Objective: to evaluate the impact of highfrequency jet ventilation (HFJV) and traditional positive endexpiratory pressure (PEEP) ventilation on blood oxygenation, gas exchange, and hemodynamics on an experimental model of acute lung injury.

Material and methods. Thirty albino outbred laboratory male rats weighing 200—300 g were randomly selected for investigations and further divided into groups: 1) traditional ventilation (TV) (n=15); 2) HFJV (n=15). The rats were anesthetized with intraabdominal ketamine (6—8 mg/kg) and sibasone (15—45 mg). Anesthesia was maintained by the bolus administration of ketamine (1 mg/kg every 15—20 min). Tracheostomy was carried outwith a 0.2—0.4 mm diameter endotracheal tube that was then fixed using surgical thread 2—2.5 cm deep to the cricoid cartilage.

Results. Acute respiratory distress syndrome (ARDS) has clear histological criteria for lung tissue structural injury; it is widely prevalent in clinical practice and associated with high mortality rates. The paper describes anexperimental ARDS model, the essence of which is 45—55% aspiration of the circulating blood volume for 10—15 minutes. A Reosorbilact® solution was used to compensate for the volume of blood loss, which was followed by the administration of autothromboplastin (16—20 mg/kg animal weight). PEEP was studied for its impact on gasexchange, hemodynamics, and blood oxygenation during HFJV and TV. Gas exchange parameters during TV and HFJV were comparatively analyzed.

Conclusion. The use of PEEP for ARDS was ascertained to improve blood oxygenation due to decreased pulmonary shunt, better respiratory muscle performance, lower infiltrated and atelectatic tissue volumes, and higher lung functional residual capacity

The course of critical conditions in neurology and neurosurgery has specific features associated with the complex pathogen esis of brain injury, which in turn determines the specificity of resuscitation care. For a brief description, general resuscita tion methods in neurology and neurosurgery should be characterized by the term of neuroresuscitation. The paper presents the latest trends in multimodality monitoring and specific therapy in neuroresuscitation. Furthermore, it gives the data show ing the great importance of infection monitoring for the treatment of critically ill neurological and neurosurgical patients.

The literature review reflects the present view of pathological mechanisms for mitochondrial dysfunction in hypoxia during critical conditions. It notes the role of succinates in the development of mitochondrial dysfunction, further organdisorders, and multiple organ dysfunctions in different diseases during emergency hypoxia adaptation only due to the mobilization of energy resources: their centralization, intensified carbohydrate, fat, and protein catabolism, as well as to suppressed anabolic processes in tissues. The mechanism of emergency adaptation to hypoxia during critical conditions develops with a characteristic decrease in the amount of succinate (as a substrate for the enzyme), which enables the correction of its deficiency with the promising increase of oxygen consumption, the activation of aerobic oxygenation processes, and the reduction of intracellular aerobic metabolic processes.

Nosocomial pneumonia (NP) remains a relevant problem of resuscitation. Molecular biomarkers are significant promises for diagnosing NP. Objective: to estimate the informative value of the plasma levels of Clara cell protein (Club Cell Protein, CCP) as a diagnostic molecular candidate biomarker in NP. Subjects and methods. The investigation was conducted at the Research Institute of General Reanimatology (RIGR), Russian Academy of Medical Sciences (RAMS), in 2010—2013. It included 85 patients in accordance with the criteria of inclusion and exclusion and 30 donors. Acute respiratory distress syndrome and its stages were diagnosed using the criteria of RIGR, RAMS. Plasma Clara cell protein (CCP) levels were measured by the enzyme immunoassay Human Clara Cell Protein ELISA, RD191022200, BioVendor, USA. The findings were statistically analyzed using the package Statistica 7.0. ROC curve analysis was made to determine the sensitivity and
specificity of CCP. The difference at p<0.05 was considered significant. Results. On days 1, 3, 5, and 7 of the investigation, the plasma CCP levels in patients with NP were lower than in those without this disease. Within all these days, the plasma CCP concentrations in patients with and without NP were higher than in healthy donors. On days 1 and 3, the plasma content of CCP was much lower in patients in whom NP had been caused by Pseudomonas aeruginosa (in association with other pathogens) than in those with NP uncaused by Pseudomonas aeruginosa. Within the first 24 hours, the CCP level of 17.5 ng/ml had 86.5% sensitivity and 66.7% specificity in diagnosing Pseudomonas aeruginosainduced NP (area undercurve, 0.74; 95% confidence interval, 0.630—0.829; p=0.0001). The prognostic value of the positive and negative results of this test was 81.8 and 74.1%, respectively. Conclusion. The time course of changes in the plasma levels of Clara cell protein was studied in the patients with nosocomial pneumonia. Clara cell protein was shown to be of informative value in the diag nosis of Pseudomonas aeruginosainduced NP; on the day when nosocomial pneumonia was diagnosed, the plasma CCP level of 17.5 ng/ml had 86.5% sensitivity and 66.7% specificity in diagnosing Pseudomonas aeruginosainduced NP.

Objective: to evaluate the efficiency of early immune replacement therapy (EIRT) in patients with severe polytrauma (SCI).

Subjects and methods. Two hundred and twentyfive victims aged 35.5±14.1 years with SCI (ISS>30 scores), including 158 cases of nosocomial pneumonia, were examined. According to the use of EIRT with donor immunoglobulin (IgG) (daily within the first three days), the patients were divided into two groups: 1) standard intensive treatment was added by EIRT (n=126) and 2) that without EIRT (n=99). Immunological examination was performed on days 1, 3, 6, and 9 after injury. The investigators determined the relative and absolute counts of major lymphocyte populations: T (CD3+) and B (CD19+) lymphocytes, those of T cell populations: (CD4+) helper T cells and (CD8+) cytotoxic T lymphocytes, the concentrations of the immunoglobulins A, O, and M classes (IgA, IgG and IgM), neutrophil absorptive and bactericidal activ
ities, and the serum levels of large, middle, and small circulating immune complexes, Creactive protein, and procalcitonin. The incidence of nosocomial pneumonia and sepsis and the outcome of injury were analyzed in both groups.

Results. The performed investigation indicated that EIRT in Group 1 victims resulted in a 27.6% decline in the number of patients who had received mechanical ventilation (MV) for more than 3 days and reduced the rate of earlyonset pneumonia and sepsis by 24.3 and 5.2%, respectively, and the intensive care unit length of stay from 20.2 to 12.5 days, mortality rates by 12.1%, and deaths by 1%.

Conclusion. EIRT used to treat victims with SCI could decrease the duration of MV and the incidence of nosocomial pneumonia, which in turn reduced mortality rates in the examined groups.

Objective: to study the clinical efficiency of using selective lipopolysaccharide (LPS) adsorption in postoperative gram negative sepsis in cancer patients.

Subjects and methods. Examinations were made in 47 patients (11 women and 36 men) aged 47 to 84 years, who had been operated on for cancer and whose postoperative period had been complicated by gramnegative sepsis. The patients were divided into 2 groups: 1) 15 patents who received standard therapy (a control group); 2) 32 who had LPS adsorption using immobilized polymyxin B (a study group).

Results. Upon completion of the selective LPS adsorption program, there was regression of the clinical signs of sepsis, statistically significantly lower peripheral blood leukocyte and neutrophil levels, and better blood biochemical parameters in 87.5% of cases. High baseline endotox in activity decreased from >0.6 to <0.4 units in 89% of the patients. After the final session of LPS adsorption, the need for vasopressor support reduced due to hemodynamic profile optimization. After selective endotoxin adsorption cycles, 15 of 26 cases did not need to continue organ replacement therapy. Twentyeightday mortality rates in the study and control groups were 25.0 and 53.3%, respectively.

Conclusion. Incorporation of LPS adsorption into a set of intensive therapy for gramnegative sepsis is pathogenetically substantiated and can effectively abolish the manifestations of the systemic effects of bacterial endotoxin. The early and timely use of LPS adsorption provides inhibition of an initiating stimulus, which makes it possible to prevent the progression of a septic process and the development of severe sepsis and septic shock and improves the results of therapy in cancer inpatients.

Objective: to define the prognostic value of intracranial pressure (ICP) changes in highvolume hemofiltration (HVHF) in patients with severe sepsis and normal preperfusion ICP.

Subjects and methods. A retrospective study was conducted in 50 patients (a total of 134 sessions) with severe sepsis and normal baseline ICP who received ther apy using HVHF for extrarenal indications. Based on ICP changes before and after HVHF, the investigators identified 2 groups: 1) no ICP changes (n=81); 2) elevated ICP (n=53).

Conclusion. HVHF is ineffective when the normal preperfusion ICP is increased in patients with severe sepsis who have a concurrence of an arteriovenous carbon dioxide difference of more than 8 mm Hg and a Glasgow coma score of less than 10.

Objective: to study the nanostructure of red blood cell membranes and erythrocyte index in preterm neonatal infants.

Subjects and methods. The trial enrolled 47 neonatal infants, including 33 preterm infants who were included in a study group and 14 fullterm infants who formed a comparative group. The gestational age of the preterm infants was 33.3±1.9 weeks and the birth weight was 2065.4±304.8 g. Red blood cell counts, hemoglobin, and erythrocyte indices were estimat ed and the red blood cells were examined using an atomicforce microscope.

Results. At birth, the preterm infants showed macrocytosis, intrauterine poikylocytosis, and the impaired nanostructure of red blood cell membranes. Intrauterine hypoxia affects the red blood cell membrane nanostructures: a phospholipid bilayer and a spectrin matrix, without damaging the membrane protein component. The detected changes are reversible and directed to maintaining the functional ability of red blood cells in a critical situation. At birth, gestational age, a baby's weight, hemoglobin, and blood cholesterol and standard bicarbonate levels influence the parameters of a red blood cell component. The early neonatal period was characterized by an active process on the red blood cell membranes and a change of morphological forms, suggesting the continuing postnatal rearrangement of erythropoiesis and a preterm infant's adaptation to new environmental conditions.