILA is a "membrane ventilator" that allows for O2 gas exchange to occur by simple diffusion.
It has been used in patients with severe lung failure in ARDS, pneumonia, chest trauma, thoracic surgery
interventions.
We used Novalung-ILA in a 26 years old patient admitted in status asthmaticus stage IV with severe
dyspnea, tachycardia hypontension, altered mental status. EAB: severe respiratory acidosis,
hypercapnia; CT scan: barotrauma-pneumomediastinum, pneumothorax. In the ER, the patient is
intubated and mechanically ventilated; bilateral chest tube placement.
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He is admitted in the ICU, where the management consisted in: Beta 2 stimulators, Beta 2 nonselectives, anticholinergics, corticosteroids, theophylline, mechanical ventilation with heavy sedation
and muscle relaxation, according to the protocols. Vasopressor support is instituted.
Evolution is severe, maintaining severe metabolic acidosis, hypercapnia, difficult mechanical ventilation
with high inspiratory pressures and worsening lung hyperinflation.
We decided to use Novalung-ILA therapy by double femoral arteriovenous cannula. In the coming
hours, PaCO2 normalize, we could use more protective ventilation, reducing auto-PEEP, and air
trapping and vasopressor administration was stopped 6h later.
We used Novalung-ILA for 4 days, the patient required oro-tracheal intubation and assisted ventilation
protection and up to 2 weeks.
In conclusion, extracorporeal ventilation devices, Novalung type, can be a rescue solution in severe
acute respiratory failure, unresponsive to maximal medical therapy and mechanical ventilation and
make it possible to achieve new dimensions in the concept of protective ventilation.
Utilizarea metodelor non-invazive i invazive n ghidarea terapiei volemice la pacientul critic

- prezentare de caz
Non-invasive and invasive methods for guidance fluide therapy in critically patients - case
report
A. I. Ciumanghel, Mihaela Blaj
Spitalul Clinic Universitar de Urgene Sf. Spiridon, Secia de Anestezie i Terapie Intensiv, Iai,
Romnia
Evaluarea statusului hidric al pacientului critic este dificil de realizat i implic utilizarea de date clinice,
variabile de laborator, metode noninvasive (ecocardiografice, ultrasonografie pulmonar, i
bioimpedana spectroscopic) i modaliti invazive (termodiluia transpulmonar sau analiza undei
de puls). Prezentm cazul unei paciente de 65 ani cu DZ necompliant la tratament, admis n stare
grav cu oc septic, disfuncii multiple de organ (acidoz metabolic sever-ph<6,8). Se iniiaz repleie
volemic agresiv, suport ventilator, triplu suport vasopresor. Ecocardiografia transtoracic relev
hipovolemie (ven cav inferioar - VCI cu un diametru de15mm i cu variabilitate de 30% cu
respiraia). Ultrasonografia pulmonar arat o cretere a apei extravasculare (>100 comete n cele 28
cmpuri pulmonare) i bioimpedana confirm expandarea spaiului interstiial (over hidration OH=3,5
l i o cretere cu 25% a apei interstiiale). Toate aceste date se coreleaz cu datele obinute invaziv
furnizate de PICCO: extravascular lung water EVLW=12, SVV=17%, cardiac index=1,9, rezistente
vasculare indexate SVRI= 560dyne/cm/sec5). Evaluarea hemodinamic a fost repetat zilnic,
identificndu-se o concordan bun ntre datele obinute prin cele 3 metode. Pacienta primete
antibioterapie empiric i terapie de supleiere renal-hemofiltrare continu veno-venoase (CVVH),
obinndu-se stabilizare hemodinamic. Dup CVVH i un bilan negativ, ultrasonografia pulmonar
arat o reducere a numrului de comete (40), rezultate confirmate i de PICCO- EVLW = 9. Diametrul
VCI=20 mm, fr a variaie cu respiraia sugernd refacerea volumului intravascular, iar la PICCO:
SVV=10, CI=3,4, SVRI= 1900, se relev stabilizarea hemodinamic. Ultrasonografia pulmonar i
bioimpedana sunt dou modaliti noninvazive, uor de utilizat care pot furniza date utile n ghidarea
terapiei volemice a pacientului critic.
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Evaluation of fluid status in critically patients is difficult and involves the clinical data, laboratory
variables, non-invasive methods (echocardiography, ultrasound, pulmonary and spectroscopyc
biompedance) and invasive methods (transpulmonary thermodilution and pulse wave analysis). We
report a case of a patient 65-year-old patient with diabetus melitus without treatment, admitted in
sever status with septic shock, multiple organ dysfunction (severe metabolic acidosis, pH <6.8). There
was initiated an aggressive volume replacement, ventilator support, triple vasopressor support.
Transthoracic echocardiography reveals hypovolemia (VCI-inferior vena cava diameter and variability
of 15mm 30% breathing). Pulmonary ultrasonography shows an increase in extravascular water (> 100
comets in the lung fields 28) and thoracic electrical confirms expansion interstitial space (over hidration
OH = 3.5 liters and a 25% increase in interstitial water). All these data correlate with invasive obtained
data provided by Picco: Long extravascular water EVLW = 12, SVV = 17%, cardiac index = 1.9, vascular
resistance index SVRI = 560dyne / cm / sec5). Hemodynamic evaluation was repeated daily, identifying
a good concordance between the data obtained by the 3 methods. The patient receives empirical
antibiotic therapy for renal replacement - continuous veno-venous hemofiltration (CVVH), yielding
hemodynamic stabilization. After CVVH and a negative balance, pulmonary ultrasonography shows a
reduction in the number of comets (40), results confirmed by PICCO- EVLW = 9. VCI diameter = 20 mm,
without variation breathing suggesting restoring intravascular volume, and at PICCO: SVV = 10, CI =
3.4, SVRI = 1900 is revealed hemodynamic stabilization. Ultrasonography and bioimpedance are two
non-invasive ways, easy to use which can provide data useful in guiding fluid therapy in critically ill
patient.
Plasarea cateterelor arteriale la pacienii de terapie intensiv poate fi efectuat ecoghidat!

Placing arterial catheters in intensive care patients can be performed ecoguided
E. Tincu, Florina Roxana Duca, D. Damian
Spitalul Municipal de Urgen, Secia de Anestezie i Terapie Intensiv, Moineti, Romnia
Plasarea cateterului arterial i a cateterului venos central este actualmente procedur obligatorie la
admisia pacienilor n Terapie Intensiv.
Accesul vascular (venos i arterial) este, de regul, executat folosind elemente din semiologia clasic
(palpare, orientare dup repere anatomice), dar i ecoghidat.
Obiectivele lucrrii: Evaluarea numrului de tentative i a timpului necesar plasrii cateterului arterial,
precum i a complicaiilor cateterizrii la ambele loturi (clasic i ecoghidat).
Material i metod: Pacienii au fost evaluai i mprii n dou loturi: lotul martor - pacieni
cataterizai utiliznd reperele anatomice i palparea; lotul n studiu - pacieni cataterizai ecoghidat n
timp real, in plane.
Rezultate: Procedura de plasare a cateterului arterial efectuat sub ghidaj ecografic s-a efectuat rapid
i sigur (sub 1 minut), fr a se fi nregistrat nicio complicaie fa de lotul martor. La pacienii din lotul
martor s-au nregistrat cteva incidente (puncii repetate, hematoame locale, schimbarea locului de
puncie). Timpul efectiv de inserie a cateterului arterial la cele dou loturi a fost sensibil egal.
Concluzii: Experiena personal n cateterizarea vascular (arterial i venoas) de plasare a cateterelor
vasculare sub ghidaj ecografic arat c tehnica este foarte sigur, rapid i fr complicaii locale (chiar
i la nceptori) i poate fi impus ca i standard de practic curent n seciile A.T.I.
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Placing arterial catheter and central venous catheter procedure is currently mandatory for the patients
admission in ICU.
Vascular access (arterial and venous) are usually executed using classical elements of semiology
(palpation, guidance by anatomical landmarks), and ecoguided.
Objectives: Assessment of the number of attempts and the time required arterial catheter placement
and also analyze catheterization complications in both groups (classic and ecoguided).
Methods: Patients were evaluated and divided in two groups: control group - patients catheterized
using anatomical landmarks and palpation; study group -patients catheterized ecoguided in real time,
"in plane".
Results: Arterial catheter placement procedure performed under ultrasound guidance was carried out
quickly and safely (under 1 minute) without having recorded any complication compared to control
group. In the control group there were several incidents (repeated punctures, local hematoma,
changing the puncture site). The time required for arterial catheter insertion in the two groups was
approximately equal.
Conclusions: Personal experience in vascular catheterization (arterial and venous) for placing catheters
under ultrasound guidance shows that the technique is very safe, fast and local uncomplicated (even
for the beginners) and can be imposed as standard practice in Intensive Care Units.
Cderea unui imperiu: coagulopatia cirotic. O analiz tromboelastometric

The fall of an empire: cirrhotic coagulopathy. A thromboelastometric insight
M. Popescu (1), Gabriela Droc (2), Carmen Orban (3), Dana Tomescu (4)
(3) Universitatea Titu Maiorescu, Facultatea de Medicin, Bucureti, Romnia
Introducere: Pacienii cu boal hepatic terminal (BHT) au fost considerai drept natural anticoagulai.
Introducerea tromboelastometriei rotaionale i a unei analize complexe a hemostazei la acest grup
de pacieni a determinat apariia teoriei coagulrii rebalansate. Obiectivele studiului au fost
reprezentate de compararea parametrilor standard cu cei derivai ROTEM n vederea elaborrii unui
profil hemostatic al pacientului cu BHT.
Material i metode: n studiu au fost inclui 162 de pacieni consecutivi cu BHT admii n secia de
terapie intensiv anterior transplantului hepatic. Au fost nregistrai parametrii demografici i scorurile
de severitate ale BHT (MELD i MELD-Na). Urmtoarele teste au fost efectuate la momentul admisiei:
biochimice, teste standard de coagulare (aPTT, INR, PT), fibrinogenemia, numr de trombocite i
analiza tromboelastometric. Au fost nregistrai att parametrii ROTEM standard, ct i cei derivai
(MaxV, MaxVT, AUC, InTEM TPI, ExTEM TPI, MCE).
Rezultate: Scorul MELD mediu a fost de 16.96.08, iar scorul MELD-Na a fost de 19.196.27. Am
observat o corelaie semnificativ statistic ntre InTEM CFT i AUC (p=0.003), MCE (p=0.001, R
quadratic 0.196) i InTEM TPI (p=0.001). ExTEM CFT s-a corelat semnificativ statistic cu ExTEM TPI
(p=0.006, R cubic 0.469). Trombocitopenia s-a asociat cu o scdere a valorilor ExTEM MCF (p=0.008),
ExTEM TPI (p=0.001) i MCE (p=0.001). Trombocitopenia sub 60000/uL a fost predictiv pentru
scderea ExTEM MCF i am observat o corelaie liniar ntre numrul de trombocite i ExTEM TPI (R
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linear 0.466). De asemenea, trombocitopenia sub 70000/uL s-a asociat cu o scdere exponenial a
elasticitii cheagului (R quadratic 0.362). Am observat o asociere non-linear ntre concentraia
fibrinogenului i polimerizarea fibrinei n FibTEM (p=0.001), cu o valoare prag a fibrinogenului de
135mg/dl pentru predicia FibTEM MCF sub 9mm (R quadratic 0.562).
Concluzii: Pacienii cu BHT nu sunt att de coagulopai cum se credea n trecut. Parametrii derivai
tromboelastometrici pot oferi o perspectiv asupra mecanismelor fiziopatologice ale coagulopatiei
cirotice mai ales asupra rolului central al trombocitelor i fibrinogenului.
Introduction: Patients with End-Stage Liver Disease (ESLD) have long been considered to have an
intrinsic severe coagulopathy. Introduction of ROTEM assay and a more comprehensive understanding
of haemostasis in this group of patients have lead to the rebalance theory of coagulation. The aim of
our study was to compare standard with derived ROTEM parameters in order to establish a haemostatic
profile in patients with ESLD.
Material and Methods: We included 162 consecutive patients with ESLD admitted to the Intensive Care
Unit prior to liver transplantation. We recorded demographic variables and severity of ESLD scores
(MELD and MELD-Na). Biochemical tests, standard coagulation tests (aPTT, INR, PT), fibrinogen levels,
platelet count and ROTEM assay (ExTEM, InTEM, ApTEM and FibTEM) were performed at the same
time. Both standard and derived ROTEM parameters (MaxV, MaxVT, AUC, InTEM TPI, ExTEM TPI, MCE)
were recorded.
Results: The mean MELD score was 16.96.08 and the mean MELD-Na score was 19.196.27. We found
a significant correlation between InTEM CFT and AUC (p=0.003), MCE (p=0.001, R quadratic 0.196) and
InTEM TPI (p=0.001). ExTEM CFT strongly correlated with ExTEM TPI (p=0.006, R cubic 0.469).
Thrombocytopenia correlated with decreased ExTEM MCF (p=0.008), ExTEM TPI (p=0.001) and MCE
(p=0.001). A platelet count below 60000/uL was predictive of decreased ExTEM MCF and a linear
correlation between platelet count and ExTEM TPI was observed (R linear 0.466). Also a platelet level
below 70000/uL was associated with an exponential decrease in clot elasticity (R quadratic 0.362). We
found a non-linear correlation between fibrinogen concentration and fibrin polymerization (p=0.001)
with a value for fibrinogen below 135 mg/dL predicting a FibTEM MCF below 9mm (R quadratic 0.562).
Conclusion: Patients with ESLD are not so coagulopathic as previously considered. Derived ROTEM
parameters may offer an insight to the patophysiological mechanism of observed results and underline
the role of both platelets and fibrinogen.
SRATI 2016
11 - 15 mai / May
Sinaia

Simularea medical din perspectiva instructorilor

Medical simulation from the instructors' point of view
C. Moldovan (1), Orsolya Benedek (2), J. Szederjesi (2), Alexandra Lazr (3), M. Petrior (1), L. Azamfirei
(3)
Romnia
(2) Universitatea de Medicin i Farmacie, Disciplina de Anestezie i Terapie Intensiv I, Trgu Mure,
Romnia
(3) Universitatea de Medicin i Farmacie, Disciplina de Anestezie i Terapie Intensiv II, Trgu Mure,
Romnia
Introducere: Simularea medical ctig teren ca metod educaional i studenii sunt entuziati n
privina ei, dar care este prerea instructorilor?
Obiectivul studiului: Evaluarea i cuantificarea perspectivei instructorilor asupra utilizrii simulrii
medicale n educaie.
Material i metod: Am efectuat un studiu prospectiv observaional utiliznd chestionare coninnd 5
ntrebri cu rspunsuri evaluative fixe (1 = minimum, 5 = maximum) i 2 ntrebri cu rspuns liber.
Aceste chestionare au fost completate de 26 de instructori.
Rezultate: n privina gradului de satisfacie, punctajul cel mai mare a fost atribuit de instructorii de ATI
i Chirurgie, 4.83 0.37, iar cel mai sczut de ctre instructorii de obstetric/ginecologie: 4.25 0.82.
Ameliorarea performanelor studenilor a fost notat de instructorii de chirurgie cu 4.5 0.5, iar de cei
de obstetric/ginecologie cu 3.62 0.69. Instructorii de chirurgie au considerat c au obinut cel mai
ridicat grad de implicare activ a studenilor, iar gradul cel mai sczut a fost la pediatrie: 3.2 1.16.
Dotarea tehnic a fost evaluat de instructorii de ATI cu cel mai nalt grad, iar cel mai mic a fost atribuit
de instructorii de chirurgie: 4.33 0.74 puncte. Utilitatea simulrii n educaia studenilor a fost
apreciat cel mai bine de ctre instructorii de ATI, chirurgie i pediatrie, iar instructorii de
obstetric/ginecologie i-au acordat 4.5 0.86 puncte.
Concluzii: Dei exist cteva neajunsuri, opinia instructorilor despre utilizarea simulrii medicale ca
metod educaional este preponderent pozitiv.
Introduction: Medical simulation is gaining traction as an educational method and the students are
quite enthusiastic about it, but what about the instructors?
Aim: To assess and quantify the opinion of the instructors on the use of medical simulation in education.
Material and Methods: We conducted a prospective observational study using questionnaires
developed for a set goal. The questionnaire contained 5 questions with pre-set values and 2 questions
with open answers. 26 instructors filled out the questionnaires.
Results: Regarding the level of satisfaction, the highest grading was obtained from ICU and surgery
instructors, with 4.83 0.37 and the lowest from OBGYN with 4.25 0.82. When asked about students
performance enhancement, Surgery graded it with the highest mark, 4.5 0.5 and the lowest was
registered at OBGYN with 3.62 0.69. Surgery instructors considered that they obtained the highest
student involvement, grading it with 4.5 0.5 and the lowest was at Pediatrics with a grade of 3.2
1.16. When asked to assess the technical equipment, ATI instructors considered it to be of 5 points,
while the lowest grade was registered with surgery instructors with 4.33 0.74 points. When asked
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about the usefulness of simulation in student training, ATI, Surgery and Pediatrics awarded the highest
grade, only OBGYN considered it to be 4.5 0.86 points.
Conclusion: Despite a few caveats, instructors have a positive perspective on the use of medical
simulation as an ancillary educational method.
Hipotermia terapeutic dup stopul cardio-respirator: ce este, de ce se aplic, cum se aplic

i cine sunt candidaii
Therapeutic hypothermia after cardiac arrest: what, why, who and how
Daniela Lazea
Brigham and Women's Hospital, Anaesthesia and Critical Care, Boston, SUA
Stopul cardio-respirator rmne principala cauz de mortalitate n Statele Unite, supravieuirea este
de 34%, iar supravieuirea cu recuperare neurologic bun este de numai 8%. Din punct de vedere
patofiziologic, dup faza iniial de ischemie, stopul cardio-respirator determin o cascad de
evenimente ca producia de radicali liberi, distrugerea homeostaziei i activarea proteazelor care sunt
responsabile de distrugerea axonilor i a sinapselor, conducnd la defecte neurologice. Hipotermia
terapeutic inhib o parte din aceste mecanisme. Exist studii care au dovedit c recuperarea
neurologic este superioar cnd pacienii sunt supui hipotermiei terapeutice n primele 6 ore dup
recuperarea circulaiei spontane. Protocoalele actuale prevd ca pacienilor care sufer stop cardiorespirator (prin fibrilaie ventricular, tahicardie ventricular sau asistolie) s li se aplice hipotemia
terapeutic prin metode interne sau externe. Temperatura trebuie meninut pentru 24 de ore, dup
care trebuie nceput renclzirea cu un ritm de 0.25- 0.5 C/or pn la temperatura normal.
Prezentarea va trece n revist efectele hipotermiei i ale renclzirii, studiile cele mai relevante despre
hipotermia terapeutic i care sunt protocoalele curente referitoare la acest subiect.
Cardiopulmonary arrest remains the leading cause of death in the United States, and overall survival is
34%, while the survival with good neurological function is about 8%.
Pathophysiologically, brain damage through hypoxia is due to two main mechanisms. The first is direct
ischemic cell death leading to necrosis and apoptosis, and the second is reperfusion injury with
production of free radicals, disruption of homeostasis and protease activation. Therapeutic
hypothermia inhibits numerous pathways of these two mechanisms.
Mild therapeutic hypothermia has been shown to be beneficial for neurological outcome and survival
for patients after resuscitation from sudden cardiac arrest (Arrich 2012).
Patients with VF, asystole, or PEA cardiac arrest requiring CPR and with return of spontaneous
circulation qualify for initiation of hypothermia within 6 hours of ROSC.
According to the guidelines, comatose survivors of cardiac arrest should be cooled with internal or
external cooling techniques to a target temperature. This target temperature should be maintained for
24 hours, and after this cooling period the patients should be rewarmed at a rate of 0.25 C to 0.5
C/hour to normothermia.
This presentation will review the effects of hypothermia and rewarming, the present literature about
hypothermia and the current guidelines.
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11 - 15 mai / May
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Edem pulmonar prin presiune negativ tip I, posibil declanat prin administrarea de petidin
- caz clinic
Type I negative pressure pulmonary oedema possible induced by pethidine administration case report
A. Brcan (1), Ligia Gheorghe (2)
(1) Spitalul Clinic Judeean de Urgen, Secia de Anestezie i Terapie Intensiv, Braov, Romnia
(2) Spitalul Clinic de Copii, Secia de Anestezie i Terapie Intensiv, Braov, Romnia
Edemul pulmonar prin presiune negativ este o entitate patologic perioperatorie acut, rar,
potenial amenintoare de via. Pentru clinicienii anesteziti, prevenia i recunoaterea precoce a
acestei complicaii este esenial. Din nefericire, tratatele de anestezie nu prezint suficient de bine
aceast condiie patologic. n practica clinic a pacientului critic este imperativ s recunoatem i s
putem face diagnosticul diferenial al formelor de edem pulmonar acut, care asociaz un risc vital
major. Prezentm un caz de edem pulmonar de presiune negativ tip I, aprut la un biat n vrst de
17 ani supus unei intervenii chirurgicale de apendicectomie sub anestezie general. Particularitatea
cazului este c administrarea de petidin pentru tratamentul frisonului postanestezic, asociat altor
factori de risc, a fost factorul farmacologic declanator. Prezentm mecanismele fiziopatologice,
formularea diagnosticului clinic i paraclinic i principiile de terapie intensiv. Acesta a fost primul caz
de edem pulmonar prin presiune negativ cu care ne-am confruntat n practic, fiind o provocare att
clinic, ct i de documentare.
Negative pressure pulmonary oedema is an acute, potentially life threatening, uncommon
perioperative pathological entity. For anaesthesia providers, prevention or early recognition of this
complication is essential. Unfortunately, the standard reference anaesthesia textbooks do not
sufficiently address negative pressure pulmonary oedema. It is important to make an early differential
diagnosis between various pulmonary oedema conditions in critically ill patients and promptly
recognize a high risk of acute morbidity. We present a case of type I negative pressure pulmonary
oedema in a healthy 17-year-old boy who underwent an emergent appendectomy under general
anaesthesia. The particularity of our case revolves around the administration of pethidine for
postanaesthetic shivering, along with other anaesthetic risk factors, which may have served as the
trigger of type I negative pressure pulmonary oedema. We present the pathophysiological mechanisms,
the formulation of clinical and paraclinical diagnosis and the principles of intensive care therapy. This
was the first such case experienced in our practice, and presented a remarkable learning opportunity.
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Hipercapnia permisiv intraanestezic i recuperarea postoperatorie dup colecistectomia

laparoscopic: studiu prospectiv randomizat
Permissive hypercapnia and anaesthesia outcome after laparoscopic cholecystectomy:
prospective, randomized study
Victoria Rusu, A. Beli
Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Catedra de Anesteziologie Nr. 1
Valeriu Ghereg, Chiinu, Republica Moldova
Introducere: Recent, mai multe echpe de cercetare au semnalat despre potenialele efecte benefice
ale hipercapniei deliberative intraanestezice asupra evoluiei intraoperatorii i postoperatorii a
pacientului: reducerea ratei de infecii de plag, necesar mai redus n opioizi, cicatrizare accelerat a
plgii operatorii.
Scopul studiului: Evaluarea efectelor hipercapniei deliberative moderate (ETCO2=45-50 mmHg)
intraanestezice asupra recuperrii postoperatorii dup colecistectomie laparoscopic.
Material i metode: Studiu prospectiv randomizat (lot normocapnie, n=42; lot hipercapnie, n=58). Aviz
Comitet Etic pozitiv, acord informat scris, obinut. Anestezie: inducie - propofol, fentanil, meninere
- propofol, miorelaxare - tracrium. Statistica: t-Student, Fisher exact test, Mantel-Cox test i ANOVA.
Rezultate: Loturi similare din punct de vedere al vrstei, IMC, ASA, duratei interveniei i celei de
spitalizare. Lot hipercapnie vs. normocapnie, respectiv: durata trezirii din anestezie - mediana, 15 vs.
20 min (2=12,6; p<0,0001); durata ileusului postoperatoriu - mediana, 28 vs. 30 ore (2=10,8;
p=0,001); riscul de GVPO, n favoarea lotului hipercapnie - OR=0,50 (95CI=0,24-1,05), p=0.0695. Testele
neurocognitive aplicate (DCT, DSST, Wechsler, Stroop) - rezultate similare pre vs. postoperatoriu att
n limitele loturilor, ct i ntre loturi. Limitare studiu: eantion redus, intervenie scurt, hipercapnie
uoar.
Concluzii: Hipercapnia moderat deliberativ intraanestezic pare s reduc durata de trezire, durata
ileusului postoperator i a riscului de GVPO, fr efecte hemodinamice i neurocognitive negative.
Cuvinte cheie: hipercapnie deliberativ, intraanestezic, recuperare postoperatorie.
Background: Recently, more research teams have signaled the potential beneficial effects of induced
mild hypercapnia during the anaesthesia on intraoperative and postoperative outcome: reducing the
rate of wound infections, lower necessity in opioids, accelerated wound healing.
Aim: Estimation of the effects of intraoperative induced mild hypercapnia (ETCO2=45-50 mmHg) on
postoperative recovery after laparoscopic cholecystectomy.
Materials and Methods: Prospective randomized study (normocapnic lot, n=42; hypercapnic lot, n=58).
Positive agreement of Ethics Committee, written informed consent. Anaesthesia: induction - propofol,
fentanyl, maintenance - propofol, relaxants - tracrium. Statistics: t-Student, Fisher exact test, MantelCox test and ANOVA.
Results: Lots similar in terms of age, BMI, ASA, surgery and hospitalization period. Hypercapnic lot vs.
normocapnic lot: length of awakening from anaesthesia - median, 15 vs. 20 min (2=12,6; p<0,0001);
postoperative ileus period - median, 28 vs. 30 hours (2=10,8; p=0,001); PONV risk, in favor of
hypercapnic lot - OR=0,50 (95CI=0,24-1,05), p=0.0695. Neurocognitive tests (DCT, DSST, Wechsler,
Stroop), similar resuls for both lots and for the pre and postoperative periods. Study limits: reduced
sample, short period of surgery, mild hypercapnia.
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Conclusions: Induced mild hypercapnia intraanaesthesic seems to reduce the awake period, length of
ileus and PONV risk in postoperative period, with no hemodinamic and neurocognitive adverse effects.
Keywords: Induced hypercapnia, intraanesthesic, postoperative recovery
APACHE II, SOFA, ISS i RTS prezic apariia sepsisului la pacienii politraumatizai
APACHE II, SOFA, ISS and RTS predict the occurence of sepsis in multiple trauma patients
S. Tranc (1), Cristina Petrior (1), C. Ciuce (2), Adriana Slavcovici (3), Natalia Hagu (1)
(1) Universitatea de Medicin i Farmacie Iuliu Haieganu, Clinica ATI II, Cluj-Napoca, Romnia
(2) Universitatea de Medicin i Farmacie Iuliu Haieganu, Clinica Chirurgie I, Cluj-Napoca, Romnia
(3) Universitatea de Medicin i Farmacie Iuliu Haieganu, Clinica de Boli Infecioase, Cluj-Napoca,
Romnia
Obiectiv: Evaluarea scorurilor APACHE II, SOFA, ISS i RTS pentru predicia apariiei sepsisului la
pacienii politraumatizai. Scorurile funcionale sunt utilizate pentru prezicerea mortalitii la pacienii
politraumatizai. Sepsisul este cauza principal pentru mortalitatea tardiv din traum i apariia sa
este favorizat de supresia imunologic cauzat de dezechilibrele homeostatice.
Material i metode: Scorurile APACHE II, SOFA, ISS i RTS au fost calculate n primele 24 ore de la injuria
traumatic pentru 64 pacieni politraumatizai. Apariia complicaiilor infecioase a fost urmrit timp
de 14 zile. n analiza Kaplan Meier, procentul pacienilor care nu a dezvoltat sepsis a fost luat n
considerare.
Rezultate: Pentru SOFA, o valoare-prag de 4 puncte a fost identificat: 89% dintre pacienii cu SOFA<4
nu au dezvoltat infecii, n timp ce 37% dintre pacienii cu SOFA>4 nu au dezvoltat infecii (p<0.01). Nici
un pacient cu APACHE II5 nu a prezentat sepsis. Dintre pacienii cu APACHE II ntre 5 i 10 puncte,
84% nu au dezvoltat sepsis, dar dintre pacienii cu APACHE II11, numai 49% nu au dezvoltat sepsis
(p<0.01). Pentru RTS am identificat o valoare-prag de 7 puncte: 88% dintre pacienii cu RTS7 i 43%
dintre cei cu RTS<7 nu au prezentat infecii (p<0.01). Dintre pacienii cu ISS<22, 88% nu au dezvoltat
sepsis, iar dintre cei cu ISS22, 56% nu au dezvoltat sepsis (p<0.01).
Concluzie: Scorurile funcionale de severitate APACHE II, SOFA, ISS i RTS prezic nu numai mortalitatea,
dar i riscul de apariie al sepsisului la pacienii politraumatizai.
Objective: To determine whether APACHE II, SOFA, ISS and RTS predict the occurrence of sepsis in
multiple trauma patients. Physiological composite scores are used to predict mortality in multiple
trauma patients. Sepsis is the leading cause for late mortality in trauma victims and is favoured by the
immune suppression due to homeostasis dysregulation.
Material and Methods: APACHE II, SOFA, ISS and RTS were calculated for the first 24 hours after the
injury for 64 adult polytrauma patients. The occurrence of infectious complications was investigated
for 14 days. The infection-free rates for the multiple trauma patients were considered as end-points in
the Kaplan Meier plot analysis.
Results: For SOFA, a cut-off score of 4 points was identified to predict the occurrence of sepsis, with
89% of the patients with SOFA<4 being infection-free, while 37% of those with SOFA>4 were infectionfree (p<0.01). None of the patients with APACHE II5 points developed infections. From the patients
with APACHE II scores 5-10, 84% did not develop sepsis, while from those having APACHE II11, only
49% were infection-free (p<0.01). For the RTS, we identified a cut-off of 7 points to be most
discriminative: 88% of the patients with RTS7 and 43% of those with RTS<7 were free from infections
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(p<0.01). From the patients with ISS<22 88% did not develop sepsis, while from those with ISS22 56%
did not develop sepsis (p<0.01).
Conclusion: The functional severity scores APACHE II, SOFA, ISS and RTS predict not only mortality, but
also the occurrence of sepsis in multiple trauma patients.
Impactul consilierii psihologice preoperatorii asupra durerii, consumului de analgezice i a

simptomelor psiho-emoionale postoperatorii la paciente programate pentru chirurgia
cancerului mamar - studiu clinic randomizat
The impact of preoperative psychological counseling on pain, analgesic consumption and
psychological symptom on patients scheduled for breast cancer surgery - a randomized
clinical study
Armeana Olimpia Zgaia (1), Florina Pop (1), C. Vlad (2), G. Lazr (2), C. Lisencu (2), F. Ignat (2), M.
Murean (2), A. Irimie (2)
(1) Institutul Oncologic Prof. Dr. I. Chiricu, Clinica de Chirurgie, Cluj-Napoca, Romnia
(2) Universitatea de Medicin i Farmacie Iuliu Haieganu, Clinica de Chirurgie Oncologic, ClujNapoca, Romnia
Introducere: Chirurgia cancerului mamar se asociaz cu distres psihologic preoperator ce poate avea
efecte secundare postoperatorii negative. Am realizat un studiu clinic randomizat pentru a investiga
efectul tehnicilor de relaxare preoperatorii asupra intensitii durerii acute, a consumului de analgezice
i a simptomelor psihoemoionale postoperatorii.
Material i metode: 102 paciente programate pentru chirurgia cancerului mamar au fost randomizate
n 2 grupuri, un grup a primit consiliere psihologic (PSY-CON Group), iar un grup nu a beneficiat de
aceast terapie (Contr Group). Randomizarea nu s-a efectuat orb. Consilierea psihologic a fost
efectuat de acelai psiholog clinician. 48 de ore postoperator au fost evaluate durerea acut,
consumul de analgetice i simptomele psihologice.
Rezultate: Pacientele din PSY-CON Group au avut o durere acut postoperatorie semnificativ mai mic
att la trezire (T1), ct i la 2 (T2), 8 (T3) 12 (T4), 24 (T5), 30 (T6) i 36 (T7) ore postoperator (median
(IQR)= 1.5 versus 6 at T1; p< 0.001, median(IQR)=1 versus 4 at T2; p< 0.001, median (IQR)=1 versus 2
at T3; p<0.025; median (IQR)=0 versus 1 at T4; p<0.002, median (IQR)=0 versus 1 at T5; p<0.002,
median (IQR)=0 versus 2 at T6; p< 0.001, median (IQR)=0 versus 0 at T7; un consum de tramadol i
AINS postoperator semnificativ mai mic (median (IQR)=1 versus 3; p<0.001 respective median (IQR)=1
versus 2; p< 0.001) i mai puine simptome psihologice postoperatorii (median (IQR)=5 versus 23;
p<0,5) comparativ cu pacientele din CONTR Group.
Concluzii: Acest studiu evideniaz faptul c tehnicile de relaxare preoperatorii scad intensitatea
durerii acute postoperatorii, consumul de analgetice postoperatorii i simptomele psihoemoionale
postoperatorii la pacientele programate pentru chirurgia cancerului mamar.
Background: Breast cancer surgery is associated with pre-surgical psychological distress that may have
negative post-surgical side effects. We conducted a randomized clinical study to investigate the effects
of preoperative relaxing techniques on the postoperative intensity of acute pain, analgesic
consumption and psychological symptoms.
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Material and Methods: We randomly assigned 102 patients scheduled for breast cancer either to
receive or not to receive pre-surgical psychological counselling. Patients were not blinded randomized.
The psychological counselling was performed by a clinical psychologist. Acute post-surgical pain and
psychological symptoms and analgesic consumption were assessed at different times postoperatively
for a period of 48 hours.
Results: Patients in the psychological counselling group (PSY-CON Group) had significantly lower
intensity of pain in the recovery room (T1), at 2 (T2), 8 (T3) 12 (T4), 24 (T5), 30 (T6) and 36 (T7) hours
after surgery (median (IQR)= 1.5 versus 6 at T1; p< 0.001, median (IQR)=1 versus 4 at T2; p< 0.001,
median (IQR)=1 versus 2 at T3; p<0.025; median (IQR)=0 versus 1 at T4; p<0.002, median (IQR)=0 versus
1 at T5; p<0.002, median(IQR)=0 versus 2 at T6; p< 0.001, median (IQR)=0 versus 0 at T7; p<0.039),
significantly lower consumption of postoperative tramadol and NSAIDs (median (IQR)=1 versus 3;
p<0.001 respectively median (IQR)=1 versus 2; p< 0.001) and fewer psychological symptoms after
surgery (median (IQR)=5 versus 23; p<0,5) than patients in the control group (CONTR Group).
Conclusion: The study indicates that preoperative relaxation techniques decreases the intensity of acute
post-surgical pain, postoperative analgesic consumption and psychological symptoms.
Managementul anestezic pentru cezarian la o pacient cu amiotrofie spinal: prezentare

de caz
Anaesthetic management for cesarean section in a patient with spinal muscular atrophy:
case report
Orsolya Benedek (1), M. Veres (2), Alexandra Lazr (3), Bianca Grigorescu (4), Sanda Maria Copotoiu
(1)
Romnia
(2) Spitalul Clinic Judeean de Urgen, Clinica Anestezie i Terapie Intensiv, Trgu Mure, Romnia
Romnia
Introducere: Amiotrofia spinal este o afeciune neuromotor periferic autosomal recesiv care rezult
n pierderea masei i forei musculare.
Obiectiv: Prezentarea efecturii cezarienei de urgen utiliznd TIVA.
Material i metode: Prezentm cazul pacientei de 22 ani cu amiotrofie spinal care se prezint la Clinica
de Obstetric i Ginecologie din cadrul Spitalului Clinic Judeean de Urgen Trgu Mure cu sarcin la
termen cu debut de travaliu. Se decide efectuarea cezarienei de urgen. La consultul preanestezic am
constatat prezena concomitent a stomacului plin i a criteriilor de intubaie dificil, mobilitate
cervical redus, distan tiro-mentonier i deschiderea gurii reduse, cu un scor Mallapatti 3 puncte
si prognaie marcat. La examinarea coloanei vertebrale am notat mobilitate redus fr evidenierea
spaiilor intervetebrale. Am optat pentru efectuarea anesteziei generale dup temporizarea
interveniei la un interval de 6 ore de repaus alimentar. La inducie am administrat Lidocain 0,5 mg/kg,
Propofol 2,5 mg/kg i Rocuronium 0,3 mg/kg. Am efectuat intubaia orotraheal cu lam flexibil la un
scor Cormack de 4 puncte i am meninut anestezia cu infuzie continu cu Propofol 1mg/kg/or.
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Delivrena ftului a avut loc dup 4 minute de la iniierea anesteziei cu scor APGAR de 9/10. Dup
extragerea ftului am administrat Fentanyl n doze de 3 g/kg. La sfritul interveniei am reversat
blocul neuromuscular cu Sugammadex. Am detubat pacienta dup reversia total a anesteziei.
Rezultate: Am utilizat cu succes TIVA la o gravid cu patologie spinal degenerativ.
Concluzii: Gravida cu amiotrofie spinal este o provocare att pentru echipa obstetrical, ct i pentru
echipa anestezic.
Introduction: Spinal muscular atrophy is an autosomal recessive peripheral neuromotor disease that
affects muscle mass and causes muscle weakness.
Aim: To report the use of TIVA for emergency caesarean section.
Material and Methods: We report the case of a 22-year-old patient with spinal muscular atrophy who
arrived at the Obstetrics and Gynaecology Clinic of the Trgu Mure Emergency Clinical County Hospital
at term in labor. Emergency caesarean section was indicated. The pre-anaesthesia consult revealed the
presence of a full stomach and several difficult airway management criteria such as reduced cervical
mobility, reduced thyroid-menton distance and mouth opening with a Mallampatti score of 3 points
and large anterior upper denture. The spinal column showed reduced mobility without distinct vertebral
space. We chose general anaesthesia after 6 hours of fasting. To induce anaesthesia we administered
Lidocaine 0.5 mg/kg, Propofol 2.5 mg/kg and Rocuronium 0.3 mg/kg. Orotracheal intubation was
achieved on the second attempt with a flexible blade at a Cormack score of 4 points and we maintained
the anaesthesia with Propofol 1mg/kg/hour. The newborn was delivered in 4 minutes with and APGAR
score of 9/10. After delivery, we opted for Fentanyl in doses of 3 g/kg. At the end, we reversed the
neuromuscular blockade with Sugammadex. The patient was extubated after full recovery from
anaesthesia.
Results: We successfully applied TIVA to a pregnant patient with a spinal degenerative disease.
Conclusions: The pregnant patient with spinal muscular atrophy is a challenge for both the obstetrical
and anaesthesia team.
Recunoaterea i rezolvarea asincroniilor ventilatorii: problem important a pacientului

critic i medicului intensivist
Recognition and resolving ventilator asynchrony: an important issue for the critical ill and
intensive care physician
F. T. Borjog, C. Boro, Irina Postolache, Adriana Nica
Spitalul Universitar de Urgen, Secia de Anestezie i Terapie Intensiv, Bucureti, Romnia
Sincronizarea ventilaiei mecanice cu efortul respirator al pacientului reprezint idealul pe care
medicul intensivist trebuie s l ating. Problemele legate de asincronism trebuie recunoscute i
cutate soluiile adecvate pentru corectare.
Asincronismul ntre pacient i ventilator are consecine negative. Plecnd de la disconfortul creat
pentru bolnav, leziuni ale fibrelor musculare ale diafragmului cu scderea forei musculare, creterea
sarcinii de lucru (work of breathing) pn la volutraum, barotraum i implicit VILI (ventilator induced
lung injury). Acestea sunt cteva din elementele care contribuie la prelungirea duratei de ventilaie
mecanic, creterea numrului de zile n terapie intensiv i nrutirea prognosticului pacientului.
n ncercarea de a aduce beneficii n educaia noastr privind ventilaia macanic, am cutat n
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literatura medical studii care au urmrit interaciunea ntre ventilator i pacient, au identificat
asincronismele i au oferit o posibil soluie. Pe baza acestora am rezumat principalele dissincronii
ntlnite, cauzele posibile i metodele prin care pot fi corectate.
Synchronisation between mechanical ventilation and the breathing effort of the patient is the ideal that
every intensive care physician must reach. Problems related to asynchrony must be identified and
appropriate solutions for correction must be searched.
Asynchrony between patient and ventilator has unwanted consequences. Starting with the discomfort
of the patient, structural damage to the muscle fibres of the diaphragm with weak muscle force,
increasing work of breathing all the way to volutrauma, barotrauma and ventilator induced lung injury.
All these extend the duration of mechanical ventilation, increase the number of intensive care days and
worsen the clinical outcome.
In our attempt to bring benefits in our education regarding mechanical ventilation we have searched
studies in medical literature that have followed the patient - ventilator interaction, identified the
asynchrony and have offered a possible solution. Based on these studies we summarized the main
asynchronies, possible causes and ways to correct them.
Factorii de risc asociai tehnicilor i procedurilor medicale versus rezistena antimicrobian

a germenilor, n evoluia pacientului din terapia intensiv
Risk factors associated to medical techniques and procedures versus antimicrobial resistance
in patient outcomes in the Intensive Care Unit
Teodora Olariu (1), Dana Gabriela Negru (2), I. Olariu (3), Amalia Niculescu (1), Carmen Panti (4),
Lcrmioara Andreica (5), Angelica Rita Chiorean (6), V. Toma (7)
(1) Universitatea de Vest Vasile Goldi, Clinica de Anestezie i Terapie Intensiv, Arad, Romnia
(2) Direcia de Sntate Public, Arad, Romnia
(3) Universitatea de Vest Vasile Goldi, Clinica Protetic, Arad, Romnia
(4) Universitatea de Medicin i Farmacie, Clinica de Chirurgie, Oradea, Romnia
(5) Spitalul Clinic Judeean de Urgen, SPCIN, Arad, Romnia
(6) Universitatea de Medicin i Farmacie Iuliu Haieganu, Clinica de Radiologie, Cluj-Napoca,
Romnia
(7) Universitatea de Vest Vasile Goldi, Facultatea de Medicin General, Arad, Romnia
Obiectiv: Stabilirea Riscului Relativ de deces prin factorii de risc asociai tehnicilor i procedurilor
medicale versus rezistena antimicrobian a germenilor, n evoluia pacientului cu nosocomialitate din
terapia intensiv.
Material i metode: Am analizat infeciile nosocomiale din anul 2015 din seciile terapie intensiv ale
SCJU Arad, rata deceselor, germenii de spital identificai, la care am urmrit rezistena antimicrobian
dobndit, dup excluderea celei naturale, utiliznd definiia grupului ESKAPE pentru bacteriile Gram
negative i pozitive cu importan particular recent. Pentru identificarea germenilor s-au utilizat
kituri rapide, iar pentru antibiograme s-a utilizat metoda difuzimetric. Datele au fost prelucrate IBM
SPSS Statistics 20, MedCalc i Epi Info 7.
Rezultate: Au fost identificai 4747 germeni n toate seciile, dintre care 491/10.34% n seciile ATI, cu
rezisten antimicrobian n procent de 396/80.65%. n acelai timp s-au nregistrat 191 infecii
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nosocomiale, dintre care 58 pe seciile ATI/30.36%, cu 43 decese/74.13%. Factorii de risc asociai
tehnicilor i procedurilor medicale / antibioterapie, cateter, ventilaie mecanic, sond urinar etc au
fost identificai n 147 dintre cazuri pe spital /76.96%. Riscul Relativ de apariie a deceselor pe ATI prin
factori de risc asociai tehnicilor i procedurilor medicale este de 6,8265 de ori mai mare fa de alte
secii spitaliceti, P < 0,0001 (95% CI, 4,0343 to 11,551), iar prin rezisten antimicrobian de 3.9070 .
Concluzii: n seciile ATI exist ambele riscuri crescute de deces la pacienii cu nosocomialitate, att
prin tehnicile i procedurile medicale practicate, ct i prin rezistena antimicrobian a germenilor
asociai.
Cuvinte cheie: Risc Relativ, rezisten antimicrobian, terapie intensiv
Objective: To estimate the relative risk of death associated to risk factors due to medical techniques
and procedures versus antimicrobial resistance of germs in nosocomial infections in patient evolution
in ICU.
Material and Methods: All registered nosocomial infections in the ICU of Arad Hospital in 2015 have
been analysed in terms of the death rates and acquired antimicrobial resistance in identified hospital
germs, after excluding the natural antimicrobial resistance, using recently ESKAPE group definition for
Gram negative and positive germs. In order to identify these germs, rapid tests were used and for
assessing theirs antimicrobial susceptibility disk diffusion method was used. Data were IBM SPSS
Statistics 20, MedCalc and Epi Info 7 processed.
Results: There were identified 4747 germs in all medical units, including 491/10.34% in ICU, with
396/80.65% antimicrobial resistant germs. At the same time, 191 nosocomials were recorded of which
58/30.36% in ICU with 43/74.13% deaths. Risk factors associated to medical procedures and techniques
as antibiotic therapy, catheterization, mechanical ventilation and so on were identified in 147 cases
/76.96% of all hospital wards. The relative risk of death in the ICU due to techniques and medical
procedures involved risks is 6.8265 times higher than other hospital wards, P <0.0001 (95% CI, 4.0343
to 11.551) and due to antimicrobial resistance is 3.9070.
Conclusions: Our data shown that in ICU is an increased risk of death in patients with nosocomials, due
to techniques and medical procedures and to antimicrobial resistant germs.
Keywords: Relative Risk, antimicrobial resistance, ICU
Valoarea predictiv a scorurilor de intubaie dificil. este necesar elaborarea unui nou
scor?
Predictive value of difficult intubation scores. Is the development of a new score necessary?
M. Veres (1), Sanda Maria Copotoiu (2), A. Cioc (1), Orsolya Benedek (2), Monica Orlandea (1), Bianca
Grigorescu (3), L. Azamfirei (2), Judit Kovacs (2)
(2) Universitatea de Medicin i Farmacie, Clinica de Anestezie i Terapie Intensiv, Trgu Mure,
Romnia
Scop: Evaluarea valorii predictive a scorurilor propuse pentru estimarea intubaiei dificile.
Material i metode: Studiul este prospectiv observaional, am inclus 154 pacieni n perioada ianuarie
- februarie 2016. Pentru evaluarea existenei cii aeriene dificile am determinat scorurile El Ganzouri,
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Wilson, Macocha, SPIDS (The Simplified Predictive Intubation Difficulty Score), Mallampati i Cormack.
Clasificarea n funcie de dificultatea intubaiei a fost realizat conform criteriilor Cook. Comparaiile
s-au efectuat n funcie de fiecare scor predictiv n parte.
Rezultate: Scorul cu puterea de predicie cea mai semnificativ pentru intubaie dificil a fost scorul
SPIDS, cu AUC=0.888 (95%CI 0.824-0.953), urmat de scorul El Ganzouri cu AUC=0.818 (95% CI 0.7150.921), scorul Macocha cu AUC=0.799 (95% CI 0.669-0.929), ultimul fiind scorul Wilson cu AUC=0.675
(95% CI 0.531-0.818). Valoarea cut-off a fost de 13 puncte n cazul scorului SPIDS, 4 puncte n cazul
scorului El Ganzouri, 3 puncte n cazul scorului Macocha i 2 puncte n cazul scorului Wilson. Valorile
cele mai mari de sensibilitate i specificitate au fost obinute n cazul scorului SPIDS (ss=0.895,
sp=0.733), urmate de scorul Macocha (ss=0.737, sp=0.859), scorul El Ganzouri (ss=0.632, sp=0.852) i
scorul Wilson (ss=0.632, sp=0.704). Valoarea cea mai mare de odds ratio a fost obinut n cazul
scorului SPIDS (OR=23.3, p<0.0001) i cea mai mic n cazul scorului Wilson (OR=4.01, p=0.005).
Concluzii: Ar fi indicat introducerea scorului SPIDS i eventual El Ganzouri n examenul preanestezic
n vederea evitrii complicaiilor legate de calea aerian dificil.
Aim: To evaluate the predictive value of the scores that estimate a difficult intubation. Material and
Material and Methods: We performed a prospective observational study. We included 154 patients
between January 2016 and February 2016. We assessed the El Ganzouri, Wilson, Macocha, SPIDS (The
Simplified Predictive Intubation Difficulty Score), Mallampati and Cormack scores to determine the
presence of a difficult airway. We used the Cook criteria to classify difficult intubation and to further
compare aforementioned predictive scores.
Results: The most significant predictive score for difficult intubation was the SPISD score, with an
AUC=0.888 (95%CI 0.824-0.953), followed by El Ganzouri score with an AUC=0.818 (95% CI 0.7150.921), by the Macocha score AUC=0.799 (95% CI 0.669-0.929) and lastly by the Wilson score with an
AUC=0.675 (95% CI 0.531-0.818). The cut-off scores were 13 points for SPIDS, 4 points for El Ganzouri,
3 points for Macocha and 2 points for Wilson. The highest sensitivity and specificity was attained by
the SPIDS score (ss=0.895, sp=0.733), followed by the Macocha score (ss=0.737, sp=0.859), the El
Ganzouri score (ss=0.632, sp=0.852) and the Wilson score (ss=0.632, sp=0.704). The highest odds ratio
was attained by the SPIDS score (OR=23.3, p<0.0001) and the lowest by the Wilson score (OR=4.01,
p=0.005).
Conclusions: The introduction of SPIDS score and possibly the El Ganzouri score in the pre-anaesthetic
assessment might aid in avoiding complications arising from the management of a difficult airway.
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Transplantul hepatic n urgen n incompatibilitate major ABO la o pacient cu insuficien

hepatic acut toxic-medicamentoas
Emergency liver transplantation in major ABO incompatibility in a patient with drug induced
acute liver failure
Daniela Andrada Tudor (1), Gabriela Droc (2), Graiela Manga (2), I. Popescu (3), V. Braoveanu (4),
Mariana Mihil (5), Elena Moraru (6), V. Cojocaru (6), Dana Tomescu (1)
(3) Institutul Clinic Fundeni, Centrul de Chirurgie General i Transplant Hepatic, Bucureti, Romnia
(4) Institutul Clinic Fundeni, Clinica de Chirurgie General, Bucureti, Romnia
(5) Institutul Clinic Fundeni, Secia de Gastroenterologie, Bucureti, Romnia
(6) Spitalul Clinic Republican, Secia de Anesteziologie i Reanimatologie, Chiinu, Republica Moldova
Introducere: Insuficiena hepatic acut (IHA) este o afeciune rar care apare la pacienii fr
patologie hepatic preexistent i care necesit tratament specific n urgen. n ultimii ani rata de
supravieuire a pacienilor s-a mbuntit substanial ca urmare a progresului fcut n managementul
IHA n Terapie Intensiv (TI). Transplantul hepatic (TH) reprezint singura metod certificat de
cretere a supravieuirii.
Materiale i metode: Prezentm cazul unei paciente n vrst de 23 de ani admis de urgen n TI
pentru tratament specific al IHA post ingestie de sulfasalazin i antiinflamatoare n doze terapeutice,
cunoscut cu artrit reactiv i polialergic. Se efectueaz protocolul de IHA i se practic TH n urgen
cu gref cadaveric ABO incompatibil (ABOi). Se nregistreaz datele clinice i paraclinice perioperatorii
i evoluia postoperatorie.
Rezultate: La admisia n TI pacienta prezint encefalopatie hepatic (EH) gradul II, tegumente icterice
(BT 17.8 mg/dl), erupie cutanat generalizat, scor MELD 30, grup sanguin 0+. Analizele de laborator
arat citoliz sever, coagulopatie (INR 3.29). Se instituie dializ hepatic MARS. Starea pacientei se
agraveaz cu EH gradul IV ce necesit intubaie orotraheal (IOT). Pacienta este listat la Agenia
Naional de Transplant ca prioritate pe lista de ateptare i n paralel se evalueaz mama pentru
donare de lob hepatic drept. Volumetria arat lob stng al donatorului insuficient ca mas hepatic.
Se anun disponibilitatea unei grefe cadaverice A+ i se decide efectuarea TH n urgen, n
incompatibilitate de grup. Se aplic protocolul de desensibilizare perioperator. TH decurge fr
incidente, evoluia postoperatorie este favorabil, cu remiterea EH i normalizarea probelor de citoliz
i colestaz.
Concluzii: TH n incompatibilitate de grup reprezint o soluie alternativ pentru pacienii cu IHA n
condiiile din Romnia n care disponibilitatea grefelor hepatice este impredictibil. Aplicarea
protocolului de desensibilizare scade incidena apariiei complicaiilor precoce i tardive.
Introduction: Acute liver failure (ALF) is a rare condition that occurs in patients without pre-existing
liver pathology and requires prompt medical evaluation and treatment. In recent years the survival rate
of the patients has improved substantially as a result of the progress made in the management of ALF
in Intensive Care Unit (ICU). Liver transplantation (LT) is the only certified method of increasing survival.
Materials and Methods: We present the case of a 23-year-old admitted in ICU for specific treatment of
ALF post ingestion of sulfasalazine and anti-inflammatory drug in therapeutic doses. The patient is
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known with reactive arthritis and allergic diseases. ALF protocol is carried out and emergency LT is
performed with cadaveric graft in ABO incompatibility. Clinical and laboratory data are recorded and
perioperative and postoperative evolution.
Results: At admission in ICU the patient presents hepatic encephalopathy (EH) grade II skin jaundice
(BT 17.8 mg / dl), generalized rash, MELD score 30, blood group 0+. The analyses of laboratory data
shows cytolisis and severe coagulopathy (INR 3.29). Liver dialysis MARS is established. Patient's
condition worsens with EH grade IV that requires endotracheal intubation. The patient is listed on the
National Transplant Agency as a priority on the waiting list. The mother is evaluated in parallel for right
hepatic lobe donation. Volumetric tests show insufficient liver mass of the left hepatic lobe. The
availability of cadaver grafts A + is announced and LT is decided upon in emergency incompatibility
group. Perioperative desensitization protocol is applied. LT runs without incident, the postoperative
evolution is favourable, with the remission of EH and and normalization of cytolysis and cholestasis.
Conclusions: LT in blood type incompatibility is an alternative solution for patients with ALF in Romania
where the availability of liver grafts is unpredictable. Applying the desensitization protocol decreases
the incidence of early and late complications.
Impactul repleiei volemice asupra apariiei complicaiilor pulmonare la pacienii

transplantai hepatic
The impact of intraoperative fluid transfusion on postoperative pulmonary complications in
liver-transplant patients
Lavinia Nicoleta Jipa (1), Roxana Ciobnau (1), Daniela Ungureanu (1), Dana Tomescu (2), Gabriela
Droc (1)
Obiectivele studiului: Terapia volemic este unul din elementele determinante asupra evoluiei
pacienilor transplantai hepatic. Obiectivul acestui studiu este analiza influenei repleiei volemice
intraoperatorii asupra apariiei complicailor pulmonare postoperatorii.
Material i metode: Au fost analizai retrospectiv 40 de pacieni supui transplantului hepatic n
perioada ianuarie - aprilie 2014. Pacienii au fost mprii n 2 grupuri: Grupul A pacienii cu complicaii
pulmonare, grupul B - pacienii fr complicaii. Au fost analizate date demografice, teste de laborator,
volumul transfuziei de produi sangvini intraoperator, cantitatea total de soluii cristaloide i coloide
administrat, precum i complicaiile pulmonare aprute postoperator. Radiografia pulmonar a fost
efectuat de rutin n cazul tuturor pacienilor.
Rezultate: Studiul nostru a inclus 26 de brbai (65%) i 14 femei (35%). 23 de pacieni (57.5%) au
dezvoltat complicaii pulmonare. S-a observat c pacienii din grupul A au beneficiat de o cantitate
mare de fluide intraoperator (peste 100ml/kgc) fa de cei din grupul B (p=0.02). Transfuzia de plasm
n primul grup a fost mai mare fa de grupul B (p=0.05), iar grupul A a primit o cantitate mai mare de
soluii cristaloide (p=0.04). Repleia volemic intraoperatorie se coreleaz cu durata staionrii pe
secia de Terapie Intensiv (p=0.01) i cu o durat mai lung de extubare. Scorurile Meld i Meld-Na
nu au fost diferite n cele 2 grupuri.
Concluzii: Repleia volemic excesiv intraoperatorie se asociaz cu apariia complicaiilor pulmonare
i cu prelungirea staionrii pe secia de Terapie Intensiv.
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Goal of study: Fluid management is one of the key elements for a successful liver transplantation (LT).
The aim of this study was to assess the influence of intraoperative fluid management on postoperative
pulmonary complications.
Material and Methods: We analyzed 40 patients who underwent liver transplantation at Fundeni
Clinical Institute between January and April 2014. The patients were divided into two groups: Group A
- patients with pulmonary complications, Group B - patients without pulmonary complications. Various
data was analysed: demographic data, laboratory results, volume of intraoperative blood and fluid
transfusion, intraoperative blood loss and fluid balance, duration of surgery, postoperative pulmonary
complications, extubation time and length of PACU stay. Radiographic analysis was standardized in
order to assess the presence of pulmonary complications.
Results: Our study included 26 men (65%) and 14 women (35%). 23 patients (57.5%) developed
pulmonary complications after LT. The study revealed that intraoperative fluid transfusion exceeded
100ml/kg in patients with pulmonary complications compared to those without pulmonary
complications. (p=0.02). Plasma transfusion in group 1 was higher than in group 2 (p=0.05) and group
1 received more crystalloid solutions than group 2 (p=0.04). We found that intraoperative fluid balance
>45ml/kg correlates with postoperative pulmonary complications (p=0.01), longer PACU stay (p=0.01)
and longer extubation time (p=0.04). The Meld and Meld Na scores were not significantly different
between the two groups (p=0.26).
Conclusion: Excessive intraoperative fluid transfusion is associated with postoperative pulmonary
complications, prolonged PACU stay and extubation time.
Prima intervenie chirurgical fetal deschis din Romnia - mielomeningocel lombo-sacrat

fetal operat n sptmna 26 de gestaie - management anestezic perioperator
The first open fetal surgery in Romania (lombo-sacral myelomeningocoele) in the 26th week
of pregnancy - perioperatory anaesthesia management
Ani Rahimian
Spitalul Regina Maria, Secia de Anestezie i Terapie Intensiv, Bucureti, Romnia
Odat cu introducerea, n anii 80, a conceptului de ft ca pacient, se ridic i problema diagnosticului
i tratamentului afeciunilor acestuia. Conceptul a evoluat de la diagnosticul prenatal i observarea
seriat a feilor cu anomalii anatomice, ajungndu-se la o nou ramur a medicinii, medicina maternofetal. n Izoimunizarea Rh cu hidrops fetal, s-a realizat prima intervenie fetal de succes prin
transfuzia de snge intrauterin, n cordonul ombilical. De atunci i pn acum s-au introdus n practic
mai multe tipuri de intervenii intrauterine. Intervenia intrauterin se ia n considerare cnd ftul
prezint leziuni congenitale care i pot afecta sau compromite funciile vitale, ducnd la deces sau pot
duce la o morbiditate foarte crescut postnatal. Sunt trei tipuri principale de intervenii fetale: 1)
Intervenie intrapartum ex utero - ex utero intrapartum treatment (EXIT); 2) Proceduri deschise la
jumtatea gestaiei - midgestation open procedures; 3) Proceduri minim invazive - minimally invasive
midgestation procedures. Interveniile fetale intrauterine prezint un risc crescut chirurgical i
anestezic att la ft, ct i la mam. Corectarea unei malformaii anatomice in utero prin intervenie
chirurgical deschis este nsoit de risc chirurgical i anestezic i mai mare. Managementul anestezic
perioperator al interveniilor fetale deschise prezint elemente care nu se ntlnesc n alte tipuri de
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intervenii chirurgicale, ncepnd cu faptul c sunt anesteziai simultan doi pacieni care se afl i n
interdependen, continund cu imaturitatea i vulnerabilitatea ftului i alte particulariti. n lucrare
doresc s evideniez experiena clinicii noastre n interveniile intrauterine, prezentndu-v
managementul anestezic pentru primul caz de mielomeningocel fetal operat intrauterin n Romnia,
prin intervenie chirurgical deschis. Intervenia chirurgical s-a efectuat n Spitalul Regina Maria
Bneasa, la data de 05.11.2015, la pacient cu vrsta gestaional de 26 sptmni. A avut succes att
din punct de vedere anestezic, ct i chirurgical, nu au existat complicaii intra- sau postoperator, iar
ftul s-a nscut prin operaie cezarian la 36 sptmni de sarcin. n prezent copilul se afl n program
de recuperare ortopedie i fizioterapie, prognosticul motor este bun, nu prezint hidrocefalie i nici
semne de leziuni cerebrale.
In the 1980s, with the introduction of the concept of the fetus as a patient, rises the issue of diagnosis
and treatment of its afflictions. The concept has evolved from prenatal diagnosis and serial
observations of fetuses with anatomical abnormalities, to a new branch of medicine, the materno-fetal
medicine. The Rh isoimmunisation with hydropic fetus provides the first successful example of fetal
intervention, through blood transfusion in the umbilical cord. Since then, several intrauterine
interventions have been done. Fetal surgical intervention is considered when the fetus presents with a
congenital lesion that can affect or compromise vital function, leading to death or cause severe
postnatal morbidity. There are 3 basic types of surgical interventions: 1) Ex utero intrapartum
treatment (E.X.I.T.) ; 2) Midgestation open procedures; 3) Minimally invasive midgestation procedures
Fetal surgery has high surgical and anaesthetic risks for the fetus and also for the mother. Correcting
an anatomical malformation in utero with open fetal surgery has even a higher anaesthetic and surgical
risks. Anaesthetic perioperatory management for the open fetal surgery has elements that are not
encountered in other types of surgical procedures, starting with the fact that there are 2 patients
simultaneously anaesthetized in interdepending, following with the fetal prematurity and vulnerability
and other particularities. In my work, I wish to underline the experience of our clinic in intrauterine fetal
surgery, by presenting you the perioperative anaesthetic management of the first fetal open surgery
for fetal myelomeningocele in Romania. The surgical intervention was performed on the 5th of
November 2015, on a patient in the 26th week of pregnancy. The intervention was a success from both
points of view, anaesthetic and surgical. There were no intra- or post-operatory complications and the
fetus was delivered by C-section at 36 weeks of pregnancy. Now, the child is following a recuperation
schedule, orthopedically and physiotherapy. The motor function prognostic is good, there are no signs
of hydrocephaly or brain lesions.
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Caracteristica comparativ a complicaiilor severe ale gripei a(h1n1) 2009 vs 2015 - 2016
Comparative study of severe complications of A(H1N1) from 2009 vs 2015 - 2016
V. Cojocaru, Doriana Cojocaru, Elena Rmbu, V. Guan, S. Ursul, A. Botizatu, Iana Cotorcea, Corina
Guium
Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Clinica de Anesteziologie i
Reanimatologie, Chiinu, Republica Moldova
Material i metode: n studiu au fost inclui 182 pacieni, plasai n clinca ATI cu criterii de ARDS i alte
complicaii severe ale gripei AH1N1, divizai n 2 loturi: Lotul I - 114 pacieni admii n TI n 2009, lotul
II - 68 pacieni admii n anii 2015 - 2016.
Metode de terapie: terapia respiratorie, antibioterapia, corecia dezechilibrelor homeostazice, terapia
eferent, oxigenarea extracorporeal membranar.
Discuii: n anul 2009 gripa a deinut un caracter pandemic, cu morbiditate nalt i letalitate joas.
Majoritatea pacienilor admii n TI erau de vrst tnr (357 ani), printre ei gravidele au constituit
pondere nalt (22,8%). n anii 2015 - 2016, gripa nu a depit pragul epidemic, dar numrul
complicaiilor i deceselor raportat la numrul bolnavilor a fost relevant mai frecvent dect n 2009.
Comorbiditile la pacienii din lotul I au constituit 25,7%, iar n lotul II 86,9%. n lotul I s-a determinat,
la majoritatea pacienilor, o stare de hiperactivitate a sistemului imunitar cu un coeficient imunoreglator sczut, iar n lotul II o stare de hipoergie caracterizat printr-o depresie a tuturor
componentelor sistemului imunitar.
Concluzii: Agresiunile biologice noi cu caracter potenial epidemic provoac un rspuns violent din
partea populaiei umane, manifestate prin hiperactivitatea sistemului imunitar cu complicaii severe
caracteristice acestui fenomen. Ulterioarele valuri (epidemii) de mbolnviri, cauzate de acelai agent,
se caracterizeaz prin afectarea preponderent a populaiei cu statut constituional somatic
compromis pe fondalul unei depresii imunitare coexistente i complicaiile avnd evoluie sever cu
rezultat dramatic.
Material and Methods: The study included 182 patients placed in the ICU with clinical criteria for ARDS
and other severe complications of A(H1N1) influenza, divided into 2 groups: the first group - 114
patients admitted to the ICU in 2009, the second group - 68 patients admitted to the ICU in 2015 - 2016.
Methods of therapy: respiratory therapy, antibiotics, correction homeostatic imbalances, efferent
therapy, extracorporeal membrane oxygenation.
Discussion: In 2009 influenza virus had a pandemic character with a high morbidity and low lethality.
Most patients admitted to the ICU were young of age (35 7 years), with a high share of pregnant
women among them (22.8%). In the 2015 - 2016 epidemic threshold of influenza was not exceeded, but
the number of complications and deaths related to the number of patients was more frequent than in
2009. Comorbidities in the Ist group of patients were 25.7% and 86.9% in the IInd group. In the Ist group
was determined, in most patients, a hyperactivity of the immune system with a low immuno-regulator
coefficient, while in the IInd it was observed a state of hypoergosis, characterized by a depression of all
components of the immune system.
Conclusions: New biological aggressions with an epidemic potential cause a violent response from the
human population which is manifested by a hyperactivity of the immune system with severe
complications, typical for this phenomenon. Following epidemic streams of the disease caused by the
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same agent is characterized by predominantly affecting the population with a compromised somatic
status against a coexisting immune depression and complications, with severe evolution and dramatic
results.
Noradrenalina poate influena indexul arterei hepatice la pacienii cu transplant hepatic?

Does noradrenaline in the anhepatic phase influence hepatic artery resistive index in
patients with liver transplantation?
Graiela Manga (1), Ecaterina Scrltescu (2), T. Dumitracu (3), Dana Tomescu (2), Gabriela Droc (1)
(3) Institutul Clinic Fundeni, Secia de Chirurgie General, Bucureti, Romnia
Studii recente arat c administrarea de vasopresor sau vasoconstrictor poate influena indexul de
rezistivitate (IR), ca rezultat al relaiei reciproce dintre fluxul arterial i venos. Scopul acestui studiu
este de a identifica factorii intraoperatori care influeneaz IR n postoperatorul imediat. Acest studiu
retrospectiv include un numr de 65 de pacieni cu transplant hepatic. n cursul interveniei
chirurgicale au fost monitorizate: sngerarea intraoperatorie, transfuzia de produi de snge,
administrarea de factori de coagulare, durata operaiei i necesarul de medicaie vasopresoare
intraoperator. Echografia Doppler a fost efectuat n zilele 1,2,3,4,5 postoperator (PO). Analiza
statistic a fost efectuat n SPSS 19.0, folosind ecuaia Mann-Whitney pentru variabile cantitative cu
p<0,05 seminificativ statistic. Studiu a inclus 31 de brbai (47,68%) i 34 de femei. Scorul MELD(SD)
i MELD-NA(SD) a fost 16,53 (6,61), respectiv 19,06 (6,72). IR nu s-a corelat cu sngerarea
intraoperatorie (p=0,768 PO 3, p=0,481 PO 5), necesarul transfuzional (p=0,182 PO 3, p=0,337 PO 5) i
factorii de coagulare administrai (p=0,607 PO 3, p=0,979 PO 5). O bun corelaie a fost gsit ntre
durata fazei anhepatice i IR n PO 5 (p=0,022) i ntre necesarul de vasopresor n timpul fazei
anhepatice i IR n PO 3 (p=0,025) i POD 5 (p=0,01). IR n postoperatorul imediat a fost influenat de
necesarul de noradrenalin n cursul fazei anhepatice. Umplerea adecvat poate reduce necesarul de
vasopresor n faza anhepatic i neohepatic i poate reduce complicaiile vasculare arteriale.
Recent studies show that IR are modified by the administration of a vasodilatator or vasoconstrictor
stimuli, resulting from portal vein and hepatic artery flow relationship. The goal of this study was to
investigate the intraoperative factors that influence IR in the early postoperative period. This
retrospective observational study included 65 patients with liver transplantation. During surgery
intraoperative bleeding, transfusion of blood derivates, concentrated coagulation factors, anhepatic
phase length and vasopressor medication were noted. Doppler ultrasonography was performed
intraoperative and in postoperative days (POD) 1,2,3,4,5. Statistical analize was performed in SPSS var.
19.0 using Mann-Whitney test for quantitative variables with p<0,05 statistically significant. Study
included 31 men (47,68%) and 34 women. Mean MELD (SD) and MELDNa (SD) scores were 16,53
(6,61) and 19,06 (6,72). IR did not correlate with intraoperative bleeding (p=0,768 POD 3, p=0,481
POD 5), transfusional requirements (p=0,182 POD 3, p=0,337 POD 5) and coagulation factors
administered (p=0,607 POD 3, p=0,979 POD 5). A good correlation was found between anhepatic phase
duration and IR in POD 5 (p=0,022) and between noradrenaline dose in anhepatic phase and IR in POD
3 (p=0,025), and POD 5 (p=0,01). IR early after transplantation was influenced by noradrenaline dose
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in anhepatic phase. Adequate preloade could reduce vassopresor requirements in the anhepatic and
neohepatic phase and reduce postoperative vascular arterial complication.
Beneficiile Ondansetronului asociat anesteziei spinale la gravidele cezarizate. Studiu dublu

orb randomizat controlat placebo
Ondansetron benefits when given after spinal anaesthesia for C section. Double blind,
controlled, randomised study
Lavinia Florentina Rad (1), Ioana ola (1), Cristina Oana Daciana Teodorescu (2), Alexandra Andreea
Gociu (1), P. O. Teodorescu (1)
(2) Spitalul Clinic Municipal, Secia de Anestezie i Terapie Intensiv, Oradea, Romnia
Anestezia spinal este metoda anestezic de elecie pentru operaia cezarian. Aceasta se asociaz
frecvent cu hipotensiune i bradicardie i poate avea efecte adverse att asupra mamei ct i a ftului.
Owczuk i colab. au observat c Ondasetron 4mg IV atenueaz hipotensiunea.
Material i metode: Am efectuat un studiu dublu orb randomizat controlat placebo. Am utilizat un
program computerizat ce a mprit aleator, n 2 grupuri, 52 de paciente programate pentru operaie
cezarian. Pacientele au prezentat risc anestezic ASA I cu vrst cuprins ntre 20 i 40 ani. nainte de
efectuarea anesteziei spinale, grupul O (n=26) a primit intravenos 4 mg/2ml Ondansetron, iar grupul S
(n=26) a primit 2ml NaCl 0,9%. Toate pacientele au primit ranitidin 1mg/kg IV, metoclopramid
0,4mg/kg IV i au fost prehidratate cu sol Ringer lactat 20 ml/kg/h timp de 30 min. Anestezia spinal sa efectuat cu bupivacain hiperbar 0,5% folosind un ac spinal de 27 gauge la nivelul L3-L4. S-a
monitorizat TA medie, frecvena cardiac i necesarul de droguri vasopresoare, precum i frecvena
episoadelor emetizante.
Rezultate: La pacientele din grupul O s-a redus semnificativ incidena scderii TA medii, au necesitat
doze mai mici de droguri vasopresoare (P=0,009) i s-a redus semnificativ numrul episoadelor
emetizante.
Concluzie: Admininstrarea de Ondansetron 4 mg cu 5 minute nainte de efectuarea blocului
subarahnoidian are efecte benefice, reducnd hipotensiunea, necesarul de vasopresoare i
discomfortul emetizant la pacientele supuse operaiei cezariene sub anestezie spinal. Studiul nostru
concord cu alte 10 trialuri controlate randomizate pe 863 de paciente aflate n bazele de date
Medline, Embase i Libraria Cochrane.
Spinal anaesthesia is the elective anaesthetic procedure for C section. It is frequently associated with
hypotension and bradycardia and can have adverse effects both on the mother and the newborn.
Owczuk and associates observed that Ondansetron 4 mg IV attenuates hypotension.
Material and Methods: We designed a double blind randomized placebo and controlled study. We used
a computerized program that randomized in 2 groups 52 patients programmed for C section. Patients
were of ASA I anaesthetic risk with age between 20 and 40 years old. Before initializing spinal
anaesthesia, group O (n=26) received 4 mg/2ml Ondansetron and group S (n=26) received 2 ml 0.9%
normal saline. All the patients benefited of 1mg/kg iv ranitidine, 0.4 mg/kg iv metoclopramide and had
an iv upload with ringer lactate 20 ml/kg/h for 30 minutes. Spinal anesthesia was conducted at L3-L4
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level using 0.5 % hyperbaric bupivacaine using a 27 G spinal needle. We monitored mean arterial
pressure, heart rate and the need for vasopressor drugs and the emetic episodes.
Results: Patients from group O had a significant reduction in mean arterial pressure drop, needed lower
doses of vasopressor drugs (P=0.009) and had fewer PONV.
Conclusion: Ondansetron 4 mg IV 5 minutes before spinal anaesthesia has beneficial benefits, reducing
hypotension, the need for vasopressor drugs and PONV for patients scheduled for C section under spinal
anaesthesia. Our study is in accordance with other 10 controlled randomized trials with 836 patients
that we found in Medline, Embase and Cochraine Library database.
Beneficiul utilizrii filtrului de adsorbie al citokinelor la pacient cu ARDS sever post infecie
AH1N1 - prezentare de caz
The benefits of cytokine adsorption therapy in a patient with ARDS and AH1N1 infection case report
Alexandra Marcu (1), Ana Grigora (1), Graiela Manga (1), Mara tefan (1), D. Coriu (2), Sorina Bdeli
(2), C. Stnescu (3), Dana Tomescu (4)
(2) Institutul Clinic Fundeni, Secia de Hematologie, Bucureti, Romnia
(3) Institutul Clinic Fundeni, Secia de Chirurgie General, Bucureti, Romnia
Introducere: Sindromul de detres respiratorie acut (ARDS) este caracterizat prin instalarea acut a
insuficienei respiratorii hipoxemice (cu indice de hipoxemie sczut) i prezena infiltratelor alveolare
bilaterale (excluznd edemul pulmonar cardiogenic sau atelectazia) evideniate n prima sptmn
de la apariia simptomatologiei clinice.
Materiale i metode: Prezentm un caz clinic al unui pacient n vrst de 72 de ani admis n secia de
Terapie Intensiv, diagnosticat cu ARDS sever datorat infeciei AH1N1. S-au nregistrat rezultatele
investigaiilor paraclinice i evoluia pn n momentul transferului din Terapie Intensiv.
Rezultate: Pacientul a fost admis n Terapie Intensiv pentru insuficien respiratorie acut hipoxemic
i febr, cu imagine radiologic sugestiv pentru ARDS. A necesitat ventilaie mecanic non-invaziv i
ulterior intubaie orotraheal i ventilaie mecanic controlat. Probele biologice au documentat
infecie AH1N1. S-a instituit terapie specific cu antivirale (Oseltamivir) i s-au efectuat proceduri de
epurare extracorporeal cu cartu de adsorbie a citokinelor, edine repetate de bronhoaspiraie i
manevre de recrutare alveolar (inclusiv poziia prone). Evoluia pacientului a fost complicat de
apariia multiplelor episoade de suprainfecie bacterian cu germeni multirezisteni i a ocului septic
cu disfuncii multiple de organ. n aceste condiii tratamentul n Terapie Intensiv a fost unul complex.
Pacientul a beneficiat de monitorizare invaziv avansat prin analiza undei de puls, ceea ce a permis
ghidarea terapiei volemice i a ventilaiei macanice n funcie de parametri derivai, inclusiv a apei
pulmonare extravasculare. Evoluia pacientului a fost favorabil, cu remisiunea disfunciilor de organ,
pn n momentul transferului din Terapie Intensiv.
Concluzii: Managementul ARDS cauzat de o infecie viral impune un tratament complex specific i
nespecific. Rata complicaiilor este crescut, cu predominena episoadelor de suprainfecie bacterian
cu germeni multirezisteni, frecvent evolund cu oc septic i disfuncii multiple de organ, iar
prognosticul este rezervat i rata decesului crescut.
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Introduction: The Acute Respiratory Distress Syndrome (ARDS) is characterized by the development of
an acute hypoxemic respiratory failure and the presence of bilateral pulmonary infiltrates (in the
absence of evidence for cardiogenic pulmonary edema or atelectasis) within one week of clinical insult
or onset of respiratory symptoms.
Materials and Methods: We present the case report of a patient of 72 years old, admitted in the
Intensive Care Unit (ICU), with the diagnosis of severe ARDS due to AH1N1 infection. There have been
recorded all the clinical and paraclinical data and the evolution until the moment of discharge from the
ICU.
Results: The patient was admitted in the ICU with acute hypoxemic respiratory failure and fever, with
suggestive radiologic images for ARDS. Non-invasive mechanical ventilation was initiated, and then
orotracheal intubation and controlled mechanical ventilation. The laboratory results confirmed AH1N1
infection. Antiviral therapy was initiated with Oseltamivir. The patient received continuous renal
replacement therapies with hemadsorption devices, bronchiolar lavage and recruitment manoeuvres
(including prone position). The evolution was complicated with multiple episodes of bacterial
superinfection with multidrug resistant bacteria with septic shock and multiple organ dysfunction
syndrome. The patient benefited from an advanced invasive monitoring with pulse contour analysis,
which guided the volemic therapy and the mechanical ventilation management using the derived
parameters, especially the extra vascular lung water index. The evolution of the patient was favourable,
with the resolution of organ dysfunctions until the moment of discharge from the Intensive Care Unit.
Conclusions: The management of ARDS caused by o viral infection imposes a specific and non-specific
complex treatment. The rate of complications is high, with the predominance of bacterial
superinfection episodes with multidrug resistant bacteria, usually leading to septic shock and multiple
organ dysfunction syndrome. The prognosis is poor and the survival rate is low.
Managementul purpurei trombotice trombocitare i al disfunciei renale post-administrare

de gemcitabin la un pacient cunoscut cu duodenopancreatectomie cefalic
Management of thrombotic thrombocytopenic purpura and renal dysfunction postadministration of gemcitabine in a patient known with cephalic duodenopancreatectomy
Daniela Andrada Tudor (1), Graiela Manga (2), Ana Maria Crian (3), Florina Buica (4), Dana Tomescu
(1)
(3) Institutul Clinic Fundeni, Secia de Hematologie, Bucureti, Romnia
(4) Institutul Clinic Fundeni, Secia de Oncologie, Bucureti, Romnia
Introducere: Gemcitabina este un antineoplazic indicat ca tratament adjuvant de prim linie n
cancerul pancreatic rezecabil. Purpura trombotica trombocitopenica (PTT) apare ca o complicaie rar
ntlnit n literatur ca urmare a tratamentului chimioterapic cu gemcitabin cu o inciden ce variaz
ntre 0.015% i 1.4%.
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Materiale i metode: Prezentm cazul unui pacient n vrst de 39 de ani cunoscut cu
duodenopancreatectomie cefalic pentru ampulom vaterian i chimiotratat timp de 6 luni cu
gemcitabin.
Pacientul dezvolt hipertensiune arterial (HTA) sever i disfuncie renal post cur de chimioterapie
i este admis de urgen pe secia de Terapie Intensiv (TI) pentru acidoz marcat cu acidemie,
hiperlactatemie, insuficien respiratorie hipoxemic, trombocitopenie, HTA, disfuncie renal. Se
nregistreaz parametrii clinici i paraclinici i evoluia post tratament.
Rezultate: La admisia n TI pacientul se prezint comatos: GSC 3 puncte, hipertensiv (TA=225/118
mmhg), cu insuficien respiratorie hipoxemic, disfuncie renal (cre=2.68 mg/dl,uree=116)
trombocitopenie, anemie, ph=6.9, BE=-20, Lac=10mmol/l. Pacientul este reechilibrat hemodinamic i
este detubat la 4 ore postadmisie. Se solicit consulturi interdisciplinare (gastroenterologie, nefrologie,
hematologie) i se stabilete diagnosticul de PTT post tratament chimioterapic cu gemcitabin. Se
iniiaz dializ renal i tratament specific cu corticosteroizi i plasmaexchange pentru PTT. Dup 7
edine de plasmaferez se nregistreaz o cretere marcant a numrului de trombocite. Se menine
disfuncia renal pentru care necesit dializ renal. Se decide transferul pacientului pe secia de
Hematologie i revine n TI pentru efectuarea plasmaferezei.
Concluzii: PTT-ul asociat gemcitabinei este o complicaie cu o rat mare de mortaliate i morbiditate,
dar care poate fi recunoscut rapid cu ajutorul datelor clinice i de laborator. Abordarea
multidisciplinar este esenial pentru managentul terapeutic.
Introduction: Gemcitabine is an antineoplastic agent indicated as first-line adjunctive therapy in
resectable pancreatic cancer. Thrombotic thrombocytopenic purpura (TTP) it's a rare complication of
chemotherapy with gemcitabine with an incidence ranging between 0.015% and 1.4%.
Materials and Methods: We present the case of 39-year-old patient known with cephalic
duodenopancreatectomy for carcinoma of ampulla of vater. The patient undergoes 6 months of
chemotherapy with gemcitabine and develops severe hypertension and renal dysfunction. The patient
is admitted to the Intensive Care Unit (ICU) for marked acidosis, hyperlactatemia, acute hypoxemic
respiratory failure (AHRF), hypertension, thrombocytopenia and acute renal failure. We registered the
clinical and laboratory parameters an the post treatment evolution.
Results: At admission in ICU patient presented comatose: GSC 3 points, TA = 225/118 mmHg, AHRF
(SpO2 = 64% ), renal dysfunction (cre=2.68 mg/dl,BUN=116 mg/dl), thrombocytopenia (PLT =) anemia,
pH = 6.9, BE = -20, Lac = 10mmol / l. The patient is haemodynamically balanced and extubated after 4
hours from admission. We asked for interdisciplinary check-ups (gastroenterology, nephrology,
hematology) and we diagnosed the patient with TTP post gemcitabine chemotherapy. We initiated
renal dialysis and specific treatment with corticosteroids and plasmaexchange for PTT. Platlet count
begun to rise after 7 sessions of plasmapheresis, but the renal dysfunction still required dialysis. We
decided to transfer the patient to the hematology department and to return in ICU for plasmapheresis.
Conclusions: TTP associated with gemcitabine is a complication associated with a high rate of morbidity
and mortality, but that can be recognized quickly using clinical and laboratory data. The
multidisciplinary approach is essential for therapeutic management.
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Prezentri orale Sesiuni Asisteni

Oral presentations Nurses sessions____________________________________________________
Eficiena protocolului standardizat de insulinoterapie n terapie intensiv dup chirurgia

cardiac adult la pacienii cu versus fr diabet zaharat
The effectiveness of a standardized protocol of insulin therapy in the intensive care unit after
adult cardiac surgery in patients with versus without diabetes
Lilia Casm (1), Elena Fatnic (1), A. Beli (2), Svetlana Plmdeal (2), V. Savan (1)
(1) Spitalul Internaional Medpark, Anestezie i Terapie Intensiv, Chiinu, Republica Moldova
(2) Institutul de Medicin Urgent, Catedra Anesteziologie i Reanimatologie nr.1 Valeriu Ghereg,
Chiinu, Republica Moldova
Introducere: Hiperglicemia i rezistena la insulin sunt frecvente la pacienii chirurgicali i n stare
critic. Administrarea intravenoas continu a insulinei rapide, conform unui protocol standardizat,
ar avea o eficien diferit la beneficiarii de intervenie pe cord, suferinzi de diabet zaharat (DZ) vs. cei
fr diabet zaharat (non DZ) preoperator.
Scopul studiului: Evaluarea complianei protocolului standardizat de insulinoterapie utilizat i
determinarea eficienei lui la pacienii cu i fr DZ.
Materiale i metode: Au fost analizate datele pacienilor beneficiari de chirurgie cardiac, admii n UTI
n perioada 1 august 2015 - 31 octombrie 2015. Corecia glicemiei s-a efectuat de ctre asistenta
medical, conform protocolului standardizat, medicul indicnd frecvena controlului glicemic. Datele
prezentate drept medie (95%CI) i [extreme]. Statistic: testul t-Student.
Rezultate: Au fost nrolai 46 de pacieni: 12 (26%) - cu DZ i 34 (74%) - fr DZ. Pacienii cu DZ au avut
o glicemie semnificativ mai mare la 6 ore (9,6 (7,9 - 11,3) [5,2 - 14,0] vs. 8,5 (7,9 - 9,0) [5,3 - 11,9]
mMol/L, p=0,003) i la 12 ore postoperatoriu (8,9 (7,8 - 9,9) [6,4 - 11,3] vs. 7,6 (7,1 - 8,1) [4,9 - 11,5]
mMol/L, p=0,001), i un consum sporit de insulin n primele 24 de ore postoperatoriu: (42,2 (35,5 48,9) [22,8 - 57,4] vs. 31,8 (28,5 -38,1) [12,2 - 53,5] UI, p=0,003). Aderena la protocol a fost >80% n
primele 24 de ore, iar eficiena acestuia a fost mai important (17% vs.45%) la pacienii fr DZ.
Concluzie: Protocolul standardizat de insulinoterapie postoperatoriu dup chirurgia cardiac s-a
dovedit a fi mai eficient la pacienii nediabetici.
Introduction: Hyperglycemia and insulin resistance are common in surgical patients and in critical
condition. The use of continuous intravenous insulin according to a standardized protocol would have
a different effectiveness to patients after cardiac surgery suffering preoperatively diabetes mellitus
(DM) versus those without DM.
The purpose of the study: To assess the adesion of standardized protocol used and to determine the
effectiveness of insulin in patients with and without diabetes.
Materials and Methods: In this study was analyzed data of all patients after cardiac surgery admitted
in ICU between 1 August 2015 and 31 October 2015. The correction of glycemia was performed by the
nurse, according to a standardized protocol. The frequency of glycemic control was prescribed by a
doctor. Data are presented as mean (95% CI) and [extreme]. Statistics: Student's t-test.
Results: 46 patients were enrolled : 12 (26%) - with DM and 34 (74%) - without DM. Patients with DM
had significantly higher blood sugar at 6 postoperative hours (9.6 (7.9 to 11.3) [5.2 to 14.0] vs. 8.5 (7.9
to 9.0) [ 5.3 to 11.9] mMol / L, p=0.003) and at 12 hours (8.9 (7.8 to 9.9) [6.4 to 11.3] vs 7.6 (7 1 - 8.1)
[4.9 to 11.5] mmol / L, p=0.001), also a higher consumption of insulin in the first postoperative 24 hours
(42.2 (35.5 to 48.9 ) [22.8 to 57.4] vs 31.8 (28.5 to 38.1) [12.2 to 53.5] UI, p=0.003). Adherence to
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protocol was > 80% in the first 24 hours, and its effectiveness was more important (17% vs.45%) in
patients without DM.
Conclusion: Insulin therapy according to a standardized protocol after cardiac surgery has been shown
to be more effective in non-diabetic patients.
Aderena i eficiena unui protocol standardizat de insulinoterapie n unitatea de terapie

intensiv dup intervenie cardiac la aduli
Adhesion and efficiency of a standardized protocol of insulin therapy in intensive care unit
after adult cardiac surgery
Ecaterina Bodareva (1), Elena Fatnic (1), Victoria Lazari (1), Svetlana Plmdeal (2), A. Beli (2), V.
Savan (1)
(1) Spitalul Internaional Medpark, Secia de Anestezie i Terapie Intensiv, Chiinu, Republica
Moldova
(2) Institutul de Medicin Urgent, Catedra Anesteziologie i Reanimatologie nr.1 Valeriu Ghereg,
Introducere: Gestionarea atent a hiperglicemiei n unitatea de terapie intensiv (UTI) poate reduce
durata spitalizrii, morbiditatea i mortalitatea. Variabilitatea glicemiei poate fi controlat mai eficient,
dac se utilizeaz un protocol standardizat de perfuzare intravenoas continu de insulin rapid.
Presupunem c eficiena controlului glicemiei este mai bun, dac aderena fa de protocol este
nalt. Scopul a fost evaluarea eficienei protocolului dat n funcie de corectitudinea aplicrii lui.
Materiale i metode: Au fost nrolai 46 de pacieni operai pe cord, internai postoperatoriu n UTI a
Spitalului Internaional Medpark n perioada 01.08.2015 - 31.10.2015. Controlul glicemiei i aplicarea
protocolului standardizat de insulinoterapie au fost efectuate de ctre asistenta medical.
Obiectivul terapeutic a fost o glicemie inferioar de 7 mMol/L, evitnd episoadele de hipoglicemie.
Rezultate: Corectitudinea aplicrii protocolului la ora 0, 3, 6, 12, 24 i 36 postoperatoriu a fost,
respectiv, de 97%, 81%, 86%, 89%, 82% i 69%. Complementar, pentru orele 3, 6, 12, 24 i 36
postoperatoriu, protocolul a fost eficient n 30%, 21%, 34%, 36% i 44% din cazuri. Protocolul a fost
respectat totalmente la toate orele de verificare n 48% din cazuri. Nu au fost constatate diferene n
eficiena controlului glicemic la aplicarea corect vs. incorect a protocolului.
Concluzii: Cu toate c rata utilizrii corecte a protocolului a fost relativ nalt, variabilitatea
corectitudinii pe parcursul zilei, precum i eficiena lui redus n meninerea glicemiei-int, impune
modificarea parametrilor de prescripie la specificul pacientului operat pe cord.
Introduction: Careful management of hyperglycemia in the intensive care unit (ICU) may reduce length
of hospital stay, morbidity and mortality. Variability in glucose levels can be controlled more effectively
by using a standardized protocol with continuous infusion of intravenous insulin. We suppose that the
glycemic control is better, if adhesion to the protocol is high. The aim was to assess the effectiveness
of the protocol given by the correctness of its application.
Materials and Methods: Enrolled 46 patients after adult cardiac surgery hospitalized in the ICU of
Medpark International Hospital between 01.08.2015 and 31.10.2015. Glycemic control and application
of standardized protocol with insulin were performed by the nurse. Therapeutic target blood sugar was
lower than 7 mMol /L, avoiding episodes of hypoglycemia.
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Results: Adhesion to the protocol at 0, 3, 6, 12, 24 and 36 after surgery were, respectively, 97%, 81%,
86%, 89%, 82% and 69%. Also, for the post operative hours: 3, 6, 12, 24 and 36, protocol was effective
in respectively 30%, 21%, 34%, 36% and 44% of cases. The protocol was fully respected at all times of
the verification in 48% of cases. There were no differences in efficiency of glycemic control in correct
versus incorrect application of protocol.
Conclusions: Although the rate of correct use of the protocol was relatively high, variability of accurancy
throughout the day and reduced his effectiveness in maintaining blood glucose target requires
changing in the parameters of prescription to the specific patient after cardiac surgery.
Importana kinetoterapiei precoce la pacientul cu arsuri cutanate

The importance of early physical therapy for patients with skin burn injuries
R. I. Achimescu (1), Simona Florentina Fotache (1), Andreea Mihaela Stroi (1), Alexandrina Andreescu
(1), Anca Crjeu (2), D. Corneci (1)
(2) Spitalul Universitar de Urgen Elias, Secia de Anestezie i Terapie Intensiv I, Bucureti, Romnia
Obiective: Recuperarea pacientului ars prin kinetoterapie precoce care urmrete diminuarea
efectelor adverse - contracturi, cicatrici, meninerea mobilitii, a independenei funcionale i a unui
psihic bun.
Material i metod: n aceast lucrare v prezentm experiena noastr cu 12 pacieni cu arsuri
complexe (grad II/III, 15% - 60% suprafa corporal, din care opt cu arsuri de ci aeriene superioare i
inferioare) ngrijii pe o perioad de dou luni n Secia de Terapie Intensiv a Spitalului Universitar de
Urgen Elias. Succesul kinetoterapiei la supravieuitorul cu arsuri presupune participarea unei echipe
multidisciplinare nc din prima zi. Recuperarea precoce s-a bazat pe managementul postural,
mobilizri pasive/active, posturri anti-contracturi i mpotriva deformitilor, fixarea de atele,
ngrijirea cicatricilor, ntinderi i mobilizare precoce. Pacienii au fost evaluai la admisie, externare, o
lun i trei luni de la ieirea din spital.
Rezultate: La momentul externrii din secia de Terapie Intensiv nici unul dintre acetia nu prezentau
complicaiile asociate imobilizrii prelungite i leziunilor de arsur, ci mbuntirea statusului
funcional, a mobilitii, coordonrii, for muscular i cicatrici cheloide, dar cu pstrarea amplitudinii
articulare.
Concluzii: Aceast experien, chiar dac limitat pe un numr mic de pacieni cu arsuri ns cu
rezultate bune privind contracturile, mbuntirea mobilitii articulare, a forei musculare i
aspectului cosmetic, susine importana kinetoterapiei precoce la pacientul ars. Recuperarea acestor
pacieni este anevoioas i de durat, implicnd o echip multidisciplinar i participarea activ a
pacientului.
Aims: The rehabilitation of the burn patient during the acute phase is to minimise the adverse effects
i.e. contracture and scarring, mobility, functional ability and psychological health.
Material and Methods: This paper presents our experience with 12 patients with complex burns (grade
II and III, 15% - 60% of body surface, eight burns of the upper and lower airways) admitted to our
Intensive Care Units, Elias Emergency University Hospital over a two month period. The successful
rehabilitation of the burn survivor requires a multi-disciplinary team from the 1st day. The early therapy
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was focused on postural management, active/passive range of motion, anti-contracture and
antideformity positioning, splinting, early mobilization, stretching and management of the scars.
Patients were evaluated at admission, discharge, one and three months from discharge.
Results: At the time of discharge none of our patients presents any of the complications associated with
prolonged immobilization and burns. We had improvement in range of motion, functionality,
coordination, muscle force, decrease of keloids scars.
Conclusions: Although a small number of patients, our experience reconfirms the importance of physical
therapy and splinting after a burn injury. We achieved good results in preventing contracture,
improving range of motion, muscle force and good cosmetic results. Rehabilitation is a lengthy process
which involves a continuum of care, multidisciplinary team and the full participation of the patient.
Scorul OMEGA-RO, calcul informatizat n A.T.I. Institutul Regional de Oncologie, Iai

OMEGA-RO score calculation computerized I.C.U. Regional Institute of Oncology, Iai
Elena Iacob, Luminia Popeanu, Ioana Grigora
Institutul Regional de Oncologie, Clinica de Anestezie i Terapie Intensiv, Iai, Romnia
Introducere: Aprecierea cantitii i complexitii activitii seciilor de anestezie i terapie intensiv se
face pe baza scorului OMEGA-RO prevzut n ORDINUL nr. 1500 din 24 noiembrie 2009 privind
aprobarea Regulamentului de organizare i funcionare a seciilor i compartimentelor de anestestezie
i terapie intensiv din unitile sanitare.
Obiective: Informatizarea calcului scorului Omega.
Material i metod: Pentru calculul acestui scor s-a conceput un modul n cadrul programului medical
informatic folosit n unitatea noastr care are la baz realizarea unei codificri ntre actele i manevrele
medicale ce compun scorul OMEGA i CODURILE AUSTRALIENE de raportare a procedurilor medicale.
Scorul OMEGA-RO se bazeaz pe nregistrarea a 48 de acte terapeutice notate de la 1 la 10 puncte
Omega i repartizate n 3 categorii. Scorul se calculeaz la sfritul spitalizrii i este egal cu suma
punctelor din fiecare categorie.
Rezultate: Din 1 ianuarie 2016 calculul scorului OMEGA-RO se face automat, astfel nct la externarea
pacientului i nchiderea dosarului electronic al acestuia, programul calculeaz i afieaz n raportul
anual valoarea scorului pentru acel pacient. Graie acestui modul a fost posibil rularea retroactiv a
datelor din anul 2015, calcularea scorului pentru acest an i raportarea la timp a datelor ctre
Ministerul Sntii.
Concluzii: Buna colaborare cu echipa sistemului informatic integral i munca n echip a permis
rezolvarea cu uurin a unei sarcini ce ar fi nsemnat o munc titanic de culegere manual a datelor
din dosarele pacienilor n forma tiprit. Acest tandem ntre personalul medical i specialitii IT
constituie cheia succesului pentru realizarea planului naional de informatizare a sistemului medical n
Romnia.
Introduction: Finding quantity and complexity of the business sections of anaesthetics score is based
on OMEGA-RO provided in the Order nr. 1500 of 24 November 2009 on approval of the organization
and operation of sections and departments and intensive care units.
Objectives: Computerization Omega score calculation.
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Material and Methods: In order to calculate this score a module was designed within the medical
informatics program used in our unit which is based on achieving medical coding between acts and
manoeuvres that compose the score OMEGA CODE Australian reporting medical procedures. OMEGARO score is based on the recording of medium 48 therapeutic acts marked from 1 to 10 points and
divided into three Omega categories. The score is calculated at the end of hospitalization and is equal
to the sum of points in each category.
Results: From January 1, 2016 OMEGA-RO score calculation is done automatically, so when a patient is
discharged from the hospital and its electronic file is closed, the program calculates and displays the
final score in the annual report for that patient. With this module it was possible to run the retrospective
data from 2015, calculate the score for this year and timely report the data to the Ministry of Health.
Conclusions: Good collaboration with the IT team and the teamwork allowed to easily solve a task that
would have been a titanic work of manual data collection from patient records in printed form. This
tandem between medical staff and IT specialists is the key to success for achieving national plan for
computerization of medical system in Romania.
Anestezia fetal - experien inedit pentru asistentul de anestezie terapie intensiv

Fetal anaesthesia - a special experience for the ICU nurse
Ctlina Srbu, Ctlina Fierbntu, Ani Rahimian
Spitalul Regina Maria, Secia de Anestezie i Terapie Intensiv, Bucureti, Romnia
Prezentm implicarea echipei de anestezie ntr-o intervenie chirurgical special, respectiv chirurgie
fetal la o pacient n sptmna 26 de sarcin, al crei ft prezenta mielomeningocel rupt.
Mioelomeningocelul este una dintre cele mai severe forme de spina bifida i este caracterizat prin
defecte de nchidere la nivelul pielii, vertebrelor i meningelui care las expus mduva ctre lichidul
amniotic. Copiii care se nasc cu acest defect vor avea disabiliti severe precum paralizia memebrelor
inferioare, lipsa controlului asupra reflexelor de miciune i defecaie. Intervenia chirugical de
nchidere precoce, nc din via intrauterin, a acestui defect, crete ansele copilului de a avea
tulburri neurologice ct mai mici.
Anestezia pentru aceast intervenie este deosebit de special, avem 2 pacieni care au necesiti
diferite de anestezie, intranestezic se au n vedere multiple obiective dintre care menionm:
meninerea homeostaziei materne n condiii de tocoliz intraoperatorie i postoperatorie agresiv,
meninerea homeostaziei fetale, prevenia infeciei intraamniotice, a sngerrii masive i a tulburrilor
de coagulare, prevenia naterii premature.
We are presenting anaesthesia team involvement in a very special surgical procedure, respectively open
fetal surgery in a patient 26 weeks pregnant, whose fetus had ruptured myelomeningocele.
Myelomeningocele is the most severe form of spina bifidus and is characterized by closing defects on
skin, vertebrae and meninges that leaves the spine open to the amniotic fluid. Babies born with this
defect will have disabilities such as lower limbs paralysis, lack of control over reflexes of micturition and
defecation. Surgical procedure for early closer of defect, since intrauterine life, will increase the chances
for a better neurological outcome.
Anaesthesia for this procedure is very special, we have two patients with different anaesthetic needs,
and multiple anaesthetic objectives, such as: maintaining maternal homeostasis in a state of aggressive
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intra- and postoperative tocolysis, maintaining fetus homeostasis, prevention of infection, of heavy
bleeding and coagulopathy, prevention of premature labor.
Managementul nou nscutului cu atrezie de esofag

The management of newborns with esophageal atresia
Florentina-Daniela Turcu, Ielena Peter
Spitalul Clinic de Urgen pentru Copii Louis urcanu, Secia de Anestezie i Terapie Intensiv,
Timioara, Romnia
Numrul crescut al nou nscuilor cu atrezie de esofag din ultimii doi ani cu adresabilitate ctre clinica
noastr a determinat o atenie sporit ctre mbuntirea tratamentului.
Obiectiv: Un management corect (chirurgical, terapeutic i de nursing) influeneaz pozitiv rata de
supravieuire a nou nscutului cu atrezie de esofag.
Material i metod: Studiul s-a efectuat pe dou loturi: A - 15 pts (internai n perioada 2002 - 2012) i
B - 12 pts (2013 - februarie 2016) cu atrezie de esofag. Atrezia de tip III B a fost preponderent n cele
dou loturi. S-au analizat comorbiditile, tehnica chirurgical, numrul de zile de ventilaie mecanic,
staionarea n terapia intensiv i particularitile antibioterapiei.
Rezultate: Complicaiile aprute n ambele loturi au fost de natur chirurgical: dezunirea
anastomozei, infecii de plag, fistul bronic, complicaii asociate ventilaiei mecanice, precum i
incidente legate de ngrijirea pacientului (suprimarea accidental a gastrostomei). De asemenea,
antibioterapia administrat pacienilor din lotul B a fost mai bine corelat cu rezultatele bacteriologice.
Totodat rata de staionare n terapia intensiv a fost mai lung la pacienii din lotul B. Aadar, o
diferena semnificativ s-a observat ntre rata de supravieuire dintre loturi (55% lot A, versus 91.6%
lot B).
Concluzii: mbuntirea tehnicii chirurgicale (prin efectuarea anastomozei termino-terminale per
primum), a antibioterapiei i a nursingului, mpreun cu evoluia aparaturii de terapie intensiv, a
determinat creterea ratei de supravieuire.
The increased number of newborns with esophageal atresia that were addressed in our clinic in the last
two years demanded a greater focus on improving the treatment.
Hypothesis: Employing correct surgical, therapeutic and nursing approaches will influence positively
the survival rate of newborns with esophageal atresia.
Materials and Methods: The study was performed on two lots of patients: Lot A - 15 pts (hospitalized
in the period 2002 - 2012), and lot B - 12 pts (2013 - February 2016), all diagnosed with esophageal
atresia. Type III B atresia was predominant in both lots. Several aspects were analysed such as
comorbidities, surgical technique, the number of days on mechanical ventilation, the stationing in
intensive care and the particularities of the antibiotic therapy.
Results: The complications that occurred in both lots were of surgical nature, such as: leakage of the
anastomosis, wound infections, bronchial fistula, complications associated with mechanical ventilation
and patient care incidents (accidental removal of gastrostomy). The antibiotic therapy administered to
lot B was better correlated with the bacteriological results, and the time spent in the intensive care unit
was prolonged. The outcome showed a significant difference in survival rates between the lots (55% on
lot A, versus 91.6% on lot B).
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Conclusion: Improving the surgical technique (by performing termino-terminal anastomosis per
primum), the antibiotic therapy and the nursing, along with the evolution of intensive care equipment,
determined a substantial increase in survival rate.
Pacientul cu arsuri majore - impactul psihic asupra asistenilor medicali dintr-o secie de
Terapie Intensiv multidisciplinar
The patient with major burns - psychological impact on nurses in a multidisciplinary
Intensive Care Unit
Ioana-Antoanella Mazilu, Alexandrina Andreescu, Teodora Zamfirescu, D. Corneci
Spitalul Universitar de Urgen Elias, Clinica de Anestezie i Terapie Intensiv, Bucureti, Romnia
Pacientul cu arsuri majore reprezint o provocare din punct de vedere al complexitii
managementului acestuia. Tratamentul acestei mari urgene chirurgicale este continuu i susinut pe
toat perioada de evoluie a arsurii. n urma evenimentului tragic de la Clubul Colectiv, n Secia Terapie
Intensiv a Spitalului Universitar de Urgen Elias, Bucureti au fost admii 12 pacieni cu arsuri
majore, rata mortalitaii fiind de 0%.
Scopul studiului: Evaluarea impactului psihic asupra asistenilor medicali dintr-o secie de terapie
intensiv multidisciplinar prin prisma nursing-ului pacientului cu arsuri majore.
Metodologie: Studiul este observaional, retrospectiv, de cohort, avnd ca instrument de cercetare
chestionarul aplicat grupului int reprezentat de asistenii medicali din Secia Terapie Intensiv a
Spitalului Universitar de Urgen Elias, Bucureti, acetia fiind mprii n dou grupuri n funcie de
vechime - grupul A >5 ani i grupul B<5 ani.
Rezultate: Din grupul A, 91% au considerat c au fost afectai n acea perioad, doar 55% din grupul B
(p=0,43), din grupul A, 92% au considerat experiena ca fiind benefic n dezvoltarea profesional, doar
36% din grupul B (p=0,16). Nici un asistent medical din grupul A nu ar dori s lucreze ntr-o terapie cu
specificul-Arsuri Majore, pe cnd 18% din grupul B ar dori s profeseze n aceast ramur (p=0,16).
Concluzie: Complexitatea nursing-ului pacientului cu arsuri majore a avut un impact emoional, psihic
i fizic deosebit asupra asistenilor medicali.
The patient with severe burns represents a major challenge in terms of the complexity of its
management. The treatment of this great surgical emergency is continuous and sustained throughout
the evolution of the burn. Following the tragic incident in the Colectiv Club, were admitted to the
Intensive Care Unit (ICU) of Elias Emergency University Hospital 12 patients presenting major burns.
The mortality rate was 0%. Objective: Assessment of psychological impact on nurses in a
multidisciplinary ICU, through observing the nursing of the patient with major burns. Materials and
Methods: Observational, retrospective, cohort study with the questionnaire as a research tool, applied
to the target group, represented by the nurses of Intensive Care Unit of Elias Emergency University
Hospital, who were divided into 2 groups based on seniority - group A >5 years and group B <5 years.
Results: In group A, 91% felt that they were emotionally affected during that time, while in group B,
only 55% felt this way (p=0.43). In group A, 92% considered as beneficial in the professional
development, and only 36% from group B (p=0.19). No nurse in group A would like to work in an ICU
with major burn specifics, while in group B, 18% would like to practice in this branch (p=0.16).
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Conclusions: The complexity of the nursing of the patient with severe burns had a great emotional,
psychological and physical impact on the nurses.
Infeciile nosocomiale - ignoran, fric sau prejudecat?!

Nosocomial infections - ignorance, fear or prejudice?!
Daniela Adriana Boanc, Ioana Grigora
Introducere: n pofida progreselor teoretice i practice din medicina contemporan, infeciile
nosocomiale continu s reprezinte o problem stringent medical i economic. Tabloul clinic grav,
cu potenial epidemiologic indutabil, duce la prelungirea perioadei de spitalizare, creterea
semnificativ a costurilor de ngrijire, decalarea relurii activitii profesionale i reintegrarea n viaa
social cotidian.
Obiective: Studiul a fost retrospectiv asupra cazurilor de infecii nosocomiale identificate, raportate i
analizate n cadrul IRO Iai n anul 2015.
Materiale i metod: Datele au fost obinute n urma analizei pe un numr de 12765 pacieni cu
internare continu n IRO Iai pe seciile Hematologie, Chirurgie I i II, Oncologie Medical, Radioterapie
i ngrijiri Paleative, iar 4282 au tranzitat n secia ATI. Studiul a fost retroactiv i cuprinde toi pacienii
internai n perioada ianuarie - decembrie 2015. n cursul anului 2015 au fost declarai i identificai
prin studiul foilor de observaie un numr de 74 de infecii nosocomiale, pe baza definiiei de caz
standard, conform ORDINULUI NR. 916 din iulie 2006 i a datelor menionate n dosarul pacientului:
27 cazuri n cadrul seciei Chirurgie I, 19 cazuri n cadrul seciei Chirurgie II, 11 cazuri n cadrul seciei
Hematologie, 7 cazuri n cadrul seciei ATI, 3 cazuri n cadrul seciei de Chirurgie Plastic, 3 cazuri n
cadrul seciei de Radioterapie, 2 cazuri n cadrul seciei de Chirurgie Toracic, 1 caz n cadrul seciei de
ngrijiri Paliative, 1 caz n cadrul seciei de Oncologie Medical.
Rezultate: Din analiza s-au constatat urmtoarele: vrsta, boala de baz, rezultatele bacteriologice,
curba febril, simptomatologie, consum de antimicrobiene, durata de spitalizare, complexitatea
planului terapeutic, respectarea/nerespectarea protocoalelor de Precauiuni Universale, acetia fiind
factori majori n apariia infeciilor nosocomiale.
Concluzii: Infeciile nosocomiale sunt factori care agraveaz starea clinica a pacientului, mai ales la
pacientul oncologic, crescnd costurile de ngrijire, durata de spitalizare i tratament. Infeciile
nosocomiale au o frecven mult peste cea raportat oficial. Este imperios necesar contientizarea
imporantei identificrii, raportrii i individualizrii msurilor ce se impun pentru diminuarea acestui
fenomen, innd cont de impactul major asupra societii.
Introduction: In spite of the progress in the theoretical and practical training in medicine, contemporary
nosocomial infections continue to represent a medical and economical problem. The serious clinical
picture, with indutabil epidemiological potential, leads to the extension of the period of hospitalization,
a significant increase in the cost of care, significant delay in the resuming of the professional activity
and reintegration in the social life.
Objectives: The study was a retrospective review of the cases of nosocomial infections identified,
reported and analyzed in IRO Iai in 2015.
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Materials and Methods: Data have been obtained from the analysis on a number of 12765 patients
with continuous admittance in Iasi IRO in the departments of Hematology Surgery I and II, Oncology,
Medical radiotherapy and Paleative Cares and 4.282 in transit at the Area Intensive Care. The study
was retroactive and includes all admitted patients in the period January to December 2015. In the
course of the year 2015 there have been declared and identified by studying the observation sheets a
number of 74 nosocomial infections on the basis of the definition of the event, the standard in
accordance with Order No 916 of July 2006 and of the data referred to in patient file: 27 Cases in the
department of Surgery I, 19 Cases in the department of Surgery II, 11 Cases in the department of
Hematology, 7 Cases in thedepartment of Area Intensive Care, 3 Cases in the department of Plastic
Surgery, 3 Cases in the department of Radiotherapy, 2 Cases in the department of Thoracic Surgery, 1
Cases in the department of Palliative Care, 1 Cases in the department of Medical Oncology.
The results: Through the analysis the following facts were established: age, disease, bacteriological
results, fever curve, symptomatology, consumption of antimicrobials, duration of hospitalization, the
complexity of the therapeutic plan, compliance/failure to comply with the protocols on Universal
Precautions, these being a major factor in the occurrence of nosocomial infections.
Conclusions: Nosocomial infections are factors that aggravate the patient's clinical condition, especially
the patient in oncology, increasing the costs of the care, the duration of the hospitalization and
treatment. Nosocomial infections have a frequency over the reported journal. It is imperative to create
awareness regarding the importance of identification, reporting and individual action to be taken in
order to diminish this phenomenon, taking into account the major impact on society.
Formarea profesional - ntre obligaie i necesitate

Professional training - between constraint and necessity
Loredana uuianu, Luminia Popeanu, Ioana Grigora
Formarea profesional reprezint totalitatea activitilor de pregtire teoretic i practic desfurate
n vederea dobndirii i mbuntirii nivelului de cunotinte, abiliti i aptitudini profesionale.
Formarea profesional continu, obligatorie, este stipulat n Ordonana de Urgen nr. 144 din 28
octombrie 2008 (actualizat).
Obiective: Analiza activitilor de Educaie Medical Continu la care au participat asistenii medicali
din Secia ATI a IRO Iai, precum i analiza impactului asupra asistenilor participani.
Material i metod: Au fost evaluate cantitativ participrile asistenilor medicali din Secia ATI a
Institutului Regional de Oncologie Iai la cursurile de formare profesional desfurate n anul 2015,
iar analiza impactului s-a fcut cu ajutorul unui chestionar n care li s-a cerut participanilor s-i
prezinte opinia cu privire la utilitatea teoretic i practic a noiunilor dobndite.
Rezultate: Cei 61 de asisteni medicali ai seciei noastre au participat la un numr de apte cursuri
organizate de Institutul Regional de Oncologie Iai i un curs organizat de Academia de tiine
Medicale.
Opinia asistenilor medicali privind impactul teoretic al acestor cursuri arat c majoritatea consider
valoroas achiziia teoretic, iar opiniile privind aplicabilitatea practic sunt variabile n funcie de tema
cursului.
Concluzii: Formarea profesional, dincolo de aspectul obligatoriu, stipulat de lege, reprezint o
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component absolut necesar n pregtirea asistenilor medicali, rspunznd nevoii de rennoire
permanent a cunotiinelor medicale ce duce la creterea performanelor profesionale i a gradului
de satisfacie la locul de munc.
Introduction: Continuous medical education (CME) refers to all theoretical and practical activities
undertaken to improve the acquisition and level of knowledge and professional skills. Continuous
medical education is mandatory and it is stipulated in the law no. 144/28 October 2008.
Objectives: The analysis of Continuous Medical Education activities involving nurses in Anaesthesia and
Intensive Care Unit, Regional Institute of Oncology, Iasi and its impact on their professional skills.
Materials and Methods: We assessed training courses attended by ATI nurses during 2015 and we
analyzed their impact using a questionnaire regarding the usefulness of acquired theoretical and
practical knowledge.
Results: A number of 61 nurses attended 7 courses organized by the Regional Institute of Oncology, Iai
and one course organized by the Academy of Medical Sciences.
Nurses opinion on the impact of these courses shows that the majority considers important the
acquisition of theoretical knowledge, while the opinions on practical applicability vary depending on
course subject.
Conclusions: Continuous medical education, beyond its compulsory, law stipulated feature, is an
indisputable necessity, covering the need for permanent renewal of medical knowledge, leading to
increased professional performance and work satisfaction.
Empatia - noua competen profesional. Empatia - o privire spre suflet

Empathy - the new professional competence. Empathy - a window to the soul
Tereza Ghiurca, Luminia Popeanu, Ioana Grigora
Introducere: Conform indicaiilor Organizaiei Mondiale a Sntii, ngrijirea bolnavilor oncologici
trebuie s fie complex i interdisciplinar i s implice asisten medical, asisten psihologic i, nu
n ultimul rnd, asisten spiritual. Aceast ngrijire interdisciplinar are drept scop evaluarea i
tratarea impecabil a durerii i a altor probleme fizice, psiho-sociale i spirituale (OMS, 2002). n cazul
bolnavului oncologic, nu va fi tratat doar boala ca atare, ci pacientul su, mai bine spus, persoana
uman n toat complexitatea ei.
Obiective: Aprecierea capacitii empatice a personalului medical din Clinica ATI IRO IAI.
Material i metod: S-a distribuit un chestionar avnd 10 ntrebri cu cte 3 variante de rspuns, la un
numr de 90 de cadre medicale din secia ATI. 66 persoane au rspuns ntrebrilor.
Rezultate: Toi respondentii par s tie ce nseamn empatia, dar 3% dintre acetia consider c nu
este prea important n relaia cu pacienii i ali 3% declar c le este greu s-i exprime empatia, dei
recunosc importana ei. Toi respondenii cred n efectele benefice ale empatiei fa de pacieni, dei
42,4% s-au declarat a fi rareori influenai de starea de spirit a celorlali. 6% dintre ei nu sunt siguri
dac empatia ine de religie sau nu.
Concluzie: Rezultatul chestionarului a pus n eviden necesitatea nsuirii i dezvoltrii empatiei ca o
component profesional, n faa dorinei pacientului de a avea alturi persoane fa de care s-i
exprime temerile i preocuprile. Empatia nu este o tehnic ce trebuie utilizat fa de pacient, ci un
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proces, un mod de a fi n relaie cu ceilali aflai n nevoie. Empatia se poate exprima n multe moduri,
n special prin limbajul non-verbal. Prin urmare, orice aciune poate fi fcut cu empatie, dragostea
pentru ceilali, se poate transmite prin orice micare, prin orice sclipire, privire i prin cea mai fin
mimic a feei.
Introduction: According to World Health Organization guidelines, the experience of caring for an
oncologic patient is an awareness of the fact that such care is an interdisciplinary approach involving
medical, psychological and, not least, spiritual assistance. This interdisciplinary care aimed at
"impeccable assessment and treatment of pain and other physical problems, psychosocial and
spiritual" (WHO, 2002). In oncologic patients, not just the disease should be treated, but the patient or,
better said, the human person in all its complexity.
Objectives: Findings regarding the empathic capacity of medical staff from ATI IRO Iai.
Material and Methods: We distributed a questionnaire with 10 questions, each one with 3 possible
answers, to a number of 90 healthcare professionals from ICU ward. From 66 persons we received
feedback.
Results: All responders seem to know what empathy means, but 3% of them consider it not very
important in relationship with the patients and other 3% of them find it difficult to express empathy,
although they recognize its importance. All responders believe in the beneficial effects of expressing
empathy to the patients, although 42.4% declared themselves to be seldom influenced by the mood of
the others, 6% of them are not sure if empathy is something religiously related or not.
Conclusion: The results of the questionnaire revealed the necessity of acquiring empathy as professional
competence in response to the patients desire to have in front of them persons to whom to express
their fears and concerns. Empathy is not a technique to be used, but a process, a way of being in
relationship with others in need, which may be expressed in many ways, particularly through nonverbal language. Therefore, any action can be done with empathy and the love for the others can be
expressed by words, by body language or by the finest pantomime face.
Reacii adverse transfuzionale

Adverse events of blood transfusion
Maricica uc, Luminia Popeanu, Ioana Grigora
Institutl Regional de Oncologie, Secia de Anestezie i Terapie Intensiv, Iai, Romnia
Introducere: Utilizarea clinic a hemotransfuziilor ne convinge c aceast metod de tratament nu este
ntotdeauna inofensiv. Hemotransfuziile reprezint un transplant de esut lichid viu care necesit o
vigilen sporit pentru a preveni i depista la timp efectele adverse, ce in de transfuzia sngelui i
componentelor sanguine.
Obiectiv: Evaluarea reaciilor adverse transfuzionale la sngele i derivatele sanguine administrate n
Institutul Regional de Oncologie Iai n anul 2015.
Material i metod: Studiu retrospectiv desfurat n Institultul Regional de Oncologie Iai pe 12 luni
(1.01 - 31.12.2015) cu extragerea din baza de date a Unitii de Transfuzie Sanguin a Institutului
Regional de Oncologie Iai a numrului de uniti de snge transfuzate, a numrului de pacieni
transfuzai i a numrului de evenimente transfuzionale.
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Rezultate: S-au identificat un numr de 4252 de uniti de snge i 5671 derivate administrate la un
numr de 1082 pacieni, dintre care 758 politransfuzai. S-au nregistrat un numr de 30 de evenimente
posttransfuzionale minore i zero evenimente tansfuzionale majore.
Concluzii: Frecvena mare a pacienilor politransfuzai impune msuri de precauie luate
pretransfuzional n funcie de patologia pacientului i de istoricul transfuzional al acestuia.
Micrometoda de determinare a compatibilitii este considerat cea mai important component de
securitate pentru depistarea anticorpilor iregulari. n acest mod putem preveni imunizarea pacienilor
i reducerea reaciilor adverse hemolitice transfuzionale. Respectarea procedurilor de lucru este foarte
important pentru evitarea accidentelor transfuzionale i a reaciilor adverse severe.
Introduction: The clinical use of blood transfusion demonstrates that this treatment is not harmless.
Blood transfusion represents a transplant of liquid live tissue and mandates for an increased attention
in order to prevent and early detect its adverse effects.
Objective: To evaluate the blood and blood products adverse events recorded in the Regional Institute
of Oncology, Iai during 2015.
Material and Method: A retrospective study was performed in the Regional Institute of Oncology, Iai
during a 12 months period (1.01 - 31.12.2015) by extracting data from the Transfusion Unit database:
the number of transfused blood units, of patients receiving blood transfusions and the number of
transfusional events.
Results: We identified that a 4252 blood units and 5671 blood products units were given to 1082
patients, including 758 patients with repeat transfusions. We recorded 30 minor posttransfusional
events and no major transfusional event.
Conclusion: The high frequency of multiply transfused patients imposes cautions before the transfusion
according to patients pathology and to his transfusional history. The compatibility testing is the most
important component of transfusional security in order to assess irregular antibodies. In this manner
we can prevent patients immunization and we can reduce hemolytic adverse reactions. Following the
recommended procedures it is possible to avoid transfusional events and severe adverse reactions.
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e-Postere e-Posters________________________________________________________________
Efectele tardive ale contuziei de cord la un pacient supus osteosintezei transpediculare la 5

nivele pentru traumatism al coloanei vertebrale toracice
Delayed effects of cardiac concussion in a patient undergoing transpedicular stabilization of
5 thoracic levels spine trauma
Iana Cotorcea (1), Corina Guium (1), V. Guan (2), S. Ursul (2), A. Botizatu (3), Doriana Cojocaru (2), A.
Bodiu (4), V. Cojocaru (2)
(1) Spitalul Clinic Republican, Secia de Anestezie i Terapie Intensiv, Chiinu, Republica Moldova
(2) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Secia de Anestezie i Terapie
Intensiv, Chiinu, Republica Moldova
(3) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Secia de Anestezie i Terapie
Intensiv I, Chiinu, Republica Moldova
(4) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Secia de Neurochirurgie,
Contuzia (comoia) cardiac (miocardic) este o form de traumatism cardiac nchis care are puine
semne clinice specifice. n aceste cazuri durerea toracic este o manifestare clinic frecvent ntlnit,
ns originea ei este dificil de stabilit, dat fiind faptul c ea poate avea numeroase surse extra-cardiace.
De asemenea, contuzia cardiac nu are semne specifice care pot fi determinate prin metode de
laborator sau la investigaii paraclinice, iar la examenul anatomo-patologic deseori nu se gsete nimic
semnificativ. n acest context, un pacient cu contuzia grav a cutiei toracice, ndeosebi dup o perioad
de timp (1-2 luni) de la momentrul traumei, poate prezenta multiple surprize dramatice n timpul
unei anestezii, indiferent pentru care patologie este supus interveniei.
Caz clinic: Pacientul M, 72 de ani, dou luni dup traumatism asociat, catatraumatism: TVM nchis,
amielic, perioad subacut; fractur vertebral Th10-Th11 cu dislocare Th10 spre dreapt; fracturi ale
coastelor Th10, Th11, Th12; contuzia pulmonului drept. Pleurezie postraumatic pe dreapt, s-a
solicitat anestezie pentru fixare transpedicular a coloanei vertebrale pe 5 nivele. Monitoring
preoperator: Tas,Tad,Tam, FCC, coagulogram, analiz biologic a sngelui i urinei, ionogram, EKG,
Ecodopller, radiografie pulmonar, CT toracic. La inducie pacientul a prezentat hipotensiune sever
(60 i 30 mmHg), bradicardie, dereglri severe de ritm i conducere (exrasistole vetriculare n salve,
bigiminie). S-a suspectat contuzie cardiac. Intervenia chirurgical a fost sistat. Ulterior s-a efectuat
o pregtire preoperatorie intit. Peste 15 zile pacientul a fost supus osteosintetezei traspediculare
(durata interveniei 9 ore), evoluie favorabil.
Myocardial concussion is a form of closed cardiac trauma that has few specific clinical signs. In these
cases, chest pain is a frequent clinical manifestation, but its origin is difficult to determine, given that
it can have numerous extra-cardiac sources. Also, cardiac contusion has no specific signs which can be
determined by laboratory methods or laboratory investigations and histopathological examination
often can not find anything significant.
In this context, a patient with severe chest concussion, especially after a period of time of 1-2 months
from the traumatic event, may present multiple "dramatic surprises" during anaesthesia, no matter
what intervention is programmed.
Case report: Patient M, 72 years old, two months after associated trauma, catatrauma: amielic VMT,
subacute period; Th10-Th11 vertebral fracture with dislocation of Th10 to right; Rib fractures Th10,
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Th11, Th12; right pulmonary contusion; posttraumatic pleurisy of the right lung. It was sought from the
neurosurgery team anaesthesia for transpedicular spine fixation on 5 levels.
Preoperative Monitoring: NIBP (BPs, BPd, BPm), HR, blood coagulogram, biological analysis of blood
and urine, ionogram, EKG, Doppler echocardiography, chest radiography, chest CT.
At the induction the patient presented severe hypotension (60 and 30 mmHg) with bradycardia, severe
arrhythmias (vetricular exrasystoles, bigeminy). Cardiac contusion was suspected. The surgery was
postponed. Subsequently it was conducted a targeted preoperative preparation. After 15 days of
treatment, the patient underwent transpedicular stabilization (surgery lasted for 9 hours), which was
followed by a positive outcome.
Evaluarea blocului de nerv femural n analgezia perioperatorie n chirurgia traumatic a

oldului
The role of femoral nerve block in perioperative analgesia in traumatic hip surgery
M. L. Dobre, Raluca Ungureanu, Liliana Mirea, Ioana-Cristina Grinescu, Ioana Grinescu
Spitalul Clinic de Urgen, Clinica de Anestezie i Terapie Intensiv, Bucureti, Romnia
Obiectiv: Evaluarea calitii analgeziei perioperatorii asigurat prin bloc locoregional de nerv femural
n chirurgia ortopedic dup traumatismele de old.
Material i metode: Studiu prospectiv, randomizat, intervenional ce a inclus pacienii supui
interveniei chirurgicale de osteosintez a fracturilor de old (col femural i pertrohanterian) i care
au beneciat de anestezie spinal asociat preoperator cu bloc de nerv femural ( grup BNF) versus fr
bloc (grupul C control). S-a evaluat calitatea analgeziei prin scorul VAS la momentul efecturii
anesteziei spinale i n primele 24 ore dup procedura anestezico-chirurgical, gradul de satisfacie al
pacienilor legat de procedura anestezic, necesarul de analgetice postoperator (AINS i opioide),
rezultatele ind analizate statistic.
Rezultate: Au fost inclui n studiu 34 pacieni (17 n lotul BNF i 17 n lotul C), fr a se inregistra
diferene statistice ntre loturi n ceea ce privete datele demografice, scorul ASA i tipul interveniei
chirurgicale. S-au nregistrat diferene semnificativ statistice ntre loturi (p<0,05) n favoarea BNF
versus C n ceea ce privete calitatea analgeziei cuantificat prin scorul VAS (la 0,6,8,12 ore din
momentul efecturii rahianesteziei). Evaluarea consumului de analgetice n primele 24 ore a relevat o
diferen semnificativ statistic ntre cele dou loturi n ceea ce privete consumul de AINS, precum i
consumul de opioid.
Concluzii: Blocul de nerv femural ofer condiii excelente de analgezie perioperatorie, att n etapa
preoperatorie pentru asigurarea confortului pacientului i facilitnd poziionarea pentru practicarea
rahianesteziei, ct i postoperator, asigurnd o analgezie de bun calitate.
Aim of study: Assessment of femoral nerve block for perioperative analgesia in orthopaedic traumatic
hip surgery.
Material and Methods: Prospective, randomized, interventional study which included patients
undergoing surgical fixation of hip fractures under spinal anaesthesia with associated preoperative
femoral nerve block (BNF group) versus no block (C control group). We assessed the quality of analgesia
by VAS score at the time of spinal anaesthesia and in the first 24 hours after the procedure, patient
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satisfaction related to the anaesthetic procedure, postoperative analgesic requirements (NSAIDs and
opioids). The results were statistically analysed, with significance assumed at p<0.05.
Results: We included 34 patients (17 in group BNF and 17 in group C), without statistical differences
between groups in terms of demographics data, ASA score and type of surgery. There were statistically
significant differences between groups (p <0.05) in favour of BNF group regarding the quality of
analgesia measured by VAS score (at the time of the spinal anaesthesia and 6,8,12 hours). We found
statistically significant difference between the two groups concerning NSAIDs and opioids requirements
in the first 24 postoperative hours.
Conclusions: Femoral nerve block offers excellent perioperative analgesia: it ensures patient comfort in
the preoperative stage, facilitates positioning for spinal anaesthesia and provides high quality of
postoperative analgesia.
Caz sever de infecie meningococic provocat de neisseria meningitidis gr.c

A sever case of meningococcal infection causal by Neisseria meningitidis gr.C
Diana Vlad (1), Tatiana Alexeev (2), Ludmila Manic (3), Stela Cornilova (3), Ludmila Brc (1), Tatiana
tirbu (2), Galina Rusu (2), Maria Neaga (1)
(1) Spitalul Clinic Municipal de Boli Infecioase pentru Copii, Secia de Terapie Intensiv, Chiinu,
Republica Moldova
(2) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Facultatea Educaie Continu
n Medicin i Farmacie, Catedra Boli Infecioase, Chiinu, Republica Moldova
(3) Spitalul Clinic Municipal de Boli Contagioase de Copii, Secia de Terapie Intensiv, Chiinu,
Republica Moldova
Introducere: Infecia meningococic este o maladie sever cu o mortalitate semnificativ i o
prevalen n cretere a serogrupului C n Europa i America de Nord. Morbiditatea prin infecia
meningococic (serotipurile A i B) n municipiul Chiinu n anul 2015 a constituit 1,85 la 100000
populaie, cu o cretere n ultimii 2 ani.
Obiectivul studiului: Analiza evoluiei clinice a unui caz de infecie meningococic cu Neisseria
meningitidis gr C, (meningococcemie, meningoencefalit). oc toxiinfecios gr III. Edem cerebral. SCID.
Miocardit toxic. Nefrit toxic. Hepatit toxic. Pancreatit toxic.
Rezultatele studiului: Pacienta cu vrsta de 8 ani, spitalizat (22.05.2015) n stare extrem de grav, n
secia de terapie intensiv. Maladia a debutat cu 18 ore anterior spitalizrii, cu febra 39,50C, sopor
(GCS 10), microcirculaie compromis (TRC 5 sec), vome cu za de cafea, erupii hemoragice multiple
(3,5 - 6,0 cm) pe tegumente i mucoase, cu necroze n centru, semne meningiene i de focar pozitive.
Examenul paraclinic denot: leucocitoz marcat (42,3x109/l), neutrofilie (92%), anemie gr.III,
citorahie neutrofilic, acidoz metabolic avansat, nivel crescut al ureei, creatininei, transaminazelor
hepatice, proteinurie, leucociturie, eritrociturie. Tratamentul: echilibrarea volemic, electrolitic i
fluido-coagulant, corticosteroizi ( 20-30 mg /kg), antibiotice (cloramfenicol n primele 24 ore, apoi
ceftriaxon asociat cu ampicillin, i la a 5-a zi cu metronidazol), terapia sindromal. Durata spitalizrii
a fost de 28 zile, externat vindecat, fr sechele.
Concluzie: Infecia meningococic cu Neisseria meningitidis gr.C, la un copil de 8 ani, a avut o evoluie
sever prelungit, soldat cu vindecare complet, fr sechele.
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Introduction: Meningococcal infection is a severe disease with significant mortality and the prevalence
of C serogroup in Europe and North America. The morbidity of meningococcal infection (A and B
serotypes) in 2015 in Chiinu municipality was 1.85 per 100,000 people, with an increasing index in
the last 2 years.
The purpose of the study: The analysis of clinical evolution of a case of meningococcal infection with
N.meningitidis gr.C (meningococcemia, meningoencephalitis). Toxic-infectious shock grII. Cerebral
edema. SCID. Toxic myocarditis. Toxic nephritis. Toxic hepatitis. Toxic pancreatitis.
The study results: A 8-year-old girl was hospitalized in the intensive care unit in extremely severe
general condition on March 5, 2015. The disease began with 18 hours before the hospitalization with
fever 39,5C, sopor status (GCS 10), compromised microcirculation (TRC 5s), haemorrhagic vomiting,
multiple hemorrhagic rash with central necrosis from 3.5 to 6.0 cm located on skin, mucosa; positive
meningeal and focal signs. The laboratory tests reveal: marked leukocytosis (42.3 x 109 / l), neutrophilia
(92%), anemia gr.III, neutrophilic pleocytosis, advanced metabolic acidosis, increased urea and
creatinine, liver transaminases, proteinuria, leucocyturia, eritrocyturia. The treatment included:
balanced fluids, electrolyte and coagulating- fluids, corticosteroids (20-30 mg / kg), antibiotics
(chloramphenicol in the first 24 hours, then ceftriaxone associated with ampicillin, and at the 5th-day
metronidazole), symptomatic therapy. The duration of hospitalization was 28 days, fully recovered at
hospital discharge, without sequelae.
Conclusion: The meningococcal infection with Neisseria meningitidis gr. C to a 8-years-old child had a
prolonged and severe evolution, resulting in complete recovery without sequelae.
Cauz rar de hemoptizie aprut la o pacient tnr

Rare cause of haemoptysis in a young female patient
Marilena Negoi (1), Elena-Luminia Stnciulescu (1), Tatiana Ciomartan (2), Daniela Ologoiu (1), Oana
Marinescu (1), Ioana Grinescu (1)
(2) Institutul de Ocrotire i ngrijire a Mamei i Copilului, Secia de Anestezie i Terapie Intensiv,
Bucureti, Romnia
Introducere: Coriocarcinomul reprezint forma de boal gestaional trofoblastic cea mai rar i
agresiv, avnd o inciden de 1/20000 - 1/ 40000 gestaii. Rezultatele pot fi favorabile dac este
diagnosticat i tratat precoce, dei metastazele hepatice i pulmonare sunt frecvente.
Metode: Raportare de caz.
Rezultate: Pacient n vrst de 30 de ani este admis n STI pentru stare general grav, tuse i
hemoptizie moderat, insuficien respiratorie acut. Antecedentele personale patologice au
evideniat multiple avorturi spontane i elective, ultimul n urmcu trei sptmni.
La scurt timp dup internarea n STI, hemoptizia a recidivat, iar insuficiena respiratorie hipoxemic
acut a impus suportul ventilator. Antecedentele recente de avort spontan au indicat efectuarea
testului de gonadotropin corionic uman, care demonstrat prezena unui titru hormonal foarte
crescut (62385 mIU/ml), compatibil cu patologia trofoblastic cu metastaze pulmonare.
Coriocarcinomul a fost confirmat de examenul anatomopatologic al produsului de concepie avortat,
prelevat n urm cu trei sptmni.
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Concluzii: Coriocarcinomul ar trebui inclus n diagnosticul diferenial al hemoptiziei aprute la pacienta

tnr cu antecedente recente de sarcin. Diagnosticat i tratat precoce, coriocarcinomul este curabil
n 90-95% din cazuri.
Constimmntul informat a fost obinut de la familia pacientei ce face subiectul prezentrii.
Introduction: Choriocarcinoma is the most aggressive and rare form of gestational trophoblastic
disease, with an incidence of 1/20000 - 1/40000 gestations. In spite of its frequent lung and liver
metastasizing, outcomes are good if early diagnosis and treatment is applied.
Methods: Case report.
Results: A 30-year-old severely ill female patient was admitted to the ICU, with cough and moderate
haemoptysis, acute respiratory failure. History revealed multiple spontaneous and elective abortions,
the most recent one three weeks prior to admission.
Shortly after ICU admission, haemoptysis recurred, and she required ventilatory support for severe
acute hypoxemic respiratory failure. The recent spontaneous abortion prompted beta-human chorionic
gonadotropin testing, which revealed very high titers (62385 mIU/ml) suggesting trophoblastic disease
with lung metastases. Choriocarcinoma was confirmed by the pathology result of the abortive material
taken three weeks earlier.
Conclusions: Choriocarcinoma should be included in the differential diagnosis of haemoptysis in young
women with pregnancies in recent history. With early diagnosis and treatment, it can be cured in 9095% of cases.
Informed consent was obtained from the presented patients family.
Utilitatea testelor de agregare plachetar n chirurgia cardiac

The utility of preoperative platelet function tests in cardiac surgery
Daniela Filipescu, M. Luchian, Cornelia Florescu, Marilena Alina Punescu, Ioana Marinic
Institutul de Urgen pentru Boli Cardiovasculare Prof. Dr. C.C. Iliescu, Secia de Anestezie i Terapie
Intensiv II, Bucureti, Romnia
Obiectiv: Pacienii din chirurgia cardiac cu tratament dublu antiagregant au risc mare de sngerare
postoperatorie. VN (VerifyNow) i MEA (multiple electrode platelet) sunt teste de agregare plachetar
point-of-care care evalueaz eficiena tratamentului antiplachetar (TAP). Acest studiu compar MEA
cu VN n determinarea activitii reziduale plachetare la pacienii din chirurgia cardiac cu TAP i a
predictibilitii riscului de sngerare postoperatorie.
Material i metod: Acesta este un studiu prospectiv pilot ce include pacieni din chirurgia cardiac
electiv, care au primit TAP. Pacienii au fost tratai cu aspirin sau cu terapie dubl antiagregant
(aspirin i clopidogrel). Pacienii au fost evaluai preoperator prin ambele metode: MEA i VN. Au fost
transfuzai conform unui protocol instituional. Primul scop este analiza rezultatelor oferite de cele
dou teste. Al doilea scop este analiza corelaiei dintre rezultatele oferite de cele dou teste i
sngerarea perioperatorie. Analiza rezultatelor celor dou teste a fost realizat folosind testul de
corelaie Spearman.
Rezultate: 15 pacieni din chirurgia cardiac au fost inclui n studiu. Inhibiia receptorului P2Y12 a fost
investigat cu testul ADP (MEA) i testul PRU (VN), inhibiia receptorului pentru aspirin cu testul ASPI
(MEA) i testul ARU (VN), iar activitatea trombocitar dependent de trombin cu MEA - testul TRAP.
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Exist o corelaie medie (p=0.015) ntre testul ASPI (MEA) i ARU (VN). Nu a fost gsit nici o corelaie
ntre ADP i PRU. Nici unul dintre teste nu se coreleaz cu sngerarea postoperatorie. Nici un pacient
nu a primit concentrat trombocitar.
Concluzii: VN poate nlocui testul MEA n instituia noastr, n urgen sau atunci cnd laboratorul nu
este disponibil.
Objective: Cardiac surgical patients treated with dual anti platelet therapy (APT) are at risk of severe
postoperative bleeding. VerifyNow (VN) and multiple electrode platelet aggregometry (MEA) are both
point-of-care PFTs that evaluates the efficacy of APT. This study compares MEA with VN for determining
the residual platelet reactivity in patient with APT undergoing cardiac surgery and their value in
prediction of surgical bleeding.
Material and Methods: This is a prospective study design pilot including patients undergoing elective
cardiac surgery and treated with APT. Patients are treated with aspirin or dual APT (aspirin and
clopidogrel). Platelet function was assesed preoperatively by both MEA and VN. All patients have a
transfusion protocol according to a local protocol. The primary endpoint is the correlation between the
results of the 2 point-of-care platelet function tests. The secondary endpoint PFT with MEA and VN are
analysed for association with perioperative blood loss. The correlation between methods was evaluated
using the Spearman correlation test.
Results Fifteen cardiac surgery patients were admitted to this study. The inhibition of P2Y12 receptor
is investigated with: MEA-ADP test and VN-ARU test. The inhibition of aspirin receptor is investigated
with ASPI test (MEA) and ARU (VN). The TRAP test (MEA) investigates the thrombin-dependent platelet
reactivity. There is a moderate correlation (p=0,015) between ASPI test (MEA) and ARU (VN). No
correlation between ADP and PRU. No relationship was found between all tests and perioperative blood
loss. No patient received platelet concentrate.
Conclusions VN may replace in our institution MEA in emergency cases or when central lab. is
unavailable.
Vitamina D - factor de risc n hipertensiunea arterial la copii

Vitamin D - risk factor for arterial hypertension in children
Nelea Mtrgun (1), Svetlana Cojocari (2), Lilia Bichir-Thoreac (2), Olga Erohina (2)
(1) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Departament Pediatrie,
(2) Spitalul Clinic de Urgen pentru Copii Louis urcanu, Secia Pediatrie 2, Chiinu, Republica
Moldova
Datele cercetrilor tiinifice obinute n ultimii ani au identificat rolul sistemului D-endocrin ca
mecanism potenial n reglarea tensiunii arteriale. Deficiena vit. D este asociat cu dereglarea
metabolismului Ca, activarea sistemului renin- angiotensin - aldosteron, disfuncie endotelial i
dezvoltarea sindromului metabolic.
Scopul studiului: Aprecierea nivelului seric al 25 OH D3 la copii hipertensivi, supraponderali i obezi.
Material i metode: Studiul a inclus 100 copii supraponderali i obezi (vrsta medie ani 14.38) divizai
n II loturi de cercetare: I lot- de 50 de copii cu HTA, supraponderali i obezi; Lotul II - 50 copii
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normotensivi, supraponderali i obezi; lotul III-50 de copii normotensivi, normponderali. 25 OH D3 a

fost determinat prin metod hemiluminiscent.
Rezultatele studiului: Nivel de ser 25-OH D3 a fost redus n ambele grupuri studiate (lotul I-21,
1ng/mL; Lotul II-23, 3ng/mL) comparativ cu lotul de control 34, 5ng/mL. De asemenea, nivelul seric al
25 OH D3 a fost mai sczut la copiii hipertensivi, supraponderali i obezi (lotul I) comparativ cu lotul II.
Concluzii: Nivelul seric al 25 OH D3 s-a nregistrat important diminuat n lotul copiilor hipertensivi
comparativ cu lotul martor ceeea ce nu exclude implicarea acesteia n realizarea hipertensiunii
arteriale.
The data of the scientific researches of recent years have identified the role of the D - endocrine system
as a potential mechanism in the regulation of the arterial hypertension. Vitamin D deficiency is
associated with the disorder of Ca metabolism, enabling of rennin-angiotensine-aldosterone system,
endothelial disfunction and metabolic syndrome.
The objective of the investigation: Estimation of the serum level of 25 OH D3 in children with arterial
hypertension, overweight and obesity.
Materials and Methods: The investigation included 100 children with obesity and overweight (average
age 14,38), divided into 2 groups: the I group - 50 children with arterial hypertension, overweight and
obesity; the II group - 50 children with normal tension, overweight and obesity. 25OHD3 was
determined by chemiluminescence method.
The results of the investigation: The level of serum 25-OH D3 was reduced in both groups (group I- 21,
1ng/mL; group II-23, 3ng/mL) in comparison with control group 34, 5ng/mL. The serum level of 25 OH
D3 was also lower in children with arterial hypertension, overweight and obesity (group I) as compared
to group II.
Conclusion: It is important that serum level of 25 OH D3 was reduced in the group of children with
arterial hypertension in comparison with the control group which does not exclude its implication in the
realization of the arterial hypertension.
Managementul gravidei cu status epilepticus: prezentare de caz

Management of a pregnant patient with status epilepticus: case report
Orsolya Benedek (1), M. Veres (2), M. Morariu (2), . Toma (3), Alexandra Lazr (4), Sanda Maria
Copotoiu (1)
(1) Universitatea de Medicin i Farmacie, Disciplina Anestezie i Terapie Intensiv I, Trgu Mure,
Romnia
(2) Spitalul Clinic Judeean de Urgen, Clinica de Anestezie Terapie Intensiv, Trgu Mure, Romnia
(3) Universitatea de Medicin i Farmacie, Disciplina Obstetric Ginecologie I, Trgu Mure, Romnia
(4) Universitatea de Medicin i Farmacie, Disciplina Anestezie i Terapie Intensiv II, Trgu Mure,
Romnia
Introducere: Crizele epileptice persistente refractare la tratament pot afecta advers evoluia sarcinii i
pot pune n pericol viaa mamei.
Obiectiv: Prezentarea unui caz de status epilepticus la gravid.
Material i metod: Prezentm cazul pacientei de 34 ani cunoscut cu epilepsie sub tratament
medicamentos cu Levetiracetam, Valproat de sodiu i Lacosamid, care este preluat n compartimentul
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ATI al Clinicii de Obstetric i Ginecologie din cadrul Spitalului Clinic Judeean de Urgen Trgu Mure
cu status epilepticus i sarcin monofetal de 23-24 sptmni pe baza ecografiei obstetricale.
Pacienta a beneficiat mprealabil de tratament cu 6 doze de Diazepam 10 mg i s-a iniiat Fenitoin
50mg/kgc n infuzie continu. La preluare pacienta se afla n status epilepticus care dup finalizarea
infuziei cu Fenitoin a tranzitat n crize focale la intervale de 3-5 minute. Se decide intubaia
orotraheal cu ventilaie mecanic i iniierea infuziei continue cu Propofol 20-50 g/kgc/min. Dup
10 ore de infuzie de Propofol, crizele s-au spaiat la 30 minute, drept pentru care se decide asocierea
de Fenobarbital 100 mg intramuscular. Ftul a fost monitorizat ecografic la fiecare 2-3 ore, activitatea
cardiac ritmic i micrile active fetale fiind prezente pe tot parcursul tratamentului. Dup 26 ore de
la internare nu s-au mai nregistrat crize epileptice. Pacienta a fost externat cu evoluie favorabil.
Rezultate: Am reuit remiterea statusului epileptic la o gravid cu sarcin n evoluie.
Concluzii: La o gravid epileptic este posibil remiterea crizelor cu preul epuizrii tuturor liniilor de
tratament disponibile cu prognostic fetal i matern bun.
Introduction: Persistent refractory epileptic seizures can adversely affect a pregnancy and can
jeopardise the life of the mother.
Aim: To present the case of status epilepticus of a pregnant patient.
Material and Method: We report the case of a 34-year-old pregnant patient with epilepsy under
treatment with Levetiracetam, Sodium valproate and Lacosamide, who was admitted to the ICU of the
Gynaecology and Obstetrics Clinic of the Emergency Clinical County Hospital of Trgu Mure with status
epilepticus and a 23-24 weeks singleton live pregnancy according to the obstetric ultrasound. Before
admission, the patient received 6 doses of Diazepam 10 mg and Phenytoin 50mg/kgc was initiated in
continuous infusion. Upon admission the patient was in status epilepticus which transitioned to focal
seizures at 3-5 minutes after the Phenytoin infusion. Tracheal intubation with mechanical ventilation
was initiated and Propofol 20-50 g/kgc/min was started. After 10 hours of Propofol infusion the
seizures appeared every 30 minutes, for which we associated intramuscular Phenobarbital 100 mg. The
fetus was monitored with ultrasound every 2-3 hours, rhythmic cardiac activity and fetal movements
were present throughout the treatment. After 26 hours from the admission the patient was seizure
free. She was discharged with a good outcome.
Results: We treated successfully an episode of status epilepticus in a pregnant patient.
Conclusions: In the case of an epileptic pregnant patient it is possible to stop the seizures with the price
of exhausting all available treatment lines to ensure a favourable maternal and fetal outcome.
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Expresia redox la pacientul critic politraumatizat. Influena terapiei antioxidante asupra

incidenei de sepsis. Studiu prospectiv dintr-un singur centru
The redox expression in the critically ill trauma patient. The influence of the antioxidant
therapy on the incidence of sepsis. A prospective study of single center
Loredana Luca (1), A. F. Rogobete (1), O. Bedreag (2), M. Papuric (2), Carmen Alina Cradigati (1),
Mirela Sarandan (1), Corina Vernic (2), Ancua Pop Coman (1), Lavinia Melania Bratu (3), D. Sndesc (2)
(1) Spitalul Clinic Judeean de Urgen Pius Brinzeu, Clinica de Anestezie i Terapie Intensiv Casa
Austria, Timioara, Romnia
(2) Universitatea de Medicin i Farmacie Victor Babe, Facultatea de Medicin, Timioara, Romnia
(3) Universitatea de Medicin i Farmacie Victor Babe, Facultatea de Farmacie, Timioara, Romnia
Obiectivul studiului: Un procent ridicat de pacieni politraumatizai dezvolt sepsis n timpul staionrii
n unitatea de terapie intensiv. Mai mult dect att, augmentarea statusului inflamator prin producia
excesiv de radicali liberi este responsabil de reducerea drastic a ratei de supravieuire. n acest studiu
prospectiv s-au evaluat aspectele clinice la pacieni critici politraumatizai, precum i influena terapiei
antioxidante asupra incidenei de sepsis.
Material i metode: Acesta este un studiu prospectiv efectuat n perioada ianuarie 2015 - decembrie
2015, cu acordul Comisiei de Etic n cadrul Unitii de Terapie Intensiv Casa Austria, Spitalul Clinic
Judeean de Urgen Pius Brnzeu Timioara. Criteriile de includere sunt reprezentate de Injury
Severity Score (ISS) > 16 i vrsta > 18 ani.
Rezultate: Grupul de pacieni la care s-a administrat terapie antioxidant a fost format din 35 de
pacieni care au ndeplinit criteriile de selecie (Grupul 1, n = 35), iar Grupul de control a fost constituit
din 32 de pacieni (Grupul 2, n = 32). n Grupul 1 s-a observat o scdere semnificativ statistic n ceea
ce privete incidena de sepsis (p < 0.05) i MODS (p < 0.05). Nu au fost evideniate diferene
semnificative n ceea ce privete timpul de ventilaie mecanic (p > 0.05) i timpul de staionare n
unitatea de terapie intensiv (p > 0.05). Rata de mortalitate a fost semnificativ statistic mai mic n
cazul Grupului 1 (p < 0.05).
Concluzii: Prin modularea expresiei redox sunt aduse mbuntiri semnificative n ceea ce privete
incidena de sepsis i prognosticul acestor pacieni.
Objectives: A high percentage of trauma patients develop sepsis during the stay in the ICU. More than
that, the augmentation of the inflammatory status by excessive production of free radicals is
responsible for the drastic reduction in survival. In this prospective study we evaluated the clinical
aspects in the critically ill trauma patients and the influence of the antioxidant therapy on the incidence
of sepsis.
Materials and Methods: This is a prospective study conducted from January 2015 - December 2015 in
the Intensive Care Unit Casa Austria, Emergency County Hospital Pius Brinzeu Timioara with the
consent of the ethics committee The including criteria were represented by the Injury Severity Score
(ISS) > 16 and age above 18 years.
Results: The group of patients who benefited of the antioxidant therapy was made by 35 patients who
met the selection criteria (Group 1, n = 35) and the control group was made by 32 patients (group 2,
n=32). In Group 1 we observed a statistically significant decrease in the incidence of sepsis (p < 0.05)
and MODS (p < 0.05). There were no significant differences in terms of time mechanical ventilation (p
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> 0.05) and the residence time in the intensive care unit (p > 0.05). The mortality rate was significantly
lower in group 1 (p <0.05).
Conclusions: By modulating the expression of redox there are significant improvements in the incidence
of sepsis and outcome of these patients.
Epurarea extrarenal n supradozarea cu Dabigatran - prezentare de caz

Renal replacement therapy in Dabigatran accumulation - case presentation
Cornelia Florescu, Oana Constantin, Ioana Marinic, B. Prodan, Marilena Alina Punescu, Simona
Marin, M. Luchian, Daniela Filipescu
Institutul de Urgen pentru Boli Cardiovasculare Prof. Dr. C.C. Iliescu, Secia de Anestezie i Terapie
Intensiv, Bucureti, Romnia
Scopul acestei prezentri este de a demonstra eficiena terapiei epurare extrenal pentru facilitarea
clearance-ului Dabigatranului la pacienii care prezint supradozarea acestui tip de anticoagulant.
Pacient n vrst de 67 de ani se prezint n Serviciul de Cardiologie pentru agravarea simptomelor de
insuficien cardiac. Pacientul prezint un istoric de fibrilaie atrial (scor CHADS 2 = 1) sub tratament
cu Dabigatran iniiat cu patru luni nainte de admisie, moment n care acesta nu prezenta disfuncie
renal. Testele paraclinice la internare arat valori anormale ale parametrilor de coagulare i difuncie
renal (aPTT 65 sec, INR 5.82, creatinemie 7.5 mg/dl, BUN 300 mg/dl, trombocitopenie 84000/mmc).
Lund n considerare aceste rezultate, s-a decis oprirea tratamentului cu Dabigatran. n urmtoarele
trei zile, starea pacientului s-a agravat, acesta devenind oliguric. Valorile parametrilor de coagulare i
ale funciei renale nu s-au ameliorat.
S-a iniiat terapia de substituie renal (hemodiafiltrare continu veno-venoas) timp de 24 de ore,
avnd ca rezultat ameliorarea funciei renale i a testelor de coagulare. Evaluarea coagulrii s-a
efectuat prin determinarea aPTT, INR i trombelastografie (ROTEM).
Pacientul a fost transferat n Serviciul de Nefrologie, unde a rmas internat pentru nc 21 de zile. n
aceast perioad, a beneficiat de multiple edine de dializ intermiten, ceea ce a dus la
mbuntirea profilului de coagulare, precum i a funciei renale (creatininemie 2,7 ml/dl, BUN 82
mg/dl, aPTT 35.4 sec, INR 1.8, diurez spontan).
Concluzii: n cazul supradozarii de Dabigatran, este recomandat, n absena disponibilitii antidotului,
s se iniieze terapia de substituie renal pentru a reduce riscul de sngerare, n cazul n care testele
de coagulare nu se normalizeaz doar prin oprirea tratamentului anticoagulant.
This cases purpose is to prove the efficiency of renal replacement therapy to enhance Dabigatran
clearance in patients with that anticoagulant accumulation.
67-year-old male, presented to the Cardiology Department for worsening symptoms of cardiac failure.
Notably he had a medical history of atrial fibrillation (CHADS 2 score 1) for which he took Dabigatran
for four months prior to admission. In that moment the patient had a normal renal function. The initial
laboratory tests revealed abnormal coagulation parameters and renal function (aPTT 65 sec, INR 5.82,
serum creatinine 7.5 mg/dl, BUN 300 mg/dl, thrombocytopenia 84000/mm3).
After these findings the therapy with Dabigatran was stopped. For three days the symptoms of the
patient did not improve, also he became oliguric. The coagulation and renal tests did not change.
The renal replacement therapy (RRT) was initiated (continuous veno-venous hemodiafiltration) for 24
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hours and the anticoagulation profile and renal tests were improved. Coagulation assessment was done
by aPTT, INR, and thrombelastography (ROTEM).
The patient was transferred to the Nephrology department were he stayed for another 21 days. In this
period he made multiple sessions of intermittent RRT with continuous improvement of his coagulation
status and renal function (serum creatinine 2.7 mg/dl, BUN 82 mg/dl, aPTT 35.4 sec, INR 1.8,
spontaneous diuresis).
Conclusions: In case of Dabigatran accumulation, it is recommended, in absence of antidote to initiate
RRT to reduce the risk of bleeding if the coagulation tests do not improve only by stopping the
anticoagulation therapy.
Disfuncia hepatic la pacienii cu tetralogia Fallot supui coreciei chirurgicale

Liver dysfunction after surgical correction of tetralogy of Fallot
A. Botizatu
Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Secia de Anestezie i Terapie
Intensiv, Chiinu, Republica Moldova
Date generale: O reducere a funciei hepatice este frecvent dup operaii cardiace. Etiologia este
multifactorial, dar redistribuirea fluxului sanguin de organe care are loc n timpul circulaiei
extracorporeale implic ischemia ca una dintre principalele cauze ale prejudiciului.
Scopul: Incidena dezvoltrii, identificarea factorilor predictorii i caracteristica disfunciei hepatice la
pacienii supui coreciei chirurgicale a TF n condiii de circulaie extracorporeal.
Materiale i metode: Am analizat retrospectiv toi pacienii cu TF care au suportat corecie chirurgical
la instituia noastr din iunie 2010 pn n decembrie 2015. Au fost analizate datele demografice i
morfologice n perioada preoperatorie, intraoperatorie i postoperatorie. Criteriile disfunciei hepatice
au fost considerate nivelul bilirubiemiei totale 25 mol/l, indecele protrombinic 80% i nivelul ALAT
40 UI/l.
Rezultate: n perioada de studiu au fost supui coreciei chirurgicale 45 pacieni diagnosticai cu TF.
Vrsta medie a grupului a constituit 38,25,3 luni, greutatea medie 13,41,7 kg. Durata circulaiei
extracorporeale a constituit 142,613,02 minute. Hipoprotrombinemie s-a depistat la 41 (91,1%),
hiperbilirubinemie la 21 (46,6%), transaminazemie la 24 (53,3%) pacieni.
Concluzie: Disfuncia hepatic este frecvent ntlnit la pacienii supui circulaiei extracorporeale,
principalii factori sunt durata crescut a interveniei chirurgicale, suportul ino-vasotrop n perioada
perioperatorie.
Background: A reduction in liver function is common after cardiac operations, particularly in children
with preexisting cardiac failure. The etiology is multifactorial, but the redistribution of organ blood flow
that occurs during cardiopulmonary bypass implicates ischemia as one of the principal causes of injury.
Aim: Incidence of development, identifying triggers factors and characteristic of hepatic dysfunction in
patients undergoing surgical correction of TF in conditions of extracorporeal circulation.
Subjects and Methods: We retrospectively reviewed all patients who have undergone surgical
correction TOF at our institution from June 2010 to December 2015. Were analyzed demographic and
morphological data during preoperative, intraoperative and postoperative. Liver dysfunction criteria
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were considered total bilirubiemiei level 25 micromol / L, prothrombin index 80% and ALT levels
40 IU/l.
Results: During the study were subjected to surgical correction of 45 patients diagnosed with TOF. The
average age of the group was 38.2 5.3 months, average weight 13.4 1.7 kg. The duration of
extracorporeal circulation was 142.6 13.02 minutes. Hypoprothrombinemia was detected in 41
(91.1%), hyperbilirubinemia 21 (46.6%) and transaminasemia 24 (53.3%) patients.
Conclusion: Hepatic dysfunction is frequently encountered in patients undergoing extracorporeal
circulation, the main factors are increased during surgery, ino-vasotrop support in the perioperative
period.
Insuficien hepatic acut sever remis prin tehnica de adsorbie i filtrare a plasmei
(cpfa)
Severe acute liver failure submitted by adsorption and filtering technique plasma (CPFA)
Mary-Nicoleta Lupu, Florena Clrau, Cristina Bordeianu, C. Ariton
Spitalul Clinic Judeean de Urgen Sf. Apostol Andrei, Clinica de Anestezie i Terapie Intensiv,
Galai, Romnia
Tehnica de adsorbie i filtrare a plasmei permite trecerea sngelui printr-un plasmafiltru. Plasma
obinut trece apoi printr-un cartu adsorbant care poate reine cytokine, bilirubin, returnd apoi
plasma n snge. Ulterior se realizeaz i hemofiltrare, suplinind funcia renal.
Dorim s prezentm cazul unui pacient de vrst tnr, mare consumator de alcool, cu afectare
hepatic sever cronic, nediagnosticat anterior, internat n regim de urgen pentru insuficien
hepatic acut. Tratamentul medicamentos de susinere a funciilor vitale s-a dovedit ineficient,
moment n care s-a hotrt folosirea metodei mai sus menionate. Evoluia pacientului a fost
favorabil, fenomenele de encefalopatie hepatic remindu-se sub aceast terapie.
Concluzii: Tehnica de cuplare a adsorbiei i filtrrii plasmei i-a dovedit eficiena att n ocul septic,
ct i n insuficiena hepatic acut.
Severe acute liver failure submitted by adsorption and filtering technique plasma (CPFA) adsorption
and filtering technique allows the passage of blood plasma through a plasmafilter. The obtained
plasma then passes through a sorbent cartridge which can hold cytokines, bilirubin, returning then
plasma in the blood. Subsequently hemofiltration is performed, supplying renal function. We want to
present the case of a young patient, alcohol consumer, with severe chronic liver disease, undiagnosed
previously, hospitalized urgently for acute liver failure. Supportive drug therapy proved ineffective, and
it was decided to use the above mentioned method. The patients evolution was favourable, hepatic
encephalopathy phenomena healing with this therapy.
Conclusions: The technique of coupling plasma adsorption and filtration has proven its efficiency both
in septic shock and acute hepatic insufficiency.
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Noi trenduri n managementul durerii - eliberarea controlat de anestezice locale din matrici
siloxanice
New trends in pain management - controlled release of local anaesthetics from siloxane
matrix
A. F. Rogobete (1), O. Bedreag (2), M. Papuric (2), Carmen Alina Cradigati (1), Mirela Sarandan (1), A.
Dinu (2), Sonia Elena Popovici (2), D. Sndesc (2), Monica Dragomirescu (3), Gabriela Preda (4)
(3) Universitatea de tiine Agricole i Medicin Veterinar a Banatului, Facultatea de Zootehnie i
Biotehnologii, Timioara, Romnia
(4) Universitatea de Vest, Facultatea de Chimie, Biologie, Geografie, Timioara, Romnia
Obiectivul studiului: n lucrare se analizeaz capacitatea de eliberare a dou anestezice, lidocain i
bupivacain, din sisteme de eliberare controlat sintetizate din tetraetoxisilan i tetrametoxisilan.
Materiale i metode: Sinteza matricilor siloxanice utilizate a plecat de la doi precursori, tetraetoxisilan
i tetrametoxisilan, n care s-a ncapsulat lidocain, respectiv bupivacain. Eliberarea controlat s-a
efectuat n sisteme artificiale in vitro: temperatura 30 0C, 36,5 0C i 40 0C, respectiv pH-ul 6,7 i 8.
Capacitatea de eliberare a anestezicului local din matricea siloxanic s-a determinat spectrofotometric.
Rezultatele au fost interpretate statistic.
Rezultate: S-au evideniat profiluri asemntoare pentru ambele anestezice locale la parametrii
asemntori. pH-ul nu a influenat semnificativ din punct de vedere statistic capacitatea de eliberare
a anestezicelor (p>0.05). Temperatura la care s-a produs eliberarea anestezicului a influenat statistic
(p<0.05) capacitatea de eliberare.
Concluzii: Aceste sisteme sunt promitoare pentru obinerea unor preparate farmaceutice ce pot fi
utilizate n practica clinic actual.
Objectives: The paper analyzes the release of two anaesthetics, lidocaine and bupivacaine, from
controlled release systems synthesized from tetraethoxysilane and tetramethoxysilane.
Material and Methods: We used two precursors, tetraethoxysilane and tetramethoxysilane for the
synthesis of siloxane matrices, in which lidocaine and bupivacaine were encapsulated. The controlled
release was carried out in artificial in vitro systems, at temperatures of 30 0C, 40 0C or 36,5 0C and pH
from 6, 7 to 8. The ability of the release of the local anesthetic from the siloxane matrix was determined
spectrophotometrically. The results were interpreted statistically.
Results: We showed similar profiles of the two local anaesthetics for both parameters. While pH did not
influence statistically significant the matrix ability to release the anaesthetics (p> 0.05), the
temperature did influence (p <0.05) this ability. Conclusions: These systems are promising for the
obtaining of pharmaceutical preparations which can be used in current clinical practice.
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Trecerea de la administrarea intravenoas la cea oral a terapiei antiinfecioase la pacientul

critic. Serie de cazuri
Intravenous to oral antimicrobial therapy conversion in citically ill patients. Case series
Ioana Grigora, M. L. Gorcioaia, V. G. Palade
Universitatea de Medicin i Farmacie Gr. T. Popa, Clinica de Anestezie i Terapie Intensiv, Iai,
Romnia
Introducere: Conform OMS utilizarea iraional a medicamentelor antiinfecioase, mai ales a celor cu
administrare intravenoas, reprezint o problem major pe plan mondial, conversia la forma de
administrare oral fiind una dintre soluii. Principalele obstacole, care limiteaz aceast conversie, sunt
reprezentate de credina c administrarea oral nu asigur aceeai biodisponibilitate cu administrarea
i.v. i c n acest proces trebuie folosit aceeai substan activ. La pacientul critic, conversia de la
forma cu administrare i.v. la cea oral, imediat ce starea acestuia o permite, este tot mai recomandat
i numeroase studii demonstrnd c unele antiinfecioase au forme orale cu biodisponibilitate
comparabil cu a formei intravenoase, utilizarea lor nsoindu-se de scderea duratei de utilizare a
antibioticelor, a costurilor asociate ngrijiriilor medicale i a duratei spitalizrii. Antiinfecioasele orale
utile conversiei sunt cele cu biodisponibilitate oral > 90%, dintre care fac parte quinolonele,
linezolidul, fluconazolul, voriconazolul.
Serie de cazuri: Prezentm o serie de cazuri clinice, att medicale, ct i chirurgicale, la care s-a
practicat conversia de la administrarea intravenoas la cea oral a antiinfecioaselor. Toi pacienii au
fost diagnosticai cu oc septic, MODS i au avut culturi pozitive. n toate cazurile s-a iniiat terapie
antiinfecioas intravenoas empiric, cu spectru larg, apoi intit. n momentul conversiei la
antiinfecioase orale pacienii prezentau nc disfuncii de organ, n ameliorare. Evoluia a fost
favorabil, acetia fiind externai din secia de Terapie Intensiv.
Concluzie: n cazuri selecionate conversia de la terapia antiinfecioas i.v. la cea p.o. la pacientul critic
este sigur, avnd avantaje att pentru pacient, ct i pentru sistemul sanitar.
Introduction: According to WHO, irrational use of antimicrobial drugs, especially the intravenous ones,
is a major medical issue and one solution is the switch over to oral therapy.
The main limits of this conversion are the supposition that oral drugs dont achieve the same
bioavailability as the intravenous ones, and that only the same medicine must be used during this
process. During critical illness the switch over from intravenous to oral drugs, as soon as the patients
clinical status allows it, is increasingly used worldwide. Clinical trials have shown that there are
antimicrobial drugs with oral bioavailability approaching that of the IV ones, and their usage is
associated with a decreased period of administration and hospitalization and lower healthcare costs.
Oral chimiotherapics suitable for conversion should have oral bioavailability >90%, among which
quinolones, linezolid, fluconazole and voriconazole are included.
Case series: We analyze a clinical case series of medical and surgical patients, that have undergone the
switch over from IV to oral antimicrobial drugs. All patients had septic shock, multiple organ
dysfunction and positive cultures. Broad spectrum empirical intravenous antimicrobial therapy was
initiated in all cases and was changed after to targeted therapy. At the time of the conversion to oral
drugs all patients still had organ dysfunction. All had good clinical outcome and were discharged from
the ICU.
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Conclusions: The switch over from IV to oral antimicrobial drugs during critical illness is safe and has
many advantages for patients and health care system.
Sindromul de encefalopatie posterioar reversibil - Un caz cu pierderea vederii bilaterale n timpul
unei cezariane
Posterior reversible encephalopathy syndrome - a case of bilateral loss of vision during an elective C
section
P. O. Teodorescu (1), Camelia Luncan Breb (2), F. Maudarbaccus (2), Codrua Chicaru (3)
(1) Spitalul Clinic de Obstetric Ginecologie, Secia de Anestezie i Terapie Intensiv, Oradea, Romnia
(3) Spitalul Clinic Universitar de Urgene Sf. Spiridon, Secia de Anestezie i Reanimare, Iai, Romnia
Introducere: Sindromul de encefalopatie posterioar reversibil reprezint un cumul de simptome
neurologice i modificri radiologice precum cefalee, alterarea statusului mental, tulburri de vedere
pn la cecitate i convulsii. Este adeseori asociat cu o cretere abrupt a tensiunii arteriale, dei
etiologia este divers.
Cazul: Pacienta n vrst de 42 de ani, cu antecedente de migren clasic, se prezint pentru o
intervenie cezarian electiv. Cu 3 sptmni nainte de prezentarea la spital a fost inut sub
observaie pentru hipertensiune fr proteinurie, dar nu i-a fost recomandat medicaie pentru
hipertensiune. I s-a efectuat rahianestezie, dar la scurt timp dup inducerea anesteziei necesit
bolusuri repetate de fenilefrin pentru episoade de hipertensiune. Pacienta prezint un rspuns
exagerat la doza standard de fenilefrin, tensiunea arterial ajungnd la 215/100 de la o valoare
minim de 70/40. Nate un ft sntos, dar mic pentru vrsta gestaional i la scurt timp dup aceea
acuz cefalee intens cu pierderea total a vederii bilaterale fr alte deficite neurologice. I s-au
administrat labetalol i magneziu n infuzie continu. IRM-ul efectuat de urgen arat semnale hiperintense n ambii lobi occipitali. Evoluia clinic favorabil cu remiterea complet a simptomelor a putut
fi observat pe parcursul urmtoarelor 7 ore. IRM de control efectuat dup 2 sptmni de la
incidentul neurologic evideniaz rezoluia complet a semnalelor hiper-intense.
Concluzie: Acest caz denot importana cunoaterii PRES i subliniaz reversibilitatea acestei patologii.
IRM cerebral este gold-standard-ul n diagnosticul PRES. Recunoaterea rapid a PRES i instituirea
precoce a tratamentului este esenial n evitarea complicaiilor care pot determina dizabiliti sau pot
duce chiar la deces.
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a constellation of neurological
symptoms and radiological abnormalities consisting of headaches, altered mental status, visual
disturbances/blindness and seizures. It is often associated with an abrupt increase in BP, although the
aetiology is diverse.
Case report: A 42-year-old lady, G3P2, 39/40, with a background history of classical migraine with
visual aura, presented for an elective LSCS. Three weeks prior to presentation, she had been observed
for borderline hypertension without proteinuria, but was not on medications. She underwent an
uneventful spinal anaesthetic, but soon after required phenylephrine boli for hypotensive episodes. She
experienced an exaggerated response to standard dose of phenylephrine and her BP reached 215/110
from a low 70/40. A healthy but small for dates baby was delivered, but soon after, the mother
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complained of severe headache with total loss of bilateral vision. Her fundi were normal on
ophthalmoscopy and she had no other neurological deficit. She was treated with labetolol and
magnesium infusion. Urgent MRI showed hyperintense signals in both occipital lobes on diffusion and
FLAIR sequences. Clinical improvement with complete resolution of symptoms was observed within 7
hours. Follow up MRI 2 weeks later showed complete resolution of previously noted abnormal signals.
Conclusion: This case demonstrates that awareness of PRES is important and also highlights the
potential reversibility of this condition. Cerebral MRI is the key investigation for diagnosis of PRES. Rapid
recognition and institution of treatment is essential to avoid complications, which can cause permanent
disability or even death.
Disfuncia neurocognitiv postoperatorie poate fi anticipat prin monitorizarea oximetriei

cerebrale
Postoperative neurocognitive dysfunction may be predicted by cerebral oximetry
M. Veres (1), M. Petrior (1), Alexandra Lazr (2), Raluca Fodor (2), Carmen Sircu (3), Monica
Orlandea (1), I. Neme (1), Sanda Maria Copotoiu (2)
(2) Universitatea de Medicin i Farmacie, Disciplina Anestezie i Terapie Intensiv, Trgu Mure,
Romnia
(3) Institutul de Urgen pentru Boli Cardiovasculare i Transplant, Secia de Anestezie i Terapie
Intensiv Pediatric, Trgu Mure, Romnia
Apariia disfunciei neurocognitive postoperatorii (POCD) este neclar, se presupune existena mai
multor factori etiologici. Scopul studiului este investigarea rolului valorilor sczute la oximetria
cerebral perioperatorie n apariia disfunciei neurocognitive potoperatorii.
Material i metode: Studiu prospectiv, observaional, efectuat pe un numr de 22 de pacieni internai
n Spitalul Clinic Judeean de Urgen Trgu Mure, la Clinica de Ortopedie, supui artroplastiei de old
i de genunchi. La fiecare pacient s-a determinat punctajul obinul prin testul Mini Mental State
Examination (MMSE) preoperator, respectiv postoperator la 4 zile.
Parametrii urmrii: vrsta, comorbiditile, tipul i durata anesteziei, tensiunea arterial medie, alura
ventricular, saturaia oxigenului n sngele periferic, oximetria cerebral n perioada preoperatorie,
intraoperator i postoperator.
Rezultate: Valorile medii obinute pentru oximetria cerebral, la pacienii care au dezvoltat disfuncie
neurocognitiv au fost: preoperator, partea stng - 66,833,7; partea dreapt - 64,677,6;
intraoperator, partea stng - 64,924,7; partea dreapt - 64,177,0; postoperator, partea stng 65,673,8; partea dreapt - 64,006,0. Sublotul care nu a dezvoltat disfuncie neurocognitiv a obinut
urmtoarele valori: preoperator, partea stng - 75,408,2; partea dreapt - 73,508,1; intraoperator,
partea stng - 73,106,2; partea dreapt - 72,604,9; postoperator, partea stng - 74,675,7; partea
dreapt - 73,104,3. Diferenele dintre valorile medii ntre cele dou subloturi sunt semnificative
statistic, la un prag de semnificaie =0,05.
Concluzii: Pacienii care au dezvoltat disfuncie neurocognitiv postoperator au prezentat valori
semnificativ mai mici ale oximetriei cerebrale preoperator i intraoperator.
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The occurrence of the postoperative neurocognitive dysfunction (POCD) is not clearly stated and it
assumes the existence of multiple etiological factors. The aim of this study is the investigation of
cerebral oximetry values perioperatively, in postoperative neurocognitive dysfunction (POCD)
Material and Methods: This is a prospective, observational study, which enrolled 22 patients, admitted
in the Emergency Clinical County Hospital Trgu Mure Orthopaedics Clinic, after hip and knee
arthroplasty. Each patient had the Mini-Mental State Examination (MMSE) score calculated
preoperatively, intraoperatively and 4 days postoperatively. We recorded the following parameters:
age, medical background, type and duration of anaesthesia, heart rate, peripheral oxygen saturation,
cerebral oximetry preoperatively, intraoperatively and postoperative.
Results: The mean values of cerebral oxymetry for patients in the group with neurocognitive
dysfunction were: preoperative - left side - 66,833,7; right side 64,677,6; intraoperative, left side 64,924,7; right side - 64,177,0; postoperative, left side - 65,673,8; right side 64,006,0. The group
without neurocognitive dysfunction obtained the following results: preoperatively, left side - 75,408,2;
right side 73,508,1; intra-operative, left side - 73,106,2; right side - 72,604,9; postoperative, left
side - 74,675,7; right side - 73,104,3. The groups are statistically different regarding the cerebral
oxymetry values, at a significant =0,05.
Conclusions: The patients with neurocognitive dysfunction postoperatively had significantly lower
values on cerebral oxymetry both pre-operatively and intra-operatively.
Managementul perioperator i provocrile anestezice pentru chirurgia citoreductiv cu

chimioterapie hipertermic intraperitoneal
Perioperative management and anaesthetic challenge for cytoreductive sugery with
hyperthermic intraperitoneal chemotherapy
Luminia Cmpeanu, Andreea Cantor, Izabela Smadu, A. Farcaiu, N. Roadevin
Spitalul Sf. Constantin, Secia de Anestezie i Terapie Intensiv, Braov, Romnia
Introducere: Chirurgia citoreductiv cu chimioterapie hipertermic intraperitoneal (HIPEC) prin
tehnic nchis ofer o opiune terapeutic promitoare pentru o categorie atent selectat de pacieni
cu carcinomatoz peritoneal. Procedura chirurgical n discuie este lung i complex, implic
pierderi sanguine i lichidiene semnificative, alterri hemodinamice, hematologice i metabolice
perioperatorii, toate acestea fiind asociate cu o morbiditate i mortalitate semnificative. Lucrarea de
fa i propune s prezinte experiena noastr n managementul anestezic i terapia intensiv
postoperatorie la aceti pacieni.
Material i metode: Studiul retrospectiv a fost efectuat pe 52 de pacieni supui citoreduciei tumorale
cu HIPEC ntre 2013 i 2016, n spitalul Sf. Constantin, Braov. Sunt prezentate protocolul anestezic
aplicat, terapia intensiv intraoperatorie, tratamentul postoperator imediat, ct i diferite alte
complicaii cu managementul acestora.
Rezultate: S-au nregistrat pierderi lichidiene i sanguine masive n timpul interveniei chirurgicale
citoreductive, fluctuaii termice, creterea presiunii venoase centrale i a presiunii n cile aeriene,
creterea PaCO2, alterarea indicelui de hipoxemie, creterea lactatului seric n timpul HIPEC, fluctuaii
hemodinamice, acidoz mixt (metabolic i respiratorie). Metodele de resuscitare aplicate continuu
intraoperator pentru corecia tuturor acestor dereglri sunt continuate n reanimare, alturi de
tratamentul complicaiilor asociate.
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Concluzie: Citoreducia tumoral cu HIPEC a devenit n ultimii ani tratamentul standard pentru anumite
tipuri de malignitai cu extensie la suprafaa peritoneal. Procedura chirurgical este considerat o
provocare pentru anestezistul reanimator, fiind asociat cu tulburri variate ale funciilor organismului
pacientului. Aceste dereglri cu durat variabil pot s fie controlate i corectate printr-o monitorizare
atent i o intervenie terapeutic prompt.
Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) by the
closed technique provide a promising therapeutic option for highly selected patients with peritoneal
carcinomatosis. It is a long and complex procedure with significant blood and fluid loss, haemodynamic,
hematological and metabolic alterations in the perioperative period, all these being associated with
significant mortality and morbidity. The goal of study represents our experience on how to manage
these patients from anaesthetic point a view during surgery and later in intensive care.
Material and Methods: This is a retrospective study, which involves 52 patients presented for tumoral
cytoreduction and HIPEC, in our hospital, St. Constantin, Braov, between 2013 and 2014. The nethods
involve intraoperative anaesthetic management, postoperative management in intensive care and
management of various complications.
Results: HIPEC process was associated with massive losses of blood and fluids, thermal disturbance,
various changes in CVP and invasive arterial blood pressure, increasing in PaCO2, hypoxic index
alteration, elevated lactate, haemodynamic changes, mixt acidosis (metabolic and respiratory). All
resuscitations methods for haemodynamic stability during the case were continued later
postoperatively in the intensive care unit, associating complications management.
Conclusion: Over the last few years, tumoral cytoreduction with HIPEC started to be a standard
treatment for cancers with peritoneal invasion. Anaesthetic management of these patients during the
surgical procedure represents a challenge for both the anaesthetist and intensivist. All these
haemodynamic changes can be prevented by a careful management and a quick therapeutical
intervention.
Eficiena blocului paravertebral n chirurgia snului comparativ cu anestezia general

Paravertebral block efficiency in breast surgery compared with general anaesthesia
I. A. Ptru, Anca Lidia Vlcea, Cristina Mladin
Spitalul Clinic Judeean de Urgen, Secia de Anestezie i Terapie Intensiv, Craiova, Romnia
Introducere: Blocul paravertebral reprezint o tehnic anestezic efectuat cu predominan n
chirurgia snului i n chirurgia toracic, fie c tehnic anestezic, fie pentru analgezie postoperatorie.
Obiective: A fost studiat eficiena blocului paravertebral n chirurgia oncologic a snului ca tehnic
anestezic raportat la anestezia general, urmrindu-se calitatea actului chirurgical, confortul
pacientelor, efectele adverse postanestezice i analgezia postoperatorie.
Material i metode: n grupul de studiu au fost introduse 14 paciente, dintre care 7 au beneficiat de
bloc paravertebral unilateral cu sau fr sedare uoar intraoperatorie, iar celelalte 7 au fost supuse
anesteziei generale cu intubaie orotraheal. Pacientele i-au dat consimmntul pentru efectuarea
blocului dup ce au fost informate asupra beneficiilor i riscurile aferente tehnicii. Blocurile au fost
efectuate n totalitate ghidate ecografic, n condiii de asepsie i siguran, n sala de operaie.
Rezultate: Am evideniat n urma rezultatelor c pacientele supuse blocului paravertebral unilateral
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pentru chirurgia snului, cu sau fr sedare uoar intraoperatorie, au avut confort chirurgical n timpul
operaiei, cu analgezie corespunztoare att intraoperatorie, ct i postoperatorie timp de 12-15 ore,
nu s-au nregistrat greuri i vrsturi postoperatorii comparativ cu grupul pacientelor supuse
anesteziei generale, nu au necesitat analgetice intravenoase sau orale n ziua interveniei chirurgicale,
au fost mobilizate uor postoperator.
Concluzii: Blocul paravertebral unilateral pentru chirurgia snului reprezint o tehnic anestezic
eficient n efectuarea rezeciilor de sn, att timp ct nu este necesar evidarea ganglionar axilar
unde aceast tehnic anestezic nu ofer beneficii. Blocul paravertebral confer beneficii att din
punct de vedere chirurgical, ct mai ales analgetic.
Introduction: The paravertebral block represents an anaesthetic technique done mainly in breast
surgery and in thoracic surgery, either as a sole anaesthetic technique, either for postoperative
analgesia.
Objectives: We studied the efficiency of the paravertebral block in breast oncologic surgery as an
anaesthetic technique compared to general anaesthesia, and we followed the surgical act, the patients
confort, post-anaesthetic adverse effects and postoperative analgesia.
Materials and Methods: In the study group we had 14 patients, 7 had unilateral paravertebral block
with or without light sedation and 7 had general anaesthesia with orotraheal intubation. The patients
gave their consent for the block after receiving information regarding the benefits and the risks
following the technique. The blocks had been made under ultrasound guidance, in the theatre, in
aseptic conditions.
Results: Based on the results, we showed that the patients with paravertebral block for breast surgery
with or without light sedation had surgical comfort, had proper analgesia during and after surgery for
12-15 hours, no nausea and vomiting were recorded compared to the general anaesthesia group, did
not need IV or oral analgesia during the day of surgery, had early mobilisation.
Conclusion: Unilateral paravertebral block for breast surgery is an efficient anaesthetic technique for
breast resection as long as axilary ganglia resection is not needed. Paravertebral block offers surgical
and analgetic benefits.
Coagulopatie acut la un pacient cu traum cranian grav indus de tratamentul cu

Cefoperazon/Sulbactam
Acute Cefoperazone/Sulbactam induced coagulopathy in a patient with severe traumatic
brain injury
Elena-Luminia Stnciulescu, S. Godeanu, R. Asmarandei, Andreea Marin
Spitalul Clinic de Urgen, Secia de Anestezie i Terapie Intensiv, Bucureti, Romnia
Obiectiv: Scopul acestei lucrri este de a evidenia o reacie advers de reinut prin consecinele
posibile, a preparatului Cefoperazon+Sulbactam, reacie care se remite spontan la oprirea
tratamentului.
Material i metode: Prezentm cazul unui pacient n vrst de 60 ani diagnosticat cu traumatism
cranio-cerebral grav, hematom subdural acut, hemoragie intraparenchimatoas, admis postoperator
n STI post volet fronto-temporal drept, cu evacuarea dilacerrii cerebrale i a hematomului subdural
secundar. Evoluia a fost trenant, cu disfuncie neurologic i recuperare dificil. Antibioterapia a
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constat n Cefoperazon+Sulbactam, 2g/12 ore timp de 8 zile, conform antibiogramei rezultate din
cultura secreiei traheale. Dup 5 zile de tratament pacientul a dezvoltat coagulopatie marcat
(INR=6.2, aPTT=48s, PT=56s) pentru care s-au administrat plasm proaspt congelat, complex
protrombinic uman i vitamina K, din cauza riscului crescut de sngerare. Pacientul a continuat s
prezinte valori modificate ale timpilor de coagulare. Acesta nu prezenta anterior hepatopatie (enzime
hepatice normale, fr sindroame de colestaz i hepatopriv). Ulterior, antibioterapia a fost nlocuit
cu Amoxicilin+Acid clavulanic, coagulograma revenind spontan la valori normale.
Rezultate: S-a observat c simpla ntrerupere a administrrii preparatului Cefoperazon+Sulbactam
determin regresia spontan a coagulopatiei, fr a fi necesar tratament suplimentar, dac pacientul
nu prezint risc de sngerare.
Concluzii: Tratamentul cu Cefoperazon+Sulbactam trebuie nsoit de monitorizarea atent a
coagulogramei. Studiul lui Ge Hong-Xia et al. efectuat pe 79 pacieni recomand profilaxia sngerrilor
cu 10mg vitamina K/zi la pacienii tratai cu Cefoperazon+Sulbactam i nutriie parenteral, aceast
combinaie asociind cel mai des tulburri de coagulare. Cefalosporinele au fost asociate cu anemie,
timpi de coagulare prelungii, pancitopenie i agranulocitoz.
Objective: The purpose of this paper is to highlight a notable adverse reaction, for the consequences it
might have, of the combination of two drugs: Cefoperazone+Sulbactam. This reaction resolves
spontaneously after stopping the treatment.
Material and Methods: We present the case of a patient aged 60, diagnosed with traumatic brain
injury, acute subdural haematoma, intraparenchymal cerebral haemorrhage, admitted in the ICU after
decompressive craniectomy, resection of the brain laceration and the subdural hematoma.
Postoperative recovery was slow, with severe neurological dysfunction. The elected antibiotherapy was
Cefoperazone+Sulbactam, 2g/12h for 8 days, according to antibiotic susceptibility results from tracheal
aspirate cultures. After 5 days of treatment the patient developed severe coagulopathy (INR=6.2,
aPTT=48s, PT=56s) which was treated with fresh frozen plasma, prothrombin complex concentrate and
vitamin K because of the increased risk of bleeding. The patient continued to present prolonged clotting
times; he had no previous liver dysfunction (normal liver enzymes, no cholestasis or hepatoprive
syndrome). Subsequently, antibiotherapy was replaced with Amoxicillin+Clavulanic acid, coagulation
returning to normal spontaneously.
Results: It was observed that with the mere discontinuation of Cefoperazone+Sulbactam, coagulopathy
regresses spontaneously, without the need for additional treatment, if the patient is not at risk of
bleeding.
Conclusions: Cefoperazone+Sulbactam treatment must be accompanied by careful coagulation
monitoring. The study of Ge Hong-Xia performed on 79 patients recommends prophylaxis of bleeding
with vitamin K 10mg/day in patients treated with Cefoperazone+Sulbactam and parenteral nutrition,
this combination being most often associated with coagulopathy. Cephalosporins were associated with
anemia, prolonged clotting time, agranulocytosis and pancytopenia.
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Factorii de risc pentru funcia ntrziat a grefei n transplantul renal de la donator n moarte
cerebral: experiena unui singur centru
Risk factors for delayed graft function in deceased donor renal transplantation: a single
center experience
Liliana Florena Domnior (1), Cristina Alina Buca (2), Corina incu (2), Iulia Negru (1), Eliza Burchiu
(1), I. Gener (3), A. Preda (4), S. Divan (1), Ruxanda Tulbure (1)
(1) Institutul Clinic Fundeni, Secia de Anestezie i Terapie Intensiv II, Bucureti, Romnia
(2) Institutul Clinic Fundeni, Departament Transplant Renal, Bucureti, Romnia
(3) Institutul Clinic Fundeni, Centrul de Medicin Intern - Nefrologie, Bucureti, Romnia
(4) Institutul Clinic Fundeni, Centrul Pentru Uronefrologie i Transplant Renal, Bucureti, Romnia
Obiectiv: Studiul are ca obiectiv identificarea factorilor de risc asociai cu funcia ntrziat a grefei
(delayed graft function - DGF), specifici acestui centru, pentru receptorii de rinichi de la donatori n
moarte cerebral.
Pacieni i metode: Studiul observaional prospectiv a inclus o serie de 97 de pacieni transplani renal
de la donator aflat n moarte cerebral, ntre 1 ianuarie 2014 i 30 septembrie 2014. Obiectivul
studiului a fost evaluarea funciei ntrziate a grefei renale, definit ca necesitatea de dializ n prima
sptmn posttransplant.
Rezultate: Vrsta medie a receptorilor a fost de 45 ani [IQR:37, 50]. DGF a fost prezent n cazul a 17
transplanturi renale de la donator n moarte cerebral (17.5%). Vrsta donatorului, perioada de dializ
pretransplant a receptorului, timpul de ischemie rece, timpul de ischemie cald, perioada de terapie
intensiv a donatorului, au fost factori de risc crescut asociai pentru DGF (p<0.001). Analiza
multivariat a artat c doar vrsta donatorului (Exp(B) 0.24, 95% CI 0.07-0.82; p=0.02) i perioada de
dializ pretransplantului a receptorului (Exp(B) 0.19, 95% CI 0.02-1.77; p=0.04) sunt independent
asociate cu funcia ntrziat a grefei.
Concluzii: Studiul prospectiv efectuat a demonstrat c doar vrsta donatorului i perioada de dializ a
receptorului anterior transplantului constituie factori de risc independeni la receptorii cu transplant
renal de la donator n moarte cerebral.
Not: Aceast lucrare a beneficiat de suport financiar prin proiectul CERO PROFIL DE CARIER:
CERCETTOR ROMN, contract nr. POSDRU/159/1.5/S/135760, proiect cofinanat din Fondul Social
European prin Programul Operaional Sectorial Dezvoltarea Resurselor Umane 2007-2013
Objective: The purpose of this study was to identify the center-specific risk factors associated with
delayed graft function (DGF) in recipients of kidneys from deceased donors.
Patients and methods: This prospective observational study included a series of 97 consecutive
deceased donor renal transplants performed in our center between 1st of January 2014 and 30th of
September 2014. The study endpoint was delayed graft function, defined as the requirement of dialysis
in the first postoperative week after transplantation.
Results: Median age of the recipients at transplantation was 45 [IQR:37, 50] years. Delayed graft
function occurred in 17 kidney transplants from deceased donors (17.5%). Donor age, recipient dialysis
time before transplantation, cold ischemia time, warm ischemia time, intensive care support time prior
to aortic cross-clamping were associated with an increased risk of delayed graft function (all p<0.001),
while, donor serum creatinine and recipient age were not. After multivariable analysis only donor age
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(Exp(B) 0.24, 95% CI 0.07 to 0.82; p = 0.02) and the recipient dialysis time before transplantation (Exp(B)
0.19, 95% CI 0.02 to 1.77; p = 0.04) remained independently associated with delayed graft function.
Conclusion: In this prospective study, only donor age and recipient dialysis time before transplantation
emerged as delayed graft function independent risk factors in recipients of kidneys from deceased
donors.
Acknowledgement: This work received financial support through the project entitled "CERO - Career
profile: Romanian Researcher", grant number POSDRU/159/1.5/S/135760, cofinanced by the European
Social Fund for Sectorial Operational Programme Human Resources Development 2007-2013
Eficacitatea ropivacainei 0.75% versus asocierii ropivacain 0.5%-lidocain 2% pentru

anestezia peribulbar n chirurgia strabismului
The efficacy of 0.75% ropivacaine versus 0.5% ropivacaine with 2% lidocaine for peribulbar
anaesthesia in strabismus surgery
Andreea Doriana Stnculescu, Diana Belu, Daniela Mititelu, Luminia Chiuu
Spitalul Clinic Judeean de Urgen, Secia de Anestezie i Terapie Intensiv, Craiova, Romnia
Chirurgia strabismului se realizeaz, de obicei, sub anestezie general. Cu toate acestea, anestezia
locoregional n chirurgia oftalmologic a diminuat riscul anestezic i a facilitat o recuperare mai rapid
postoperatorie.
Scopul acestui studiu prospectiv a fost compararea eficacitii anestezice i a akineziei intra- i
postoperator a ropivacainei 0,75% fa de asocierea lidocain 2% i ropivacain 0.5% utilizate pentru
anestezia peribulbar, la pacienii care sunt supui interveniei chirurgicale pentru strabism.
Material i metode: Am luat n studiu un numr total de 44 pacieni care au fost supui unei intervenii
chirurgicale oftalmologice i care au fost randomizai n dou grupuri egale. Blocul nervos a fost realizat
prin injectarea a 6-8 ml anestezic local, cu ajutorul unui ac de 23G. Au fost studiate timpul necesar
pentru instalarea akinezie globului ocular, durata akineziei, calitatea analgeziei postoperatorii,
incidena efectelor secundare, precum i consumul de analgezice necesar postoperator.
Rezultate: Blocul nervos s-a instalat dup 8 +/- 2 min n grupul lidocain-ropivacain i dup 14 +/- 2
min n grupul ropivacain 0,75%, iar durat blocului motor a fost de 210 32 min n cazul utilizrii
ropivacainei 0.75% i de 192 45 min n cazul asocierii ropivacain-lidocain. n primele 6 ore
postoperator, pacienii din ambele grupuri de atins valori similare ale analgeziei prin evaluarea scalei
la durere VAS (scor vizual analog).
Concluzie: Asocierea lidocain-ropivacain are un timp de instalare al blocului motor mai bun dect
ropivacaina, iar durat blocului motor este similar, astfel c poate fi o alegere potrivit atunci cnd
se efectueaz anestezia peribulbar pentru intervenia chirurgical de strabism.
Strabismus surgery is commonly performed under general anaesthesia. However, locoregional
anaesthesia in ophthalmological surgery has diminished anaesthetic risks and facilitated faster postsurgery recovery. In addition, strabismus surgery is one of the most painful ophthalmological
interventions and therefore could benefit from the optimum analgesia provided by peribulbar
anaesthesia in the first hours after surgery.
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The purpose of this prospective study was to compare the anaesthetic efficacy and akinesia in the intraand the postoperative period of of 0.75% ropivacaine versus 1:1 mixture of 2% lidocaine and 0.5%
ropivacaine used for peribulbar anaesthesia, in patients undergoing strabismus surgery.
Material and Methods: A total of 44 patients undergoing ophthalmic surgery were randomized into
two equal groups. Nerve block was carried out by injecting 6-8 mL of the local anaesthetic with the help
of 23G needle. Time required for onset of globe akinesia, duration of akinesia, quality of postoperative
analgesia, incidence of side effects, and analgesic consumption were recorded.
Results: Surgical block was achieved after 8 +/- 2 min in the lido-ropivacaine group and after 14 +/- 2
min in the ropivacaine group. 0.75% ropivacaine provided a motor block duration of 21032 min and
lido-ropivacaine of 19245 min. In the the first 6 hours postoperative, the patients in both groups
achieved similar values of visual analog score rating scale of pain.
We conclude that lido-ropivacaine has a better onset then ropivacaine and a similar duration of motor
block and may be a suitable choice when performing peribulbar anaesthesia for strabismus surgery.
oc anafilactic la testarea intradermic la Cefuroxim la un pacient tnr cu patologie

ortopedic
Cefuroxime intradermal test-related anaphylactic shock in a young patient undergoing
orthopedic surgery
Dana Pavelescu (1), Lavinia Elena Matei (1), Georgiana Andreea Pavel (1), Ioana Grinescu (2), Ioana
Cristina Grinescu (3)
(2) Spitalul Clinic de Urgen / Universitatea de Medicin i Farmacie Dr. Carol Davila, Secia de
Anestezie i Terapie Intensiv, Bucureti, Romnia
(3) Spitalul Clinic de Urgen, Secia de Anestezie i Terapie Intensiv I, Bucureti, Romnia
Anafilaxia reprezint o reacie de hipersensibilitate generalizat sau sistemic sever cu debut rapid
care poate duce la deces. Este un diagnostic clinic ce se bazeaz pe manifestri tipice generalizate /
sistemice, deseori dup expunerea brusc la un agent potenial declanator. n cazuri extrem de rare
anafilaxia se poate manifesta la teste cutanate (prick, idt, patch).
Prezentm cazul unui pacient n vrst de 27 ani, admis n Clinica de Ortopedie pentru fractur
clavicular, far patologie asociat, fr antecedente patologice semnificative, neag alergii de orice
natur i afirm utilizarea de antibiotice per os n antecedente (Zinnat). Preoperator se administreaz
500 ml ser fiziologic pev lent, se efectueaz testarea intradermic la Cefuroxim - diluie 0,75mg/ml. La
maxim 2 minute dup administrarea antibioticului, pacientul prezint rash cutanat generalizat,
varsturi n jet, hipotensiune arterial marcat (TA=61/28mmHg), tahicardie sinusal (AV=130b/min).
Se decide instituirea rapid a tratamentului intravenos: efedrin 10mg repetat la 3- 30 mg, adrenalin
0,1 mg repetat la 3- 0,5 mg, HHC 1000mg, Cristaloide - 8000ml, plus oxigenoterapie. Se decide
transferul n STI pentru o monitorizare adecvat ulterioar i se decide reprogramarea interveniei
chirurgicale.
Pacientului i se efectueaz teste alergologice i imunologice n vederea diagnosticului de alergie la
medicamente, n urma crora acesta este confirmat: TTL >5% pentru Amoxicilin i TTL = 5% pentru
Ropivacain, IgE specific la Ciprofloxacin=0,27 UI/mL.
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Se decide intervenia chirurgical la dou sptmni ulterior, sub AG-IOT, cu administrare prealabil:
1000 ml SF pev lent, 500 mg HHC iv, Arnetin fi 1 iv. Intervenia se desfoar fr inconveniente.
Anaphylaxis is a generalized or systemic hypersensitivity reaction with a rapid onset that may cause
death. Anaphylaxis is primarily a clinical diagnosis based on typical manifestations,
generalized/systemic that often occur after the exposure to a potential triggering agent. In extremely
rare cases, anaphylaxis can occur on skin tests (prick, IDR, patch). Therefore, we present to you the case
of a 27-year-old patient, admitted to our orthopedic clinic for a collarbone fracture, without any
associated pathology or significant medical history, without any knowledge of allergies, that states the
use of oral antibiotics in the past (Zinnat).
Preoperative we administered 500 ml saline solution, then Cefuroxime intradermal test is performed dilution 0.75 mg / ml. 2 minutes after, the patient presents generalized skin rash, vomiting, marked
hypotension (TA = 61 / 28mmHg), sinus tachycardia (AV = 130b / min).
Intravenous therapy is quickly performed: 10mg ephedrine repeated at 3 - 30 mg, 0.1 mg adrenaline
repeated at 3- 0.5 mg, 1000 mg HHC, crystalloid - 8000ml, plus oxygen therapy. The patient is
transferred to our intensive care unit for an appropriate monitoring. Allergy and immunologic tests are
performed to our patient in order to diagnose any medication allergies, which confirmed the diagnosis:
a TTL> 5% for amoxicillin, a TTL = 5% for Ropivacaine and specific IgE for Ciprofloxacin = 0.27 IU / ml.
Surgery is postponed two weeks later, under AG-IOT with prior administration of 1000 ml SF in
perfusion, HHC 500 mg iv and Arnetin 1vial iv. The intervention is conducted without any
inconveniences.
Evaluarea incidenei crizei acetonemice secundare la copii
Evaluation of the secondary acetonemic crisis in children
Tatiana Covalschi (1), Liliana Chiosea (1), Natalia Buzatu (2), V. Cojocaru (3), S. Sandu (4)
(1) Spitalul Clinic Municipal pentru Copii V. Ignatenco, Secia de Reanimare, Chiinu, Republica
Moldova
(2) Spitalul Clinic Municipal pentru Copii V. Ignatenco, Unitatea Primiri Urgene, Chiinu, Republica
Moldova
(3) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Catedra Anesteziologie i
Reanimatologie, Chiinu, Republica Moldova
(4) Spitalul Clinic Municipal pentru Copii V. Ignatenco, Secia de Anestezie i Terapie Intensiv,
Introducere: Sindromul crizei acetonemice prezint un indice important de sntate, mai ales c n
ultimii ani incidena lui este n continu cretere. Tot mai mai muli pacieni admii n secii deTI
prezint crize acetoemice secundare. Etiologia crizei acetonemice secundare este diferit i apare pe
fundalul hiperactivitii sau hipersolicitrii organismului unde are loc consumarea excesiv de energie
pn la epuizarea rezervelor glucidice i includerea mecanismului de lipoliz, n rezultatul cruia se
acumuleaz corpii cetonici. Tabloul clinic este caracterizat prin greuri, vome repetate, dureri
abdominale, inapeten, febr, dureri de cap, tahicardie, tahipnoe, oligurie. Complicaiile frecvente
asociate n caz de vom sunt deshidratarea i acidoza metabolic, ce necesit aflarea prelungit a
pacientului n secia de TI.
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Scopul studiului: Incidena crizelor acetonemice la copii aflai la tratament n secia TI i influena
asupra duratei de aflare la tratament n secia TI.
Material i metode: Studiu efectuat retrospectiv, prin analiza fielor pacienilor admii n secia TI a
Spitalului de Copii V. Ignatenco, municipiul Chiinu, iulie-decembrie anul 2015, motivul internrii
fiind criza acetonemic secundar.
Au fost evaluate 782 de fie ale pacienilor internai n TI. Grupul de baz i lotul de control au fost
identice dup vrst, sex i diagnostic. Din 782 de fie, 322 de pacieni au prezentat criz acetonemic,
constituind 41% din totalul pacienilor evaluai. Vrsta pacienilor a fost cuprins ntre 01 - 17 ani. Lotul
cu vrsta ntre 2 - 6 ani a constituit 218 pacieni - 67%. Raportul dup sex cu o uoar prevalare a
sexului masculine, 157 pacieni.
Dup factorul declanator pacienii s-au repartizat n urmtoarele grupe:
Pacienii cu afeciunile respiratorii: bronite obstructive 64 pacieni constituind 20%, pneumonii 22 de
pacieni - 7%. Afeciunile sistemului digestiv: apendicite distructive, 47 pacieni - 14%, pancreatite
acute, 34 pacieni - 11%. Infecii urinare 56 pacieni - 17%. Dup intervenii chirurgicale ORL 17 pacieni
- 5%; infeciile ORL (sinusite, tonzilite) 29 pacieni - 9%. Politraumatizaii 12 de pacieni - 4%. Convulsiile
41 pacieni - 13%. Durata medie de spitalizare n seciile Ti a pacienilor asociere cu criz acetonemic
a constatat 1,2 zile, la cei care au prezentat criza acetonemic 2,3 zile.
Rezultate: La toi pacienii a fost determinat clar factorul declanator al crizei acetonemice, infecia ca
i cauz principal a fost depistat n 252 de cazuri constituind 78%, stresul chirurgical i traumatic n
29 de cazuri - 9%, convulsiile n 41 pacieni - 13%. La toate categoriile de asociere a afeciunilor
somatice cu criz acetonemic durata de spitalizare n seciile TI a fost mai mare aproape de 2 ori.
Vrst vulnerabil constituie ntre 2 i 6 ani.
Concluzii: Incidena crizei acetonemice secundare depinde de patologia somatic i influeneaz
negativ durata aflrii n TI.
Introduction: The acetonemic crisis syndrome represents an important health index particularly
because it has continuously increased in the last years. More and more patients admitted in ICU are
with secondary acetonemic crisis. The aethiology of this syndrome is due to the hyperactivity and
overloadind of the organism which leads to the consuming of carbohydrates reserves and the
implication of lipolysis, which results in accumulation of ketone bodies. Clinically this syndrome is
manifested by nausea, repeated vomiting, abdominal pain, loss of appetite, fever, headache,
tachycardia, tachypnoea, oligury. In vomiting the frequent complications are dehydrations and
metabolic acidosis which represents the reason of the prolonged admission in ICU.
Objective: The incidence of the acetonemic crisis in children being under treatment in ICU and the
influence on the length of stay and on the treatment in ICU.
Material and Methods: A retrospective study by paper analisys of patients admitted in ICU of V.
gnatenco hospital in Chiinu in the period of time between July - December 2015, and the reason of
admission was the secondary acetonemic crisis.
782 papers of the patients admitted in ICU have been evaluated. The main group and the control group
were identical by age, sex and diagnosis. 322 were diagnosed with acetonemic crisis, which represents
41 % of evaluated children. The age of patients ranged between 1 and 17 years old.
The group of patients with the age ranged between 2 and 6 years old represented 218 patients which
constitute 67%.
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Related to the sex of the patients, the boys were a little more - 157 patients.
Related to the cause that triggered the ketoacidosiswe divided into the next groups:
Patients with respiratory diseases: obstructive bronchitis - 64 patients who constitute 20%, pneumonia
- 22 patients - 7%. Patients with digestive disorders: destructive appendicitis - 47 patients - 14%; acute
pancreatitis - 34 patients - 11%. With urinary infections were 56 patients - 17%. After ENT surgery - 17
patients - 5%; ENT infections (sinusitis, tonsillitis) - 29 patients - 9%. Polytrauma patients were 12 - 4%.
Patients with seizures were 41 - 13%.
The average length of admission in ICU in patients with association of acetonemic crisis was 1-2 days,
and with only ketonemic crisis was 2-3 days.
Results: In all examined patients the triggered cause of ketonemic crisis was clearly determined.
Infection as main cause to cause the ketonemic crisis was detected in 252 cases which constitute 78%,
the surgical and traumatic stress was determined in 29 cases - 9%, seizures were in 49 patients - 13%.
In all categories of associations between somatic disorders with ketonemic crisis the time of admission
in ICU is twice longer. The vulnerable age is between 2 and 6 years old.
Conclusions: The incidence of secondary ketonemic crisis depends on associated somatic disorder and
negatively influences the length of stay in ICU.
Cetoacidoza diabetic la copii i adolesceni - experiena clinic

Diabetic ketoacidosis in children and teenagers - clinical experience
Liliana chirca (1), Ana Oglind (2), Tatiana Sertinean (1), Elena Galamaga (1), N. Stanciu (1)
(1) Institutul Mamei i Copilului, Secia de Reanimare Pediatric i Toxicologie, Chiinu, Republica
Moldova
(2) Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Catedra Urgene Medicale,
Introducere: Cetoacidoza diabtic la copii se caracterizeaz prin existena unor tulburri hidroelectrolitice, care pot fi extrem de grave i pun viaa copilului n pericol.
Obiective: Scopul acestui studiu reiese din necesitatea implementrii unei tactici de conduit
terapeutic n cetoacidoza diabetic la copii i adolesceni la etapa prespital i spital.
Materiale i metode: Pacienii din lotul de studiu n numr de 86 provin din cazuistica seciei primire
urgene (SPU), terapie intensiv pediatric i a seciei endocrinologie a IMiC, Republica Moldova,
copiii care s-au internat pe perioada cuprins ntre 1 ianuarie i 31 decembrie 2015. Fiele copiilor cu
cetoacidoz diabetic au fost divizate n 2 loturi: I lot 28 ( 32,5%) copii cu cetoacidoz diabetic care
au manifestat respiraia acidotic tip Kussmaul, tulburri ale strii de contien, semne de
deshidratare fr vom i diaree i au primit tratamente n s. reanimare i terapie intensiv, i al II-lea
lot 58 copii (67,4%) copii cu cetoacidoz care au urmat tratamentul n s. endocrinologie, dup
stabilizarea prealabil a strii generale n SPU. Toi copii au beneficiat de examinrile de rutin a
copilului cu cetoacidoz diabetic (analize clinice, Echilibrul acido-bazic (EAB) cu calcularea gurii
anionice, glicemia, electroliii sanguini, analize biochimice sumar urina, densitatea, corpi cetonici .a.).
Rezultate i discuii: n urma studiului retrospectiv am remarcat urmtoarele: copiii au fost transportai
de ctre ambulan n proporie de 86 la sut (74 copii), iar 12 copii sau 13,9% au fost transportai de
ctre prini, tutele. Dup vrst au predominat copii mai mari de 9 ani. n timpul transportrii a fost
apreciat glicemia n 32 cazuri (43,2%) i iniiat infuzia cu scop de dezintoxicaie. Studiul a remarcat
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factorii cauzali a cetoacidozei: n 5 cazuri (17,4%) a fost confirmat diabet zaharat primar depistat; n 23
(26,7%) cazuri factorul declanator au fost infeciile; n 4 (4,6%) cazuri - stresul, exerciii fizice, 15
(17,4%) cazuri greeli n alimentaie, iar n 39 (45,3%) cazuri nu s-a dicelat nici un factor declanator. n
SPU n dependen de situaia clinic, parametrii EAB i ai nivelului electroliilor s-a continuat infuzia
cu scop de dezintoxicaie i corecia hipopotasemiei, insulina s-a administrat n PEV n dependen de
nivelul glicemiei. n 28 cazuri nectnd la tratamentul iniiat n SPU starea general a copiilor n
colaborare cu indicatorii EAB, fr schimbri semnificative i au fost internai n s. reanimare i terapie
intensiv. Au fost cateterizate 2 vene magistrale n 12 (42,8%) cazuri, iar n 16 (57,1%) cazuri a fost
necesar de cateterizat vena central, situaii n care copii prezentau semne de hipoperfuzie sever,
contiena dereglat pn la precoma sau coma I. Din totalul de copii n 58 cazuri copii dup iniierea
tratamentelor n SPU, s-a urmrit o dinamic pozitiv i au fost transferai n s. endocrinologie.
Evalund indicii EAB la internare i ulterior peste 30 minute, apoi la fiecare 2 ore de tratament cu
infuzie cu potasiu, insulina 0,1 UN/kg n PEV, n dependen de nivelul glicemiei am remarcat
urmtoarele: iniial (pH 7,09 0,09; pCO2 92,5; BE - (-19,71,7 ) cu o tendin de ameliorare peste 30
min n 16 cazuri, iar 12 cazuri doar peste 2 ore s-a observat o mbuntire a EAB. Concomitent cu
indicatorii EAB i anume a creterii pH, a pCO2, a bicarbonatului standard am remarcat i o
mbuntire a nivelului electroliilor, cu micorarea nivelului glicemiei n 20 (71,4%) cazuri. De
menionat c copiii nu au necesitat metode invazive respiratorice, toi copii au primit oxigen pe masc
sau canule nazale. Durata medie de ngrijiri medicale n terapie intensiv a fost de 2 1,6 zile contra
3,7 0,9 la copiii, asupra crora nu s-a iniiat infuzia la prespital din diverse motive. Pe perioada
studiului nici un copil nu a decedat n urma cetoacidozei diabetice. Din cele relatate mai sus putem
conchide urmtoarele:
Concluzii:
1. La etapa de prespital determinarea nivelului de glicemie rmne un indice modest, iar iniierea
terapiei infuzionale este un indicator al micorrii duratei de tratament.
2. n lotul II am remarcat ameliorarea clinic i paraclinic mai rapid a strii copiilor crora s-a
suplimentat potasiul din primele ore ale internrii n terapie intensiv.
Introduction: The diabetic ketoacidosis in children is characterized by hydroelectrolytic disorders, which
can be extremely serious and can put the child's life at risk.
Objectives: The aim of this study arises from the need to implement a tactics of therapeutic conduct in
diabetic ketoacidosis in children and teenagers on the pre-hospital and hospital stage.
Materials and Methods: The patients, who have formed the study groups, 86 of them, come from the
Emergency Department (ED) casuistry, pediatric intensive care and endocrinology department of the
Mother and Child Institute, children who were hospitalized during the period between January 1st and
December 31st, 2015. The cards of the children with diabetic ketoacidosis were divided into 2 groups:
The Ist group composed of 28 children (32,5%) with diabetic ketoacidosis who showed acidotic
breathing of Kussmaul type, disorders of the state of consciousness, signs of dehydration without
vomiting and diarrhea who received treatment in the department of reanimation and intensive care,
and the IInd group of 58 children (67.4%) with ketoacidosis who received treatment in the department
of endocrinology, after the prior stabilization of the general condition in the Emergency Department.
All children were provided with routine examinations of children with diabetic ketoacidosis (clinical
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analysis, acid-base balance (ABB) with the calculation of anion hole, blood glucose, blood electrolytes,
urine summary biochemical analysis, density, ketones, etc.).
Results and discussion: After the retrospective study we noted the following: the children were
transported by ambulance in a proportion of 86 percent (74 children) and 12 children or 13.9% were
transported by their parents, tutors. By the age prevailed children older than 9 years old. During
transport there was assessed the glucose level in 32 cases (43.2%) and initiated the infusion with the
purpose of disintoxication. The study noted the causative factors of ketoacidosis: in 5 cases (17.4%)
there was confirmed the primary diabetes mellitusdiscovered; in 23 cases (26.7%) the infectionswere
the triggering factor; in 4 cases (4.6%) - the stress, physical exercises, in 15 cases (17.4%) - diet mistakes
and in 39 cases (45.3%) there was not detected any triggering factor. In the Emergency Department,
depending on the clinical situation, ABB parameters and the electrolytes level, there was continued the
infusion with the purpose of disintoxication and correction of hypokalaemia, the insulin was
administered in ENP depending on glucose level. Regardless of the treatment initiated in the Emergency
Departmentin 28 cases the general state of children in collaboration with ABB indicators there were no
significant changes and they were hospitalized in the department of reanimation and intensive care.
There were catheterized 2 main veins in 12 cases (42.8%) and in 16 cases (57.1%) it was necessary to
catheterize the central vein, situations where children had signs of severe hypoperfusion, impaired
consciousness to pre-coma or coma of the Ist degree. Of all children in 58 cases after initiation of the
treatment in the Emergency Department there has followed a positive dynamics and they were
transferred in the department of endocrinology. Assessing the ABB indices on the admission and
subsequently over 30 minutes, then every 2 hours of the treatment with potassium infusion, 0.1 un/kgof
insulin in ENP, depending on glucose level, we have noted the following: initially (pH 7.09 0,09; pCO2
9 2.5, BE - (-19.7 1.7) with a tendency of improvement over 30 minutes in 16 cases and in 12 cases
over 2 hoursthere was noticed an improvement of ABB. Along with ABB indicators namely the growth
of pH, pCO2, bicarbonate standard we have noticed an improvement in the level of electrolytes, with a
decrease of glucose level in 20 cases(71.4%). It is worth of note that children have not required
respiratory invasive methods; all children received oxygen on mask or on nasal cannula. The average
duration of medical care in the intensive care unit was 2 1.6 days versus 3.7 0.9 in children who
have not been initiated the in-hospital infusion for various reasons. During the study there no child has
died of diabetic ketoacidosis. From the above mentioned we can conclude also the following:
Conclusions:
1. At the prehospital stage the determination of glucose level remains a modest index and the initiation
of the infusion therapy is an indicator of decreasing the duration of treatment.
2. In the IInd group we have noticed a faster clinical and paraclinical improvement of the condition of
children who was supplemented with potassium in the early hours of hospitalization in the intensive
care unit.
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Corelaii biochimice la pacienii politraumatizai cu fracturi pelvine instabile

Biochemical correlations in polytrauma patients with unstable pelvic fractures
Doriana Lupescu (1), A. Dimitriu (2), Olivera Lupescu (2), G. I. Popescu (3), M. Nagea (2), Maria Greabu
(4)
(1) Spitalul de Obstetric Ginecologie Dr. Maria Burghele, Secia de Anestezie i Terapie Intensiv,
Buftea, Romnia
(2) Spitalul Clinic de Urgen, Secia II, Clinica de Ortopedie i Traumatologie, Bucureti, Romnia
(3) Spitalul Clinic de Urgen, Secia I, Clinica de Ortopedie i Traumatologie, Bucureti, Romnia
(4) Universitatea de Medicin i Farmacie Dr. Carol Davila, Biochimie, Bucureti, Romnia
Obiectivul studiului: Scopul este evaluarea potenialelor corelaii terapeutice ntre markerii de
inflamaie i etapele managementului pacientului politraumatizat. Acest concept este valoros ntruct
st la baza noiunii de damage control surgery (DCS) n aplicarea creia medicul AI are un rol
esenial.
Material i metod: Autorii evalueaz retrospectiv 28 pacieni internai n perioada 01.01.201201.01.2015 n Spitalul Clinic de Urgen Bucureti, politraumatizai cu fracturi de bazin cu impact
hemodinamic (instabile mecanic). Au fost monitorizate testele de inflamaie acut: leucocite, VSH,
fibrinogen, protein C reactiv, interleukin 1 i interleukin 6. La pacienii stabili hemodinamic (8
cazuri) s-a practicat early total care (ETC), iar la cei 20 borderline i stabili s-a ales fixarea extern
(DCS) urmat de fixare intern abia dup remiterea reaciei inflamatorii sistemice. Au fost evaluate
complicaiile generale (mortalitate, inciden ARDS i MSOF) i durata de spitalizare.
Rezultate: Analiza datelor pe lotul studiat a artat c aplicarea de ctre echipa pluridisciplinar a
conceptului de DCS a condus la o inciden a complicaiilor mai mic (dei fr semnificaie statistic).
Testele de inflamaie acut s-au corelat cu rata mortalitii i incidena MSOF. Dintre este, IL 1 i IL 6
au avut cea mai nalt rat de predicie a coplicaiilor. La pacienii la care stabilizarea definitiv s-a
practicat dup remiterea sindromului inflamator, rata complicaiilor a fost mult mai mic.
Concluzii: Pentru medicul ATI, n cadrul echipei pluridisciplinare, testele inflamatorii i n scpecial IL 1
i IL 6 reprezint indicii utile cu privire la eficientizarea managementului pacientului politraumatizat.
Study objectives: The purpose is to evaluate the potential clinical correlations between inflammatory
markers and the steps of managing polytrauma patients. This concept is valuable because it forms the
basis of the concept of damage control surgery (DCS), which the Anaesthesia and Intensive Care
doctor helps implement.
Material and Method: The authors retrospectively evaluate 28 patients admitted to the Clinical
Emergency Hospital of Bucharest between 01.01.2012 and 01.01.2015 with multiple trauma and pelvic
fractures. The following acute inflammation tests were monitored: white blood cell count, ESR,
fibrinogen, C reactive protein, interleukin 1 and interleukin 6. In haemodynamically stable patients (8
cases) early total care (ETC) was performed and in the other 20 borderline and stable patients
external fixation (DCS) was chosen, followed by internal fixation only after the systemic inflammatory
response subsided. General complications (mortality, incidence of ARDS and MSOF) and length of stay
were evaluated.
Results: The analysis of the data revealed that multispecialty team application of DCS lead to a lower
incidence of complications (although without statistical significance). Acute inflammation tests were
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correlated with mortality and complication rates. Of these tests, IL 1 and IL 6 had the best capacity to
predict complications. In patients where definitive stabilization was performed only after the remission
of the inflammatory syndrome, the rate of complications was much lower.
Conclusions: For the anaesthetist - intensivist in a multispecialty team, the inflammatory tests and
especially IL 1 and IL6 represent useful tools for more efficiently managing polytrauma patients.
Riscuri neateptate n anestezia ambulatorie - methemoglobinemia dobndit

Unexpected risk of ambulatory anaesthesia - acquired methemoglobinemia
C. Cobilinschi (1), R. C. Tincu (2), Zoie Ghiorghiu (2), R. A. Macovei (2)
(2) Spitalul Clinic de Urgen, Secia de Anestezie i Terapie Intensiv - Toxicologie, Bucureti, Romnia
Introducere: Methemoglobina (MetHb) dobndit apare prin oxidarea hemoglobinei sub aciunea
anumitor medicamente sau substane chimice. Dapsona, prima linie de tratament pentru Dermatita
Herpetiform (DH), este asociat cu creteri ale MetHb. Diagnosticul precoce al MetHb este esenial,
mai ales n cazul pacienilor care primesc anestezie ambulatorie.
Prezentare de caz: Prezentm cazul unui pacient n vrst de 43 de ani, diagnosticat cu DH, secundar
bolii celiace, pentru care fusese tratat cu Dapson. Pacientul fusese programat s efectueze o
colonoscopie sub anestezie general intravenoas, ntr-o clinic de gastroenterologie, acuznd
hematochezie. Avnd n vedere saturaia periferic sczut (SpO2 89-91%), intervenia a fost
temporizat, pacientul fiind transferat. La admisie, pacientul prezenta dispnee uoar, cianoz
periferic, SpO2 88% i tahicardie. Investigaiile au indicat o MetHb de 17% i anemie (Hb 9.8 g/dl). n
afara msurilor generale de terapie intensiv, tratamentul a fost suplimentat cu albastru de metilen
pentru scderea rapid a MetHb i efectuarea interveniei. La 2h dup administrarea tratamentului,
nivelul MetHb a sczut pn 6%, astfel nct colonoscopia a putut fi efectuat. Lund n considerare
recircularea enterohepatic a Dapsonei, s-a decis monitorizarea postoperatorie atent pentru
urmtoarele 8 ore. Pacientul a fost externat n aceeiai zi, avnd o MetHb de 6%.
Concluzii: Determinarea preoperatorie a unui nivel crescut de MetHb este esenial pentru a putea
asigura o anestezie sigur, mai ales n cazul anesteziei ambulatorii. Albastru de metilen poate fi terapia
salvatoare, innd cont de efectele sale rapide. Reapariia MetHb trebuie, de asemenea, avut n
vedere dup tratament, mai ales n cazul MetHb induse de Dapson.
Introduction: Acquired methemoglobinemia(MetHb) is produced from oxidation of hemoglobin by
drugs or chemicals. Dapsone, the first line-treatment for Dermatitis Herpetiformis (DH), is associated
with increased levels of methemoglobin. The early diagnosis of MetHb is essential, particularly in
patients who receive ambulatory anaesthesia.
Case presentation: We report the case of a 43-year-old patient who had been priorly diagnosed with
DH, secondary to celiac disease, for which he received Dapsone. The patient was planned to perform
colonoscopy under general intravenous anaesthesia for stool bleeding in a Gastroenterology Clinic.
However, due to the patients lower peripheral oxygen saturation (SpO2 89-91%), the intervention was
postponed and he was further transferred. On admission, the patient presented mild dyspnea,
peripheral cyanosis, SpO2 88% and tachycardia. Paraclinical investigations revealed a MetHb level of
17% and anemia (Hb 9.8 g/dl). Apart from intensive therapy measures, methylene blue treatment was
SRATI 2016
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Sinaia
added for rapid decrease of MetHb, in order to proceed with the intervention. Two hours after
methylene blue administration MetHb decreased, coming down to 6 %, so the colonoscopy was
operated. Considering dapsone enterohepatic recirculation, careful postoperative monitoring was
performed in the next 8 hours. The patient was dismissed the same day having a MetHb of 6%.
Conclusions: Preoperative high MetHb recognition is essential in order to deliver safe anesthesia,
particularly in ambulatory anesthesia when patients are promptly discharged. Methylene blue can
prove to be a life-saving therapy, due to its rapid effects. However MetHb rebound after methylene
blue therapy should always be considered, especially in dapsone induced MetHb.
Modificarea profilului lipidic la pacientul critic politraumatizat. Modularea expresiei redox

prin administrarea de substane cu caracter antioxidant. Un studiu prospectiv
The modifies of the lipidic profile in the critically ill trauma patient. The modulation of the
redox expression by administrating of the antioxidants. A prospective study
A. F. Rogobete (1), O. Bedreag (2), Carmen Alina Cradigati (3), Mirela Sarandan (3), Corina Vernic (2),
Anelore Gruneantu (4), M. Papuric (2), Loredana Luca (1), Mihai Sndesc (5), D. Sndesc (2)
(1) Spitalul Clinic Judeean de Urgen Pius Brinzeu, Clinica de Anestezie i Terapie Intensiv,
Timioara, Romnia
(4) Spitalul Clinic Judeean de Urgen Pius Brinzeu, Clinica de Anesteziologie i Terapie Intensiv,
Timioara, Romnia
(5) Spitalul Clinic Judeean de Urgen Pius Brinzeu, Departamentul de Ortopedie II, Timioara,
Romnia
Obiectivul studiului: Un aspect important n ceea ce privete disfuncia molecular la pacientul critic
politraumatizat este reprezent de perturbarea expresiei lipidice prin atacul radicalilor liberi. n acest
studiu prospectiv, s-a evaluat expresia lipidic la pacienii critici politraumatizai, precum i influena
terapiei antioxidante asupra disfunciilor redox.
Material i metode: Studiul prospectiv a fost efectuat n cadrul Unitii de Terapie Intensiv Casa
Austria, Spitalul Clinic Judeean de Urgen Pius Brnzeu Timioara, cu aprobarea comisiei de etic
n perioada ianuarie 2015 - decembrie 2015. Criteriile de includere sunt reprezentate de Injury Severity
Score (ISS) > 16 i vrsta > 18 ani.
Rezultate: 35 de pacieni au ndeplinit criteriile de selecie, fiind alocai grupului de pacieni la care sau administrat substane antioxidante (Grupul A, n = 35). Grupul de control a fost alctuit din 32 de
pacieni (Grupul B, n = 32). n Grupul A au fost evideniate modificri semnificativ statistice n ceea ce
privete variabilele biologice: IL-6 (p < 0.05), PCR (p < 0.05), VSH (p < 0.05) i expresia lipidic (p < 0.05).
Mortalitatea a fost semnificativ statistic mai mic n cazul Grupului A (p < 0.05).
Concluzii: Terapia antioxidant este implicat n normalizarea valorilor biologic umorale i
mbuntirea statusului clinic.
Objectives: An important aspect in terms of molecular dysfunction in critically ill trauma patient is the
disruption of lipid expression by free radical attack. In this prospective study we tried to evaluate the
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Sinaia
lipidic expression in the critically ill trauma patient and the influence of the antioxidant therapy on the
redox dysfunctions.
Materials and Methods: The prospective study was conducted in the Casa AustriaIntensive Care Unit,
Pius BrinzeuEmergency County Hospital, Timioara with the approval of the ethics committee during
the period of January 2015 - December 2015. The including criteria were represented by the Injury
Severity Score (ISS) > 16 and age above 18 years.
Results: 35 patients met the selection criteria and were included in the study group who received
antioxidant substances (group A, n=35). The control group consisted of 32 patients (group B, n=32). In
group A there were highlighted statistically significant changes in the biological variables: IL-6 (p<0.05),
CRP (p<0.05), ESP (p < 0.05) and the lipidic expression (p < 0.05). The mortality was statistic significant
smaller in Group A (p < 0.05).
Conclusions: The antioxidant therapy is involved in the normalisation of the biologic values and in
improving of the clinical status.
SRATI 2016
11 - 15 mai / May
Sinaia

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The 42nd Congress of the Romanian Society

of Anaesthesia and Intensive Care

The 8th Romanian-Israeli Symposium on

May 11th - 15th, 2016

SRATI 2016 Abstract Book

The 42nd Congress of the Romanian Society

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