The paper presents the results of a comparative study of different routes of intrapulmonary administration of perfluorane under artificial ventilation in patients with acute respiratory distress syndrome of various genesis. It shows the advantages and disadvantages of these routes, their impact on gas exchange, pulmonary biomechanical properties, cardiac hemodynamics, the transport and uptake of oxygen, the duration of respiratory support, and the length of stay in an intensive care unit.

The authors have studied hemodynamic features in explosive mine injury in the presence or absence of a preliminary exposure to premorbid mining factors. A combined influence of premorbid mining factors following an explosive mine injury has been ascertained to induce more severe systemic and cerebral hemodynamic disorders than an isolated explosive mine injury.

The use of the authors’ algorithm of infusion-and-transfusion therapy in combination with nutritive support in victims with shock-induced burn injury within the first 24 hours of severe thermal injury ameliorates the signs of hypermetabolism, prevents protein depletion, provides a positive nitrogen balance, and promotes a rapider healing of burn wounds.

Seventy-eight patients with moderate, severe, and fatal (n = 12) acute intoxication with barbiturates, as evidenced by the measurements of their blood concentrations were examined. Cardiointervalography was made during follow-up ECG in all the patients in order to determine the tension index (TI), a cumulative measure of the tone of the autonomic nervous system. Comparison of clinical, laboratory, and cardiointervalographic data showed that sympathicotonia (TI, 90—160 conventional units) was predominant in moderate intoxication with barbiturates (their concentration was 16.14±3.2 ^g/ml), there was hypersympathicotonia (TI, more than 160 conventional units) in severe intoxication (the concentration of barbiturates, 30.56±7.6 ^g/ml); the increased tone of the parasympathetic portion of the autonomic nervous system — vagotonia (TI, less than 30 conventional units) in fatal intoxication (the concentration of barbiturates, 37.3±6.6 ^g/ml). Moreover, TI decreased with the age of patients and increased with combined intoxication with barbiturates and alcohol (its blood concentration was more than 1 g/l).

A re-entry breathing test has established that progressive hypoxia and hypercapnia cause inhibited gas exchange that are more pronounced in groups of young athletes and schoolchildren. In adult athletes, higher cardiorespiratory resistance is provided by oxygen utilization and the maintenance of the required level of blood flow.

Intensive care of patients with severe brain injury (SBI) should be performed, by taking into account damaging factors. The adequacy of correction of systemic hemodynamics and oxygen support in acute SBI determines the effectiveness of the performed treatment. Sixty-seven patients aged 21 to 68 years who had experienced SBI were examined and treated (28 patients were treated with the routine basic regimen and 39 were treated via goal-oriented correction of damaging factors). A comprehensive examination of the patients was made. The outcomes of therapy were assessed, by using the Glasgow coma scale (GCS). The episodes of hypoxia and arterial hypotension were detected in the virtually equal number of victims (as high as 90%) in both groups. The outcomes of therapy were better in patients without arterial hypotension. The mean blood pressure was maintained at a level of higher than 90 mm Hg; the volume of circulating blood was replenished. Endotracheal intubation was made in patients with depressed consciousness (less than 9 scores by GCS) if hypoxia was retained, which permitted controlled artificial ventilation to be performed. Amino acid drugs, fatty emulsions, hydroexyethyl starch preparations, and balanced enteral formulas were used to correct the internal environment. Goal-oriented correction of damaging factors in Group 2 reduced the number of poor outcomes and death rates.

The paper comparatively analyzes higher mental functions in patients after anesthesia using ketamine and diprivane at surgery for myoma of the corpus uteri. The authors have identified 6 groups of patients with different typological properties of the nervous system. Changes in higher mental functions were comparatively analyzed in the groups of patients with the similar typological properties of the nervous system after different types of general anesthesia. The following conclusions have been made: 1) The use of general intravenous anesthesia using ketamine causes changes in higher mental functions, increased asthenia and mental stress in the patients who have a shift of the balance of nervous processes to their excitability and lability irrespective of the force of the nervous system. This anesthetic procedure is contraindicated in these patients. 2) The use of general intravenous anesthesia using ketamine does not cause higher mental dysfunctions, increased asthenia or mental stress in patients who have an equilibrium of nervous processes or a shift of the balance of nervous processes to their inhibition and inertness irrespective of the force of the nervous system. This procedure is reasonable in these patients. 3) The use of general intravenous anesthesia using diprivane does not cause impaired higher mental functions, increased asthenia or mental stress and it is reasonable in all patients in the postoperative period.

The impact of 12-minute clinical death on congenital and acquired behaviors, the content of biogenic amines, the composition and size of neuronal populations in some regions of the albino rat brain were studied. It was shown that there were postresuscitative changes in emotional responsiveness and position-finding and explorative reactions and impairments in learning and memory processes, and decreases in physical endurance and algesthesia. These processes were associated with the changes in the levels of serotonin and noradrenalin in the frontal cortex of the brain, in those of dopamine and serotonin in the striatum, in some plasma biochemical parameters, and loss of neurons in the sector CA1 of the hippocampus and in the lateral sector of the cerebellum.

An experiment on 106 non-inbred male albino rats undergone 4-minute clinical death from acute blood loss has revealed that the first three days after resuscitation are marked by a concomitance of vascular disorders and cardiomyocytic dystrophic changes, the leading role being played by sludge, stasis, thrombosis, increased vascular permeability, perivascular edema, and hemorrhages. Cardiomyocytic destruction (various contractures, block-like myofibrillolysis, myocytoly-sis) is a structural basis of postresuscitative heart failure. Three days later the heart displayed concomitant processes of recovery and damage. Three types of cardiac morphological changes have been identified in relation to the ratio of these processes.

An experimental model of clinical death followed by reperfusion was used to study the postresuscitative effects of the anti-hypoxant mexidole on lipid composition and peroxidation rates in the rat myocardium. The use of mexidole in early reperfusion was shown to lead to the altered phospholipid composition of cardiomyocytes, the normalization of the activities of superoxide dismutase and catalase, the lower levels of malonic dialdehyde on postresuscitative day 30. Modifications of the myocardium lipid spectrum appeared as the elevated levels of phosphatidylserine and phosphatidylethanolamine that maintained intracellular ionic homeostasis and myocardial performance, as well as decreases in lysophosphatidylcholine having proarrhythmic activity and in sphingomyelin and phosphatidic acids.

It is expedient to assess the quality of the work of nurses delivering anesthesiological and resuscitative care from the scores of the following parameters: the volume of work, the level of vocational education, qualification grade, the observance of ethical norms and norm-setting and legal acts, and the keeping of required medical documents.

The paper presents data on current intensive care methods used in children with comas, which are based on the results of the authors’ own studies and on the data available in the literature. A hundred and fifty-eight children aged 2 to 14 years treated at the resuscitative and intensive care unit for comas of various genesis (hypoxic coma (n = 21), toxic coma (n = 42); cerebral circulatory disorders (n = 28), encephalitis (n = 11), and ketoacidotic coma (n = 56)) were followed up. The time course of changes in major biochemical parameters and free radical lipid peroxidation (FR LPO) was determined. All the patients were found to have significant metabolic disturbances — impaired acid-base balance and water-electrolyte balance, hypoxia and hyper- or hypocapnia, as well as FR LPO activation. In all types of coma, basic therapeutic measures were aimed at eliminating respiratory failure and hypoxia, making corrective and detoxification infusion therapies, sedation, and using neutropic agents. Intensive care is adequately corrected in accordance with the cause of come and with patients’ status.

The impact of laser radiation (LR) on the rate of plasma free radical processes during hypotension and after reinfusion was studied in acute experiments on non-inbred albino rats with prior severe hypovolemic hypotension (blood pressure, 25—30 mm Hg) during 60 min. LR used before blood loss was shown to increase total plasma antioxidative activity and to promote the decreased production of lipid peroxidation products during hypotension. Inclusion of LR into a package of resuscitative measures deteriorates free radical oxidative processes. LR may be a promising method for correcting the excessive rate of free radical oxidation after reinfusion at later rehabilitative stages (after recovery of the energetic potential and adaptation mechanisms).

The Negovsky Memorial Lecture, Given at The Seventh Scientific Congress
of the European Resuscitation Council, Budapest September 2004