Purpose. To compare the efficacy of metabolic hepatoprotectors at an early stage of acute alcohol poisoning complicated by toxic hepatitis.

Material and methods. 80 patients with acute alcohol poisoning complicated by toxic hepatitis who received medical treatment in the toxicology unit of the Republican Research Center of Emergency Medicine during 2015–2017 were examined. The patients were split into 3 groups. At the background of backbone therapy, patients of group I (n=30) received a hepatoprotectors on the basis of inosine, meglumine, methionine, nicotinamide, and succinic acid; patients of group II (n=20) were prescribed to receive drugs based on betaine glucuronate (glucomethamine), diethanol amine (glucodiamine), and nicotinamide ascorbate. Patients of group III (n=30) received the backbone therapy. In all patients, the concentrations of liver enzymes, bilirubin, free ammonia, blood lactate, the condition of vegetative nervous status were analyzed. Psychoastenics was examined using the MMSE score, FAB score and Reitan test.

Results. After 48 hours, in group I patients, the concentration of blood lactate became almost normal, in group II patients it decreased to 2.6Ѓ}0.9 mmol/l, and in group III patients it was equal to 2.7Ѓ}0.9 mmol/l. On day 5, in patients of groups I and II the cognitive deficit was almost absent, in patients of group III the MMSE scores were 1.3-fold and 1.4-fold lower than in patients of groups I and II, respectively.

Conclusion. The drug used in group I possessed increased antihypoxant properties but smaller hepatoprotective properties than the drug used in group II. When signs of toxic hepatitis are predominant it would be more preferable to use the drug applied in group II and when the signs of tissue hypoxia are predominant the drug applied in group I should be used.

Purpose is to evaluate the influence of intravenous sedation with dexmedetomidine and propofol on the intensity of oxidative distress, delirium severity and duration in severe polytrauma patients.

Material and methods. 100 victims (18 to 50 years of age, trauma of two regions and more, ISS score at admission equal to 16–50) were included in the study. Depending on sedation method, the patients were split into group I (n=51) and group II (n=49), in the combined therapy of whom propofol and dexmedetomidine were used, respectively. In addition to standard examinations, the blood plasma carbonylated peptides were assayed in all patients.

Results. It has been established that the assay content of carbonylated peptides in blood might reflect polytrauma severity. A link between the oxidative distress intensity and delirium duration (r=0.34; P<0.05) and severity (r=0.38, P<0.05) in severe polytrauma patients has been demonstrated, which might support the role of oxidative distress in delirium development. Influence of the sedation drugs dexmedetomidine or propofol on oxidative distress intensity was not evident in all stages of the study.

Conclusion. Significant oxidative distress promotes longer and more severe course of delirium in severe polytrauma patients. The content of carbonylated proteins over 0.78 nmol/mg predicts the development of cognitive dysfunction one month after severe polytrauma with 62% sensitivity and 67% specificity. In spite of clinical efficacy, neither dexmedetomidine nor propofol reliably reduce oxidative distress in severe polytrauma patients.

Respiratory failure (RF) after tracheal extubation occurs in 5–25% of cardiac surgical patients. Various noninvasive respiratory support techniques are available for RF treatment.

The purpose of the study is a comparative assessment of the effect on gas exchange of oxygen inhalation through a mask with noninvasive airway positive pressure mask ventilation, and high-flow lung ventilation during post-extubation respiratory failure in cardiac surgical patients.

Materials and methods. 52 cardiac surgical patients with post-extubation respiratory failure (mean age 61 (55–67) years) were included in the study. Respiratory failure critera were as follows: PaO2/FiO2 _ 300 mm Hg or SpO2 _ 88% during room air breathing. Exclusion criteria included presentation of pleural effusion in patients, pneumothorax, diaphragm paresis. Every patient was subjected consecutively to arterial blood gases test during room air breathing, low-flow oxygen therapy using a mask with a pre-volume bag, high-flow ventilation (HFNC), and noninvasive positive pressure mask ventilation (NIPPV). Each method was applied during 1 hour prior to the test. Respiratory rate (RR) and capillary blood saturation (SpO2) were monitored throughout the whole study.

Results. PaO2/FiO2 during low-flow oxygen therapy was equal to 171 (137–243) mm Hg. At the background of HFNC, this index increased to 235 (183–305) mm Hg (P=0.00004), and upon transfer to NIPPV — to 228 (180–288) mm Hg (P=0.000028). SpO2 during HFNC and NIPPV increased from 95 (93–98)% to 98 (96–99)% (P=0.000006) and 97 (95–98)%, respectively (P=0.000006 and P=0.000069). PaCO2 was higher during oxygen mask breathing compared to air breathing: 41 (37–44) mm Hg and 38 (34–42) mm Hg, correspondingly, P=0.0017. Upon transfer to HFNC, PaCO2 lowered on average by 10% (37 (33–39) mm Hg, P=0.0000001), to NIPPV — by 7% (38 (36–42) mm Hg, P=0,0015). Differences were also significant when compred RR during oxygen mask breathing (20 (16–24) respirations/minute) vs. HFNC (16 (12–20) respirations/minute, P=0.0) and vs. NIPPV (18 (16–20) respirations/minute, P=0.018). Comparison of HFNC vs. NIPPV revealed reliable difference in RR (16 (12–20) respirations/minute against 18 (16-20) respirations/minute, P=0.016), PaCO2 (37 (33–39) mm Hg against 38 (36–42) mm Hg, P=0.0034), and SpO2 (98 (96–99)% against 97 (95–98)%, P=0.022).

Conclusion. HFNC and NIPPV exert a similar positive effect on the oxygenating function of lungs and gas exchange in cardiac surgical patients with post-extubation respiratory failure. Compared to NIPPV, high-flow ventilation renders most significant positive effect on elimination of CO2, RR and SpO2, and is better tolerated by patients.

The purpose of the study is to identify the components of immunity, which might predict the development of multiple organ failure in patients after heart surgery.

Material and methods. The study included 40 patients who were operated in cardiac surgery Department. The inclusion criteria were the presence of indications for cardiac surgery. The exclusion criteria were the presence of infective endocarditis in patients. Before the operation and after 24 hours we studied the blood level of leukocytes and lymphocytes. We analyzed the phenotype of immune cells using monoclonal antibodies, serum levels of procalcitonin and C3 and C4 complement components. All patients were evaluated for multiple organ disfunction (MOD) using the SOFA scale.

The results showed that cardiac surgery leads to the development of MOD, statistically significant multidirectional changes in both quantitative and qualitative composition of all cells of the immune system, significant changes in the level of C3 and C4 components of the cascade of complement and plasma level of pro-calcitonin. ROC analysis was revealed that the relative content of monocytes is less than 7.1% of the number of leukocytes as well as the absolute content of monocytes with the CD14 + HLA-DR + phenotype less than 0.32_109/l in the preoperative period, and the C3 level of the complement component less than 0.52 g/l, as well as the maximum SOFA score in the postoperative period, were the best predictors of MOD after the procedures.

Conclusion. The components of innate immunity make it possible to predict the complication of the cardiac surgery, earlier than the SOFA scale.

Purpose of the study: to investigate the epidemiology of sepsis in patients with different locations of the infection focus, who were admitted to the intensive care unit (ICU) of a multi-specialty hospital in 2014 and 2016.

Material and methods. A retrospective analysis of examination and treatment of 860 patients admitted to ICU of a multi-specialty hospital with the diagnosis ‘sepsis’ in 2014 and 2016 was carried out. Sepsis was diagnosed pursuant to the Sepsis-2 Guidelines and verified by blood procalcitonin test. The gender, age, main diagnosis, patient’s severity at the time of admission to ICU, duration in ICU, and peculiarities of intensive care and outcomes were studied.

Results. Sepsis was diagnosed at admission in 2014 in 361 (8.6%) patients out of 4175 patients, in 2016 — in 499 (10.5%) out of 4726 patients who were admitted to ICU and had infection foci of different location. Abdominal sepsis was diagnosed in 72.3% of patients, pulmonary — in 19.7%; in 8% of patients, sepsis complicated the terminal stage of various, mostly oncological, diseases. In 2016, sepsis detectability at admission to ICU increased by 22.1% vs. the 2014 level assumed as 100% (χ2=9.281; P=0.003). In case of the abdominal sepsis, mortality amounted to 50.3% and was not different from mortality in pulmonary sepsis — 52.1% (χ2=0,163; P=0.687). The ICU in-patient duration in case of pulmonary sepsis was considerably longer than in case of abdominal. The age was a predictor of mortality in case of abdominal sepsis (the age older than 65 years predicted the risk of lethal outcome with sensitivity equal to 58.8% and specificity equal to 59.9%), which was not true for pulmonary sepsis. The mortality prognosis during abdominal sepsis was improved by combined analysis of the SOFA score and patient’s age at admission: AUROC of the combined index was equal to 0.816 (95%-confidence interval: 0.783–0.846). Depending on the infection focus location, specificity of influence rendered on mortality by different clinical indices and management methods was determined.

Conclusion. Patients admitted to ICU with sepsis represent a group of a high mortality risk amounting to 50% approximately. During chronological analysis, sepsis detectability increases but mortality does not change. Patients with pulmonary sepsis at admission to ICU are characterized by a greater severity of condition due to multiple organ failure than in case of abdominal sepsis; in such patients it is impossible to predict the risk of mortality based on APACHE II and SOFA score. Taking into account heterogeneity of the sepsis patient population, deepening of the knowledge about peculiarities of pathogenesis and clinical pattern of abdominal and pulmonary sepsis is the basic requirement for improvement of the results of treatment of this complication.

The purpose of the study is to determine early non-invasive (ultrasound) diagnostic criteria of splenomegaly in neonates with a high risk of congenital or postnatal infection.

Materials and methods. In the prospective study, 163 newborn infants of the first week of live were included. All neonates included in the study were classified as possessing a high risk of an intra-uterine infection (IUI). Depending on the birth weight, the infants were split into two groups: group «А» — 80 full-term newborns with normal birth weight, and group «В» — 83 full-term newborns with fetal growth restriction (FGR). A comprehensive examination of newborns including spleen ultrasound was carried out.

Results. An increased spleen weight coefficient (Km) was found in newborns with high risk of infection development that included congenital oromaxillofacial and gastrointestinal defects, perinatal contacts with various microorganism. The increased spleen weight and Km reflected conditions of the immune system organ of the newborn in response to an adverse exposure including infection.

Conclusion. Ultrasound examination of morphometrical characteristics of the spleen in newborns with various medical conditions represents a convenient and simple method of early diagnosis of splenomegaly. The most sensitive index is the spleen weight coefficient (Km), which reflects the immune system organ response to an adverse perinatal exposure including contact with an infectious agent. The mean spleen weight coefficient is within the range of 1.1 to 3.0. When the index exceeds 4, the risk of development of an infectious disease increases. This method can be used as a screening approach for newborns of different gestation age who have been included in the high-risk group based on a congenital or early postnatal infection.

Purpose of the study. To evaluate the influence of sublethal dose of Clozapine on the functional and morphological parameters of the cardiovascular system in rats 4 hrs. after the drug administration.

Materials and methods. The experiments were carried out on male Wistar rats weighing 200–250g (n=14). Group I received 0.9% NaCl solution administered via enteral feeding tubing under general anesthesia using Sevoflurane; group II — Clozapine dosed at 150 mg/kg in 0.9% NaCl solution; group III — Clozapine dosed at 150 mg/kg in 40% ethyl alcohol solution. 4 hrs. after drug administration, arterial blood pressure (ABP), heart rate (HR), microcirculation in the skin using laser Doppler flowmetry (LSF), fluorescence intensity of coenzymes NADH and FAD were evaluated. After euthanasia, autopsy including withdrawal of the internal organs of rats for morphological analysis was performed. Thereafter, paraffin sections of hearts were made and subsequently stained with hematoxylin and eosin, which were later examined with the help of light microscope Nikon Eclipse Ni-U.

Results. In both Clozapine groups, ABP and blood flow in the skin were lower than in the control group: ABP — by 12% in group I and by 15% in group II; blood flow — by 48% and 37%, respectively. No significant difference between the groups was observed in respect of the microcirculation indices studied. Increased fluorescence intensity of coenzyme NADH in the skin was found in the Clozapine groups compared to the control group (2.3-fold in group I and 1.9-fold in group II). Histological analysis of the hearts of animals that received Clozapine established uneven blood filling, erythrocyte sludges, fine-focal hemorrhaging, endotheliocyte nuclei oriented perpendicular to the basal membrane, uneven staining of myocardium with hypereosinophilic segments, fragmentation and undulating deformity of muscle fibers.

Conclusion. During acute Clozapine poisoning, morphological signs of disturbed circulation and myocardium damage are found in the heart, which are accompanied with development of myocardium dysfunction with arterial hypotension and decreased peripheral blood flow, also disturbed oxidative metabolism in peripheral tissues.

Purpose of the study: to investigate the influence of hypovolemia correction by infusion of malate-containing preparations and subsequent glutamine-enriched nutritional support on the maintenance of gut barrier and overhydration in animals with acute massive blood loss/  

Materials and methods. Blood samples were harvested from the tail and portal veins of rats (n=100) at different time points after the acute blood loss (>30% V/V) . Bacterial blood cultures for growth, lipopolysaccharide and presepsin concentrations, colon structures and animal weight were analyzed in blood and plasma specimens 1 hour, one day and 3 days after the hypovolemia correction. To correct the hypovolemia, in the 1st series of experiments, the Ringer’s solution and standard nutrient mixture were used; in the 2nd series malatecontaining solution and standard nutrient mixture were administered; in the 3rd series a malate-containing solution and glutamine-enriched nutrient mixture were employed.

Results. In the portal vein blood of intact animals, endotoxin measurement was equal to 17.8Ѓ}3.9 pg/ml, that of presepsin — 405.6Ѓ}80.1 pg/ml. At all stages, tail and portal blood bacterial cultures were negative demonstrating an absence of bacterial growth and gut barrier intactness for live microorganisms. One hour after hypovolemia correction and blood reinfusion, multifold increase in endotoxin concentration in the blood from both portal and tail veins was accompanied by significant increase of presepsin concentration. 24 hours after the blood loss, in the animals of the 2nd and 3rd series, the levels of endotoxin, presepsin, and edema of the colon mucous membrane and submucosal space has become lower than those in the 1st series. Three days later, the advantages of glutamine-containing nutrition in the 3rd series of the experiment were determined that revealed decreasing the endotoxin and presepsin concentrations in the portal and tail vein blood and diminishing the levels of interstitial edema of colon and animal weight growth.

Conclusion. Administration of malate-containing infusion preparations and glutamine-enriched nutrition after an acute massive blood loss contributes to decreasing presepsin production in GIT organs, abrogating endotoxin translocation into the portal vein and systemic circulation, lessening severity of edema of the mucous membrane and submucosal space of the colon, and reducing the previously increased animal body mass.