Objective: to evaluate the membrane-protecting effect of perfluorane (PF) on red blood cells during hypotension and at the early stages of the postreinfusion period, by applying its various administration regimens. Materials and methods. Experiments were carried out on 27 outbred male rats weighing 350 g. The model of the investigation was one-hour hypovolemic hypotension, followed by exsanguinated blood reinfusion. Changes in the ratio of different forms of red blood cells were studied in the blood smears. The cells were calculated under an Olympus BX-500 microscope, magnification 1000x. Three series of experiments were run, each included experimental and control groups. In the experimental groups, PF was administered in a dose of 3 ml/kg an hour before blood loss and 10 min and an hour after blood reinfusion. In the control groups, Ringer’s solution was given in the same volumes and in the same periods as in the experimental ones. Results. The positive effect of PF on the morphological parameters of red blood cells was observed in all the groups of experiments, but it differed in its magnitude depending on the time of PF administration. Preadministration of PF an hour prior to blood loss protected the erythrocyte membrane from hypoxic exposure during hypotension and increased the count of stages I—II planocytes and stomatocytes after blood reinfusion as compared to the controls. The similar results were also obtained with PF administration 10 min after blood reinfusion. In addition to the above effects, PF administration an hour following blood reinfusion promoted a reduction in the number of Stages III-IV stomatocytes. Conclusion. Thus, the most pronounced membrane-protecting effect of PF on red blood cells was obtained with its administration an hour after blood reinfusion. A slight weakening in the effect of PF during its preadministration or just after blood reinfu-sion seems to be associated with the PF-induced reduction in blood circulatory centralization that is known to be of considerable importance in compensation processes both during blood loss and at the early stages of the postresuscitation period. Key words: perfluorane, blood loss, red blood cell membrane.

Objective: to experimentally study cardiac functional and metabolic disturbances in the acute period of severe thermal injury. Material and methods. Experiments were carried out on 25 outbred male albino rats anesthesized with Nembutal (50 mg/kg intraperitoneally). Five-mm-thick copper plates heated up to 60°C were used to simulate thermal injury. Skin contact with the thermal agent lasted 15 seconds. Myocardial contractility and metabolism were examined using the specimen of the isolated isovolumically contracted heart. Results. Severe thermal injury was found to induce acute heart failure caused by cardiac bioenergy impairment, hypoxia, metabolic acidosis, and cardiomyocyte membrane destruction. Key words: thermal injury, cardiac contractility and metabolism.

Objective: to estimate the values of microcirculation, hemostasis, and fibrinolysis in patients after hip joint replacement. Subjects and methods. Thirty-two patients were examined after total endoprosthetic hip joint replacement (TEHJR). Microcirculation was explored by laser Doppler flowmetry (LDF). The level of ADAMTS-13 and its inhibitor and the concentrations of tissue factor pathway inhibitor (TFPI), tissue plasminogen activator (t-PA), and tissue plasminogen activator inhibitor-1 (PAI-1) were measured in the patients’ plasma by enzyme immunoassay. Results. Analysis of LDF measurements of the operated limb showed a 1.3-fold reduction in the value of microcirculation as compared with the intact limb in the patients in the early postoperative period after TEHJR. There were 1.3- and 1.4-fold increases in neurogenic and myogenic tones, respectively. The shunting ratio was 15% higher in the operated versus intact limb. The content of ADAMTS-13 was increased by 1.4-fold in the blood of the operated limp. As compared with the control group, the blood level of TFPI in the operated and intact limbs was elevated by 1.8 and 1.6 times, respectively. As compared with the controls, the patients after hip joint replacement displayed 1.9- and 1.6-fold decreases in the blood concentration of t-PA and PAI-1, respectively. Conclusion. In the patients after hip joint replacement, the value of microcirculation was lower, neurogenic and myogenic tones were higher, as well as there were increases in the levels of ADAMTS-13 and TFPI in the blood flowing from the operated limb as compared with the intact one. The plasma content of t-PA and PAI-1 became lower in the post-TEHJR patients than that in the control group. Key words: endoprosthetic hip joint replacement, microcirculation, hemostasis.

Objective: to study the efficacy of inhaled nitric oxide used intraoperatively to prevent lung oxygenating dysfunction in patients with coronary heart disease after myocardial revascularization under extracorporeal circulation (EC). Subjects and methods. Thirty-two patients aged 55.0±2.0 years were examined. The inclusion criteria were the standard course of surgical intervention (the absence of hemorrhage, acute cardiovascular insufficiency, perioperative myocardial infarction, etc.), a pulmonary artery wedge pressure of less than 15 – mm Hg throughout the study, and the baseline arterial partial oxygen tension/inspired mixture oxygen fraction (PaO2/FiO2) ratio of at least 350 mm Hg. There was a control group (n=21; Group 1) that used no special measures to prevent and/or to correct lung oxygenating dysfunction and Group 2 (n=11) that received inhaled nitric oxide. Ihe administration of inhaled nitric oxide at a concentration of 10 ppm was initiated after water anesthesia, stopped during EC, and resumed in the postperfusion period. Results. At the end, PaO2/FiO2 and intrapulmonary shunt fraction did not differ between the groups (p>0.05). Before EC, the patients receiving inhaled nitric oxide had a lower intrapulmonary blood shunting (8.9±0.7 and 11.7±1.0%; p<0.05). There were no intergroup differences in the values of PaO2/FiO2 at this stage. In the earliest postperfusion period, PaO2/FiO2 was higher in Group 2 than that in Group 1. At the end of operations, Groups 1 and 2 had a PaO2/FiO2 of 336.0±16.8 and 409.0±24.3 mm Hg, respectively (p<0.05) and an intrapulmonary shunt fraction of 14.5±1.0 and 10.4±1.0% (p<0.05). At the end of surgery, the rate of a reduction in PaO2/FiO2 to the level below 350 mm Hg was 52.4±11.1% in Group 1 and 18.2±11.6% in Group 2 (p<0.05). Six hours after surgery, PaO2/FiO2 values less than 300 mm Hg were diagnosed in 61.9±10.5% of Group 1 patients and in 27.3±13.4% of Group 2 ones (p<0.05). Conclusion. The prescription of inhaled nitric oxide at a concentration of 10 ppm to patients with the baseline normal level of PaO2/FiO2 ensured the prevention of lung oxygenating dysfunction in the postperfusion and early postoperative period. The preventive effect of inhaled nitric oxide was steady-state: 6 hours following myocardial revascularization under EC, the patients intraoperatively receiving inhaled nitric oxide showed a 2.3-fold lower rate of lung oxygenating dysfunction (PaO2/FiO2 less than 300 mm Hg) than the controls. Key words: lung oxygenating function, inhaled nitric oxide, operations under extracorporeal circulation, lung ischemia-reperfusion.

Objective: to evaluate the efficiency of a recruiting maneuver (RM) and adjustment of positive end-expiratory pressure (PEEP) in patients with early acute respiratory distress syndrome (ARDS). Subjects and methods. The study enrolled 16 patients (14 men and 2 women) aged 46 to 78 years (range 62±5.6 years) with ARDS of various genesis. RM was made, by stepwisely increasing PEEP and inspiratory pressure under the control of dynamic lung compliance and hemodynamic parameters. The values of blood gas composition and hemodynamics were determined during the study. Results. RM caused an increase in oxygenation index (OI) from 153.5±48.3 to 348.5±53.2 mm Hg. Oxygenation values returned to the baseline levels 30—40 min after the PEEP was set at the closure point of +2 cm H2O. If the set PEEP was 8—10 cm H2O higher than the objective, the effect of RM was retained for as long as 24 hours. When RM was performed using the maximum pressure of 50—60 cm H2O, the cardiac index (CI) was lower in all the patients and 30—50% of the baseline values were achieved in all cases, which required the optimization of cardiotonic therapy. The time of this pronounced reduction in cardiac output with RM was not longer than 5 min. After RM, during mechanical ventilation with 18—26 cm H2O PEEP, the CI did not practically differ from the baseline values (3.31±0.41 and 3.37±0.36 l/min/m2, respectively), though the dopamine dose required to maintain normal hemodynamics was somewhat higher (7.5±2.3 and 6.3±2.6 ^g/kg/min). Conclusion. Analysis of the given cases suggests that RM is highly effective in patients at the early stages of acute lung injury. The duration of RM effects may depend on the set PEEP level in individual cases. Setting PEEP at a level of +2—4 cm H2O fails to prevent repeated alveolar derecruitment in a number of patients. In these cases, it is expedient to individually adjust PEEP levels, by taking into account the long-term changes in OI and Cdyn. In this situation, PEEP may be set at a level of +8—10 cm H2O or at the maximum level that causes no hemodynamic disorders. Key words: acute respiratory distress syndrome, recruiting maneuver, alveolar derecruitment, positive end-expiratory pressure.

Objective: to study lung X-ray changes in premature neonates born from multiple pregnancy respiratory failure. Subjects and methods. Forty-six premature neonates born from multiple pregnancy who had RF were followed up; of them 9 (39.1%) and 14 (60.9%) were monochorial-diamniotic and diochorial-diamniotic twins, respectively. Lung X-ray films were analyzed in 39 infants with RF. By taking into account the babies’ gestational age and the clinical picture of RF, the newborn infants were given the exogenous surfactant Curosurf. Clinical evaluation of their status and plain lung X-ray films were made. If a fatal outcome occurred, the lung was investigated morphologically. Results. There were different lung X-ray patterns: no abnormal changes; the following X-ray signs were most characteristic: a less clear lung field transparency and an increased lung pattern in the middle internal areas of both lungs; a false aspiration pneumonia pattern caused by the Curosurf remnants being present in the airways; hyaline membrane disease and congenital pneumonia were detected in 5.1% of cases. Atelectases were found with the late administration of Curosurf. Conclusion. The prophylactic administration of Curosurf causes lung X-ray changes in the premature neonates with RF. Abnormal lung changes were absent most frequently in the first 24 hours of mechanical ventilation (MV). Atelectases and intrapulmonary hemodynamic disorders were found with the later, the so-called medical Curosurf administration. The emergence of new treatments for RF, such as early transition to MV and administration of exogenous surfactants, in premature neonates alters not only the clinical, but also X-ray pattern of respiratory distress syndrome. Key words: respiratory failure, atelectases, respiratory distress syndrome, premature neonates, multiple pregnancy, lung X-ray film.

Objective: to study the effect of reproductive hormones on the blood lipoprotein spectrum in the postresuscitation period after cardiac arrest. Materials and methods. Experiments were carried out on 66 mature albino rats of either sex weighing 200—250 g. Ten-minute cardiac arrest was induced by intrathoracic ligation of the vascular bundle. At 30 min after resuscitation, 49 animals were intramuscularly injected placebo and 17 animals were administered gyn-odian depot (Schering, Germany). The investigators measured the plasma concentrations of progesterone, 17-OH progesterone, androstenedione, dehydroepiandrosterone sulfate, testosterone, estradiol, and estriol, as well as the levels of triglycerides, total, and high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) cholesterols. Blood was sampled on days 2 and 16 in the absence of therapy and on day 16 of sex steroid therapy. Results. By day 2 postresuscitation, the progesterone/estradiol ratio increased by approximately 1.8 times in males and females. Despite the fact that there were no changes in the concentrations of triglycerides, VLDL and HDL cholesterols in both males and females at that time, but the level of LDL cholesterol increased. Gender-related differences in the LDL spectrum by day 2 postresuscitation remained only in the levels of LDL cholesterol. Despite the normalization of progesterone levels, the concentrations of triglycerides and VLDL cholesterol decreased by day 16 of the postresuscitative period in the absence of therapy. There were no gender-related differences in the lipoprotein spectrum at this stage. The exogenous estradiol in combination with dehydroepiandrosterone caused a significant increase in the concentration of HLD cholesterol and a reduction in that of VLDL cholesterol in males and females both. Conclusion. Under gynodian action, the lipid spectrum was indicative of the exogenous estra-diol and dehydroepiandrosterone sulfate activation of the receptor transport of polyunsaturated fatty acids to the cells and that of reverse cholesterol outflow from the cell membranes in the resuscitated animals. Key words: cardiac arrest, reproductive steroids, blood lipoproteins, gynodian, postresuscitation period.

Objective: to study the efficiency of intraoperative transeosophageal echocardiography in the detection of indications for and contraindications to early activation in the operating room after myocardial revascularization under extracorporeal circulation. Subject and methods. One hundred and eighty-six patients aged 55.0±0.6 years were examined. A Sonos Agilent 5500 apparatus and a multipurpose Omni-2 transducer were used for ultrasound study. Left ventricular ejection fraction was determined in the four-chamber (Simpson) and transgastric views (visualization of the left ventricle in cross-section at the level of the papillary muscles). To identify impaired myocardial contractility hindering immediate activation, the authors analyzed the data of examining 142 patients who might undergo tracheal extubation in the operating room. A decreased left ventricular ejection fraction of less than 50% in the transgastric view was considered to be a contraindication to activation. The sensitivity of echocardiography in the differential diagnosis of acute myocardial infarction _ was studied in 44 patients with echocardiographic signs of acute myocardial ischemic lesion. Results. A left ventricular ejection fraction of less than 50% (41.5±2.2%) in the transgastric view was a refusal criterion for immediate patient activation. This group of patients, as compared with those having a left ventricular ejection fraction of 60.1±1.7%, had a longer duration of inotropic therapy (45.2±2.1 and 13±1.1 hrs; p<0.05) and a more prolonged length of postoperative intensive care unit stay (36.2±1.7 and 18.8±0.75 hrs; p<0.05). The correlation coefficient between the left ventricular ejection fraction at the end of surgery and the duration of inotropic therapy was 0.51 (p<0.0001) and that with an intensive care unit stay was 0.48 (p=0.00018). Among the patients with electrocardiographic signs of acute myocardial ischemic lesion, ultrasound study did not confirm the diagnosis in 65.9% of cases, which allowed early activation to be performed without complications. Acute akinesis of the left ventricular walls in 93.8% was a sign of acute myocardial infarction verified later on by X-ray contrast and laboratory studies. Conclusion. Transeosophageal echocardiographic monitoring is a highly effective diagnostic technique that can detect patients with left ventricular systolic dysfunction and verify acute ischemia and infarction of the myocardium, which substantially increases the safety of patient activation in the operating room after myocardial revascularization. Key words: ultrasound monitoring, transeosophageal echocardiography, early tracheal extubation, early activation of cardiosurgical patients, myocardial revascularization, aortocoronary bypass surgery.

Objective: to estimate the diagnostic value of cerebral oximetry during cardiosurgical operations and to elaborate principles of the prevention of postperfusion neurological dysfunction. Subjects and methods. Four hundred and sixty-one patients operated on under extracorporeal circulation (EC) were examined. Cerebral oxygenation (CO) was monitored in all the patients. Pre-, intra-, and postoperative data were analyzed. Results. Two groups of patients were identified: 1) 148 patients with a reduced CO of lower than 45% during EC and 2) 313 patients without reduced CO. Group 1 was found to have lower preoperative levels of hemoglobin and packed cell volume and baseline reduced bilateral CO, more frequent concomitant brachiocephalic artery (BCA) stenoses of more than 50%, more detectable dyscirculatory encephalopathy (DEP) in the history. Group differences were found in the level of hemoglobin and packed cell volume, oxygen delivery, and PaCO2 during EC and there was a relationship of the rate of CO reductions to the type of cardioplegia. There were also group differences in the magnitude of CO reduction versus the baseline levels. In the postoperative period, encephalopathy (EP) was manifested in 24 (16.3%) and 12 (3.8%) patients in Groups 1 and 2, respectively (p<0.05). Decreased CO during EC was noted in 66.7% of the patients with postoperative EP. Conclusion. It is expedient to monitor CO at surgery with EC. A less than 45% decrease in CO, as well as its more than 20% reduction of the outcome levels during EC is a reliable predictor for the development of postoperative EP. The patients with preoperative anemia, concomitant BCA stenoses of more than 50%, manifestations of DEP in the history, as well as those with a baseline decreased CO of less than 70% were referred to as a group at risk for postoperative EC. Significant hemodilution and hypocapnia should be avoided in these patients during EC and preference be also given to blood cardioplegia. Key words: extracorporeal circulation, cerebral oximetry, neurological dysfunction, cerebral oxygenation.

Objective: to study the impact of correcting immune disorders on the course of the disease in patients with abdominal sepsis. Subjects and methods. Ninety-five patients with abdominal sepsis were examined. APACHE III scores were 25—30. Humoral and cellular immunological parameters were studied in all the patients. The immunotropic drug Galavit was included into the combination treatment of 42 patients. Results. An immunodeficiency state was found in 74 (80%) patients. The incorporation of targeted immunotherapy into the package of medical measures activated the immune system of patients and, in a number of cases, could elevate the level of T lymphocytes, reduced the rate of laparostomy wound suppurations by 1.9 times and the number of fatal outcomes by 10.1%. Conclusion. Incorporation of targeted immunotherapy into the package of medical measures activates cellular immunity and tissue regeneration processes and reduces the degree of endogenous intoxication, the rate of laparostomy wound suppurations, and the number of fatal outcomes. Key words: abdominal sepsis, immunomodulation, Galavit.

Objective: to evaluate the safety of postoperative analgesia via continuous intravenous infusion of promedol versus its traditional intramuscular injection. Subjects and methods. In the postoperative period, analgesia via continuous intravenous infusions of different promedol doses was performed in 20 children aged 5 months to 3 years, who had undergone elective surgical interventions. A control group consisted of 20 children in whom 1% promedol solution was intramuscularly injected in a dose of 0.5 mg/kg every 6 hours. The authors analyzed hemodynamic parameters, the duration of mechanical ventilation (MV) in the patients, the possibility of their transition to spontaneous breathing, and the need for additional sedatives for synchronization with an MV apparatus. Results. The trend in recovery of spontaneous breathing was not found to depend on the modality of analgesia. Episodes of bradypnea occurred more frequently in the patients receiving continuous intravenous infusions of promedol. However, there were no statistically significant differences between the groups. The values of blood gas composition remained in the normal range in both groups. The control group more frequently needed sedatives for synchronization with a ventilator (p<0.05) Hemodynamics was stable in the children of both groups, but tachycardia and essential hypertension were more common in the control group, which was regarded as inadequate analgesia. Conclusion. Continuous intravenous infusion of promedol in a dose of 0.1—0.2 mg/kg/hour failed to exert a pronounced inhibitory effect on respiration. The prolonged administration of the opioid analgesic allows the amount of sedatives to be reduced for synchronization with the ventilator. Moreover, the quality of adaptation to a MV apparatus does not become worse. Key words: continuous infusion of promedol, postoperative period, mechanical ventilation.

Sudden cardiac arrest (SCA) is a most important cause of death. SCA bystander first aid and cardiopulmonary resuscitation (CPR) play a key role in helping protect victims. Early defibrillation that can be made just before arrival of a professional rescue service is the optimal intervention. For this, different countries are elaborating public access defibrillation (PAD) programs based on the use of automated external defibrillators (AEDs) by nonmedical professionals. Since 2009, the service vehicles of the police of the Czech Republic and the urban police of the city of Prague, which serve its districts, have been provided by AEDs. The use of the latter in a SCA victim was first documented in spring 2010. CPR and defibril-lation were successfully carried out in the victim, which permitted neurological complications to be prevented. There is no question that AEDs can effectively defibrillate in ventricular fibrillation. CPR performed by first-contact persons correctly and successively remains to play a key role. Only if AED is incorporated into the adequately operating system, its use may be of life-saving importance to protect a number of patients. Key words: automated external defibrillation, sudden cardiac arrest, ventricular fibrillation, defibrillation.

Objective: to study the effectiveness and safety of an automatic ventilator weaning system in patients with acute respiratory distress syndrome (ARDS) on continuous mechanical ventilation (MV). Subjects and methods. Twenty-eight patients diagnosed as having severe concomitant injury were examined. Due to the evolved ARDS, all the patients were on continuous MV. The study group patients (n=10) were transited to spontaneous breathing through a Smart Care® ventilation system; the control group patients (n=18) were weaned from the ventilator under the control of a resuscitation specialist. Account was taken of the duration of ventilation in the Smart Care® mode and that of patient weaning under the control of a resuscitation specialist, and the need for reintubation, as well as postintubation complications. Results. The application of the automatic ventilator weaning mode showed a 1.3-fold reduction in the length of stay in the patients with severe ARDS under assisted ventilation. Key words: respiratory distress syndrome, mechanical ventilation, ventilator weaning.

The incidence of acute destructive pancreatitis is steadily increasing in the past decade. Objective: to emphasize the high efficiency of complex efferent therapy in treating patients with infectious pancreonecrosis. Subjects and methods. The authors compared 2 similar groups of patients with disseminated infectious pancreonecrosis. Group 1 was on the basic intensive therapy (a control group) and Group 2 received a set of efferent methods, including an original procedure combining membrane plasmapheresis and sodium hypochlorite, in addition to the standard intensive therapy (a study group). Results. There were reductions in intensive care unit bed-days and in the number of fatal outcomes. Conclusion. The set of efferent methods has shown to be effective in treating patients with this pathology. Key words: infectious pancreonecrosis, efferent therapy methods, hemodiafiltration, plasmapheresis, sodium hypochlorite.