Papers by Aleksandar Pavlovic
Serbian Journal of Anesthesia and Intensive Therapy, 2014
Kiseonik je najčešće korišćen lek u urgentnoj medicini. Obzirom da se koristi u lečenju potencija... more Kiseonik je najčešće korišćen lek u urgentnoj medicini. Obzirom da se koristi u lečenju potencijalno štetne hipoksemije on je od krucijalne važnosti u reanimaciji kritično obolelih bolesnika. Međutim, ukoliko se nepravilno koristi, oksigenoterapija može biti nekorisna ili imati štetne posledice. Britansko Torakalno Udruženje (British Thoracic Society-BTS) je objavilo savremene, na dokazima bazirane vodiče za oksigenoterapiju u hitnim stanjima sa ciljem da ukaže na indikacije za bezbednu primenu kiseonika i poboljša kvalitet kliničke prakse. Cilj rada je da upozna anesteziologe, lekare urgentne medicine i ostale zdravstvene radnike sa novim preporukama, kako u urgentnim situacijama ne bi imali dilemu da li treba primeniti kiseonik, na koji način i u kojoj koncentraciji. for many critically ill patients. If supplemental oxygen is used inappropriately it can be useless and it can have significant detrimental effects.The British Thoracic Society has published up-to-date, evidence-based guidelines for emergency oxygen use in order to encourage the safe use of oxygen in emergency situations and improve quality of clinical practice. The purpose of this article is to familiarize anesthesiologists, emergency medicine physicians, and other health care professionals with new recommendations, so that in cases of urgency they would not have the dilemma whether to apply oxygen, in what way and in which concentration.
Zdravstvena zaštita, 2008
Efikasan i pravilan sekundarni transport je sastavni deo ukupnih mera u tretmanu i efikasnom le~e... more Efikasan i pravilan sekundarni transport je sastavni deo ukupnih mera u tretmanu i efikasnom le~ewu politraumatizovanih pacijenata. Pre, ali ponekad i u toku transporta ovakvih bolesnika, bez obzira na vrstu transportnog sredstva, bolesniku je ~esto potrebno obezbediti disajni put, ordinirati kiseonik i infuzione rastvore, prikqu~iti ga na mehani~ku ventilaciju, dati mu sredstva za umirewe bolova i eventualno primeniti i druge lekove. Kontinuirani monitoring vitalnih funkcija je sastavni deo tretmana ovakvih pacijenata u toku transporta. Transport, pored adekvatne opreme, zahteva i dobro teorijski i prakti~no obu~eno osobqe. Ciq ovog rada jeste da ispita organizaciju, kadrovsku i tehni~ku opremqenost ekipa za interhospitalni transport u na-{im uslovima i time prika`e realno stawe u ovom jako bitnom delu ukupnog medicinskog tretmana te{ko povre|enih osoba. 1 Dr med. sc. Aleksandar Pavlovi}, vanredni profesor na predmetu anesteziologija, Medicinski fakultet u Pri{tini -Kosovska Mitrovica, spec. anesteziologije sa reanimatologijom; Urgentni centar Klini~kog centra Srbije, Beograd. 2 Dr med. Ana Jovanovi}, saradnik u nastavi na predmetu Anesteziologija, Medicinski fakultet u Pri{tini -Kosovska Mitrovica, spec. anesteziologije sa reanimatologijom; Urgentni centar Klini~kog centra Srbije,
Acta Poloniae Pharmaceutica, Jan 20, 2023
Acute pancreatitis (AP) is an inflammatory disease of the pancreas that causes local damage and s... more Acute pancreatitis (AP) is an inflammatory disease of the pancreas that causes local damage and systemic inflammatory response. Some of the numerical scoring systems used in the intensive care unit for the assessment of critically ill patients such as APACHE II and MEWS score could be used for AP, besides the scoring systems specific to AP (Ranson score, Pancreas score, BISAP). Therefore, the aim of this study was to examine the significance of inflammatory biomarkers and scoring systems in the evaluation of the severity of AP and outcomes. The study was conducted as a cohort prospective study, examining patients with AP, of both sexes. Laboratory analyses, as well as the scoring systems: Ranson, Pancreas score, Bedside Index of Severity in Acute Pancreatitis (BISAP), and Acute Physiology and Chronic Health Evaluation II (APACHE II) were collected on day zero and 48h after admission. The study included 50 patients of whom 8 died. The most reliable score for predicting AP severity was APACHE II0 and 48AUROC (0.753; 0.768) in relation to the inflammatory biomarkers. For initial prediction of the treatment outcome, APACHE II0, BISAP0, and CRP0 AUROC (0.813; 0.807; 0.753) had the highest discrimination rates and after 48h, APACHE II48, Ranson48, BISAP48, and Pancreas48 AUROC (0.917; 0.856; 0.789; 0.729). There was a statistically significant correlation between CRP0 and BISAP 0 (p = 0.006) and between PCT and all day-zero scores. All tested screening systems showed reliability in predicting AP severity and treatment outcomes. The best predictive power was demonstrated by the APACHE II score.
Resuscitation, Oct 1, 2013
Poster Presentations / Resuscitation 84S (2013) S8-S98 period. The second part of the study was a... more Poster Presentations / Resuscitation 84S (2013) S8-S98 period. The second part of the study was a knowledge test in BLS and ALS measures of CPR. Results: In the examined groups, during the specialization, CPR training was most present in anesthesiology and emergency medicine (score 10). Training in CPR during specialization in internal medicine (score 7), general medicine (score 6) and surgery (score 5) is similar. Lack of training in CPR is present in ophthalmologists and dermatologists (score 2). Knowledge of CPR is minimally monitored in physiatrist and psychiatrist (grade 3) and the lowest results we get from the ophthalmologists and dermatologists (score 2). All examined physicians in their professional practice had to perform CPR. Testing knowledge of BLS and ALS showed that the high level of knowledge had anesthesiologists, cardiologists and emergency medicine specialists (89-100% correct answers), then surgeons and gynaecologists (44-68% correct answers) and the lowest level of CPR knowledge had ophthalmologists, physiatrist and psychiatrist (22-38% of correct answers). Conclusion: Specialists who work with the life-threatening patients are most familiar with CPR measures. Physicians with others medical specializations also need to have basic CPR skills which require reorganization of their education.
Case Reports in Emergency Medicine
Case Report. The case of a drowning teenager is described involving application of cardiopulmonar... more Case Report. The case of a drowning teenager is described involving application of cardiopulmonary resuscitation (CPR) by an untrained rescuer in the field and fast transport to a hospital enabling a positive resuscitation outcome despite an underorganized emergency medical service in a rural area. In our case hypoxia led to extended functional disorders of the cardiovascular system, which fully recovered after adequate therapy. Conclusion. Knowledge about BLS measures by ordinary citizens, together with continuous education of health professionals concerning modern techniques of CPR, is crucial for increasing the number of patients surviving after cardiac arrest.
Srpski arhiv za celokupno lekarstvo, 2018
Introduction. Thrombophlebitis of the internal jugular vein may appear as a rare complication of ... more Introduction. Thrombophlebitis of the internal jugular vein may appear as a rare complication of oropharyngeal infection and tonsillectomy procedure. Clinical features usually include an acute onset of inflammation with formation of venous thrombosis and secondary septic propagation (Lemierre?s syndrome). The aim of this work was to present a rare case of internal jugular vein thrombophlebitis as a late complication following tonsillectomy. Case outline. We present an otherwise healthy 25-year-old male patient on whom tonsillectomy was performed due to chronic tonsillitis. Two weeks after surgery, the patient was rehospitalized for high temperature, diffuse swelling on the left side of the neck, fatigue, painful swallowing, and constrained mouth opening. Thrombophlebitis of the left internal jugular vein was diagnosed by the neck ultrasound. Complete recovery was achieved in three weeks? time by the combination of antibiotics and anticoagulant/ antithrombotic therapy. Conclusion. To...
Srpski arhiv za celokupno lekarstvo, 2019
Introduction/Objective. In this study, the effects of applied anesthetic techniques were investig... more Introduction/Objective. In this study, the effects of applied anesthetic techniques were investigated in a retrospective analysis of obese patients and those with normal body mass index undergoing in vitro fertilization, using bispectral index as an indicator of anesthetic depth. Methods. In total 116 patients with normal body mass index were allocated to group N. Another 116 patients with body mass index > 30 kg/m2 were allocated to group O. Anesthetic protocol comprised midazolam for premedication, diclofenac for pre-emptive analgesia, propofol for induction and maintenance, alfentanil for analgesia, suxamethonium for muscle relaxation. We recorded and compared the monitored parameters using t-test and ?2 test. Results. Procedure duration and recovery time were significantly longer in O group (p < 0.01). There is a statistically significant difference (p = 0.000181) in the number of patients requiring mechanical ventilation after induction of anesthesia. Propofol consumption...
Vojnosanitetski pregled, 2016
Background/Aim. Cancers of the lip, oral cavity and pharynx (LOCP) are frequently grouped togethe... more Background/Aim. Cancers of the lip, oral cavity and pharynx (LOCP) are frequently grouped together mainly because they have similar risk factors. The incidence rate of these cancers varies worldwide depending on the geographic location. The aim of this study was to determine trends in age-standardized incidence rates of LOCP cancers in the Belgrade population during a 12-year period, from 1999 to 2010. Methods. From The Serbian Cancer Registry (The Registry), we extracted all cases of LOCP cancers registered in Belgrade from January 1, 1999 to December 31, 2010. Joinpoint regression analysis was used to define trends and annual percentage change (APC). Results. A total number of 2,025 (1,509 in men and 516 in women) LOCP cancers were reported to the Registry during the study period. The age standardized rate (ASR) for the entire period and for all LOCP cancers, was 6.24 per 100,000 persons (10.35 for men and 2.86 for women). ASR for lip cancers decreased (p < 0.001) during the st...
Praxis medica, 2019
Hronična opstruktivna bolest pluća (HOBP) značajno smanjuje kvalitet života i jedan je od glavnih... more Hronična opstruktivna bolest pluća (HOBP) značajno smanjuje kvalitet života i jedan je od glavnih uzroka hroničnog morbiditeta i mortaliteta širom sveta. Akutna egzarcerbacija HOBP (AEHOBP) je životno-ugrožavajuće stanje i podrazumeva naglo pogoršanje respiratornih simptoma (pogoršanje dispneje, kašlja i/ili obilna produkcija sputuma) koje zahteva urgentno lečenje. Ovaj pregledni članak ispituje dokaze koji obuhvataju primenu oksigenoterapije i ventilatorne podrške u toku egzarcerbacije HOBP. U uvodu smo razmotrili epidemiologiju i patofiziologiju hiperkapnijske respiratorne insuficijencije, a zatim smo objasnili da je ključ za postizanje adekvatne oksigenacije primena kontrolisane oksigenoterapije niskim koncentracijama kiseonika. Kod bolesnika koji su u riziku od hiperkapnije, ciljna vrednost zasićenja hemoglobina kiseonikom (SaO) je u rasponu od 88-92%, dok se hiperkapnija ne isključi gasnim analizama arterijske krvi. Međutim, ako je vre-2 dnost parcijalnog pritiska ugljen-dioksida u arterijskoj krvi (PaCO) normalna, ciljne vrednosti SaO mogu biti u rasponu od 2 2 94-98%. Mnogi bolesnici sa HOBP su stabilni pri nižim vrednostima SaO tako da kod njih, ukoliko se dobro osećaju, ne treba 2 težiti za postizanjem uobičajenih vrednosti SaO (94-98%). Dalje smo istražili važeće preporuke za primenu ventilatorne 2 podrške kod bolesnika sa AEHOBP. Neinvazivna ventilacija je preuzela važnu ulogu u lečenju bolesnika sa akutnom respiratornom insuficijencijom nastalom zbog AEHOBP. Primena invazivne mehaničke ventalicije je poslednja opcija i povezana je sa lošim ishodom.
Srpski arhiv za celokupno lekarstvo, 2017
Even today, when over 3.5 billion passengers travel on commercial flights each year, there is con... more Even today, when over 3.5 billion passengers travel on commercial flights each year, there is confusion about the duties and role of doctors and other licensed medical professionals volunteering to provide assistance to a passenger whose life is in jeopardy, especially when it comes to measures of cardiopulmonary resuscitation in the distinctive conditions of an airborne commercial aircraft. There are still no international, standardized guidelines, rulebooks, or instructions applying to all airlines when it comes to training and organizing the cabin crew, equipping emergency medical kits and covering the role of medical professionals volunteering their services in medical emergency situations. The aim of this work was to attempt to solve a common quandary among medical professionals when it comes to airplane travel. Based on the available literature, national and regional guidelines and rulebooks of airlines, in accordance with the ethical and legal principles binding medical profe...
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, Jan 6, 2017
Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinic... more Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice. Controlled hypotension, as a strategy of lowering patient's blood pressure during anesthesia has been practiced for decades in head and neck surgery. The aim of our study was to determine the incidence and the risk factors for intraoperative bradycardia in maxillofacial, ear, nose and throat surgery, as well as to determine whether controlled hypotension affects the occurrence of IOB. The retrospective study included 2304 patients who underwent maxillofacial, ear, nose or throat surgery. We studied the influence of: sex, age, comorbidity, type of surgery, duration of anesthesia and controlled hypotension on the occurrence of IOB. IOB was registered in 473 patients (20.5%). Patients with controlled hypotension had IOB significantly more often than patients without controlled hypotension (33.9 vs 15.1%) (p = 0.000). The significant predictors of IOB were: age (...
Acta chirurgica iugoslavica, 2008
Because the supply of cadaveric organ donors is limited and their ICU management is complex, a mu... more Because the supply of cadaveric organ donors is limited and their ICU management is complex, a multidisciplinary, well-coordinated, and institutionally supported approach to management is essential to ensure the maintenance of the current supply and to increase the future supply of organs and tissues that are suitable for transplantation. The potential organ donor is at high risk for instability as a direct consequence of the loss of physiologic homeostatic mechanisms that are dependent on functioning of the central nervous system. The keys to successful ICU management of the potential organ donor include a team approach that is focused on the anticipation of complications, appropriate physiologic monitoring, aggressive life support, with frequent reassessment and titration of therapy.
Srpski arhiv za celokupno lekarstvo, 2017
While the use of simulation in medical education has a long history, it has seen its greatest str... more While the use of simulation in medical education has a long history, it has seen its greatest strides in the past 15-odd years. It may be defined as imitation, artificial while at the same time faithful, of various clinical situations through well-crafted medical ?scenarios? where, instead of actual people, we use standardized patients: plant, animal, or synthetic models, computerized interactive manikins ? simulators, with audiovisuals, as well as medical equipment used in everyday clinical practice. The fundamental goal of using simulation in medical education is an optimal balance between professional education on the one hand and complete safety and protection of patients on the other. Depending on the available finances and the level of advancement of the healthcare and education systems, medical simulation can take various forms ? from simple improvisation to the creation of a high-fidelity simulation in centers for medical simulation. Our example shows that, even with modest ...
Acta veterinaria, 2006
In this study, we wanted to determine the effectiveness of endotracheal (ET) adrenaline administr... more In this study, we wanted to determine the effectiveness of endotracheal (ET) adrenaline administration on an anesthetized model of dog in hypoxia and cardiac arrest. We wanted to simulate the most frequent clinical state where urgent administration of drugs is necessary, but it's difficult to provide an intravenous (IV) route. Healthy dogs (n=37) were used for this study. They were anesthetized, endotracheally intubated and ventilated mechanically. A precordial lead II ECG was recorded throughout the experiment. The animals were provided with arterial and central venous lines. During the experiment we measured arterial blood pressure (SP, DP, MAP) by an invasive technique, central venous pressure by H 2 O manometer, hearth rate, acid-base value, glycemia and electrolytes. Control group: after IV adrenaline administration, concentrations in the arterial blood were continually measured. I exp. group: Under equal conditions, we used ET route for adrenaline administration whereby measuring their concentration and following their haemodynamic effects. In exp. group II adrenalin in a dose of 1.5 mg was administered endotracheally using the same tehnique as in group I. In the second part of the experiment, ET administration of adrenaline under conditions of cardiac arrest was studied. Hypoxia and cardiac arrest were induced by disconnecting from the breading machine. The influence of ET adrenalin administration on lung tissue were established by histophatological analysis and acid-base values. The maximum concentration of adrenalin in the blood after the ET route are almost equal to the concentrations of the drugs after IV administration, but ET doses of adrenaline must be higher than IV doses. Adrenalin was retained in the blood for a longer period after ET administration than after IV route. As the optimal solvent for adrenalin we recommend 0.9% NaCL, and we recommend using a long cateter via the endotracehal tube deep in to the tracheobronchial system as the optimal technique for ET administration. Hypoxia and cardiac arrest do not derange absorption of drugs after ET administration. By measuring the concentration of adrenalin in arterial blood following their haemodynamic effects in different experimental conditions and by evaluating the successfulness
Srpski arhiv za celokupno lekarstvo, 2018
Ultrasound is becoming increasingly available and incorporated into emergency medicine. Focused e... more Ultrasound is becoming increasingly available and incorporated into emergency medicine. Focused echocardiographic evaluation in resuscitation (FEER) is a training program available to emergency doctors in order to ensure adequate application of echocardiography in the cardiac arrest setting. The FEER protocol provides an algorithm, whereby a "quick view" can be provided in 10 seconds during minimal interruptions in chest compressions. Performing ultrasound in the cardiac arrest setting is challenging for emergency doctors. The International Liaison Committee on Resuscitation recommend the 'quick look' echocardiography view can be obtained during the 10-second pulse check, minimizing the disruption to cardiopulmonary resuscitation.
Journal of Veterinary Science & Technology, 2018
Introduction: The aim of this study was to evaluate how the applied positive ends expiratory pres... more Introduction: The aim of this study was to evaluate how the applied positive ends expiratory pressure and prone position affected patho-histological changes in lungs, as well as parameters of ventilation, oxygenation and acidbase status in the first hours after aspiration in experimental animals. Methods: This prospective study included 15 experimental animals. The acid aspiration pneumonitis was induced by infusing gastric juice (2 ml/kg body weight) into the tube lumen during two-minute ventilation. In the first group, conventional ventilation with a tidal volume of 15 ml/kg body weight was applied. The piglets of the other group were ventilated at lower tidal volume (6 ml/kg body weight) whereas the third group received protective lung ventilation (Vt-6 ml/kg and positive end-expiratory pressure of 5 to 10 cm H 2 O) Results: Ventilation with a volume of 15 ml/kg body weight resulted in the formation of announced alveolar and interstitial edema, distension and rupture of alveoli, air leaks in lung tissue, pronounced cellular infiltration and pulmonary hemorrhage. Ventilation at a low tidal volume is characterized by micro atelectasis, alveolar collapse and pronounced cellular infiltration in interstitial and alveolar spaces. The absence of alveolar and interstitial edema, micro atelectasis, significant cellular infiltration predominantly in the pulmonary region, moderately distended alveoli and dilated small airways characterize protective ventilation of the lungs. Conclusion: Lung protective ventilation in the first hours after aspiration can prevent and/or reduce the progression of lung injury.
Serbian Journal of Experimental and Clinical Research, 2019
The aim of this study was to determine the significance of the use of the BISAP score, which is s... more The aim of this study was to determine the significance of the use of the BISAP score, which is specific for patients with AP, in relation to the application of the MEWS score that is important for assessing the condition of critically ill patients in intensive care units, but is not specific for patients with AP. The research was conducted as a cohort prospective study and included patients of both sexes, older than 18 and diagnosed with AP. BISAP and MEWS score were monitored at least at four time points: on admission to the hospital (zero), 48 hours, 72 hours and 7 days after admission to the hospital. High levels of discrimination between patients with fatal outcome and cured patients are determined in both cases, with discrimination at MEWS being somewhat higher than BISAP score. The BISAP0 had the best discrimination for BISAP score, AUROC (0.807) and also MEWS0 for MEWS score, AUROC (0.899). In our research, the highest sensitivity was shown by BISAP7d (92.1%) and MEWS48 (88....
Praxis medica, 2016
Evaluacija SOFA skora tokom boravka bolesnika u JIL je dobar prognostički indicator u proceni ish... more Evaluacija SOFA skora tokom boravka bolesnika u JIL je dobar prognostički indicator u proceni ishoda lečenja. Ovo istraživanje ima za cilj da utvrdi značaj SOFA skora u proceni pojave komplikacija, dužine boravka na mehaničkoj ventilaciji (MV), dužine boravka u JIL i ishoda lečenja lečenju bolesnika sa sepsom i/ili septičnim šokom u JIL. U jedogodišnjoj prospektivnoj studiji ispitano je 60 kritično obolelih pacijenata. Nakon prijema u JIL je izračunavan APACHE II skor, a tokom daljeg tretmana u JIL, bolesnici su ocenjivani SOFA skorom 24, 48, 72 sata i sedam dana nakon prijema. kPraćeni su dužina boravka u JIL, broj dana provedenih na MV i preživljavanje. Pacijenti koji su završili smrtnim ishodom bili su starije životne dobi u odnosu na grupu preživelih, proveli su značajno veći broj dana na MV i češće su imali septični šok kao komplikaciju (63%). Ukupan broj dana provedenih u JIL nije bio statistički značajan između ove dve grupe, za razliku od vremena provedenog na MV, gde je zabeležena statistički značajna razlika. Najbolju kalibraciju imao je SOFA 7d (0.85), što znači da ima imao najmanji statistički značajan nesklad između očekivanih i opserviranih smrtnih ishoda. Skor sa najboljom diskriminacijom između bolesnika sa smrtnim ishodom i bolesnika koji su preživeli je SOFA 7d ; AUROC (0.981). Naše istraživanje je pokazalo da svakodnevna evaluacija SOFA u JIL omogućuje predviđanje pojave komplikacija, trajanja MV i dužine boravka bolesnika u JIL. Vrednost SOFA izračunavan 7 dana pokazao je najbolju moć diskriminacije i kalibracije.
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Papers by Aleksandar Pavlovic