This review, written on the occasion of the 70th anniversary of the Institute for General Reanimatology of the Russian Academy of Medical Sciences, provides an update of recent research in the field of resuscitation medicine carried out at the Safar Center for Resuscitation Research at the University of Pittsburgh School of Medicine. Current and recent studies describing bench to bedside investigation in the areas of traumatic brain injury (TBI), cardiopulmonary arrest, hemorrhagic shock, and ultra-novel approaches to resuscitation are discussed. Investigation in TBI across a variety of topics by many investigators including mechanism of neuronal death, oxidative and nitrative stress, proteomics, adenosine, serotonin, novel magnetic resonance imaging application, inflicted childhood neurotrauma, and TBI rehabilitation is addressed. Research discussed in the program of cardiopulmonary arrest includes optimization of the use of mild hypothermia and novel investigation in experimental asphyxial cardiac arrest. In the program on hemorrhagic shock, our recent work on the application of mild hypothermia to prolong the «golden hour» is presented. Finally, a brief overview of our studies of a novel approach to the resuscitation of exsan-guination cardiac arrest using emergency preservation for resuscitation (EPR) is provided.

Objective: to study the incidence and pattern of cardiac arrhythmias and other abnormalities in the early posttraumatic period of experimental cardiac contusion and to assess their contribution to death and the development of posttraumat-ic myocardial dysfunction.

Materials and methods: experiments were carried out on non-inbred albino male rats anesthetized with sodium thiopental. An electrocardiogram, respiration rate, and left carotid blood pressure were recorded in the direct fashion. Cardiac contusion was reproduced by an original device that imitated a blow of the steering wheel to the anterior chest, as that observed when a moving car clashed against an obstacle. Some animals were traumatized after preadministration of atropine sulfate.

Results: sinus bradycardia accompanied by bradypnoea or short-term apnoea and lowered blood pressure is a compulsory and persistent ECG abnormality. Preinjection of atropine significantly prevents the occurrence of these changes and points to the likely reflectory mechanism of their development. Other ECG abnormalities (heterotopic rhythms, premature beats, conduction blockade, terminal ventricular complex changes, etc.) are encountered in a variety of combinations, including those among which typical changes that are undetectable, are diverse, short-term, and labile. Among them, there are virtually no hemodynamic and potentially fatal arrhythmias.

Conclusion: in experimental isolated cardiac contusion, the pattern of cardiac arrhythmias differs from that observed in the inpatient setting. Cardiac arrhythmias and other ECG abnormalities do not make a considerable contribution to a mortality rate under the conditions of this experiment since there are no hemodynamic ones.

 

Polytrauma is one of the main causes of death in modern medicine. It is characterized by the particular severity of clinical manifestations and attended by significant impairments of the body’s vital functions, by diagnostic difficulties, and treatment complexity. In Kuzbass, as many as 8 thousand victims annually die from severe injuries. Death rates amount 21—22% in specialized hospitals and up to 60% or more in unspecialized hospitals. On the basis of multidisciplinary medical centers, an effective network of health care facilities (HCF) is being set up to render a specialized medical aid to patients with polytrauma. The application of expensive medical diagnostic and therapeutic technologies reduces the rates of morbidity and disability among patients with polytrauma. A specialized medical aid cannot be rendered to all victims without solving the problems of their transportation to a specialized center. Of the greatest difficulty is the transportation of critically ill patients with polytrauma and unstable hemodynamics when artificial ventilation is used during transportation. The transportation service set up in the Center of Miners’ Health Care in the specialized polytrauma center is engaged in the development of the problems of safe transport of this category of victims. Organizational problems are to collect information on victims, to form a specialized team and to supply the latter with equipment. Therapeutic-and-diagnostic problems are to additionally evaluate the status of victims at the scene (in an unspecialized HCF, if required, in and around the area of an accident), to prepare a patient before transportation; to provide a complete set of intensive therapy during interhospital transportation of patients with polytrauma in relation to the predominant component of a damage. In the authors’ opinion, solution of this group of problems can enhance the efficiency of intensive care during transportation and reduce mortality rates in this category of patients.

 

The purpose of the present investigation was to study the levels of triglycerides, cholesterol metabolism, a number of biochemical plasma parameters, and the elastic properties of the arterial wall in the late period in victims with severe mechanical injury (SMI) and impaired hemodynamics.

Material and methods. The investigation included 13 persons who had experienced SMI and blood loss with impaired hemodynamics. This involved three stages: 1) at the end of the first day; 2) on days 15—30 following injury; 3) 1—5 years after SMI. The concentrations of triglycerides, total cholesterol, and high-density lipoprotein (HDL) cholesterol and the activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase were determined. Very low-density lipoprotein and low-density lipoprotein (LDL) cholesterols were calculated by the Friedwald formula. An oscillometric analyzer (APKO-8-RITs) was used to record central hemodynamic parameters and vascular elastic properties.

Results. There was a decrease in cholesterol levels and an increase in AST and ALT activities at the end of the first day. The activity of alkaline phosphatase was in the normal range. There was a reduction in AST and ALT on days 15—30 after injury. Enhanced alkaline phosphatase activity was observed at the same time. There was a considerable decrease in HDL cholesterol with the normal level of LDL cholesterol. The level of total cholesterol was in the normal range. The activities of AST and ALT were in the normal range at Stage 3 following 1—5 years after injury. At the same time, the activity of alkaline phosphatase remained increased. The content of HDL cholesterol having antiatherogenic properties remained lower although this parameter tended to become normal: there was an average increase by 33.9%. There was a decrease in arterial wall compliance and an increase in the speed of pulse wave propagation in the group of the examinees.

Conclusion. The change in biochemical parameters in victims in the late period after SMI suggests that there is a gradual tendency for the parameters of lipid metabolism to normalize. The results of a study of the elastic properties of the arterial wall are indicative of increased vascular rigidity in the victims in the late period after SMI along with hemodynamic disorders.

 

Changed lipid metabolic parameters in parallel with a blood loss volume were studied in patients with severe mechanical injury, which were comparable by the APACHE II scale severity. The study indicated the elevated levels of atherogenic fractions with the increased blood loss volume that was significantly pronounced when it was 37 ml/kg or more. A rise of the cholesterol atherogenicity index also occurred with the higher blood loss volume. Changes in the lipoprotein spectrum with a blood loss volume of 25 ml/kg or more preserve within a rehabilitative month. In severe mechanical injury, normalization of the lipid spectrum promotes the use of perfluorane. It is concluded that blood loss predominantly affects the lipoprotein spectrum in severe mechanical injury.

 

The time course of changes in myocardial lipid peroxidation processes was studied in an experiment on albino male rats that had experienced 4-minute clinical death. There was an alternation of periods of a significant increase (minute 90, hours 3—6, and days 1—3 and 14) and a decrease (days 7, 21, and 30) in the rate of lipoprotein processes and corresponding changes in the content of lipid hydroperoxides and Schiff s bases. Activation of lipid peroxidation processes occurred with deficiency of bioantioxidants and with inhibition of enzymes that made antiradical and antiperoxide protection of cardiomyocytes.

acute fatal hemorrhage; resuscitation; heart; lipid peroxidation

The study was undertaken to develop a method for detection of occult damages to erythrocytic membranes exposed to a pulsed electric field, ionizing radiation of various nature, the blood substitute perfluorane, and some chemicals. The experimental results led to the conclusion that calibration electroporation was effective in identifying occult erythrocytic membrane damages when perfluorane was administered at different concentrations and when y-radiation was used in small doses (0.5—10 cGy). Non-additivity of the rate constants of a reduction in the suspension count of red blood cells was observed when perfluorane was added or when y-radiation and a pulsed electric field had impact on biological membranes.

 

A rat model of experimental hyperhomocysteinemia (HHC) caused by chronic folic acid deficiency was used to study the impact of swimming stress on the values of agonist-induced platelet aggregation and ATP release. At week 8 of HHC development, platelet aggregability and ATP levels in response to test inductors (ADP, thrombin, and collagen) moderately increased. After stress, the rate of platelet aggregation showed a more increase in rats with HHC; however, the increment was less pronounced than in the control group. The similar changes was observed in ATP, the release of which from dense platelet granules decreased in the experimental animals exposed to stress changes as compared to the controls. The experimental findings suggest that the stress potentiates platelet dysfunction in HHC.

 

Objecive: to estimate hemostatic parameters in 15 cardiosurgical patients with chronic coronary heart disease. Ten parameters of the hemostatic system were determined at 4 stages. The patients were divided into 2 groups in relation to the baseline level of D-dimers. The study demonstrated that hypercoagulation and depressed fibrinolysis retained despite the baseline coagulative potential and the performed therapy in all the patients before discharge. It is obvious that the standard approaches to diagnosing hemostatic disorders and correcting them should be revised.

 

Objective: To determine the specific features of responsiveness of the blood aggregation system (BAS) in relation to the functional state of an organism and to the intensive care regimen in patients with sepsis and posthemorrhage.

Materials and methods. A hundred and sixteen patients with massive hemorrhage and 108 with pyoseptic complications were examined. The baseline values of the stable millivolt-range potential were recorded, which were used to correct intensive care. The condition was evaluated by the SAPS II, APACHE III, and MODS scales.

Results. The optimization of treatment for multiple organ dysfunction in a subcompensated functional state is to enhance sedation, to eliminate dehydration and vasospasm, to improve rheological blood properties, and to make early membrane detoxification. In a decompensated functional state, the main optimization goals include activation of the central nervous system and elimination of tissue hyperhydration, membrane detoxification with dehydration, inotropic support, activation of the antinociceptive system, prevention of thrombotic events, antibiotic therapy — deescalation.

Conclusion. The promptest normalization of BAS creates objective prerequisites for a good outcome; at the same time this leads to the conclusion that correction occurs more rapidly and more effectively in patients receiving the optimized treatment regimen, as evidenced by constant potential recording.

The purpose of the study was to determine whether abdominal pressure could be monitored in patients with acute pancreatitis, pancreonecrosis after endoscopic drainage of the abdomen.

Materials and methods. The results of abdominal pressure monitoring were analyzed in 94 patients with acute pancreatitis, fatty or hemorrhagic pancreonecrosis. According to the severity and duration of abdominal hypertension, the patients were divided into 3 groups. The authors analyzed their condition by the APACHE II scale, abdominal pressure, the duration of its elevation, an abdominal pressure response to peritoneal lavage, the pattern and number of organ dysfunctions.

Results. In patients with acute pancreatitis or pancreonecrosis, a long abdominal pressure rise occurs in 41.5% of cases despite laporoscopic drainage of the abdomen. A correlation between the evaluation of their condition by the APACHE II scale and abdominal pressure starts when grade 1 abdominal hypertension develops. The upper range of subjective abdominal hypertension tolerability is 26.4±3.24 cm H2O.

The present study was undertaken to analyze the efficacy of inhaled nitric oxide (iNO) in the prevention and treatment of intraoperative gas-exchange disorders during operations on the ascending aorta with hypothermal circulatory arrest. The study included 22 patients aged 16—67 years. It revealed that the use of iNO substantially improved arterial oxygenation at surgery with hypothermal circulatory arrest. The preliminary findings suggest that the preventive use of iNO during extracorporeal circulation improves the clinical course of patients after surgery with hypothermal circulatory arrest.

The paper gives the data of preoperative evaluation of autonomous nervous system tone and its correction, pharmacokinetics of local anesthetics in the subarachnoidal space, as well as the optimization of a procedure for spinal anesthesia in patients operated on for lumbosacral radiculitis.

 

The investigation was undertaken to study the hemodynamic and metabolic effects of modified (with elevated glucose and insulin levels) glucose-insulin-potassium (GIP) mixture in the correction of acute heart failure in cardiosurgical patients. After infusion of the modified GIP mixture (0.9 g of glucose per kg body weight and 3.75 units of insulin per g glucose), in 15 patients (12 males and 3 females) aged 35 to 72 (54±5) years the increase (p<0.05) in cardiac index and stroke volume index was 21% with simultaneous 20 and 17% decreases in pulmonary wedge pressure and mean pulmonary pressure, respectively (p<0.05). The duration of infusion was 5 hours. A steady-state improvement of cardiac pump function and metabolic parameters could reduce the dosage of cardiotonic drugs 12 hours after administration of the modified GIP mixture. During and after administration of the mixture, the blood levels of glucose and potassium were substantially unchanged. In the study group, all the patients survived. The duration of a resuscitative period was 2.4±0.2 days. With the management protocol used, infusion of the modified GIP mixture was favorable to the steady-state improvement of cardiac pump function without carbohydrate and electrolyte homeostatic impairments.

acute heart failure; glucose-insulin-potassium mixture

Objective: to study the venous blood levels of adrenocorticotropic hormone (ACTH), cortisol, thyrotropic hormone, and thyroxin in females with severe gestosis in the perioperative period and to develop a method for correction of the hormonal status.

Materials and methods. Eighty and nine females in whom delivery had been performed under spinal anesthesia were divided into groups: a control group that comprised females with uncomplicated pregnancy; Group 1 included 26 females with severe gestosis to whom the conventional intensive care was delivered; Group 2 consisted of females with severe gestosis who received in the complex with intensive care the developed hormonal status correction scheme: dexamethasone, 8 mg, was intravenously injected during the development of spinal block; after its development, dalargin, 50  µg/kg/hr was used before the end of surgery; dexamethasone was intravenously given in a dose of 4 mg twice daily during 3 postoperative days. The levels of the hormones were determined by enzyme immunoassay over time: Stage 1 — before surgery; Stage 2 — during surgery; Stages 3, 4, and 5 — on postoperative days 1, 3, and 5, respectively.

Results: In physiological pregnancy, a response of the hormonal adaptive system to surgical delivery develops in a certain order: the increased activity of the pituitary-adrenal system with the maximum levels of ACTH and cortisol during surgical delivery gives way to the activation of the pituitary-thyroid system with the achieved maximum level of thyroxin on postoperative day 5. Progression of gestosis to its severe degree is accompanied by a relative reduction in the functional capacities of the pituitary-adrenal system and thyroid. Surgical delivery under spinal anesthesia is attended by the activation of the pituitary-adrenal system, followed by the development of depletion. At this background, postoperative early compensatory activation of the pituitary-thyroid system promotes a relative insufficiency of thyroid functional reserves. At the same time, hormonal provision of postoperative restorative processes is impaired. The stress-limiting effect of the neuropeptide dalargin leads to the rationally inhibited hormonal secretion of the pituitary-adrenal system during surgical intervention in females with severe gestosis and, in combination with replacement therapy with dexamethasone, preserves hormonal reserves in the postoperative period. Correction of relative hypocortisolemia prevents the development of early activation of the pituitary-thyroid system and the depletion of thyroid functional reserves, and normalizes the sequence of activation of endocrine glands.

 

The paper presents the results of a study of the antioxidative and hematoprotective properties of pyrimidine derivatives: 1,3,6-trimethyl-5-hydroxyuracil and 3,6-dimethyl-5-hydrpxyuracil versus the synthetic antioxidant tonarol, а-tocopherol acetate, and the antihypoxant ethomerzole. In model systems of varying complexity, the antiradical activity of pyrimidines and their effects on spontaneous, ascorbate- and NADPH-dependent lipid peroxidation processes, as well as their protective activity were studied in different types of hypoxia. The pyrimidine derivatives were found to have the high antioxidative activity comparable with that of ionol. 1,3,6-trimethyl-5-hydroxyuracil has antihypoxic activity. Dichloroethane induced acute toxic hepatitis whose major manifestations were cytolysis, cholestasis, lipid metabolic disturbances, and an activated lipid peroxidation response. 1,3,6-trimethyl-5-hydroxyuracil limits the cytotoxic and cholestatic activity of dichloroethane, stabilizes lipid metabolism and lipid peroxidation reactions, and increases life span and survival in rats.

 

The objective of the study was to assess the diagnostic and prognostic value of the parameters of lipid peroxidation and endogenous intoxication in abdominal sepsis. For this purpose, the authors conducted a prospective study of 36 patients diagnosed as having generalized peritonitis, abdominal sepsis. According to the clinical and laboratory characteristics of the severity of sepsis, the patients were divided into 3 groups. A group of patients with the manifestations of abdominal sepsis without organ dysfunction was characterized by the activation of lipid peroxidation, the high activity of antioxidant defense and the moderate level of endogenous intoxication markers. A group of patients with the manifestations of severe sepsis and multiple organ dysfunction showed high lipid peroxidation processes and lowered antioxidant activities. A group of patients with septic shock displayed accumulation of lipid peroxidation products and inhibition of activity of enzymatic antioxidants, and high levels of endogenous intoxication markers, which was followed by the highest mortality rates in the compared groups.

 

Ischemic and early postresuscitative lipid peroxidation (LPO) changes in the cortex and subcortical structures of the brain, the left and Spiegelian lobes of the liver, the cortex and medulla of the kidney, and plasma were studied in experiments on cats, by using a model of 5-minute clinical death from long-term blood loss. At death and in the early postresuscitative period, the LPO changes were ascertained to have qualitative, quantitative, and temporary differences not only in various organs, but also in various structures of the same organ. Excessive reperfusion was shown to play a leading role in postresuscitative LPO activation in the brain. At the same time, the high rate of LPO was not always followed by adequate tissue and plasma accumulation of LPO products and it was revealed only in rather long incubation of homogenates. Not only hyperreperfusion activation of lipid peroxidation, but also its excessive inhibition caused by antioxidantive agents was established to adversely affect resuscitation after a prior terminal condition.

 

Objective: to improve the results of detoxification therapy for acute exogenous intoxications.

Materials and methods. More than 20 thousand patients with intoxication caused by psychopharmacological agents, organic phosphorus compounds, chlorinated hydrocarbons, and other poisons, in whose treatment enhanced natural detoxification methods, as well as artificial detoxification methods and antidote therapy were used, were examined.

Results. Complex detoxification should include efferent methods (hemosorption, hemo- and peritoneal dialysis and intestinal lavage, as well as physiohemotherapy (magnetic, laser, and ultraviolet) and chemohemotherapy with sodium hypochlorite) and should be composed of 2 basic stages: 1) to reduce for a short space of time (1—2 h) the blood poison level to the life-safe one (below the lethal or critical one) that promotes elimination of severe hemostatic disorders, wherein the leading role is played by efferent methods and chemohemotherapy and 2) to terminate a detoxifying process within 1—2 days, which is predominantly associated with the effect of physiohemotherapy as a potent stimulant of natural detoxification and which is achieved just via further stabilization of homeostatic disorders. In the somatogenic stage, detoxification is continued through the program use of physiochemical hemotheraupetic methods and drugs.

Conclusion. Introduction of the above principle of complex detoxification performed by a certain algorithm contributes to the higher rate of freeing the blood and urine from exo- and endogenous toxicants by 1.4-12 times and to the significant (more than 2-fold) mortality reduction achieved in an intensive care unit, Moscow City Center of Acute Intoxication Management. 

The paper summarizes the results of the authors’ own experimental studies and the data available in the literature on the implication of the neuroendocrine system, sexual dimorphism and reproductive hormones in the pathogenesis and outcome of postresuscitative disease. There is evidence for the important role of systemic hormonal balance and particularly endogenous and exogenous sex hormones in postresuscitative rehabilitative processes.

The general mechanisms and specific features of recovery of postresuscitative cerebral and systemic hemodynamics were studied in the animals that had experienced clinical death caused by various factors that were components of severe injuries during technogenic catastrophes (blood loss, carbon monoxide intoxication, chest compression). The hydrogen clearance method was used to record tissue blood flow. The thermodilution technique was employed to estimate cardiac output. There was a close, direct correlation of postresuscitative cerebral circulatory changes with the phasic pattern of recovery of cardiac output and its redistribution. An initial short increase in cerebral hemoperfusion occurred with higher cardiac output (a hyperperfusion phase) and its supradiaphragmatic fraction (an early postresuscitative circulatory centralization reaction). There was a further decrease with a progressive reduction in cardiac output and its supradiaphragmatic fraction. Postresuscitative cerebral hyperperfusion was shown to have the adaptive range favorable for vital function recovery processes and ultimate resuscitative Results. All things considered, the possibility exists of artificially modifying the postresuscitative range of cerebral hyperperfusion, by controlling the distribution of cardiac output.

 

The paper summarizes the results of experimental investigations dealing with the study of a role of morphofunctional nerve cell changes in the development of postresuscitative encephalopathies. It has been established that there are general regulations, time course and some mechanisms of changes in the density and composition of neuronal populations in the rehabilitative period after clinical death. A relationship of the state of the brain to the duration of ischemia and the rates of neurological recovery was found at the level of neuronal populations. The individual and typological features of development of postresuscitative cerebral changes were revealed. The significance of macroglia in the development of postresuscitative disease was defined. There was a relationship of abnormal changes in the neuronal populations with their immunoresponsiveness to thermal shock protein. The implication of the detected impairments was established in the development of posthypoxic encephalopathies. It is suggested that further immunocytochemical studies of neurospecific proteins and neurotrophic factors will make a considerable contribution to the solution of a problem associated with the prevention and treatment of postresuscitative encephalopathies.

 

The regularities of higher nervous activity impairments were studied in an experiment on mature albino rats in the posttraumatic period, by using the open field test. Analysis of behavioral acts indicated the difficulties encountered in constructing an adequate response to get a benefit from an activity (danger avoidance) at stages of traumatic disease due to the impossibility of rapidly and accurately solving the intricate problems facing the damaged brain. At the same time, a great contribution to higher nervous activity impairments was made by emotional disorders that were traced up to the end of a follow-up (on day 30). The found changes in higher nervous activity are indicative of the high plasticity of the central nervous system and its great capabilities to perform compensatory and adaptive processes under extreme conditions, by reorganizing the intricate system of links of its individual parameters.

Based on the own studies and the data available in the literature, the authors consider neurophysiological mechanisms, general regularities, as well as the specific features of performance of the central nervous system (CNS) in the postresuscitative period. At the emergence from clinical death, the state of neurons of the brain is primarily determined by intrinsic energy provision rather than external signalization. The following period of a postresuscitative process develops against the background of the relative recovery of bioenergetics and the capacity of a neuron to generate and transmit an impulse on retention of substantial neurological and cognitive disorders due to heterogenic ischemic lesion of the brain regions participating in the performance of a specific function. This period is characterized by the formation of the pathological functional systems associated with the break of intercentral relations, as manifested in the change of reflex reactions, in the generalization of the total bioelectric activity of the brain, in the episodes of paroxysmal activity and motor excitation, which occur spontaneously or which are provoked by nocicep-tive, audiogenic stimuli or by the administration of CNS activators. After compensation of external neurological disorders, the neurophysiological mechanisms of postresuscitative changes in the congenital and acquired forms of behavior are: a) sustained CNS hyperexcitability; b) regulatory isolation of the brain from signal of varying modality; c) the high capacity of forming intracentral relations, caused by the joint action of sustained neuronal hyperexcitability after cessation of a stimulus and by the compensatory process of reorganization and recovery of a synaptic pool and a dendritic network; d) the reduced information capacity of the brain; e) the high responsiveness of CNS to acute and chronic emotionally negative factors; f) the cerebral changes associated with the prolonged effect of drugs administered in the early postresuscitative period. In this postresuscitative period, the specific feature of brain performance is in the interrelated involvement of the above neurophysiological mechanisms in both the achievement of adaptive productivity and the formation of late encephalopathies. The findings suggest that the study of procedures for drug and non-drug protection of the brain is promising in preventing late encephalopathies.

 

Endogenous intoxication and free radical oxidation were studied in rats after 10-minute clinical death due to systemic circulatory arrest. There were qualitative and quantitative changes in toxic substances throughout a 35-day postresuscitative period, as well as increased free radical oxidation processes in the vital organs (brain, liver, kidneys). At the same time, plasma samples showed inhibited chemiluminescence along with the elevated levels of low and medium molecular-weight substances since medium-weight molecules bound ferrous iron ions that were added to induce luminescence. The chemilu-minescence technique may serve as a rapid method for evaluating the degree of endogenous intoxication.

 

Laboratory service is one of the most hang-the-expense items in the cost of treatment of patients in an intensive care unit. Isolated acid-base balance (ABB) impairments are rare in clinical practice. These impairments are generally combined and they frequently cause a drastic change in the pH value of blood. Early detection of their origin and its elimination are of profound importance in these situations. Miniaturization of analyzers has made it possible to conduct some investigations and particularly to determine ABB just in the intensive care unit or operating suite. The attached software permits creation of a database and transmission of information to the laboratory network. One year’s experience has indicated that the quality of reagents and reference substances allows real-time determination of the values of ABB with a high degree of accuracy and reproducibility at a patient’s bed.

 

Apoptosis is a variant of programmed cell death. This term was introduced by Kerr et al. in 1972, but information on the important role of apoptosis of some cells in critical conditions has recently appeared. The review of literature considers the basic mechanisms of induction, development, and regulation of apoptosis. Based on a literature update, the authors analyze the role of apoptosis in the pathogenesis of various critical conditions: acute lung lesion (neutrophilic and epithelial hypotheses), sepsis, myocardial infarction, and ischemic stroke (apoptosis of tubular epithelial cells), hepatic dysfunction in sepsis, myopathies in critical conditions. The data of studies dealing with the effects of inhaled and non-inhaled anesthetics on the apoptosis of neurons of the brain and lymphocytes are given. The review of literature presents the options of therapeutic apoptosis modulation by pharmacological methods.

 

 

This paper gives basic data on the problem of hyperergic aspiration pneumonitis (Mendelson’s syndrome) in obstetric anes-thesiological practice. It describes changes in the gastrointestinal tract during pregnancy and labor. The pathology and mechanisms of aspiration are considered. The existing preventive methods are analyzed in detail. The new regulations of preopera-tive preparation of patients for planned anesthesia at cesarean section are presented.

 

Trophic homeostasis together with oxygen provision is known to form the basis for the body’s vital activity and a prerequisite to the elimination of many abnormalities [1]. Support of trophic homeostasis along with its intrinsic factor is determined not only by the capabilities and reality of providing an organism with essential nutrients, but also by the relevant conditions for their effective assimilation, particularly in the presence of a severely progressive pathological process [1, 2]. The last decades of the 20th century were marked by the rapid development of clinical nutrition science, giving rise to the whole industry of manufacturing various formulas for both the parenteral and enteral feedings of patients (the injured). Due to the fact that there is a great variety of feeding formulas (FFs), we have now a right to tell not only about the adequate substrate provision of patients in all directions, but also about the fact that we can perform differential nutritive metabolic therapy for an existing pathological condition. At present we have a good chance of implementing the qualitative nutritive support (NS) for any category of patients. At the same time, it should be noted that recently physicians of different specialties in our country are much better aware of the importance and necessity of timely using active NS in seriously ill patients (victims) [1—3]. This paper presents the comparative characteristics of the most popular and Russia’s registered balanced polymer FFs. All information on the properties of the products has been taken from either their original package, or the advertising matters distributed by this or that manufacturer. The key properties of FFs, such as chemical composition, osmolarity, formulations, and package, have been compared.

hypermetabolism; feeding formulas; composition; osmolarity; choice

The paper provides the generalized results of studies dealing with the use of low-intensive laser irradiation in blood loss-induced critical conditions in an experiment and in patients with severe mechanical injury. In the light of recent data and the data available in the literature, the authors consider some pathophysiological mechanisms of action of laser radiation at all living matter organization levels: molecular, cellular, organ, and systemic. The feasibilities of laser correction of hemostastic disorders are defined in relation to the volume of blood loss and the functional state of compensatory systems.

 

Objective: To assess the professional education of nurses in the context of development of Russian reanimatology.

Materials and methods. The official curriculums of nurse training over 70 years of Russian reanimatology were comparatively analyzed.

Results. Despite the increased contents of the clinical discipline «Anesthesiology and Reanimatology», the duration of training in civil health care in the USSR and Russia gradually decreased from 880 (1967) to 432 (1998) hours. Only since 2004, nurse training has improved, by increasing its duration up to 10 months; however, the number of academic hours of anesthesiology and reanimatology has slightly increased, but failed to achieve the 1967 level.

Conclusion. The 70th anniversary of Russian reanimatology in the professional education of nurses in anesthesiology and reanimatology is marked by the paradoxes: the duration of training has decreased with the increased contents of anesthesiology and reanimatology.