Three Years of Experience in Anesthesiological Care for Blast Trauma at the Early Hospital Stage

Summary. The prevalence of armed conflicts, terrorist attacks and industrial accidents requires the clinician to understand explosive injuries in both civilian and military settings. The hostilities taking place in Ukraine pose many questions to anesthesiologists regarding the provision of medical care to victims with explosive trauma. Explosive trauma is combined in pathogenesis and combined in localization, which occurs because of the cumulative damaging effect on the human body of a shock wave, gas jets, fire, toxic products of explosion and combustion, fragments of the ammunition casing, secondary shells. This type of injury is often combined with damage to 2-5 anatomical areas and sometimes more. Moreover, most of the hospital care is provided in civilian hospitals located near the hostilities. The aim of study. Reducing mortality by selecting anesthesia technology and intraoperative intensive care in blast trauma victims depending on the severity of the blast trauma and the condition of the victims. Materials and methods. The study is retrospective. Data from medical histories for the period March 2022 – December 2024 were used. 1698 (1642 male, 56 female) victims of blast trauma who were assessed according to the GKO scale (standardized system for assessing the severity of trauma and the condition of victims) were admitted to the operating rooms of the Zaporizhzhia Regional Clinical Hospital. 1810 operations were performed. 1 anatomical region – 905 operations; 2 – 354; 3 – 237; 4 – 61; 5 – 27. When assessing the condition of patients according to the GKO scale, it was found that 169 victims had up to 10 points; from 11 to 19 points – 350; 644 patients had 20 – 29 points; over 30 points – 547 victims. Results. Before the operation, there was normotensive and moderate tachycardia. However, in 233 victims, systolic blood pressure was less than 90 mm Hg, which required the use of sympathomimetics and infusion therapy with crystalloids, colloids and blood products. During the operation, sympathomimetics and their combinations were continued in 233 patients. Noradrenaline was used in 179 patients at a dose of 0.1 to 0.4 μg/kg/min, dopamine in 39, adrenaline in 4, mezaton in 11 victims in bolus doses of 20-100 μg. Systolic, diastolic, pulse, mean arterial pressure and heart rate at the stage of completion of the operation did not significantly differ from the baseline. Before the operation, the victims had sub compensated metabolic and respiratory acidosis, an increase in lactate concentration (3.6±0.1 mmol/l). At the stage of the operation, the phenomena of metabolic acidosis increased, respiratory acidosis and an increase pCO2 in the blood persisted. The concentration of lactate in the blood significantly increased, on average to (4.0±0.1) mmol/l (p<0.001). Conclusion. Assessment of the severity of the victims according to the GKO scale allows you to choose the anesthesia technology considering the effect of the anesthetic drugs used on hemodynamics. At the stages of treatment of victims of blast trauma, it was possible to maintain normotensive thanks to infusion-transfusion therapy and vasopressor support. At the end of the operation, mixed decompensated acidosis and increased lactate will require further treatment in the intensive care unit.