Objective: to examine the surface heterogeneities of red blood cell membranes after acute massive blood loss and blood reinfusion, by using atomic force microscopy (AFM). Materials and methods. Experiments were carried out under nembu-tal anesthesia on male rats. Hypovolemic hypotension was induced during 60 minutes, followed by blood reinfusion. The experimental phases were as follows: control before blood loss; 5 minutes after its onset; 1 hour following hypotension; and 1 and 3 hours after reinfusion. Membrane surface images were obtained by AFM in the constant scanning mode. Spatial surface spectral transformation was used. Results. The nano-surface parameters were shown to be intrinsic characteristics of membranes. The greatest changes occurred at the early stages of transient processes: blood loss and reinfusion. Conclusion. The application of AFM permitted the authors to trace the time course of changes in the red blood cell membrane surfaces during acute total blood loss and further blood reinfusion to tolerances of fractions of nanometer. Key words: blood loss, reinfusion, nanostructure, atomic force microscopy.

Objective: to define the degree of activation of lipid peroxidation in patients with severe concomitant injury and to determine whether they could be corrected with the antioxidant agent Laprot. Subjects and methods. The time course of changes in lipid peroxidation parameters and clinical data was studied in 68 patients with severe concomitant injury, in 35 of whom Laprot (made by P. A. Herzen Moscow Oncological Research Institute, Russian Agency for Medical Technologies (Russia), was added to the standard treatment. Results. The significant activation of oxidative processes and lipid peroxi-dation, which was accompanied by antioxidant system imbalance, was ascertained to occur in severe concomitant injury. Key words: injury, lipid peroxidation, lactoferrin.

Objective: to improve the results of victims with massive crushes of soft tissues in severe concomitant injury (SCI), by applying extracorporeal detoxification techniques as soon as possible. Subjects and methods. The results of examination and treatment were studied in 41 victims with SCI treated at the N. N. Burdenko Main Military Clinical Hospital in 2006 to 2008. In the early posttraumatic period (on days 1—3), all the victims (n=41) were divided into 2 groups. Group 1 victims (n=19) underwent hemodiafiltration (HDF) with replacement at 35 ml/kg/hr; Group 2 (n=22) had plasmapheresis. Results. Early HDF applied to Group 1 victims could achieve 32, 44, and 37% reductions in the elevated levels creatine phosphokinase, myoglobin, and middle-sized molecules, respectively. In Group 2, plasmapheresis showed a lower effect (19, 25, and 26% reductions). Furthermore, there was a decrease in total protein in Group 1, which was absent in Group 2. Conclusion. The timely use of extracorporeal detoxification techniques in victims with massive crushes of soft tissues in the early posttraumatic period prevents the development of fatal complications of SCI, at the same time HDF is more effective and safe than plasmapheresis. Key words: severe concomitant injury, rhabdomyolysis, myoglobin, plasmapheresis, hemodiafiltration.

Objective: to study central hemodynamics, the determinants of coronary blood flow and myocardial oxygen demand, and the parameters of blood oxygen-transport function during alveolar mobilization in early periods after extracorporeal circulation in patients operated on for coronary heart disease. Subjects and methods. Twenty-nine patients were examined after myocardial revascularization. The alveolae were mobilized 63±2 min after extracorporeal circulation. The peak airway pressure was 31±0.3 H2O. Invasive hemodynamic monitoring was provided with Swan-Ganz catheters. Results. After building up the peak airway pressure, there was a 7.5—15 mm Hg blood pressure reduction (p<0.05) and 3.7 mm Hg right atrial and pulmonary artery wedge pressure elevations (p<0.05). Total pulmonary vascular resistance increased by 44% (p<0.05). Cardiac index reduced by 15% (p<0.05) due to decreased stroke volume. Coronary perfusion gradients and myocardial oxygen demand proportionally changed: r=0.62—0.77 (p<0.001). Oxygen transport significantly unchanged due to alveolar mobilization. After the latter, there was a close correlation between oxygen delivery and uptake (r=0.74; p<0.001). After alveolar mobilization, the changes in oxygen utilization coefficient and cardiac index had a significant correlation (r=0.43; p=0.02). After switching to artificial ventilation in the fitted mode, all the study parameters did not differ from the baseline values. Conclusion. The production of the peak airway pressure required for alveolar mobilization is attended by cardiac depression due to the right and left ventricular function determinant changes resulting in reductions in stroke volume and blood pressure. At the same time, there is imbalance between the conditions for coronary blood flow and the myocardial oxygen demand values. After artificial ventilation with the fitted positive end-expiratory pressure is switched, the mean hemodynamic values return to the baseline levels; however, there are signs of tense blood transport function. Key words: alveolar mobilization in cardiosurgical patients, hemodynamic effects of alveolar mobilization, recruitment maneuver.

Objective: to study the production of surfactant apoprotein D in preterm neonates with acute respiratory distress syndrome (ARDS) during artificial ventilation (AV). Subjects and methods. The paper presents the results of studying the production of surfactant protein D (SP-D) in various biological fluids in 44 preterm neonates. Two groups of newborn infants were identified according to the clinical manifestations of ARDS. The study group comprised 25 infants with the severe course of the disease, in this connection the preventive administration of the exogenous surfactant Curosurf and AV were made in all the neonates at birth. The control group included 19 preterm babies without signs of ARDS. Results. The study has demonstrated that in parturients and preterm neonatal infants, surfactant apoprotein D is detectable in various biological fluids: amniotic fluid, the gastric aspirate obtained just after birth, residual umbilical cord blood, serum following 8 hours of birth, and bronchoalveolar fluid. Despite the low gestational age of the neonates, the lung surfactant system is able to produce SP-D, as evidenced by its high content in the amniotic fluid and residual umbilical cord blood of preterm neonates. The production of apoprotein D in preterm neonates considerably reduces in the next few hours after birth. Conclusion. The findings suggest that fetal tissues generate SP-D, which improves pulmonary gas exchange in preterm neonates in the first hours after birth and that alveolar-capillary membrane dysfunctions are transient in the neonates on AV. Key words: preterm neonates, acute respiratory distress syndrome, surfactant, surfactant apoprotein D.

Objective: to analyze the efficiency of the Rostov Region’s medical care service for children with severe traumatic injuries due to road traffic accidents. Results. It has been established that the service meets the generally accepted stepwise principles and has a multilevel network of hospitals, which allows the earliest performance of the required volume of medical care in relation to the pattern and severity of lesions. It has been shown that 58.3% of the children with severe traumatic lesions are primarily admitted to the central district hospitals and emergency care ones that are aimed at rendering medical aid to the adult population. Thus, medical care is delivered to the above contingent by non-pediatric surgical and resuscitative-anesthetic services. Conclusion. By keeping in mind the specific features of the emergency medical system existing in the region, the authors propose its further development, by organizing interregional centers on the basis of a number of central regional hospitals for the treatment of children with traumatic lesions (among other things, by allocating pediatric beds in the intensive care units). The stepwise solution of this problem is currently being done in the Rostov Region in two main directions: 1) organization by developing a round-the-clock advisory subdivision (with an exiting sanitary aviation team) on the basis of – the regional children’s clinical hospital and 2) methodical maintenance of multidisciplinary h°spitals in delivering medical care to different age-groups children. Key words: road traffic accidents, emergency medical service, children, traumatic lesions.

Objective: to estimate the time course of changes in the BIS index during rapid, over-pressure, induction of anesthesia with sevoflurane in children. Subjects and methods. Twenty-three children aged 6 months to 12 years were examined during rapid inhalation induction of sevoflurane anesthesia at short-term facial plastic surgery. The BIS index as a criterion for depressed consciousness during anesthesia and systemic hemodynamic parameters, were studied. Results. The anesthesia induction protocol that envisaged the initial inhalation of high (8%) sevoflurane concentrations in a 100% oxygen stream with a gradual decrease in the concentration of the anesthetic to 4 and 2% by minutes 4 and 8, respectively, after the initiation of its inhalation was found to achieve an adequate steady depth of depressed consciousness, as confirmed by the values of the BIS index. The latter reduced to 51.56±4.89 and 45±3.12 within the first minute after the initiation of sevoflurane inhalation and by the end of the second minute, respectively, which suggested deep sedation. The minimum value of the index was 39.00±1.72 at minute 5. The found hemodynamic changes were induced by the inhaled anesthetic and did not exceed the admissible values. Conclusion. The estimation of the changes in brain electric activity during the described technology of anesthesia induction has suggested that the procedure for BIS index recording is of high prognostic value in preventing possible impairments in anesthetic maintenance, i. e. inadequate or excess depressed consciousness. Key words: anesthesia induction, children, sevoflurane, inhalation anesthesia, BIS index, sedation.

Objective: to define the efficiency of the intensive care priorities of eclampic coma, which reduce mortality in puer-peras, by studying systemic and metabolic disturbances. Subjects and methods. Studies were conducted in 42 puer-peras with eclampic coma (a study group) in whom the authors used their intensive care algorithm the basis for which was standard (conventional) therapy. Central hemodynamic parameters were studied by the direct method of right heart catheterization using a flow-directed Swan-Ganz catheter. Overall cerebral blood flow was measured by a noninvasive (inhalation) radionuclide method, by using the tracer 133Xe, as described by V. D. Obrist et al., on a modified КПРДИ-1 apparatus (USSR). The rate of brain oxygen uptake was determined from the oxygen content between the artery and the internal jugular vein. Studies were made in four steps: 1) on admission; 2) on days 2—3; 3) emergence from coma; 4) before transition. Results. The use of the authors’ proposed algorithm of intensive care for eclampic coma, which is aimed at enhancing cerebral blood flow due to the slight expanding effect of stabizole and antihypertensive therapy (nimodipine and magnesium sulfate), lowered the mean arterial pressure by not more than 10—25% of the baseline level. Conclusion. The proposed intensive care could reduce mortality by up to 4.8%. Key words: eclampsia, eclampic coma, intensive care.

Objective: to study the time course of changes in the values of intoxication and leukocyte phagocytic activity in patients with second-to-third degree burns with a Klinitron unit being included into the standard therapy regimen. Subjects and methods. Twenty-six patients with second-to-third degree thermal burns were examined and treated, by determining the degree of burn injury from the Frank index, the level of endotoxicosis and leukocyte phagocytic activity. Results. The incorporation of the Klinitron unit into the complex of intensive therapy in the burnt results in a reduction in the level of intoxication and favors normalization of leukocyte phagocytic activity, which lowers the likelihood of developing infectious and toxic complications of burn disease and reduces the length of intensive care unit stay. Conclusion. The use of the Klinitron unit in the complex of the standard intensive care regimen contributes to prompter scab drying, ensures temperature comfort and the maximum low contact pressure on wounds, improves conditions for engrafting the transplanted skin flaps and wound epithelization, reduces the severity of endotoxicosis, and enhances the nonspecific resistance of the organism (phagocytic activation). Key words: thermal burns, intoxication, Klinitron, nonspecific resistance.

Objective: to develop a scale for rating the severity of surgical endotoxicosis. Subjects and methods. Clinical and laboratory studies were made in 1168 patients with urgent surgical diseases, the course of which was accompanied by severe endogenous intoxication. Multistep statistical processing yielded seven signs that were most important in evaluating the severity of endotoxicosis, which characterized the baseline state of the macroorganism, the toxic potential of endogenous intoxication sources, and the result of the damaging effect of the toxic principle on the most important life support systems. Results. After scoring adaptation of each sign of endogenous intoxication to the significance of other signs, a scale was compiled to evaluate the endotoxicosis severity. The latter was estimated from the number of scores. The authors distinguish three endotoxicosis grades: moderate, severe, and very severe. Conclusion. The scale developed to evaluate the severity of surgical endotoxicosis provides a more objective assessment of the severity of endogenous intoxication since it is based on the consideration of various courses of the pathological process. It is very convenient in clinical use and makes it possible to have not only a single evaluation of the severity of endotoxicosis, but also to characterize its course over time. Key words: evaluation of the severity of endotoxicosis, toxemia gradation.

Objective: to study the informative value of the oxygenation index as a criterion for the diagnosis of acute respiratory distress syndrome (ARDS) of varying genesis. Subjects and methods. Seventy-two patients, including 27 women and 45 men, aged 19 to 65 years admitted to an intensive care unit for various diseases, in whom ARDS was diagnosed on the basis of the traditional criteria, were prospectively examined. The authors analyzed the causes of acute respiratory failure, the time course of changes in gas exchange and PaO2/FiO2, X-ray picture, and the time of respiratory support when respiratory and nonrespiratory treatments were performed. Results. After correction of the extrapulmonary causes of impaired gas exchange, optimization of respiratory support parameters, and use of aggressive artificial ventilation methods and nonrespiratory treatments, 45 (62.5%) of the 72 examinees diagnosed as having ARDS showed a considerable gas exchange improvement and a steady increase in the oxygenation index more than 300; thus, these patients stopped meeting the criteria of ARDS. Conclusion. The oxygenation index is a rather vulnerable sign of ARDS, the time course of changes in which depends on many pulmonary and extrapulmonary causes, which necessitates a comprehensive evaluation of the degree of lung injury, the causes and severity of respiratory failure and, evidently, the refinement and expansion of the criteria for establishing this diagnosis. Key words: acute lung injury, acute respiratory distress syndrome, acute respiratory failure, oxygenation index.

Case report. A pregnant woman with severe brain injury developed cerebral salt-wasting syndrome concurrent with diabetes insipidus. Placental enzymatic destruction of antidiuretic hormone and thyroid, adrenal, and renal dysfunction were excluded. Polyuria developed on day 3 when diuresis was less than 8.5 liters, there was hyponatremia (Na+ < 130 mmol/l) with a urinary Na+ content of > 40 mmol/l. The administration of 3% sodium chloride solution considerably enhanced polyuria. When minirin was given in a daily dose of 0.4 mg, diuresis reached 32.4 liters, which exceeds the levels described for the complete absence of antidiuretic hormone. The use of minirin in the mean therapeutic dose (0.6 mg daily) reduced, but failed to normalize diuresis. Evident hypernatremia and hypokalemia were absent in the existing polyuria. Brain injury in the female patient was suspected to cause and impair the synthesis of antidiuretic hormone and to increase the elaboration of ouabaine. This concomitance led to the concurrent development of central diabetes insipidus and cerebral salt-wasting syndrome. On this basis, the dose of minirin was increased up to 1.2 mg daily; hypothiazid 50 mg twice daily was prescribed. Hydrocortisone 50 mg twice daily was intramuscularly injected after diuresis reduced to 4.7 liters and hyponatremia (Na+ = 112.2 mmol/l). The performed therapy could normalize diuresis up to 1.8 liters and correct the blood levels of electrolytes. Key words: brain injury, diabetes insipidus, cerebral salt-wasting syndrome.

Hip joint endoprosthetic replacement (HJER) leads to hemodynamic disorders and massive intraoperative hemorrhage and presents a high risk (30—55% of cases) for postoperative deep vein thrombosis in the lower extremity, at the same time the possibility (12—22%) of massive pulmonary thromboembolism (PTE) is ruled out. So the choice of infusion-transfusion therapy is of paramount importance in these patients. The authors studied the efficiency of normovolemic hemodilution with the autoplasma (patented in the Russian Federation) in treating massive perioperative hemorrhage in patients undergoing HJER and in reducing postoperative thrombotic events. It was compared with infusion therapy comprising hydroxyethyl starch (130/0.4). All the patients had spinal anesthesia and standard postoperative analgesia in an intensive care unit. The administration of autologous fresh frozen plasma resulted in a 15% reduction in intraoperative blood loss, by increasing the coagulation potential and platelet aggregability. Postoperatively, there was an overall increase in the hypercoagulation potential, both the plasma link and platelet aggregability, in both groups. The use of autologous plasma by elevating the concentration of natural anticoagulants (AT III) by 9% could prevent 35 and 75% rises in soluble fibrin monomer complexes and D-dimer. In two patients from the comparative group, the postoperative period was complicated by the development of occlusive thrombosis of the femoral vein. Key words: intraoperative hemodilution, auto-plasma, vein thromboses.

Objective: to define the role and place of hyperbaric oxygenation (HBO) in the treatment and prevention of liver cell failure. Material and methods. The results of the author’s own studies and the data available in the literature on the impact of HBO on the functional state of the liver and the whole organism in liver cell failure were analyzed. Results: The therapeutic and preventive effects of HBO during therapy for liver cell failure were due to the ability of hyperbaric oxygen to regulate metabolic processes in the sick organism. By eliminating the impaired hepatic neutralization of ammonia, hyperbaric oxygen corrects its extrahepatic reactions in rendering harmless various toxic substances, which become active in response to the ammonia-neutralizing dysfunction of hepatocytes. This prevents the development of endogenous ammonia intoxication. In liver cell failure, HBO concurrently stimulates hepatic protein synthesis function and the cell link of the body’s antimicrobial protection. The therapeutic effect of HBO is not always attended by the elimination of hepatic hypoxia and the sick organism’s hypoxemia, but it persists long in the posthyperoxic period. Conclusion: HBO can and must be an integral part of complex therapy for liver cell failure. Key words: hyperoxia, treatment, liver, failure.

The presented review of literature covers the current notions of the role of nitric oxide and its metabolism in the development of encephalopathies in critically ill patients. The mechanisms of nitric oxide involvement in neurotoxicity, neuronal induction of apoptosis, and the types of nitric oxide involvement in the development of brain ischemia, focal cerebral damage in severe brain injury are described. A concise review of the experimentally founded therapy options aimed at correcting nitric oxide-induced neuronal damage (modulation of nitric oxide synthesis, antioxidants) is given. Key words: brain ischemia, brain traumatic injuries, nitric oxide synthase variants, neurotoxicity, apoptosis, correction modes.

The paper presents the results of using a new version of a respirator for high-frequency jet ventilation (HFJV) that provides static thoracopulmonary compliance (Cst.) monitoring in real time. The performed studies on a lung model and clinical trials under HFJV in 18 patients undergoing thoracic operations for tuberculosis, tumors of the lung and mediastinum have yielded original algorithms to record auto PEEP and a point on the pressure curve corresponding to a zero flow (a rough plateau), which could solve the problem of compliance recording. The clinical tests of the developed algorithms permitted a new assessment of the physiological essence of thoracopulmonary compliance during HFJV. Unlike conventional ventilation in which the lower Cst indicates higher lung stiffness (more unventilated alveolae), in contrast this during HFJV suggests fewer unventilated alveolae, which is attended by reductions in the dead space and alveolar-capillary shunt and by an increase in arterial blood oxygen tension.