The purpose of the study was to compare the relationship between the dead space volume and tidal volume (VD/VT) using volumetric capnography (VCap) during pressure controlled (PCV) and pressure supported (PSV) ventilation mode in the postoperative period.

Materials and methods. 30 randomly assigned cardiac surgical patients undergoing CABG (coronary artery bypass grafting) using ECC (extracorporeal circuit) were included in an observational, prospective study. Patients were connected to the ventilator immediately after ICU admission. After that, monitoring VD/VT, CO2 production (VECO2) as well as ventilation parameters was carried out. The parameters during PCV and PSV mode were statistically evaluated using t-test.

Results. Expiratory CO2 (ETCO2) concentration were not significantly different in both PCV or PSV (p=NS), although both VECO2 and minute ventilation (MV) increased during PSV mode (p<0.01). VD/VT in PSV mode was lower than in PCV. Gas exchange represented by alveolar ventilation (VA) was better during PSV (p<0.01). VA was also higher during PSV (p<0.05). The calculated VD/VT ratio differed between PCV and PSV mode (p<0.01).

Conclusion. VCap represents a tool for monitoring of CO2 exchange effectivness. We registered a decrease in VD/VT with improved alveolar ventilation (VA) in PSV mode. VCap seems to be a suitable instrument for adjustment of protective lung ventilation.

Purpose. Evaluation of the influence of intra-operative targeted infusion therapy managed by the monitoring of stroke volume variability on post-operative results of major surgeries of gastrointestinal organs.

Materials and Methods. The prospective study included 80 patients subjected to selective operative interventions of abdominal organs involving entero-enteroanastomosis. In the experimental group (n=39), the infusion therapy was conducted according to the developed targeted therapy protocol, of which the key parameter was stroke volume variability. In the control group (n=41), infusion therapy was conducted based on routine hemodynamic monitoring (average arterial pressure, heart rate, blood loss level with regard to intra-operative situation). In both groups, operative intervention was carried out in identical conditions (combined anesthesia, identical drugs to induce and maintain anesthesia); the only differences included infusion therapy.

Results. In the experimental group versus the control group the intra-operative infusion volume was smaller, the number of patients with complications and the total number of complications were reliably lower, and the gastrointestinal tract functional recovery occurred earlier.

Conclusion. A targeted infusion therapy based on a stroke volume variability monitoring as the key parameter allows optimizing the infusion load and facilitates reduction of the number of patients with complications and earlier recovery of gastrointestinal tract functions after major operative abdominal interventions.

Purpose: to contribute to relief of metabolic disorders associated with hypoxia by including a succinate correcting tissue metabolism into the scheme of intensive care of acute severe methadone poisoning complicated by the crush syndrome.

Materials and methods. We examined the dynamics of clinical manifestation of acute methadone poisoning complicated by crush syndrome: changes in clinical and biochemical parameters, coagulation test findings, blood gas composition and acid-base state, ECG and X-ray findings.

Results. By the 7th day after patient's admission in the ICU, stabilization of hemodynamics, recovery of spontaneous breathing and consciousness, reduction of swelling and the beginning of the formation of pressure ulcers were observed; on the 8 the day, restoration of urination and characteristics of urine were registered. On the 12th day, the patient was transferred to the toxicology unit being in a state of moderate severity and demonstrating positive changes in all clinical parameters.

This study was aimed to evaluate the dynamics of inhaled tobramycin concentration in bronchoalveolar lavage fluid and blood in victims with nosocomial pneumonia.

Materials and Methods. The study is presented as a series of clinical observations: 5 patients with severe concomitant craniocerebral injury were included, who were treated in the general resuscitation unit (men 4 (87.5%), women 1 (12.5%); age 36Ѓ}12 years; Injury Severity Score (ISS) 40.9Ѓ}8.3; acute blood loss volume 2356Ѓ}997 ml; mean bed-days 12.50 days; mortality 16.7%). Statistical analysis of data obtained was carried out using Statistica 10.0 software. Difference was considered significant at p<0.05.

Results. The dynamics of tobramycin concentrations was as follows: 1 hr. blood/BAL 0.96Ѓ}0.44 μg/ml / 49.6 μg/ml; 3 hrs. blood/BAL 0.98Ѓ}0.82 μg/ml / 15.5 μg/ml; 5 hrs. blood/BAL 0.79Ѓ}0.83 μg/ml / 3.5 μg/ml.

Conclusion.The results obtained confirm significant local concentrations of tobramycin in sputum and low in blood, which corresponds to the results of pharmacokinetic studies and clinical studies of inhaled tobramycin efficacy. At present, gathering of material for the study continues.

The aim of this study was to compare the pyramidal neurons, their processes and synapses in the stratum lucidum, stratum radiatum and stratum lacunosum of the molecular layer of the field CA3 of the hippocampus of the brain of white rats in the normal state and after acute ischemia caused by a 20-minute occlusion of the common carotid arteries.

Materials and methods. In the experiment, using histological methods (hematoxylin and eosin, staining by Nissle and immunohistochemistry for p38, MAP-2) and electron microscopy, the pyramidal neurons of field CA3, their processes and synapses in stratum lucidum, stratum radiatum and stratum lacunosum of the molecular layer were studied. The main group included animals in the reperfusion period (1, 3, 7, 14, 21, and 30 days; n=30), comparison group — falsely operated animals (n=20). Morphometric analysis was performed using ImageJ 1.46, the verification of statistical hypotheses — Statistica 8.0.

Results. After occlusion of the common carotid arteries (CCAO) in the field CA3 of hippocampus, reactive, compensatory and reparative reorganization of pyramidal neurons and their communication structures was noted. On day 1, there was a decrease, and then (days 3—14) restoration of the total number of synapses and of P38-positive material within the area of synapses. According to electron microscopy, in the early post-ischemic period, the total numerical density of synaptic contacts in the stratum lacunosum of the molecular layer decreased by 44.8%, and after 14 days recovered to control. In stratum lucidum, the area of P38-positive material decreased by 8.8% after 1 day, and recovered after 3—7 days.

Conclusion. After the CCAO, the communication systems of the pyramid neurons of the field CA3 hippocampus of white rats were reorganized. Neurons of the field CA3 had high tolerance to ischemia and ability to restore interneural relations after reperfusion. In the surviving neurons, high levels of the cytoskeleton (MAP-2) marker and synaptic vesicles (p38) were detected. Data demonstrate structural and functional safety of all components of the communication system of a significant part of pyramidal neurons in acute ischemia. After reperfusion, the most significant alterations included the reconstructed interneuron synapses in the stratum radiatum and the lacunosum molecular layer.

The purpose of the study is to assess in vitro the effect of colloidal blood substitutes on fat globules in the blood of patients with severe polytrauma.

Materials and methods. Perftoran, 5% albumin solution, dextran-40, dextran-60, modified gelatin, hydroxyethyl starches 200/0.5 and 130/0.42 were added to the blood of 19 patients with severe polytrauma at ratios 1:20, 1:10, 1:5 and 1:3, respectively, which corresponded to the addition of 0.015 ml, 0.03 ml, 0.06 ml, 0.1 ml of the blood substitute under test to 0.3 ml of blood in a tube. Microscopy of the samples with assessment of the number and area of fat globules was carried out using a transmitted-light medical microvisor mVizo-101 (LOMO, Russia) 30 minutes after the blood and blood substitute exposure and subsequent staining with Sudan IV. The findings were processed using JMicroVision 1.2.7 software.

Results. Dextran-60, hydroxyethyl starch 200/0.5 and 130/0.42 in vitro lead to a decrease in fat globules in the blood of patients with severe polytrauma in proportion to the dilution degree. Modified gelatin, dextran-40, 5% albumin solution and Perftoran have a significant additional emulsifying effect on the fat globules. The maximum emulsifying effect was obtained after addition of Perftoran to the blood.

Conclusion. The experimental data on the effect of 5% albumin solution, modified gelatin, dextran-40, and Perftoran on fat globules justify the prospect for their further clinical application for prevention and treatment of fat embolism in an extended clinical trials.

The review dwells on the problem of hemostatic disorders in patients undergoing liver transplantation and their correction in the perioperative period. The physiology of the hemostatic system, disorders of the blood coagulation system in patients at various stages of liver transplantation, correction of hemostatic disorders during and after orthotopic liver transplantation are discussed. Liver transplantation is performed in patients with liver diseases in the terminal stage of liver failure. At the same time, changes in the hemostatic system of these patients pose a significant risk of developing bleeding and/or thrombosis during and after liver transplantation. The hypothesis is suggested that the personalized correction of hemostasis disorder in liver transplantation should be based on considerating the nosological forms of the liver damage, mechanisms of development of recipient’s hemostatic disorders, and the stage of the surgery.

Acute isolated traumatic brain injury (TBI) is frequently associated with occurrence of hemostasis disorders, which may be accompanied with hemorrhagic and ischemic events in the brain matter, hence, normal functioning of the blood coagulation system is critical. Understanding of the pathophysiological mechanisms of this phenomenon might help adequate prophylaxis of secondary brain damage. Earlier, development of disseminated intravascular coagulation syndrome (DIC) has been generally considered as a mechanism of coagulation disorders during TBI. However, over the recent decades, new data emerged concerning the key role of tissue factor, systemic inflammation response, thrombocytopathy, protein C effect in the occurrence of this coagulopathy. This overview of literature is aimed at providing the new data on specific pathophysiological mechanisms underlying coagulopathy following TBI.

Radical changes in the composition, diversity and metabolic activity of gut microbiome in critically ill patients most probably affect adversely the outcome of treatment. Microbiota dysfunction may be a predictor and presumably the main cause of infectious complications and sepsis. Clinicists use objective scales for evaluation of patient condition severity including specific parameters of disorders of organs and systems; however, microbiota function is not considered specific and, hence, not evaluated. Technical capabilities of the recent decade have allowed characterizing the intestinal microbiota and that helped understanding the ongoing processes. The authors have analyzed data about the role of intestinal microbiota as a metabolic 'reactor' during critical states, possible complications related to misbalance of 'harmful' and 'beneficial' bacteria, and examined potential of a targeted therapy aimed directly at correction of intestinal microbiota. Search for papers was carried out using Scopus and Web of Science databases 2001 to 2018 years: (Gut Microbiota) AND (Critically ill OR Intensive care unit), key words taken for the search were: intestinal microbiota, metabolism, sepsis, antibiotics, critically ill patients, multiple organ failure. A number of questions in understanding of the interaction between gut microbiome and host remain open. It is necessary to take into account interference of microbial metabolism while assessing metabolome of patients with sepsis. Among low-molecular compounds found in blood of sepsis patients, special attention should be paid to molecules that can be classified as ‘common metabolites’ of humans and bacteria, for example, degradation products of aromatic compounds, which many-fold rise in blood of septic patients. It is necessary to take into consideration and experimentally model changes in the human internal environment, which occur during radical transformation of microbiome in critically ill patients. Such approach brings in new prospects for objective monitoring of diseases by evaluating metabolic profile at a particular moment of time based on integral indices reflecting the status of microbiome/metabolome system, which will supply new targets for therapeutic intervention in future.