Objective. To comparatively study the efficiency of respiratory support using biphasic positive airway pressure (BIPAP), spontaneous intermittent mandatory ventilation (SIMV), and intermittent positive pressure ventilation (IPPV) in patients with acute lung injury (ALI) and concomitant pneumothorax. Subjects and materials. Sixty-eight patients were examined. The severity of disease was 18 to 24 APACHE II scores. After elimination of pneumothorax, lung opening maneuver was made by the routine procedure 1—2 times daily on different types of respiratory support. Results. The study has indicated that in patients with ALI and concomitant pneumothorax, BIPAP reduces the time of pleural cavity drainage, which allows the lung opening maneuver to be earlier used. Conclusion. BIPAP leads to a better adaptation of a patient to respiratory support, to the limited use of sedatives, and to better gas exchange in the lung and accelerates transfer from total respiratory support to spontaneous breathing. Key words: acute lung injury, pneumothorax, BIPAP, lung opening maneuver.

Objective: to study pulmonary hemodynamics, cerebral oxygenation, intracranial and perfusion pressures in pulmonary complications in victims with severe brain injury (SBI). Subjects and materials. Retrospective studies were conducted in 47 victims with isolated brain injury. Of them, 30 patients made up a study group with poor prognosis (death, vegetative state, and severe disability). In the presence of negative clinical and neurological changes, they developed pneumonia, acute respiratory distress syndrome (ARDS) of different stages, ARDS concurrent with pneumonias. All the victims underwent invasive dynamic studies of pulmonary hemodynamics, intracranial pressure (ICP), by calculating cerebral perfusion pressure (CPP) and cerebral oxygenation (CO). Results. The studies have shown that pulmonary pressure, pulmonary vascular resistance, and pulmonary capillary wedge pressure increase and heart failure develops in the SBI victims with evolving pulmonary complications. Along with cardiopulomonary changes, ICP elevates and CPP and CO decrease. Conclusion. In traumatic brain lesions, it is very important to have information pertaining to the cardiopulmonary system and an estimation of ICP, CPP, and CO. Only comprehensive monitoring allows one to avoid the narrowness of evaluating the condition of a patient with SBI, to timely detect the development of secondary brain lesions, and to control the efficiency of intensive care. Key words: severe brain injury, pulmonary hemodynamics, intracranial and cerebral perfusion pressures, cerebral oxygenation.

Objective: to define the diagnostic and prognostic value of the serum levels of proinflammatory cytokines in patients with pneumonia of various genesis. Materials and methods. Enzyme immunoassay was used to investigate proinflammatory cytokines (tumors necrosis factor-a (TNF-a), interleukin(IL)-1a, IL-1/3, IL-6) in the venous blood serum of patients with primary (n=4) and secondary (n=20) pneumonia. Results. Critically patients with pneumonia of various genesis were observed to have statistically significantly higher venous blood TNF-a and IL-6 levels. Primary and secondary pneumonias are characterized by statistically significant differences in the levels of TNF-a and IL-6 within the first 24 hours on day 3 of the patients’ stay in an intensive care unit. In the study group, two subgroups of patients with heterodirectionally and statistically significant changes in the content of all the test cytokines within 1 to 3 days were identified. With a poor outcome of the disease, there was a statistically significant increase in IL-1/8 within the first 24 hours and in TNF-a and IL-6 on day 3. Conclusion. Measurement of proinflammatory cytokines in critically ill patients with pneumonia is of diagnostic and predictive value. Key words: pneumonia, cytokines.

Objective: to analyze the tactics of infusion therapy in old age group patients with generalized peritonitis and to search for ways of preventing acute lung injury in the early postoperative period. Subjects and methods. The adequacy of infusion therapy was analyzed in the treatment of 237 patients above 60 years of age who had generalized peritonitis. The parameters of central hemodynamics and aqueous sectors of an organism were studied by thermod-ilution and integral rheography of the body, radionuclide and thiosulfate tests. In 89 patients, normothermal infusion therapy was performed, by heating the transfused solutions to the body’s temperature. Results and discussion. When the volume of liquid is increased in the region under study, transthoracic impedance regularly decreases and it may be used as a predictor. In the early postoperative period, the scope of infusion therapy should be limited when the functional capacities of the cardiovascular system are diminished. Normothermal infusion therapy contributes to improvements of central hemodynamic parameters, microcirculation, and oxygen balance and reduces the number of pyoinflammatory complications. Conclusion. Normothermal infusion therapy diminishes a systemic inflammatory response and promotes the prevention of acute lung injury. Key words: central hemodynamics, normothermal infusion therapy, transthoracic impedance, acute lung injury.

Objective: to define the specific features of the course of acute respiratory distress syndrome (ARDS) in puer-peras with a complicated postpartum period. Subjects and methods. Sixty-seven puerperas with ARDS were examined. Group 1 included 27 puerperas with postpartum ARDS; Group 2 comprised 10 puerperas who had been treated in an intensive care and died; Group 3 consisted of nonobstetric patients with ARDS of various genesis (a control group). Results. In obstetric patients, the baseline oxygenation index was significantly lower than that in the control group. However, Group 1 patients showed a rapid increase in PaO2/FiO2 on days 3—4 of treatment. In the control group, the changes occurred later — on days 5—6. The baseline alveolar-arterial oxygen difference was significantly higher in the obstetric patients than that in the controls. In Group 1, AaDpO2 drastically decreased on days 3—4, which took place in parallel with an increase in the oxygenation index. At the beginning of the study, pulmonary shunting was high in the group of survivors, deceased, and controls. In Group 1, the shunting decreased on days 3—4 whereas in the control group this index normalized later — only by days 6—7. In Group 1, compliance remained lower throughout the observation, but on day 7 there was a significant difference in this index between the deceased, survivors, and controls. Conclusion. Thus, more severe baseline pulmonary gas exchange abnormalities are observed in obstetric patients than in general surgical and traumatological patients; the oxygenation index, alveolar-arterial oxygen difference, and pulmonary shunting index more rapidly change in patients with severe obstetric disease in its favorable course than in general surgical and traumatological patients; throughout the observation, thoracopulmonary compliance was less in obstetric patients than in the controls. Key words: acute respiratory distress syndrome, puerperium.

Objective: to study a role of lipid oxidation processes and hemostatical disorders in the pathogenesis of endogenous intoxication in patients with varying destructive complications of severe pneumonia. Subjects and methods. Sixty-two patients with destructive complications of severe pneumonia were examined; the parameters of endotoxicosis, lipid peroxidation, and impairments in the blood aggregation regulatory system were studied. Results. An acute destructive process has been established to be attended by the higher rates of lipid peroxidation, which causes phasic changes in catalase activity. Enhanced platelet functional activity in the presence of endotheliopathy and plasma thrombinemia results in the increased uptake of coagulation factors; inhibited fibrinolysis promotes the progression of microthrombogenesis, which presents as disseminated intravascular clotting (DIC). Conclusion. The accumulation of lipid peroxidation products is shown to substantially aggravate the course of a pathological pulmonary process in destructive complications of community-acquired pneumonia. Elevated thrombinemia in the presence of endotheliopathy induces acute DIC. Key words: pneumonia, destructive complications, endotoxemia, lipoperoxida-tion, hemostatic disorders.

Objective: to study the time course of changes in the respiratory biomechanics, extravascular water of the lung (EVWL) and its oxygenizing function and their relationship at different stages of surgical interventions under extracorporeal circulation (EC). Subjects and methods. 29 patients aged 37 to 72 years were examined during uncomplicated operations under EC. The parameters of artificial ventilation (AV) and lung biomechanics were recorded in real time on a Servo-I monitoring apparatus. PaO2/FiO2, Qs/Qt, and body mass index (BMI) were calculated. The EVWL index (EVWLI) was determined by the transpulmonary thermodilution technique. Studies were conducted at stages: 1) after tracheal intubation and the initiation of AV; 2) before sternotomy; 3) after sternal uniting at the end of surgery. Results. Pressures in the airways and their resistance were statistically significantly unchanged. There were significant reductions in Cdyn and Cst at the end of surgery (Stage 3). The mean values of PaO2/FiO2, Qs/Qt, and EVWLI did not undergo considerable changes. There was a significant correlation between PaO2/FiO2 and Qs/Qt (r=-0.5 to -0.8; p<0.05). At Stage 1, BMI proved to be a significant predictor of the level of PaO2/FiO2 and Qs/Qt (r=-0.5 and 0.65; p<0.05). A significant moderate relationship between Qs/Qt and Cdyn was found at Stage 3 (r=-0.44; p<0.05). There were no statistically significant correlations between the parameters of respiratory biomechanics, PaO2/FiO2, Qs/Qt, and EVWLI. At the end of surgery, pulmonary oxygenizing dysfunction (POD) was detected in 5 (17.2%) patients with increased BMI. Alveolar mobilization with a steady-state effect was used to correct POD. Conclusion. When cardiac surgery is uncomplicated and the AV and EC protocols are carefully followed, the rate of intraoperative POD is not greater than 20%, its leading causes are obesity and, most likely, microatelectasis under AV. Key words: pulmonary oxygenizing dysfunction, extracorporeal circulation, extravascular water of the lung, artificial ventilation, cardiosur-gical patients, pulmonary complications.

Objective: to study the effects of the surfactants Surfactant-BL and Curosurf on pulmonary oxygenizing properties in preterm neonatal infants with respiratory distress syndrome (RDS). The studies were performed in 81 preterm neonates with severe RDS. For the therapy of RDS, the exogenous surfactants Surfactant-BL and Curosurf were used in 52 and 29 children with RDS, respectively. The similarity of infants from both groups was statistically confirmed. Blood gas composition and artificial ventilation parameters were examined. Results. The administration of the exogenous surfactants Surfactant-BL and Curosurf normalized blood gas composition, enhanced alveolar ventilation, and improved pulmonary ventilation-perfusion relationships. The exogenous surfactants permit the performance of artificial ventilation when the values are close to the physiological ones. There were no significant differences in the effects on the surfactants on gas exchange parameters. Key words: respiratory distress syndrome, surfactant, artificial ventilation, mean airway pressure, blood gas composition.

Цель настоящей работы — изучить возможность фармакологической коррекции нарушений иммунной системы путем использования цитофлавина у больных с острыми отравлениями нейротропными ядами, осложнившимися развитием пневмонии. У 24-х больных с тяжелыми формами острых отравлений нейротропными ядами исследованы нарушения метаболизма, связанные с развитием тяжелой гипоксии тканей, и иммунной системы. В результате проведенных исследований установлено, что одним из ведущих факторов развития пневмонии при тяжелых отравлениях являются нарушения метаболизма и иммунная недостаточность. Коррекция метаболических расстройств, в свою очередь, снижает степень нарушений иммунной системы и сокращает сроки разрешения пневмонии. Ключевые слова: острые отравления, нарушения метаболизма, перекисное окисление липидов, сукцинат, цитофлавин.

Objective: to evaluate the efficiency of therapy in patients with acute intoxication with neurotropic poisons and protracted hypoxia complicated by pneumonia under guidance of impedance study of pulmonary circulation and pulmonary hydration. Subjects and methods. Ninety-six patients with acute intoxication with neurotropic poisons were examined and treated. They were divided into 3 groups: 1) 60 patients without signs of acute lung injury (ALI); 2) 17 with ALI in whom impedance methods for diagnosis and therapy monitoring were used; 3) 19 with ALI who were treated without impedance study. Systemic and pulmonary circulation and pulmonary hydration were evaluated via the one-stage application of integral body rheography (IBR) by the procedure developed by M. I. Tishchenko, thoracic rheography (TRG) after B. B. Sramek, and integral two-frequency impedance study. Results. In patients with ALI, increased thoracic fluid was accompanied by the decreased differential rheogram amplitude, which suggested the diminished pulsating component of blood flow, but the higher amplitude ratio of the differential rheograms obtained at IBR and TRG indicated the presence of impaired regional pulmonary circulation. The patients with ALI, followed by evolving pneumonia had lower differential rheogram amplitudes measured by TRG; they tended to have higher thoracic fluid levels and lower ejection rates. Conclusion. In patients with acute severe intoxication with neurotropic poisons, the risk for ALI is determined by the severity of intoxication and the duration and depth of hypoxia. The development of a critical condition determines the degree of pulmonary hyperhydration that depends on the pattern of cardiovascular abnormalities (a fall of single cardiac performance and pulmonary microcirculato-ry disorders). Monitoring of blood circulatory and microcirculatory disorders determines the basic treatment options and outcome. Key words: acute intoxication with neurotropic poisons, acute lung injury, pneumonia, integral body rheography, thoracic rheography, integral two-frequency impedance study.

Objective: to evaluate the efficiency of the combined use of traditional respiratory support and noninvasive ventilation (NV) in the therapy of acute respiratory distress syndrome (ARDS) after cardiosurgical interventions. Subjects and materials. The study included 31 patients. The basis for ARDS therapy was respiratory support that met with the principles of safe artificial ventilation (AV); a natural surfactant was endobronchially administered in all cases. The condition for study continuation and randomization was the achievement of the oxygenation index (PaO2/FiO2) up to 200 during assisted ventilation (AV) in the pressure support (PS) + continuous positive airway pressure (CPAP) mode. After simple randomization, the study group patients (n=16) underwent extubation, followed by transfer for NV. Traditional assisted PS+CPAP ventilation was continued in the control group patients (n=15). Results. In both study and control groups, adequate gas exchange, central hemodynamic, and oxygen delivery values could be maintained at all stages of the study. The duration of traditional AV/AV was significantly higher in the control group (128.9±22.4 versus 67.6±12.5 hours; p<0.01). In the study group, retransfer for AV was required in 3 cases (reintubation rate 18.8%). In the control group, 13 (86.7%) patients were transferred for spontaneous respiration); however, 3 patients were further intubated again (reintubation rate 23.1%). In this group, there were 4 (26.6%) cases of ventilator-associated pneumonia; in the study group, infectious complications were absent. Transfer for NV promoted a reduction in the time of treatment in an intensive care unit (152.3±16.5 versus 185.6±10.1 hours in the control group; p<0.01). The study revealed no significant differences in mortality rates (18.8 and 33.3% in the study and control groups, respectively; p<0.05), which is likely to be associated with a small number of observations. Conclusion. The use of NV as a component of respiratory support in ARDS in patients after cardiac intervention makes it possible to maintain adequate gas exchange and tissue oxygen transport, to reduce the frequency and severity complications due to respiratory support and the length of stay in an intensive care unit. NV does not increase the rate of tracheal intubation. Key words: acute respiratory distress syndrome, respiratory support, noninvasive ventilation.

Objective: to elucidate a role of the most significant risk factors in the development of outcomes of ventilator-associated pneumonia (VAP). Subjects and materials. In 1997—2006, the intensive care units of Novokuznetsk observed 77 children with VAP (a study group) and 30 patients without VANP who were on artificial ventilation (AV) for more than 2 days (a control group). In the group of VAP, there was a preponderance of babies of the first year of life (p=0.0097), children with the baseline pathology (p=0.0145), severe underlying diseases, multiply organ dysfunction (p=0.0388) who were long on AV. Sputum gram-negative microorganisms were shown to be isolated statistically significantly more frequently (p=0.0005). Conclusion. Antibacterial therapy should be started with a combination of reserve antibiotics by the de-escalation scheme. In children with VAP, the predictors of poor prognosis are a bilateral process; the preservation of fever in the patients on adequate antibacterial therapy and/or the preservation of the microorganism; a low (<300) oxygenation index; no positive X-ray changes. In VAP, attributive mortality was 10.4%. Key words: children, ventilator-associated pneumonia, risk factors, gram-negative microorganisms, oxygenation index, mortality.

Objective: to define the diagnostic and predictive value of the markers of fat embolism as a cause of acute lung injury (ALI) in severe concomitant trauma. Subjects and methods: 34 patients with severe concomitant trauma were examined. A dynamic study was undertaken to examine by biochemical tests and hemoviscosimetry and lipid metabolism (very low-density lipoproteins (VLDL) and triglycerides (TG)). The Murray scale was used to evaluate the severity of ALI. The authors calculated the trauma shock genicity index in accordance with the recommendations developed by the Dzhanelidze Research Institute of Emergency Care (Saint Petersburg) and the patients’ condition by the TRISS scale. Results. In all the groups, patients with severe concomitant trauma develop ALI whose severity correlates with the severity of a trauma. In the group of patients with a shock genicity index of more than 14 scores, the most significant severe hemostatic disorders develop, which are retained within 9 days. In the same group, the levels of VLDL and TG increased within the first 3 days after trauma. Conclusion. In patients with severe concomitant trauma, the parameters of the hemostatic vascular platelet link and the elevated serum VLDL and TG levels are of diagnostic and predictive value in the development of ALI and fat embolism. Key words: fat embolism, severe concomitant trauma, acute lung injury, hemostasis, lipid metabolism.

The paper presents the results of using the fourth-generation cephalosporin maxicef in the treatment of 20 patients with nosocomial pneumonia and severe concomitant injury. A control group comprised 20 patients receiving a combination of ceftazidime and amikacin. The total efficiency of the antibacterial therapy was 68.5% in the maxicef group and 40.9% in the control group (р<0.05). The therapy had to be modified in 42% of the maxicef group and in 72.7% in the control group (р<0.05). The average treatment cost was US $518 (429—606) and US $482 (368—596) in the maxicef and control groups, respectively. Nephrotoxicity was observed in 9% of the patients receiving a combination of the antibiotics. The activity of maxicef was also analyzed in vitro. Results. Maxicef was demonstrated to be highly active against the majority of gram-negative and gram-positive bacteria in vitro. Its efficacy against the most common bacteria (P.aeruginosa, S.aureus, E.coli, K.pneumonia) causing infections in severe injury was in vitro significantly higher than that of ceftazidime. The comparative study indicates that the fourth-generation cephalosporin maxicef may be used as an alternative to the standard combined therapy. Key words: concomitant injury, maxicef, nosocomial pneumonia, a combination of ceftazidime and aminoglycoside, nosocomial infection pathogens.

Objective: to improve the results of intensive care in patients with acute lung injury in the presence of severe sepsis. Subjects and methods. Complex intensive therapy was analyzed in 87 patients with severe sepsis and acute lung injury. The patients were divided into 2 groups: 1) 43 patients treated without immune-replacement therapy; 2) 44 were additionally given the intravenous immunoglobulin G Gamimun H. The laboratory parameters, mortality, and intensive care duration in an intensive care unit (ICU) were analyzed. Results. Immune-replacement therapy reduced the length of stay in the ICU from 15±5.5 to 11.5±4.4 days and mortality from 55.8 to 27.3%. Conclusion. The immunoglobulin G Gamimun (BAYER) used in patients with acute lung injury in the presence of severe sepsis has shown its high efficacy, quality, and safety. Key words: sepsis, acute lung injury, immunoglobulins, Gamimun.

Objective: to determine the duration of exposition of filters and their most optimum position in different types of respiratory circuits. Subjects and methods. Group 1 comprised patients receiving not more than 12-hour artificial ventilation (AV) through a coaxial respiratory-circuit, without a humidifier, moisture accumulators, and a nebulizer. The filters were set between the intubation tube and the circuit. Group 2 included patients having more than 12-hour AV through the disposal respiratory circuits including a nebulizer, a humidifier, and inspiratory and expiratory moisture accumulators. The filters were set in front of the inspiratory circuit and behind the expiratory one on an AV apparatuses. Before regularly replacing a filter and/or a circuit, samples were taken for bacteriological tests from different portions of the circuit at various intervals: 4, 12, 24, 48, 96, 120, and 144 hours after initiation of AV, as well as before tracheal extubation in a patient. Results. The data obtained during the study have indicated that the breathing circuit filters afford a reliable protection from the entry of environmental microorganisms into the patient’s respiratory tract. In Group 1, AV did not result in the occurrence of pneumonia or tracheobronchitis. The moisture accumulators and the Y-shaped connector are the most infection-susceptible parts of a respiratory circuit. Mechanical circuit contamination and a larger number of pathogenic microbial strains were observed after 4—5-day AV. Conclusion. All procedures associated with circuit seal failure should be performed, by observing the aseptic rules. The recommended time of using a respiratory circuit during prolonged AV is 96—120 hours. Key words: intensive care unit, artificial ventilation, nosocomial pneumonia, antibacterial respiratory circuit filter.

Objective: to reveal the impact of adaptive supporting ventilation (ASV) on the time of patients’ activation after cardiac surgery under extracorporeal circulation. Methods. A randomized controlled study was performed. The study covered patients with aortic or mitral valve replacement under extracorporeal circulation. The patients were divided into groups: 1) those in whom ventilation was maintained in the ASV mode (a study group); 2) those in whom a ventilator was disconnected in accordance with the standard protocol (a control group). Both disconnection protocols were divided into 3 phases. In the study group, the setup of a ventilator in the ASV mode (minute ventilation) was 100% of the theoretical value. In the control group, spontaneous intermittent mandatory ventilation was applied (p support 10 mm H2O). In the study group, phase II was characterized by a 50% decrease in minute ventilation. In the control group, the ventilator-induced respiration rate in phase II decreased to 6 breaths/min (p support 5 mm H2O). In phase III, ventilation decreased by more 50% in the study group; in the control group, the apparatus was switched to the spontaneous mode. At the end of Phase III, the patient was extubated. Results. Thirty-four of the 45 included patients completed the protocol and only their results were taken into account when statistically processed. In failure or violation of the protocol, none patient was excluded from the study. According to the scheduled exclusion criteria, the data of 11 subjects (6 from the study group and 5 from the control one) were not processed. There were no great differences between the groups, by taking into account the total parameters, clinical data, inotropic support, and the results of a study of oxygen transport. The basic result of the study was the total artificial ventilation time that was significantly shorter in the ASV group. Conclusion. The present study has provided evidence that the protocol for patients’ early activation using the ASV mode is practical and may accelerate patients’ extuba-tion after valve replacement under extracorporeal circulation. Key words: adaptive supporting ventilation, artificial ventilation, cardiosurgery, extracorporeal circulation.

Objective: to evaluate the efficiency of an extended package of preventive measures on the incidence of nosocomial respiratory infections in surgical patients at an intensive care unit (ICU). Subjects and methods. The study included 809 patients aged 35 to 80 years. A study group comprised 494 patients in whom an extended package of preventive measures was implemented during 7 months (March-September). A control group consisted of 315 patients treated in 2004 in the same period of time (March-September). The groups were stratified by age, gender, underlying diseases, and APACHE-2 and SOFA scores. The extended package of anti-infectious measures involved a high air purification in ICUs («Flow-M» technology), routine use of ventilatory filters, closed aspiration systems with a built-in antibacterial filter under artificial ventilation for over 2 days. Results. The proposed technologies could reduce the frequency of tracheobronchitis and ventilator-associated pneumonias in the groups of patients at high risk for nosocomial infections substantially (by more than twice). Conclusion. The findings have led to the conclusion that the extended package of preventive measures is effective in preventing respiratory infections in ICU patients. Of special note is the proper prevention of upper airway contamination with pathogenic microorganisms, by employing the closed aspiration systems with a built-in antibacterial filter. The routine use of high-tech consumables in the intensive care of surgical patients causes a considerable decrease in the incidence of nosocomial pneumonia, ventilator-associated pneumonia, and purulent tracheobronchitis and a reduction in the number of microbiological studies. Key words: ventilator-associated pneumonia, prevention of nosocomial infections, closed aspiration system.

Objective: to study the nature and time of development of pulmonary and adrenal structural changes in early concomitant brain injury. Materials and methods. The lungs and adrenals from 120 persons who had died from severe concomitant brain injury were morphologically studied. Pulmonary and adrenal specimens were embedded in paraffin. Histological sections were stained in hematoxylin-eosin, by using the procedures developed by Weigert, van Gieson, and Mallory. The Schick test and other histochemical methods were used. Morphometric studies were also employed. Statistical processing used Student’s t-test. Results. In injury, the early pulmonary structural changes were ascertained to be circulatory disorders, bronchial and bronchiolar mucosal damage, and the development of atelectases and focal emphysema. The morphological criteria for increased adrenal cortical functional activity are focal delipidization, diminished cortical transparency, the «spotty» appearance of the cortex, boundary-spanning between the cortical and reticular zones, multiple cytolysis, and iron plethora. Conclusion. Severe concomitant brain injury is followed by pulmonary structural changes underlying acute respiratory failure. Adrenal structural and functional changes play an important role in the pathogenesis of lung injury. Key words: severe concomitant brain injury, lung injury, adrenals.

Objective: to study the expediency and efficiency of using methylene blue (MB) on a model of pneumectomy (PE) and subsequent ventilator-induced lung injury (VILI) in sheep. Materials and methods. The study was conducted at the Research Laboratory of University of Tromse. The experiment included 23 sheep weighing 41.0±4.9 kg. Thoracotomy and right-sided pneumonectomy were performed in the animals under general anesthesia and controlled artificial ventilation. After measurement of the parameters of systemic hemodynamics and extravascular water of the lung (EVWL), the animals were divided into 3 groups: 1) a control group (CG, n=7) with a tidal volume (TV) of 6 ml/kg and an end-expiratory positive pressure (PEEP) of 2 cm H2O; 2) a VILI group (n=9) with a TV of 12 ml/kg and a PEEP of 0 cm H2O; 3) a group of MB (n=7) that was given in parallel with a damaging ventilation mode. The thermodilution technique (using a Cold Z-021 monitor, (Pulsion, Germany)) was employed to measure volumetric parameters and EVWL. The parameters of pulmonary hemodynamics, respiratory mechanics, and blood gas composition were recorded. Results: After its reduction at PE, EVWL index increased during damaging ventilation in the VILI and MB groups. In addition, there was an increase in pulmonary artery wedge pressure after PE in the MB and VILI groups. In the latter group, arterial hypoxemia was observed at the end of the experiment. Along with this, after PE pulmonary compliance decreased and airway pressure elevated in the VILI and MB groups. Conclusion: In the presented model of VILI, MB does not prevent the development of postp-neumectomic edema of the lung. Key words: thermochromodilution, acute lung injury, pneumectomy, ventilator-induced lung injury, postpneumectomic edema of the lung, methylene blue.

The paper discusses whether the «lung opening» maneuver in combination with the endobronchial administration of a pulmonary surfactant can be used in the treatment of patients with acute respiratory distress syndrome (ARDS) of various genesis. The authors outline data of their studies of the separate use of both methods and present the results of successful treatment in a patient with severe concomitant injury and posttraumatic ARDS in the combined use of the «lung opening» maneuver and Surfactant-BL. With intensive care, the combined use of these methods is a more effective way of improving gas exchange as compared with their use alone. Key words: acute respiratory distress syndrome, surfactant-BL, «lung opening» maneuver, combined use of both methods.

The review considers a role of ischemia-reperfusion in the pathogenesis of acute lung injury (ALI) and presents data on the experimental models of ischemia-reperfusion in the lung and its resistance to ischemia. It also demonstrated the leading role of systemic inflammatory reaction in the pathogenesis of ALI in ischemia-reperfusion. ALI is shown to occur in spontaneous ischemia-reperfusion of both the lung (lung transplantation, extracorporeal circulation) and other organs, such as the intestine, liver, and lower limbs.

The fundamental role of the cardio-respiratory system is to supply the tissues with adequate amount of oxygen to cover their metabolic need. Acute lung injury and acute respiratory distress syndrome are characterized by atelectasis of the alveoli, causing inadequate gas exchange in the lung and lack of oxygen supply to the body. Under these circumstances by increasing the FiO2 only may not be enough to improve oxygenation. One of the possible alternatives is the lung recruitment manoeuvre, during which the alveoli are opened up with high inflation pressure and to keep them open by maintaining appropriate positive end expiratory pressure. However, high intrathoracic pressures may cause haemodynamic instability by affecting the work of the heart and compressing the mediastinal veins. It is uncertain, how haemodynamics are best monitored during lung recruitment. Is continuous monitoring of the mean arterial pressure and the central venous pressure enough, or do we need to measure invasive haemodynamic parameters such as cardiac output and intrathoracic blood volume during such an aggressive intervention?. The aim of this article is to give a review of the possible answers for these questions based on the results of physiological and recently published clinical and experimental research. Key words: lung recruitment, acute respiratory distress syndrome, positive end expiratory pressure, extravascular lung water, oxygenation, hemodynamic monitoring.

The servoventilator allows, apart from the standard modes, the application of several special modes of artificial lung ventilation (ALV) and the use of some new set-up features of the servoventilator. In his first part, the author describes and analyzes the so-called two-level ventilation 2-level+PS, which constitutes one of the progressive ventilation modes, at some other ventilators called as BiPAP, Bilevel, BiPAP-SIMV. This mode allows a patient to breathe in two pressure levels (Ppc/PEEP), whereas in the lower pressure level (PEEP) it allows the effective ventilatory support of spontaneous breathing by the pressure support (PS) mode. In this case, the mode is identical to the BiPAP-SIMV one. Further, the author describes a new mode of three-level ventilation (multilevel ventilation, MLV), in which patient breathes in three programmed levels of pressure that are PEEP, Phigh, and Ppc. This ventilation mode allows one to improve gas distribution in the non-homogenous injured lung. The further new mode that is implemented in the ventilator is so-called continuous flow ventilatory support (CFVS). It is unique in such a feature that catheter is introduced into the trachea of a spontaneously breathing patient, through which the gas flow from the ventilator flows and by washing out the dead space it decreases its volume and increases alveolar ventilation, without any need to intubate the patient or to perform relaxation. The patient is at his full consciousness. The author also describes the functionality of the new mode of intelligent ventilation regulation in pressure modes, a so-called minute ventilation servosystem that after the set-up of ventilatory parameters maintains the patient’s minute ventilation that is set by a doctor. Further, the author describes an adjustable Bias flow that is advantageous in such a feature that the negative inspiration peaks in the hyperventilating patient are eliminated and, thus, significantly relieves the work of an assistor. The ventilator also keeps at its disposal a monitor of mechanical properties of the lung, indicating the static compliance, airways resistance, inadvertent (auto) PEEPi and alveolar pressures. The Q/V and V/P loops are also naturally included. In conclusion, the author draws attention to the fact that the ventilator does not require compressed air for its operation and that it constitutes a step forward in the new modes of ALV. Key words: multilevel ventilation, lung mechanical properties, PEEPi, Cst, Bias flow, CFVS.

Objective: to examine changes in the function of the autonomic nervous system (ANS) in patients with intoxication with cauterizing liquids in relation to the condition of patients in order to early determine the prognosis of the disease. Subjects and methods. ANS was studied in 130 patients aged 15 to 82 years who had been poisoned by cauterants, treated at the Toxicological Unit, Voronezh Regional Hospital, and at the Center for Acute Intoxication Treatment, N. V. Sklifosovsky Research Institute of Emergency Care, Moscow, in 2004—2006. Cardiointervalographic parameters were analyzed in relation to the condition of patients, the time elapsed after intoxication prior to the patients’ admission to a specialized hospital, the presence of hemolysis and blood alcohol, the degree of upper gastrointestinal mucosal burn, and the pattern of poisoning (accidental or intentional). Results. Within the first hours after intoxication with cauterizing liquids, ANS was found to be impaired, which was associated with the development of hyper-sympathicotonia caused by the increased activity of its sympathetic part and the decreased tone of the parasympa-thetic one. The magnitude of hypersympathicotonia depends on the severity of poisoning, on the time elapsed after the onset of intoxication, on the presence of hemolysis, the blood content of alcohol, the degree of upper gastrointestinal burn, and the nature of poisoning. The preponderance of the tone of the ANS parasympathetic part suggests the disturbance of adaptive and compensatory mechanisms and a poor prognosis. Conclusion. Cardiointervalography is recommended for the objective evaluation of the severity of poisoning with cauterizing liquids and the efficiency of performed therapy and for the prediction of the outcome of the disease. Key words: cauterizing liquids, autonomic nervous system, cardiointervalography, adaptive and compensatory mechanisms.

Objective: to use the factor analysis of laboratory and clinical signs in patients poisoned by cauterizing liquid to evaluate a response to chemical injury. Subjects and methods. The autonomic nervous system (ANS) was studied in 130 patients aged 15 to 82 years who were treated at the Toxicological Unit, Voronezh Regional Hospital, and at the Center for Acute Intoxication Treatment, N. V. Sklifosovsky Research Institute of Emergency Care, Moscow, for intoxication with cauterizing liquids. The parameters of general and biochemical blood analyses, the level of free plasma hemoglobin, and the blood and urinary concentrations of ethanol were analyzed. Results. The factorization of signs divided the symptom complex into 6 factors; the first four of them being of the greatest importance. Conclusion. The studies have indicated that an adequate ANS response is of initial and major value in the prediction of poisoning with cauterants. Key words: factor analysis, factorization of signs, cauterizing liquids, autonomic nervous system.