Objective: to study lung morphological changes in a closed chest injury model in laboratory animals. Material and methods. Experiments were carried out in 30 male albino nonbred rats weighing 350—380 g. Closed chest injury was simulated, by exposing the chest of anesthetized rats to a 300-g metal cylinder falling from a height of 30 cm. The observation periods were 1, 3, 6, and 24 hours. Results. The signs of evident perivenular edema that was uncharas-teristic to acute respiratory distress syndrome induced by other causes are an important peculiarity of lung morphological changes in this experimental model of closed chest injury. Conclusion. The experimental studies clarified the pattern of lung morphological changes in the early period after closed chest injury. Key words: closed chest injury, pulmonary edema.

Objective: to study the effect of sevoflurane on functional recovery in animals after clinical death. Materials and methods. Experiments were carried out on male albino rats. The cardiac vascular fascicle was ligated to simulate temporary circulatory arrest. Its time was 10 minutes. Clinical death was modeled in the animals anesthetized with sevoflurane or chloral hydrate. The functional state of resuscitated animals was evaluated from the time of recovery of effective cardiac performance, spontaneous breathing, corneal reflex, and neurological deficit scores. Their elevated plus-maze behavior was examined. Results. The rats anesthetized with chloral hydrate, unlike those anesthetized with sevoflurane, showed an earlier recovery of spontaneous external breathing and corneal reflex and, in succeeding 2 days following resuscitation, less neurological deficit scores. In addition to a prompter recovery of central nervous system functions on postresuscitation day 4, the sevoflurane-anesthetized rats had a greater gain in body weight for its value on the day of clinical death modeling than the chloral hydrate-anesthetized rats. A study of their behavioral activity showed that the resuscitated rats of both groups differed from false-operated ones in a trend towards reduced number of executions, which is indicative of the higher level of rat phobic state in the postresuscitation period. No differences were observed between the groups of the resuscitated animals in all the indicators examined. Conclusion. Ten-minute clinical death modeling in sevoflurane-anesthetized rats accelerates neurological recovery and improves their general state as compared to chloral hydrate-anesthetized rats. At the same time, both anesthesia modes stop the development of the higher level of phobic state seen in the rats in the postresuscitation period. The findings do not preclude the involvement of the preconditioning properties of sevoflurane in the postresuscitation processes of brain functional recovery. Key words: circulatory arrest, sevoflurane.

Objective: to study body glutamine kinetics in hepatic failure and in the course use of hyperbaric oxygenation (HBO). Material and methods. Experiments were performed on 210 female albino rats. HBO was thrice conducted at 3 ata as a 50-min session once daily after hepatectomy (HE, 15—20% of the liver weight); glutamine levels were measured in their visceral organs and blood from the following vessels: the aorta, v. porta, v. hepatica, v. renalis. Results. By eliminating the glutamine-excretory dysfunction of the operated liver, HBO corrects its glutamine deficiency. At the same time, HBO activates glutamine production by gastrointestinal organs with its further incretion into the portal blood flow. It also stimulates the absorption of glutamine by lung tissue and its deamidation in the latter, but causes a reduction in myocardial glutamine concentrations. By stimulating the development of arterial hyperglutaminemia, HBO prevents the development of transient glutamine deficiency in the splenocytes and delayed postoperative portal hypoglutaminemia. HBO does not exert a substantial impact on brain tissue glutamine changes, but it regulates renal glutamine kinetic changes induced by partial HE. Conclusion. Hyperbaric oxygen used for hepatic failure induced by HE recovers body kinetic disorders of glutamine in this abnormality, by concurrently regulating the adaptive changes in its metabolism in the organs, which occur in response to liver damage. Key words: glutamine, metabolism, hepatic failure, hyperoxia.

Objective: to evaluate the effect of positive end-expiratory pressure (PEEP) on cerebral perfusion pressure (CPP) in intracranial hypertension in an experiment using a biological model. Materials and methods. The experiment was carried out on 10 pigs aged 2 months and weighing 17—20 kg. The experimental animals were anesthetized. The authors monitored the following parameters: invasive arterial and central venous pressures, intracranial pressure (ICP), and peak inspiratory pressure. ICP was simulated with a subdurally placed balloon. During mechanical ventilation (MV), PEEP was gradually increased up to 5, 10, 15, and 20 cm H2O. Results. PEEP elevation during MV was accompanied by a progressive rise in intrathoracic pressure and a reduction in mean blood pressure. When PEEP was increased, there was a significant rise in ICP in the intact brain and basic subcompensated intracranial hypertension; no statistically significant change in ICP was observed in decompensated intracranial hypertension. The safe PEEP with regard to CPP was determined by the severity of basic intracranial distention (it was 15 cm H2O in the intact brain and 10 cm H2O in subcompensated hypertension); PEEP exerted no significant effect on CPP in decompensated intracranial hypertension. Conclusion. The effect of PEEP on CPP is determined by not only the value of PEEP, but also by the severity of brain damage. Key words: positive end-expiratory pressure, intracranial pressure, cerebral perfusion pressure.

Objective: to evaluate the functional state of intestinal microcirculation in diffuse peritonitis caused by hollow organ perforation and to determine its possible relationship to skin microcirculation. Subjects and methods. Seventeen patients with diffuse peritonitis resulting from hollow organ perforation were examined. The patients’ mean age was 58.5±2.8 years; a control group consisted of 35 apparently healthy individuals. The functional state of the intestinal microcirculatory bed (the mid-transverse colon, the ileum at a distance of 60 cm from the ileocecal corner, the small bowel at a distance of 50 cm of the ligament of Treitz, and an area next hollow organ perforation) and skin was evaluated by laser Doppler flowmetry by means of a ЛАКК-02 laser capillary blood flow analyzer made in the Russian Federation (LAZMA Research-and-Production Association, Russian Federation). Results. Perforation of the affected intestinal portion became worse in patients with diffuse peritonitis. Blood flow stability was ensured by the higher effect of mainly active components of vascular tone regulation on the microvascular bed. Regulatory changes were equally pronounced at both the intraorgan and skin levels. Conclusion. The findings suggest that the patients with diffuse peritonitis have changes in microcirculatory regulation aimed at maintaining tissue perfusion. These changes are universal at both the intraorgan and skin levels. Key words: microcirculation, micro blood flow, intestine, peritonitis, tissue perfusion.

Objective: to analyze the impact of different detoxification techniques on pulmonary gas exchange function in patients with generalized peritonitis complicated by multiple organ failure. Subjects and methods. One hundred and thirty patients with generalized peritonitis were examined. According to the used detoxification techniques, the patients were divided into 5 groups. All the patients underwent a comprehensive examination, the key element of which was the evaluation of gas exchange parameters. Results. Membrane plasmapheresis and plasmapheresis with sodium hypochlorite infusion to the plasma filter in patients with peritonitis are shown to improve pulmonary blood oxygenation.

Objective: to estimate tracheal morphological changes in children, by using a device for the continuous monitoring and regulation of endotracheal tube cuff pressure. Subjects and methods. Two groups of children were examined. In Group A comprising 22 children aged 2 months to 16 years, the adequacy of the external control balloon palpation method was estimated to measure endotracheal tube cuff pressure. In Group B consisting of 12 children aged 5 to 18 years on mechanical ventilation for more than 3 days, the efficiency and appropriateness of applying a PressureEasy device for monitoring the pressure in the endotracheal tube cuff were assessed to prevent postintubation tracheal complications. In the latter group, the authors identified a study subgroup (BI) of 8 patients where this device was employed and a control group of 4 patients (BII) where it was not used. Results. Group A showed that endotracheal tube cuff pressure was 20—30 cm H2O in 31.8% of cases, greater than 30 cm H2O in 36.4%, and lower than 20 cm H2O in 31.8%. Subgroup BI displayed considerably lower macro- and microscopic histological changes than Subgroup BII. Conclusion. Determination of endotracheal tube cuff pressure by palpation of the external control balloon does not reflect its real values. The magnitude of tracheal changes is more intensive if continuous monitoring and regulation of pressure in the endotracheal tube cuff is absent. The PressureEasy device to monitor endotracheal tube cuff pressure permits its variability maintenance at a given level, by mitigating the damaging effect of the cuff on tracheal tissue. Key words: endotracheal tube, cuff, histology, ischemia, prevention, pressure, trachea.

Objective: to reduce the amount of anesthetics and analgesics during carotid artery surgery, by combining general anesthesia and superficial cervical plexus block. Materials and methods. The study included 33 operations on the carotid arteries. Group 1 covered 17 operations for which a combination of propofol and fentanyl was used for anesthesia. Group 2 comprised 16 operations for which, in addition to propofol and fentanyl, superficial cervical plexus block with bupivacaine solution was carried out. At surgery the authors estimated hemodynamic parameters, plasma cortisol levels, the number of intra- and postoperative complications, and morbidity rates. The intensity of pain syndrome and the amount of analgesics were assessed within the first 20—24 hours after surgery. Results. During anesthesia, Group 2 children needed a lower amount of propofol and fentanyl to maintain anesthesia, shorter mechanical ventilation and earlier extubation than did Group 1 patients. At surgery, Group 2 patients showed a significantly reduced hemodynamic response to skin incision and lower plasma cortisol levels when the carotid artery was exposed. Postoperatively, Group 2 patients had a lower intensity of pain syndrome than Group 1 patients. Conclusion. As compared with general anesthesia, the anesthesia based on propofol and fentanyl in combination with superficial cervical plexus block using bupivacaine solution provides optimal intraoperative patient protection and improves analgesia within the first 24 hours after surgery.

The paper reviews urgent approaches to tracheostomy in intensive care unit patients, by analyzing the data available in the modern Russian and foreign references. It describes moot points on indications for, time and methods of tracheostoma application. Key words: tracheostoma; time of tracheostomy; techniques for tracheostomy; percutaneous dilatational tra-cheostomy; puncture dilatational tracheostomy.

The paper analyzes the data available in the references on different aspects of using hypertonic sodium chloride solution during surgery under extracorporeal circulation in cardiosurgical care. The hypertonic solution is shown to lower positive fluid balance in the perioperative period, to increase cardiac output with simultaneously decreased vascular resistance, to improve lung oxygenating function, and to normalize tissue blood circulation and neurological status in patients exposed to artificial perfusion. There is evidence for its effect on the immune system and capillary endothelium. It is suggested that it is necessary to study the effect of the hypertonic solution on the incidence of complications and death rates during surgery under extracorporeal circulation and it is proposed to use the solution under long-term extracorporeal circulation. Key words: hypertonic saline, sodium chloride, extracorporeal circulation.

Based on the data of numerous current references, the review describes different neuromonitoring methods during cardiac surgery under extracorporeal circulation. It shows that it is important and necessary to make neuromonitoring for the early diagnosis and prevention of neurological complications after cardiac surgery. Particular attention is given to cerebral oximetry; the possibilities and advantages of this technique are described. Correction of cerebral oximetric values is shown to improve survival rates and to reduce the incidence of postoperative complications. Lack of cerebral oximetry monitoring denudes a clinician of important information and possibilities to optimize patient status and to prevent potentially menacing complications, which allows one to conclude that it is necessary to use cerebral oximetry procedures within neu-romonitoring in cardiac surgery. Key words: extracorporeal circulation, cerebral oximetry, neurological dysfunction, cerebral oxygenation.

The paper provides an analytical review of the references on the role of microcirculatory disorders in the development of critical conditions, the significance of circulatory monitoring, specifically, to make a presumptive prognosis of multiple organ dysfunction. It defines main directions in the diagnosis and correction of microcirculatory disorders as direct (infusion therapy) and indirect (influence on the components of a systemic inflammatory response, by extending to microcirculatory correction) microcirculatory exposures. Key words: critical conditions, multiple organ dysfunction, procedures to evaluate and correct microcirculation.

Objective: to evaluate the efficiency of using inhaled tobramycin in addition to systemic antibacterial therapy in the treatment of severe nosocomial pneumonias (NP) in critically ill patients. NP remains one of the most urgent problems in resuscitative units. Traditional intravenous injection of broad-spectrum antibiotics does not allow their bactericidal concentration to be achieved in the lung. Inhaled antibiotics in addition to systemic antibacterial therapy reduce the clinical symptoms of NP, assist the switching of patients to spontaneous breathing, and decrease the titer of microbes in bronchial lavage fluid. Subject and methods. This paper describes the experience of successfully using inhaled tobramycin during systemic antibiotic therapy in 10 patients with severe NP. Results. The use of inhaled tobramycin in addition to systemic antibiotic therapy is accompanied by a reduction in the signs of endogenous intoxication and acute respiratory failure, by a decrease in the titer of pathogenic microorganisms in bronchial alveolar fluid, and by an increase in their response to systemic antibiotics, by positive X-ray changes in 60% of the patients, and by the switch of 30% of the patients to spontaneous breathing. Adverse reactions as oto- and vestibu-lotoxicity were recorded in two patients; there were no cases of nephrotoxicity. Conclusion. The administration of inhaled tobramycin in a dose of 300 mg twice daily is effective and safe as a supplement to systemic antibiotic therapy in the treatment of severe NP caused by polyresistant gram-negative pathogens. Key words: nosocomial pneumonia, inhaled tobramycin.

The paper presents information on the studies of poor outcomes in medical practice and that from expert practice. Key words: poor outcome, iatrogenia, forensic medical examination.