Emily
Editor, Senior Moderator
Bielka, K., Kuchyn, I. & Horoshko, V. Intensive care units during the Ukraine war: challenges and opportunities. Intensive Care Med (2023). https://doi.org/10.1007/s00134-023-07117-5
... Pain management and long-term consequences
Acute and chronic pain management has become one of the most significant problems during the war in Ukraine. Approximately 80% of ICU patients injured during war experience severe pain [3]. Pain becomes chronic in nearly 83% of combatants with blast injuries and 75% with gunshot wounds [4]. Post-traumatic stress disorder (PTSD) develops in 82% of traumatized combatants, becoming a national challenge in the future years.
... Resistant wound infections management
Since 2021, we have had a national standard on antibiotic therapy prescription and de-escalation in Ukraine, although it does not include antibiotic therapy guidelines for patients with blast injuries and deep soft-tissue infections. The Joint Trauma System also gives no clear guidance for the treatment of combat trauma-related infections [8]. Combat injuries, especially from blast-related trauma, are usually more complicated than civilian trauma.
Deep soft-tissue infections and osteomyelitis develop in 50–75% of blast-trauma cases and result in substantial mortality [8, 9]. The most common pathogens, which caused wound infections during the war in Ukraine, are Pseudomonas aeruginosa (22.5%), Proteus mirabilis (21.3%), Staphylococcus aureus (23.8%), Streptococcus pyogenes (18.8%), and Escherichia coli (13.8%); with resistant wound infections increasing mortality up to 12% [10]. Almost all patients receive antibiotics from the first day of injury, with nearly 80% being carbapenems, often in combination with vancomycin or fluoroquinolone. As the patient moves from one hospital to another at the stages of evacuation, there is little antibiotic stewardship and heterogeneity in the used dosages and antibiotics in different hospitals. Highly variable antibiotic prescriptions have resulted in selective resistance for frequently used and currently effective antibiotics. Resistant infection also causes delays in patient transfer to specialized centers and surgical treatment due to the need of isolation...
https://link.springer.com/article/10.1007/s00134-023-07117-5
... Pain management and long-term consequences
Acute and chronic pain management has become one of the most significant problems during the war in Ukraine. Approximately 80% of ICU patients injured during war experience severe pain [3]. Pain becomes chronic in nearly 83% of combatants with blast injuries and 75% with gunshot wounds [4]. Post-traumatic stress disorder (PTSD) develops in 82% of traumatized combatants, becoming a national challenge in the future years.
... Resistant wound infections management
Since 2021, we have had a national standard on antibiotic therapy prescription and de-escalation in Ukraine, although it does not include antibiotic therapy guidelines for patients with blast injuries and deep soft-tissue infections. The Joint Trauma System also gives no clear guidance for the treatment of combat trauma-related infections [8]. Combat injuries, especially from blast-related trauma, are usually more complicated than civilian trauma.
Deep soft-tissue infections and osteomyelitis develop in 50–75% of blast-trauma cases and result in substantial mortality [8, 9]. The most common pathogens, which caused wound infections during the war in Ukraine, are Pseudomonas aeruginosa (22.5%), Proteus mirabilis (21.3%), Staphylococcus aureus (23.8%), Streptococcus pyogenes (18.8%), and Escherichia coli (13.8%); with resistant wound infections increasing mortality up to 12% [10]. Almost all patients receive antibiotics from the first day of injury, with nearly 80% being carbapenems, often in combination with vancomycin or fluoroquinolone. As the patient moves from one hospital to another at the stages of evacuation, there is little antibiotic stewardship and heterogeneity in the used dosages and antibiotics in different hospitals. Highly variable antibiotic prescriptions have resulted in selective resistance for frequently used and currently effective antibiotics. Resistant infection also causes delays in patient transfer to specialized centers and surgical treatment due to the need of isolation...
https://link.springer.com/article/10.1007/s00134-023-07117-5
Katarzyna Nowomiejska