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Severe trauma: evolution and outcome predictive models


Author: Arnaut Oleg
Degree:doctor habilitat of medicine
Speciality: 14.00.37 - Anaesthesiology and Reanimathology
Year:2021
Scientific consultants: Aurel Saulea
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Gheorghe Rojnoveanu
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 21 January, 2021
Approved by NCAA on the 27 April, 2021

Abstract

Adobe PDF document – 1.53 Mb / in romanian
Adobe PDF document – 1.51 Mb / in english

Thesis

CZU 616-001-037(043.2)

Adobe PDF document 16.00 Mb / in romanian
395 pages

Keywords

Severe trauma, predictive models, „distant” lesions, protease/antiprotease system

Summary

Structure: introduction, seven chapters, conclusions, bibliography (189 entries), 258 text pages, 83 figures, 89 tables, 41 formulas. Obtained results were published in 77 scientific works.

Study field: Physiology and physiopathology, Anesthesia and Intensive Care Study aim: Elaboration and validation of evolution and outcome predictive models in severe traumas and/or polytraumas for the optimal risk estimation unfavorable evolution within the local medical system.

Study objectives: Analysis of the common traumatic scores used to predict survival/death in a patient with trauma in order to determine the potential score for implementation in the local medical system; Effective variables/biomarkers/risk factors identification in order to develop alternative predictive models for treatment outcomes (survival/death) in severe trauma; Common predictive trauma models validation for the severe trauma population within the Emergency Medicine Institute (EMI) from Chișinău, Republic of Moldova; Development and validation of alternative survival predictive models in severe trauma within the EMI; Comparative evaluation of the developed/validated predictive model/models with the common traumatic scores; Elaboration of predictive models for prolonged artificial pulmonary ventilation (VAP) risk estimation and the effect of pneumonia in UTIR, both being based on the developed/validated alternative predictive scores; Complex analysis of the protease/antiprotease system components in order to predict the „indirect” lesions occurrence in experimental model of severe trauma; „Indirect” injuries intensity predictive scores elaboration for severe trauma experimental model, Protease/antiprotease system destructive/protective potential estimation in polytrauma patients. Elaboration and comparative evaluation of newly developed scores; Principles formulation for creating the National Trauma Register in the Republic of Moldova.

Novelty and scientific originality: in an interdisciplinary study they were validated the usual traumatic scores for national healthcare system, alternative predictive models were developed, protease/antiprotease system components potential in predicting tretment otcomes and “distant” lesions was estimated.

The applied scientific problem of major importance solved: scienticical fundametation of the evaluation / elaboration of predictive scores for the evolution or treatment outcomes for severe trauma, which led to the development of predictive models for severe trauma patients survival rate and development of "distant" lesions, which allowed to stratify patients according to the risk of unfavorable evolution and determine the research directions for the prediction / prophylaxis / treatment of "distant" lesions.

Theoretical significance and applicative value of the paper: The research results filled the gaps in the pathophysiology of severe trauma and allowed to form a system of predictive models for individualizing treatment of severe trauma patients.

Implementation of scientific results: The methodical recommendations were implemented in the daily practice of the Clinic of Anesthesiology and Reanimatology no. 1 „ValeriuGhereg” of EMI, in the teaching process of training medical staff in the Discipline of Physiology and the Discipline of Anesthesiology and Intensive Care, SUMPh „Nicolae Testemitanu”.