Objective: to evaluate the efficiency of therapy for massive obstetric hemorrhage, by applying thromboelastography (TEG).

Subjects and methods. Sixty six patients with massive obstetric hemorrhage who were divided into two groups: a study (A; n=37) and comparison (B; n=29) groups were examined. A control group (C; n=30) comprised women with physiological blood loss during labor. The efficiency of TEG was evaluated from the volume of blood loss and the frequency of hysterectomy.

Results. Fibrin clot density, MA have the highest prognostic capacity to identify the risk of massive obstetric hemorrhage [AUC=0.83 (95% CI 0.79—0.87); р=0.001]. A therapeutic and diagnostic set for massive obstetric hemorrhage, by applying TEG, can reduce the number of hysterectomies by 3. 1 times (p=0.02), the volume of blood loss by 1.3 times (p=0.03), and the use of fresh frozen plasma by 2.0 times (p=0.01).

Conclusion. Rapid evaluation of the blood coagulation system, by using a TEG® 5000 device (Haemoscope Corp., USA) makes it possible to perform timely pathogenetic sound therapy, to prevent a critical condition, and to implement organ-sparing tactics.  

Objective: to develop a procedure to reduce perinatal blood loss, by permitting the lower use of allogeneic blood.

Subjects and methods. The investigation enrolled 96 female patients with moderate and severe preeclampsia, whose status was complicated by massive blood loss. The women were divided into 2 groups: a study group (n=55) that was treated by a package of proposed measures and a control group (n=41) that was retrospectively assessed. During the study, the investigators made a dynamic assessment of peripheral blood parameters and hemostatic system markers, monitored blood and central venous pressures, hourly and daily diuresis, acid base and water electrolyte balance parameters, and collected medical history data.

Results. The investigation established that a package of proposed measures to reduce massive obstetric blood loss significantly accelerated the restoration of general clinical and biochemical parameters in the early postoperative period.

Conclusion. The proposed procedure is easy-to-use and it is of obvious practical use because it can reduce the use of donor blood components by twice and the length of hospital stay by 6. 5 bed-days. 

Objective: to determine the efficiency of postoperative 3-in-1 parenteral nutrition with Oliclinomel N8-800 in correcting protein-energy malnutrition in patients undergoing extended surgical interventions into the abdominal organs.

Subjects and methods. Forty-one patients with gastric and pancreatic neoplasms treated in the intensive care unit, N. N. Burdenko Main Military Clinical Hospital, in January to October 2013 were examined. All the patients were males. The mean age was 63.5±11.87 years. The study design: a prospective controlled randomized trial. Group 1 (a comparison group) entered 21 patients. Conventional parenteral nutrition regimens with Oliclinomel N7-1000E 2000 ml were used on postoperative day 2. The intestine was lavaged with a glucose-electrolyte solution within the first postoperative hours. The glucose-electrolyte solution and standard enteral formula were intraintestinally administered as the absorptive and digestive functions of the small bowel recovered. On postoperative days 7 and 8, the parenteral nutrition was stopped and completely switched to enteral feeding. The dissimilarity of Group 2 (a study group) (n=20) was that it received parenteral nutrition with Oliclinomel N8-800 2000 ml.

Results. Complete parenteral nutrition, then mixed parenteral-enteral nutrition stabilized protein metabolic parameters in the patients of both groups in a unilateral fashion, but more promptly in Group 2 than in Group 1. The nutritional support program in Group 2 caused significantly less reduction in the body' cellular weight than in Group 2 in the first and entire period of the follow-up, which appears to be related to the administration of large amounts of nitrogen.

Conclusion. The results suggest that the use of Oliclinomel N8-800 for parenteral nutrition adequately corrects postaggressive nitrogen deficiency, promotes the normalization of protein and carbohydrate metabolism and a positive nitrogen balance and the resolution of hypermetabolism/hypercatabolism after extended abdominal surgery. 

Objective: to determine the capacities of a noninvasive hemodynamic study in patients with colorectal cancer within a preoperative anesthesiological examination.

Subjects and methods. The hemodynamic status was preoperatively analyzed in 97 patients (46 men and 51 women) with colorectal cancer. Their mean age was 67.59±9.48 years. The POSSUM intraoperative risk scores were 20.20+3.2. Central hemodynamics was preoperatively assessed in all the patients, by applying a «Computerized Diamant System for Monitoring the Cardiorespiratory System and Tissue Hydration» (Saint-Petersburg, Russia — Registration Certificate ФСР No 2008/03201 dated 22 August, 2008).

Results. The non-invasive hemodynamic study can supplement a preoperative examination in patients with colorectal cancer. The patients with colorectal cancer were diagnosed as having hypodynamic and eudynamic circulation in 43.3 and 56.7% of the cases, respectively. The age of the patients was not established to have a significant impact on their hemodynamic status, which confirms that it is expedient to make perioperative multifactorial risk assessment.

Objective: to evaluate the antihypoxic effect of Mexicor in patients with gastrointestinal bleeding of ulcerative etiology.

Materials and methods. The paper presents the materials obtained during the treatment of 53 patients with nonvaricose gastrointestinal bleeding who were hospitalized with grades II—III hemorrhagic shock.

Results. Incorporation of Mexicor into the comprehensive program for the intensive therapy of acute gastrointestinal bleeding was ascertained to reduce the activity of prooxidant processes, and the manifestations of tissue hypoxia and systemic inflammation and to improve systemic hemodynamic parameters and the clinical course of an early posthemorrhagic period.

Conclusion. The use of Mexicor in patients with gastric bleeding reduces the number of complications and the duration of treatment in the intensive care unit.  

Hypoxia and mitochondrial damage are a key component of the pathogenesis and tanatogenesis of a critical condition, suggesting the need for its prevention and maximally rapid elimination.

Objective: to analyze the efficacy and safety of infusion antihypoxants used in critically ill children from the results of researches.

Materials and methods. Available investigations dealing with infusion therapy in children and papers on the use of infusion antihypoxants in adults in 2005 to 2013 were sought in the medical databases PubMed and Cochrane Library with their free availability and analyzed.

Results. The analysis included 70 trials. The pathophysiology and pathobiochemistry of hypoxia in critically ill children are given; the current principles of its correction by infusion therapy are considered in detail. Particular emphasis is placed on trials evaluating the efficacy and safety of succinic acid solutions in children. Main indications for and contraindications to their use are demonstrated.

Conclusion. The use of Krebs cycle substrate-based infusion antihypoxants (malate, succinate) is an effective and promising procedure for the intensive therapy and correction of hypoxia in both adults and children with critical conditions. Considering the fact that papers on the use of infusion antihypoxants in children are scanty, there is a need for further investigations. 

Objective: to analyze the combined use of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy with switching into the ECMO circuit in cardiac surgical patients over 18 years of age and to reveal predictors of a fatal outcome in this combination of auxiliary organ support techniques.

Materials and methods. The retrospective cohort study postoperatively used a combination of ECMO and continuous renal replacement therapy in 27 cardiac surgical patients aged over 18 years with severe cardiopulmonary insufficiency concurrent with acute kidney lesion. In all cases, the continuous renal replacement therapy circuit was switched into the line after an ECMO pump. The end points of the study were the duration of dialysis-dependent acute renal failure, the frequency of complications, and hospital mortality.

Results. In all cases with a favorable outcome, the duration of continuous renal replacement therapy was 3 days longer than that of ECMO. There were no cases of recovery if the duration of continuous renal replacement therapy was shorter than that of ECMO and the duration of the latter was more than 10 days. The duration of sympathomimetic support (>3.5 days ) was shown to be an independent and significant predictor of death (AUC 0.99; CI 99.9%, 0.96—1.0) in the patients receiving continuous renal replacement therapy and ECMO. It was established that the number of inotrophic drugs (>2) and the highest lactate level (>1.99 mmol/l) could be used to predict hospital mortality in patients with acute kidney injury and severe cardiopulmonary insufficiency (AUC 0.85 and 0.86; sensitivity/specificity 0.83/0.67 and 0.86/0.67, respectively).

Conclusion. The concurrent use of ECMO and continuous renal replacement therapy in severe cardiac surgical patients with potentially reversible cardiopulmonary insufficiency and acute kidney injury is a sound and complementary combination of auxiliary organ support techniques.