Objective: to experimentally reveal the optimal infusion therapy option for systemic hemodynamics, contractility and metabolism of the isolated rat heart in the early period of severe thermal injury. Material and methods. Experiments were carried out on 124 outbred albino male rats anesthetized with Nembutal (50 mg/kg intraperitoneally) to study myocardial contractility and metabolism of burnt animals, by applying an isolated isovolumically contacting heart specimen. Thermal injury was simulated by the contact method using the copper plates heated up to 60°C. Skin contact with the thermal agent lasted 15 seconds. Results. The parameters of systemic hemodynamics and myocardial contractility and metabolism of the isolated heart were found to be improved during infusion therapy performed in the early period of severe thermal injury. The best effect was obtained by infusion therapy combining isotonic sterofundin solution and venofundin solution, as well as isotonic sterofundin and gelofusine. Key words: thermal injury, cardiovascular system, infusion therapy.

Objective: to reveal a relationship of placental inflammatory changes to bacterial infection in premature neonates with respiratory failure. Material and methods. Bronchoalveolar aspirate was bacteriologically studied in 157 premature neonates with respiratory distress syndrome (NRDS); the total and differential leukocyte counts were measured in their peripheral blood. The levels of the cytokines IL-1^3, IL-4, IL-6, and TNF-a were studied in different biological fluids of mothers and their babies; the placentas were also morphologically examined. Results. An analysis of bacterial cultures from the tracheobronchial tree revealed no growth of bacterial microflora in 61.8% of cases, Enterococcus faecalis and Staphylococcus epidermidis were isolated in 6.4 and 8.3% of the infants, respectively; Staphylococcus haemolyticus, Staphylococcus capitis, Enterobacter agglomerans, and hemolytic group A Streptococcus were seen in 1.9% each; moreover, 1.3% of the newborn infants were found to have Bacillus spp., Staphylococcus aureus, Escherichia coli, Acinetobacter spp., and Serratia marcescens. Other microorganisms and a microbial association were encountered in 8.9% of cases. Placental morphological examination revealed different inflammatory changes concurrent with chronic and acute placental insufficiency. The investigation demonstrated that the maternal peripheral plasma levels of IL-1^, IL-4, IL-6, and TNF-a were within the physiological range at the end of the first period of delivery. The amniotic fluid displayed elevated IL-6 and TNF-a concentrations and normal IL-4 and IL-1e levels, suggesting that there was an intrauterine inflammatory process. Conclusion. Premature birth is associated with various placental inflammatory changes, which causes intrauterine stimulation of macrophages in the chorionic villi. Specific immune defense mechanisms that prevent the development of a fetal infectious process, i.e. the maternal infectious process, may induce preterm birth, but fail to lead to fetal and neonatal diseases. The investigation has shown that NRDS is a major disease in premature neonatal infants. Key words: intrauterine infection, premature neonates, cytokines, neonatal res piratory distress syndrome.

Objective: to study the clinical efficiency of undifferentiated and differentiated use of escalation and de-escalation procedures for optimizing positive end-expiratory pressure (PEEP) during mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) resulting from direct and indirect damaging factors. Subjects and methods. During a prospective study, 24 examined patients (16 men, 8 women; their age was 22 to 65 years) with ARDS of different genesis were divided into 2 groups. Group A (n=11; 7 men, 4 women) and Group B (n=13; 9 men, 4 women) included patients with ARDS arising from both direct (gastric content aspiration, blunt chest injury with lung contusion, and acute bilateral bacterial pneumonia) and indirect (abdominal sepsis, severe nonthoracic injury, and acute massive blood loss) damaging factors. The results of treatment via differentiated or undifferentiated, according to the cause of ARDS, use of escalation and de-escalation procedures for PEEP optimization were assessed in Groups A and B patients. Results. The differentiated, according to the cause of ARDS, use of escalation and de-escalation procedures for PEEP optimization makes it possible to more effectively improve the parameters of pulmonary gas exchange and biomechanics and to reduce the length of respiratory support and stay in the intensive care unit, the incidence of ventilator-associated pneumonia, and mortality rates in patients with ARDS resulting from direct and indirect damaging factors. Conclusion. It is advisable to apply the differentiated, according to the cause of ARDS, approach to choosing escalation or de-escalation procedures to optimize PEEP in patients with ARDS of different genesis. Key words: acute respiratory distress syndrome, direct damaging factors, indirect damaging factors, mechanical ventilation, positive end-expiratory pressure, escalation PEEP optimization procedure, de-escalation PEEP optimization procedure, lung opening manoeuver.

Objective: to define the prognostic value of hemodynamic monitoring data and overall oxygen balance in the postperfusion period of cardiosurgical operations. Subjects and methods. Three hundred and fifty-three patients (317 men, 35 women) aged 57±0.6 years, who had been operated on under extracorporeal circulation (78±6 min) with a Swan-Ganz catheter being used, were retrospectively examined. Among the examined, 277 patients had undergone coronary bypass surgery (3.1±0.2 shunts); 18, mitral valve replacement; 42, aortic valve replacement; 9, mitral and aortic valve replacement; and 7 had one-two heart valve replacement with shunting of 2±1 coronary arteries. The left ventricular ejection fraction averaged 48±0.04%. The parameters of central hemodynamics and oxygen balance were recorded when the sternum was brought together. There was a group of those who had been discharged from hospital and a group of those who had died in hospital. The authors used an intergroup comparison of parameters and an analysis of ROC curves, by recording the cut off values. Results. The postperfusion risk factors of hospital mortality were a mean pulmonary artery pressure of more than 29 mm Hg; a pulmonary artery wedge pressure of greater than 16 mm Hg; a cardiac index of less than 2.35 l/min/m2; a stroke volume index of less than 22.7 ml/m2; an indexed oxygen transport of less than 315.6 ml/ml2; a blood lactate level of higher than 4.6 mmol/l; an adrenal dose need of more than 115/ng/kg/min. Left ventricular stroke work indicators, such as a stroke work index of less than 21.2 g”‘Xm”2 and, to the maximum extent, a pump coefficient of lower than 2.8 g”‘Xm”2/mm Hg, have a high degree of accuracy in suggesting the risk of mortality. Conclusion. The invasive monitoring of pulmonary pressure and cardiac efficiency in the postperfusion period permits an objective prediction of a risk for hospital mortality. Key words: cardiosurgery, Swan-Ganz catheter, heart failure, mortality.

Objective: to study the state of systemic microcirculation and endothelial function in comas induced by acute cerebrovascular accident (ACA). Subjects and methods. The study was conducted within the first 7 days of ACA in 38 coma patients, who were divided into groups according to the etiology of stroke: Group 1 comprised 20 patients with hemorrhagic stroke; their mean age was 56.6±2.3 years; Group 2 consisted of 18 patients with ischemic stroke; their mean age was 58.5±2.2 years. A control group included 34 apparently healthy individuals; their mean age was 55.1±2.1 years. The microcirculatory bed was evaluated within 7 days, by applying cutaneous laser Doppler flowmetry using a LAKK-02 capillary blood flow laser analyzer made in Russia (LAZMA Research-and-Production Association, the Russian Federation). Coincidentally with recording of the microcirculatory blood flow, blood samples were collected to explore the serum concentrations of endothelin-1, stable nitric oxide metabolites, van Willebrand factor, and thrombomodulin. Results. Throughout the study, the patients with coma induced by ACA were found to have microcirculatory disorders consisting in higher microperfusion along with the markedly increased influence of active modulators of vascular tone, as well as endothelial functional structural changes. Conclusion. The data obtained in the study suggest that there were uniform changes in the state and regulation of systemic microcirculation in patients with ACA irrespective of the type of stroke (hemorrhagic or ischemic). Key words: stroke, microcirculation, microvascular bed, micro blood flow, tissue perfusion, endothelium.

Objective: to upgrade the quality of predicting an outcome in patients with acute colonic ileus (ACI) in relation to the level of a constant potential. Material and methods. Four hundred and seventy-one case histories of patients operated on for ACI caused by colonic cancer were retrospectively analyzed. Results. An analysis of the capacity of scales to accurately predict a fatal outcome in the general population showed that the CR-POSSUM scale significantly underrated the risk for a fatal outcome (O/R ratio = 1.684 (1.515—1.871); however, the APACHE III and SAPS II scales demonstrated an adequate accuracy (O/R ratio = 1.112 (1.088—1.136) and 1.069 (1.054—1.085), respectively). When dividing subgroups according to the value of constant potential, the greatest agreement was achieved predominantly in Subgroup 1, by using the CR-POSSUM and APACHE III scales (the area under the characteristic curve was 0.913 and 0.93, respectively). It should be pointed out that all the scales had a good calibration after additional identification of subgroups, unlike in the general population of patients (p>0.05). The SAPS II scale also demonstrated a good calibration, but a low discriminating power particularly in groups with average and low negative values of a constant potential. Key words: severity rating scales, acute colonic ileus, constant potential.

Objective: to evaluate the efficiency of combination use of hyperbaric oxygenation, succinate-containing solutions, and anti-edematous agents in patients with acute carbon monoxide poisoning. Subjects and methods. The results of treatment were analyzed in 32 patients admitted in 2009—2011 for severe acute carbon monoxide poisoning and a Glasgow coma score of 6—8. The patients were divided into 2 groups: 1) patients whose combination therapy involved hyperbaric oxygenation, Succinasol infusions, and L-lysine-aescinate injections; 2) those who received traditional therapy. All the patients underwent complex clinical, laboratory, and neurophysiologic examinations. Results. Just 24 hours after the combination use of Succinasol and L-lysine-aescinate, Group I patients were observed to have substantially reduced lactate, the content of the latter approached the normal value following 48 hours, which was much below the values in the control group. The similar pattern was observed when endogenous intoxication parameters were examined. During the performed therapy, the level of consciousness and that of intellect according to the MMSE and FAB scales were restored more rapidly in the study group patients than in Group 2. Conclusion. The combination use of hyperbaric oxygenation, the succinate-containing solution Succinasol, and the anti-edematous agent L-lysine-aescinate considerably enhances the efficiency of intensive therapy for acute carbon monoxide poisoning. Key words: carbon monoxide, toxic hypoxic encephalopathy, combination therapy, hyperbaric oxygenation, succinic acid, L-lysine-aescinate.

The main cause of death in the intensive care units is infectious complications, including sepsis and septic shock. Immunoglobulins are the most potent mechanisms in anti-infective defense. Whether intravenous immunoglobulins should be used in urgent situations remains to be solved. The mechanisms of action of immunoglobulins are diverse and depend on dosage and time of use. The paper analyzes the data available in the Russian and foreign literature on the possible points of use of intravenous immunoglobulins in the treatment of acute conditions accompanied by sepsis. It also gives the authors’ data on the use of intravenous immunoglobulins to treat toxic epidermal necrolysis. Key words: intravenous immunoglob-ulins, sepsis, toxic epidermal necrolysis.

The review deals with the mechanisms of action of opioids and the synthetic analogue of endogenous leuenkephaline dalargin. It discusses the relation of delta-opioid receptors to the phenomenon of pharmacological preconditioning that may explain the universal cytoprotective properties of dalargin observed in clinical observations. Key words: opioids, opioid receptors, pharmacological preconditioning, cytoprotection, dalargin.

The review deals with sedation in intensive care unit patients. It covers problems in monitoring, choice of a goal sedation level, use of a sedation pause and timely choice of medications. Key words: intensive care unit sedation, sedation scale, sedation pause, goal sedation level.

The year 2012 is the anniversary year of the Russian history of cardiac defibrillation. Two anniversaries associated with the name of N. L. Gurvich, the founder of impulse defibrillation by high-voltage capacitor discharge, are being celebrated this year.