Objective: to study the impact of the processes of lipid peroxidation (LPO) and antioxidant defense (AOD) on consciousness recovery trends in puerperas with eclampic coma. Subjects and methods. Two patient groups were examined. Group 1 (control) comprised 12 puerperas delivered by elective cesarean section; Group 2 included 26 puerperas with eclampic coma, delivered by emergency cesarean section. To evaluate the efficacy of cytoflavin in leveling oxidative stress, Group 2 was divided into 2 subgroups: 2a) non-cytoflavin and 2b) cytoflavin. Investigations were made in the puerperas with eclampic coma at four stages: 1) on admission (on days 1—2 after the first convulsive attack); 2) on days 2—3 after admission); 3) during emergence from coma state; 4) before transition from an intensive care unit. Results. Comparison of the results obtained in two groups suggests that the eclampic coma puerperas showing a significant increase in lipid peroxides in the presence of AOD exhaustion have uncompensated oxidative stress. Comparative assessment of subgroups 2a and 2b established that incorporation of cytoflavin into the complex therapy of puerperas reduced the duration of coma. Conclusion. The use of cytoflavin results in a rapider normalization of LPO and an enhancement of AOD in puerperas with coma, which contributes to an earlier emergence from coma. Key words: eclampic coma, lipid peroxidation, antioxidant defense, consciousness recovery, cytoflavin.

Objective: to improve pregnancy outcomes in severe gestosis. Subjects and methods: Sixty-five women with incomplete pregnancy in presence of severe gestosis were examined and the status of 65 neonatal babies was evaluated in the early neonatal period. The women were allocated into 3 groups: 1) 19 pregnant women were urgently operated on for severe admission condition (preeclampsia); 2) 22 pregnant women received standard therapy for gestosis; 3) 24 had standard therapy for gestosis in combination with 6% solution of the hydroxyethyl starch Stabisol®. Results. During gestosis therapy, pregnancy prolongation was 4.5±1.2 bed/days in Group 2 and averaged 7.6±1.6 bed/days in Group 3. The rate of neonatal referral to an intensive care unit was 63.1, 50.0, and 37.5% in Groups 1, 2, and 3, respectively. Referral to a neonatal pathology unit at the second stage of nursing was required in 100, 77.2, and 62.5% in Groups 1, 2, and 3, respectively. Conclusion. The use of 6% solution of the hydroxyethyl starch Stabisol® in complex therapy for gestosis in incomplete pregnancy prolongs pregnancy, accelerates rehabilitation in puerperas, prevents respiratory distress syndrome in full measure, and improves the neonatal adaptation period and perinatal outcomes as a whole. Key words: severe gestosis, incomplete pregnancy, 6% solution of Stabisol®.

Objective: to evaluate the neonatal autonomic nervous system, by analyzing cardiac rhythm variability (CRV). Subjects and methods: Examinations were made in 7 full-term neonates with the physiological course of the early adaptation period on days 2 and 5 after birth (a control group) and in 11 neonatal babies with various surgical pathology during surgical interventions (a study group). Results. Just in the preoperative period, the neonatal infants with surgical pathology showed a comparatively higher activity of the sympathetic nervous system than did the healthy infants, which determines the intensive performance of most systems of the body. The anesthesia introduction period and tracheal intubation were accompanied by a predominance of very low frequency (VLF) fluctuations associated with energy metabolic regulation. A drastic increase in stress index by almost 2 times and a reduction in spectrum power are indicative of the considerable tension of regulatory systems. The basic stage is characterized by a preponderance of high-frequency (HF) fluctuations and an increase in VLF ones by the end of surgery with lower low-frequency (LF) power fluctuations and by the maximum SI values, which indicates the enhanced activity of the subcortical autonomic centers in the hypothalamo-pituitary system and cerebral cortex. Conclusion. The CRV indicators recorded at all surgical stages in neonatal babies with surgical pathology reflect a critical increase in the activity of autonomic cardiovascular system regulation, which are undetectable by conventional anesthesiological monitoring techniques, in which the changes in hemodynamics (blood pressure and heart rate) were characterized by the relative stability of the indicators. The studies supported the informative value of – using the methods for statistical and spectral analyses of CRV in neonates at surgery to optimize anesthesiological defense and to make a timely correction of impaired homeostasis.

Objective: to analyze the results of treating viral-bacterial pneumonias in pregnant women and puerperas in the 2009 seasonal influenza period. Subjects and methods. Five hundred and seven pregnant women who were admitted to the clinics of three institutions for the diagnosis of pneumonia between October and December of 2009 were examined; of whom 52 subjects were hospitalized to the intensive care units for severe hypoxia and/or sepsis. The general principles of specific and symptomatic therapies, the efficiency of ventilation modes, organ protection methods, and morphological material were analyzed. Results. The total problems of the diagnosis and clinical course of the disease and the specific features of intensive care were identified. There were 2.4% deaths among all the pregnant women admitted for viral infection concurrent with pneumonia or 23.1% in all the patients admitted to the intensive care unit. The autopsy results were analyzed. Conclusion. The severest viral-bacterial pneumonias were noted in the third trimester of pregnancy. The later start of specific antiviral therapy was an independent predictor of death. Continuous veno-venous hemofiltration is inadequately effective in treating acute lung injury, producing a satisfactory organ-saving effect. The standard respiratory maneuvers showed a low effectiveness during mechanical ventilation. Key words: seasonal influenza A/H1N1, pneumonia, pregnancy, respiratory failure, intensive care.

Objective: to estimate the incidence of adult respiratory distress syndrome (ARDS) and to define the main biochemical parameters characterizing the severity of preeclampsia in pregnant women. Subjects and methods. The study was conducted in 117 pregnant women aged 18 to 42 years with varying preeclampsia at 36—38 weeks of gestation. Results. According to the severity of preeclampsia in pregnant women, there was an increase in the rate of free radical oxidation that caused direct damage to the vascular endothelium, by inhibiting the total antioxidant activity of plasma, which largely depended on the state of the nitroxidergic system. There was an inverse correlation between nitrite levels and hemodynamic parameters and a functional relationship between systemic hemodynamic disorders and nitrite levels in pregnant women with preeclampsia. There was a reduction in the count of platelets and a significant increase in platelet aggregation in stages III and IV ARDS. Conclusion. Varying interstitial lung edemas develop in relation to the severity of preeclampsia. The maximum impairment of lipid peroxidation processes and lower nitrate levels were noted in severe preeclampsia. There was a progressive platelet count fall in Stages III and IV ARDS. In the authors’ opinion, the magnitude of involvement of platelets in aggregates and free radical damage to the pulmonary vascular endothelium play a significant role in the development of ARDS in pregnant women with preeclampsia. However, impairments in the thrombocytic link are likely to be regarded as a direct cause of lung dysfunction. Key words: preeclampsia, respiratory distress syndrome, nitrites, lipid peroxidation.

Objective: to study the clinical efficiency of introducing an algorithm for organ-protective intensive care. Materials and methods. 3278 case histories of patients admitted to the clinic in 2000—2009 for surgical treatment (under extracorporeal circulation) for coronary heart disease (CHD) and acquired heart defects (AHD) were retrospectively analyzed. Throughout the analyzed period, the patients operated on for CHD and AHD were 2068 (63.1%) and 1210 (36.9%), respectively; the postoperative incidence of multiple organ dysfunction (MOD) among all the patients was 11.8% (378 patients); mortality in MOD was 3.75% (n=123) of the operated patients (included into the study) or 32.5% of all the patients with MOD. Conclusion. The incidence of MOD is in proportion to the number of surgical interventions and depends on their specific features (recurrence, baseline severity, comorbidity, or multifocal atherosclerosis). Preventive intensive therapy for MOD reduced mortality and altered its syndromic pattern towards a preponderance of pyoseptic complications. Key words: cardiosurgery, extracorporeal circulation, multiple organ dysfunction.

Objective: to comparatively estimate major hemostatic parameters during plasma sorption (PS) and molecular adsorption recirculating system (MARS) therapy in patients with liver cell failure. Subjects and methods: Forty-one patients with liver cell failure were examined. The patients’ condition was rated using the APACHE III, SOFA, MODS, and Child-Pugh scales. As a complex of intensive therapy, all the patients were treated with extracorporeal techniques: MARS therapy in Group 1 (n=17) and plasma sorption in Group 2 (n=24). The patients’ age was 18 to 65 years. Results. MARS therapy, unlike PS, normalizes the parameters of coagulation hemostasis and stabilizes platelet counts within 5 days in the postperfusion period. MARS therapy is the procedure of choice for the treatment of patients with liver cell failure. Mortality was 35.3 and 54.2% in Groups 1 and 2, respectively. Key words: molecular adsorption recirculating system, plasma sorption, acute liver cell failure.

Objective: to study the effectiveness of some types of semipermeable dialysis membranes and replacement therapy techniques in patients with isolated acute renal failure (iARF). Subjects and methods: Eighty-nine patients aged 24 to 67 years, who received intensive and replacement/maintenance therapy, were examined. The patients were divided into 3 groups in accordance with their condition rated by the APACHE III scale, from the used dialysis membranes and renal replacement/maintenance therapy options. Results. By varying the permeability of a membrane, its area and the volume of convection, we can control the rate of substance elimination, which is similar to that of test markers having a molecular weight of 100 to 15000 Da. Conclusion. Adequate replacement therapy for iARF is possible only when high-flux, high-permeability dia-lyzers are applied. The indices of hemodialysis/hemodiafiltration adequacy in terms of urea cannot be determinants in patients with iARF. The achievement of elimination of low-molecular-weight proteins — markers of uremic intoxication to 30—35% and/or an increase in effective albumin concentrations as a summary marker of toxicity by 16—20% is of much more importance. Key words: isolated acute renal failure, uremic toxins, hemodialysis, hemodiafiltration.

Objective: to elaborate therapeutic and diagnostic tactics for bleedings from esophagogastric varices (EGV) in an intensive care unit (ICU). Subjects and methods: The experience in treating 102 patients with profuse bleeding from EGV, admitted to the ICU, Acad. V. Vakhidov Republican Specialized Center of Surgery, in 2000—2008, was summarized. Results. The findings show that just less than 40% of the patients with hepatic cirrhosis are admitted for the clinical manifestations of active bleeding from EGV, the latter being profuse in 17.6%. These indicate that the noticeable admission preponderance of patients with first-degree blood loss and the low proportion of those with critical third-degree blood loss are noteworthy. Retrospective analysis demonstrated that hemostasis was achieved in 97 (95.1%) patients, by applying solely conservative measures using a Blakemore tube (in both variants of its use). After removal of the Blakemore tube, stable hemostasis retained in 88.9% of the patients with bleedings from the veins of the middle third of the esophagus, in 71.8% of cases of those from its lower third and only in 24.1% of the patients with those from the cardiac stomach. Conclusion. According to the results of the study, we propose the therapeutic and diagnostic tactics for patients with profuse bleedings from EGV, which involve the use of a Blakemore tube and a complex of conservative measures with traditional hemostatic therapy, the administration of portal pressure-reducing agents to prevent or treat hepatic failure. Key words: bleeding, esophagogastric varices, hepatic failure, intensive therapy.

Objective: to study the regularities of circulation of epidemic Pseudomonas aeruginosa strains in the intensive care unit and to formulate main prophylactic measures against pseudomonas infections. Materials and methods: A prospective epi-demiological observation was made with daily microbiological monitoring of major loci in patients and environmental objects in the intensive care unit for 244 days. A total of 1314 clinical material samples from 888 patients and 488 washes from hospital environmental objects were studied and 211 P.aeruginosa strains were identified by microbiological, serological, and molecular genetic studies. Results. Intensive circulation of epidemic Pseudomonas aeruginosa strains of predominantly O12 serogroup was found in the intensive care unit. The main sources of infection were patients and moist hospital environmental objects; the most important transmission routes are the hands of medical staff and anesthetic respiratory equipment. There was a predominant lesion in the respiratory tract: the incidence of pseudomonas infection was 3.5 times greater than that in the patients on mechanical ventilation equipment. The basic prophylactic measures in the intensive care unit, which are aimed at eliminating P.aeruginosa, should involve daily observation of necessary sanitary-hygienic and antiepidemic rules and organization of care for patients. Conclusion. Prophylactic and antiepidemic measures at hospital should be based on the results of circulating microflora monitoring.

Objective: to develop a method for preventing hepatic failure. Subjects and methods: Sixty-three patients with a complicated course of acute pancreatitis, admitted to the intensive care unit, were examined and treated. Thirty-one patients received standard intensive therapy and 32 patients had an intensive treatment program comprising deferoxamine in a dose of 6—12 mg/kg without octreotide. The activities of AsAT and AlAT and the levels of total bilirubin and its fractions, ferritin, and free hemoglobin were determined in plasma three times (on admission, 1 and 3 days later); the activities of superoxide dismutase and catalase were also examined. The severity of endotoxemia was assessed by the levels of low- and medium-molecular-weight substances in plasma and on red blood cells. Results. Incorporation of deferoxamine into the intensive therapy program for severe acute pancreatitis could reduce the incidence of hepatopathy and decrease that of pancreatogenic sepsis and retroperitoneal phlegmon by 3 times and mortality rate by 19.6%. Conclusion. The use of deferoxamine in the intensive therapy program is pathogenetically warranted because, by binding excess iron ions in plasma, the agent prevents the development of occasionally fatal complications of acute pancreatitis.

Objective: to evaluate the blood-saving activity, efficacy, and safety of tranexamic acid. Subjects and methods. Thirty-seven patients allocated into two groups were enrolled in the study of the efficacy of tranexamic acid as an agent in reducing blood loss during hip joint replacement. Group 2 patients were injected tranexamic acid, 10 mg/kg body weight, 20—30 minutes before and 3 hours after surgery in the same dosage. This resulted in a significant (48.5%) reduction in total blood loss (from 1089.6 to 560.8 ml) (p<0.05). No tranexamic acid-induced complications were found. The administration of tranexamic acid during total endoprosthetic replacement of the hip joint could reduce blood loss by 35 and 59.4% in the intraoperative and postoperative periods, respectively, and total blood loss by 48.4%. The use of tranexamic acid allows one to refuse transfusion of blood components during total endoprosthetic replacement of the hip joint. Key words: hip joint replacement, blood loss, tranexamic acid.

In foreign countries, the anesthesiological and resuscitative tactics that ensure the maximally rapid discontinuation of mechanical ventilation are regarded as a fundamental therapeutic component of the so-called fast-track cardiac surgery that provides a shorter length of hospital stay, an intensified therapeutic process, and lower-cost treatment. In the Russian literature, this methodic approach is customarily designated early activation, by bearing in mind that discontinuation of mechanical ventilation is a key point of postoperative recovery of the patients’ physical activity. The main Russian and foreign publications on the specific features of therapeutic tactics in early periods after cardiac surgery are historically analyzed. The paper covers the polemic between the supporters and opponents of the earliest activation of patients operated on under extracorporeal circulation, the change of views on a need for obligatory postoperative mechanical ventilation, and the impact of the rate of activation and physical activity on the quality of rehabilitation. Terminology and clinicians’ points of views on the optimum activation periods are analyzed. Key words: early activation, operations under extracorporeal circulation, tracheal extubation in an operating room, early tracheal extubation, postoperative rehabilitation of cardiosurgical patients.