Diagnostic criteria for and approaches to differentiated treatment for acute respiratory distress syndrome (ARDS) in nosocomial pneumonia (NP) have been elaborated, but approaches to preventing this syndrome in the presence of risk factors have not been investigated. Safety-mode mechanical ventilation (MV) (protective MV) is the most probable way of preventing ARDS in NP. Objective: to evaluate the efficiency of MV with safety parameters in preventing ARDS in NP in patients with surgical abdominal infection. Subjects and methods. This retrospective unicentric study was conducted at the clinical bases of the V. A. Negovsky Research Institute of General Reanimatology in 2013—2014. During a retrospective analysis, the patients were divided into two groups: 1) safe MV — after NP was diagnosed, the patients underwent safetymode MV (tidal volume (TV) 6—8 ml/kg); 2) standard MV — after NP was diagnosed, the patients were on MV with traditional parameters (TV 8—10 ml/kg). The incidence of ARDS in the patient groups was taken as a main criterion for the efficiency of safetymode respiratory support. The duration of MV, the length of stay in an intensive care unit, and 30day mortality rates were estimated as secondary criteria for the efficiency of safety-mode respiratory support. The findings were statistically analyzed using a Statistica 7.0 package. The data were expressed as the median (± 25—75 percentiles interquartile range (IQR)). The difference at p<0.05 was considered signif icant. >Results. Comparison of oxygenation index (OI) and extravascular lung water index (ELWI) showed that there were natural significant differences between the safe MV and standard MV groups in these indicators, beginning from day 2 of the investigation. The standard MV group displayed a significant decrease in OI and an increase in ELWI at 7 days versus at day 1 of the investigation. In the safe MV group, TV was naturally lower than that in the standard MV group on days 1, 3, and 5 of the study. From day 3, the statistical lung compliance was lower in the standard MV group than that in the safe MV group, which was linked to the development of ARDS in the patients in this group. From day 3, the peak airway pressure was higher in the standard MV group than that in the safe MV group. From this time, the plateau airway pressure was higher in the standard MV group than that in the safe MV group. There were significant differences in the incidence rate of ARDS in NP in the patient groups: ARDS developed in 6 (15.0%) and 20 (67.1%) NP patients who underwent safe and standard MV, respectively (p=0.0001, Fisher's exact test). The NP patients who used MV with safety parameters were recorded lower lengths of MV (14.8±6.2 days) and stay in an intensive care unit (19.2±6.0 days) than those who had standard MV (20.0±6.3 and 23.9±7.7 days) (Fig. 9). There were significant differences in mortality rates between the patient groups in the NP patients on safe MV whose mortality was 27.5% (n=11); this in the NP patients on standard MV was 46.7% (n=14) (p=0.0046, Fisher's exact test). Conclusion. MV with safety parameters allows for preventing ARDS in NP in patients with surgical abdominal infection, which improves treatment outcomes.

Objective: to evaluate the efficiency of transpulmonary thermodilution (TPTD) for the choice of measures to correct hemodynamics in patients with severe nosocomial pneumonia (NP). Subjects and methods. The investigation enrolled 107 NP patients admitted to an intensive care unit (ICU). Group 1 patients were intensively treated in accordance with a protocol for hemodynamic correction during early goaldirected therapy for sepsis. In Group 2, infusion thera py and sympathomimetic agents were prescribed depending on the results of TPTD. Results. Patients in both groups did not differ in the examined clinical and laboratory indicators. On day 1 of intensive therapy, in Group 2 (a TPTD controlled intensive treatment group) the prescription of sympathomimetic drugs was virtually twice more active than in Group 1; and the value of positive hydrobalance was, twice less. In 5 days, the frequency of use of sympathomimetic agents had no intergroup differences and, in 7 days became less in Group 2 patients. After the therapy patients in Group 2 did not require substantial amounts of infusion and great positive hydrobalance, resulting in lower central venous pressure (CVP) values. After 5 days of intensive therapy, the positive hydrobalance in Group 2 patients was 5 times less and on day 7 this indicator became negative. There were no intergroup differences in CVP on day 1; however, this indicator was higher in Group 1 patients from day 2 to the end of the followup period. At days 5—7, Group 2 patients exhibited elevated SvO2 values and hypolactatemia. At day 3, the SOFA severity was somewhat higher in Group 2 than in Group 1, then substantially reduced and on days 5—7 it was 2—2.5 scores lower in Group 2 than in Group 1. The mortality in ICU was 49% and 33% in Groups 1 and 2, respectively (χχ2=3.899; pConclusion. The determination of infusion amounts and indications for the use of sympathomimetic drugs on the basis of the integrated assessment of global enddiastolic volume index, cardiac index, and total peripheral vascular resistance index results in improved clinical outcomes in mechanically ventilated patients with severe NP. This approach ensures the use of sympathomimetic agents and to avoid hypervolemic loading. 

Objective: to conduct an atomic force microscopy (AFM) study of the red blood cell nanostructure in neonatal infants with ABO and rhesus (Rh) isoimmunization. Subjects and methods. The investigation included 27 neonates, including 13 infants with Rh sensitization and 14 with ABO isoimmunization. The course of pregnancy complicated by Rh sensitization was characterized by the emergence of the blood titers of Rh D antibodies and immunoglobulin G (IgG) subclasses: IgG1, IgG2, and IgG3. IgG production increased at 34 weeks' gestation when all the subclasses were detectable in different titers. There was either Rh or ABO incompatibility between the newborns and their mothers. Differential diagnosis of isoimmunization was made in the pair of an O (I) Rh-negative mother and an A (II) Rh-positive baby. Complete blood count and blood biochemical indicators were estimated; Rh D and IgG antibody titers were determined; red blood cells from 11 neonatal infants were examined using an AFM. The investigation was performed with residual umbilical cord blood and central venous blood during neonatal treatment. Results. Combination therapy for neonatal Rh or ABO isoimmunization terminates a cascade of immunological responses and erythrocyte hemolysis, lowers bilirubin levels, but fails to influence the morphological composition and macrostructure of red blood cell membranes. The consequences of the perinatal effects on the red blood cell membrane persist for a certain time and are outside the early neonatal period.

Objective: to estimate the significance of capillary blood oxygen parameters for the prognosis of longstanding hemodynamically significant patent ductus arteriosus (HSPDA) in extremely low birthweight (ELBW) neonates. Subjects and methods. On day 8 of their life, two groups of ELBW newborn infants with and without HSPDA were examined for capillary blood рН, рkО2, %SO2с, O2ct, АkDO2, and RIk, as well as mechanical ventilation (MV) parameters (Pip, MAP, and FiO2). Comparison of two independent samples used nonparametric statistical tests: MannWhitney test, Wald Wolfowitz test, and Kolmogorov-Smirnov test. A logistic regression analysis was used to assess the relationship between the examined parameters and the presence or absence of HSPDA. ROC curves were constructed, by choosing the cut-off point, to estimate the predictive power of the model developed using logistic regression. Results. The developed model has high sensitivity and high specificity (84,6 and 97% respectively). The logistic regression equation takes the form: -0.479•О2сt+0.708•Pip-6.823. Conclusion. Capillary blood oxygen parameters proved suitable for predicting the duration of HSPDA functioning. The resultant good predictive power of the model developed for day 8 of life points to the fact that this period is critical from the viewpoint of resolution of respiratory distress syndrome or development of bronchopulmonary dysplasia, which is crucially significant for MV duration and further prediction. HSPDA is one of the most important factors contributing to the development of bronchopulmonary dysplasia in ELBW neonatal infants.

Objective: to study the specific features of the clinical course of acute intoxications with venoms due to the bites of Naja (cobra) naja and Naja kaouthia and those of intensive therapy in patients with the severest forms of this condition. Subjects and methods. Two clinical cases of acute intoxications with venoms due to Naja naja and Naja kaouthia bites were examined. The specific features of their clinical picture over time, changes in clinical and biochemical indicators, blood gas composition, and acidbase balance, coagulogram readings, ECG and radiological findings were studied. Results. Acute intoxication with venoms due to serious cobrabites was found to be characterized by the development of toxicohypoxic encephalopathy, toxic myopathy with skeletal and respiratory muscle paresis to develop acute respiratory and cardiovascular failure, coagulopathy, and metabolic disorders. Specific therapy (with an anti-ophidic serum in one case) resulted in drastically worsening health conditions as fulminant acute respiratory distress syndrome. A package of intensive therapy measures should include actions based on general resuscitation approaches — maintenance of life support systems (breathing, blood circulation), anti-sensitizing therapy, correction of metabolic disturbances with substrate antihypoxants (cytofavin, reamberin), and antimicrobial therapy. Conclusion. In the severest acute intoxications due to cobra snakebites, specific therapy methods (with anti-ophidic serum) should be used with extreme caution and particular emphasis should be laid on the general resuscitation-based principles. 

Objective: to evaluate the efficiency of pharmacological correction of endogenous intoxication in patients with Stages III—IV ovarian cancer (OC) in the perioperative period. Subjects and methods. Thirty-to-70-year old seventy patients with Stages III-IV OC who had been surgically treated under general anesthesia were examined. The bio chemical parameters of intoxication, such as middleweight molecules, the total, effective concentration and binding capacity of albumin, integral hematological indices of intoxication, and C-reactive protein, were studied in the perioperative period. Results. Analysis of the performed tests showed that the premorbid background in all the examinees was characterized by varying degrees of endogenous intoxication (EI), increased leukocytic index of intoxication, hematological index of intoxication, and modified hematological index of intoxication, an imbalance between the accumulation and binding of overproduced toxic ligands, the intensified production of acutephase inflammatory proteins by the activation of a systemic inflammatory response, and decreased systemic responsiveness. These changes occur with suppressed systemic responsiveness, inadequate intoxication compensation by physiological detoxification systems and hemostatic instability. Conclusion. The use of heptral and Remaxol as part of the metabolic pharmacological correction infusion program nonequivalently caused reductions in the activity of an inflammatory response and the efficiency of EI correction in patients with OC in the perioperative period. The administration of Remaxol for systemic hyporesponsiveness and pronounced intoxication in OC patients promoted the optimization of systemic responsiveness, by producing a reduced toxic effect of tumorassociated EI. 

Objective: to study the impact of hyperbaric oxygenation (HBO) on renal ammonia excretion during liver resection (LR). Material and methods. Experiments were carried out on 138 pubescent rats (females). Three HBO sessions were performed at 3 ATA lasting 50 min once daily after LR (15—20% of the liver weight). The kidney, blood (aorta, v. renalis), and urine were examined. The levels of ammonia, glutamine, and urea were measured. Results. By eliminating postoperative arterial hyperammonemia, HBO stimulates urinary ammonia ion excretion. This is achieved through elimination of the inhibitory effect of LR under HBO on ammonia secretion into the renal tubules and through activation of intracellular ammoniagenesis in nephrocytes, including that uncoupled with arterial glutamine deamidation. HBO potentiates simultaneously the activating effect of LR on the glutamine cycle in the kidneys mainly through the hyperproduction of renal glutamine and its influx from them into the bloodstream. HPO enhances the stimulatory effect of LR on urea reabsorption in the kidneys, but, unlike non-oxygenated rats, there was no reduction in urine urea excretion due to increased arterial blood urea concentrations. Termination of the body's exposure to hyperoxia restores urea reabsorption in the kidneys with the persisting stimulatory impact of HBO on the formation of urea by nephrocytes and its incretion from the latter into the bloodstream.