Morphological studies were used to examine the lungs from 92 persons who had died from brain and concomitant injuries and massive blood loss and from 117 experimental animals (rats) in systemic circulatory disorders and vascular thrombosis of the pulmonary microcirculatory bed. The purpose of the study was to assess the nature, intensity, and developmental periods of the morphological signs characterizing acute pulmonary lesion. Disorders of circulation (including microcirculation), damages to bronchial and bronchiolar mucosae, the development of atelectases, dyst-electases, and focal emphysema were found to be early structural changes in injury and massive blood loss. Pulmonary edema and the signs of a systemic inflammatory reactions form within the first hours following injury and massive blood loss. Experimental studies confirm that microcirculatory disorders and individual traits play an important role in the development of acute pulmonary lesion.

The most severe sequels of acute lung lesions are manifested by the impairment of ventilation-perfusion relations, by the development of primary pulmonary hypertension, by circulatory disorders and the increased content of extravascular fluid in the lung, whose diagnosis is extremely difficult. The purpose of the study was to access the capacities of early diagnosis of systemic hemodynamic and pulmonary circulatory disorders in acute lung lesion in patients with critical states. Hydro- and hemodynamics was evaluated in 32 persons in the early phase of intoxications with neurotropic poisons, in 15 with severe concomitant injury, and in 22 patients with critical states intensively treated cardiac surgery. Hemodynamics was determined, by concomitantly using the integral body rheography technique after M. I. Tishchenko and transthoracic impedance cardiogra-phy. The rheographic techniques could evaluate the state of systemic hemodynamics, the nature and effectiveness of pulmonary pulsatile blood flow, that depended on pulmonary hypertension, and increased thoracic fluid. The determination of the level of lactate and its arterial and venous blood ration with consideration of lactate clearance enabled the authors to evaluate both the effectiveness of systemic perfusion and impaired metabolic processes in the lung. Drastically decreased pulsatile blood flow, ineffective volumetric load, low oxygenation index, increased thoracic fluid volume, and the ratios of the arterial to venous blood concentration of lactate with its normal clearance may be early signs of acute lung lesion.

The paper presents the results of a study, which prove the advantages of artificial ventilation with a descending air flow on inspiration, tidal volume 6 ml/kg body weight; P peak < 30 cm H2O in showing its efficiency, by optimizing the parameters of the respiratory pattern, by improving gas exchange in the lung, by reducing the time of respiratory support, the length of stay in an intensive care unit, and mortality rates as compared with artificial square-wave air flow on inspiration, TV 12—15 ml/kg body weight; Ppeak tracheal >35 cm H2°.

The paper considers the current concept of diffuse alveolar lesion (DAL), a rather rare condition that requires intensive care measures. The clinicomorphological manifestation of DAL is adult respiratory distress syndrome. The causes of DAL occurring with an infectious process, including septic conditions, as well as with inhalations of toxic gases and aerosols; shock, radiation, drug therapy, etc. are presented. The pathogenesis of DAL and its pathological anatomy is described in detail, pathological lung alterations in different periods after the onset of the disease being characterized.

The study was undertaken to examine the clinical and X-ray features of the respiratory distress syndrome (RDS) in very premature babies. A hundred and thirty-nine cases of respiratory distress were analyzed in premature babies treated at intensive care units. All the infants were born to mothers with a history of gynecological and obstetric diseases in the severe condition. The signs of respiratory distress began to manifest themselves in the babies at a maternity room. Two major clinical and X-ray types of the course of RDS were identified. X-ray studies have established that it is expedient to identify 2 types of the course of RDS in profoundly premature babies in the first 72 hours of life. The first type is characterized by mild or moderate respiratory distress and a favorable course and it corresponds to stages 1—2 according to the X-ray classification. The second type shows a more severe respiratory failure, a greater magnitude of X-ray changes (stages 3—4 by the X-ray classification), and a poor course. A clear distinction of two types of the X-ray pattern of RDS in very premature babies may be of great predictive value.

The paper deals with the economical and ecological use of inhalation anesthetics in low-flow anesthesia (LFA, 1—0.5 l/ min) and high-flow anesthesia (HFA, more than 2—6 l/min). Four hundred and ninety six inhalational anesthesias lasting at least 80 minutes were analyzed in each group under consideration. The concentration of inhalation anesthetics was measures in the atmosphere of an operative theatre if inhalational anesthesia lasted more than 4 hours. There is evidence for the economical and ecological benefits in the use of LFA in terms of the availability of appropriate anesthesiological equipment, monitoring, and a highly skilled anesthesiologist.

The study was undertaken to examine the impact of the lung on the content of adrenaline, noradrenaline, serotonin, and lactic acid in systemic blood flow and to define their contribution to the development of acute respiratory distress syndrome (ARDS) in severe brain injury (SBI). Forty victims with severe brain injury were examined. A study group comprised 26 patients. On admission, the patients were found to have ARDSj, later on 12 patients of them were observed to have its progression and to develop pneumonia in its presence. A control group included 14 victims. There were no postoperative complications. During 7 days after brain injury, the time course of changes were determined in the mixed venous (pulmonary arterial) and arterial (femoral arterial) levels of adrenaline and noradrenaline by fluorometry and in those of serotonin and lactic acid by the fluorescence technique [8] and enzymatic assay, respectively. The performed studies have indicated that in SBI, a significant activation of the sympathicoadrenal system results in a noticeable humoral reaction, by increasing the concentration of biologically active substances in the blood flowing to the lung, which leads to a load and subsequent decompensation of nongas exchange functions of the lung in the inactivation of serotonin, noradrenaline, their absorption of lactate, which in the presence of neurodystrophic changes has a great impact on the development of ARDS in victims with SBI. In this case, the clinical, X-ray, and biochemical signs of the development of ARDS appear 12—36 hours after the detected nongas exchange dysfunctions are detectable.

Functional lesions of organs depend on the size of a diseased vessel and frequently require the use of intensive therapy methods. The commonest manifestation of antiphospholipid syndrome (APS) is deep vein thrombosis of the leg and pulmonary thromboembolism (PTE).

Objective: to estimate the frequency of lung lesions in primary APS (PAPS), secondary (in the presence of systemic lupus erythematosus (SLE)) and catastrophic APS and to assess a relationship between lung pathology and other clinical and laboratory manifestations of the disease.

Subjects and methods. The study covered 372 patients followed up at the Institute of Rheumatology, Russian Academy of Medical Sciences, since 1990, of whom 290 and 82 patients had SLE and PAPS, respectively. Among the 290 patients with SLE, there were 96 males and 194 females. At the moment of the study, the patients’ age was 31.2±11.1 years and the duration of the disease was 8.6±7.2 years. The group of patients with PAPS comprised 20 males and 62 females. Their mean age was 35.6±9.9 years and the duration of the disease was 11.9±8.5 years. Thrombotic events were verified only by instrumental studies. Lung pathology was instrumentally confirmed; all the patients underwent lung X-ray study, if required, scintigraphy and computed tomography.

Results. Lung lesion associated with the pathology of vessels was revealed in 28% of the examined patients (105/372). There were prevalent patients with PTE, followed by the development of lung infarcts, which was present in 96 (91%) of the 105 patients with pulmonary vascular pathology. Autopsy revealed pulmonary microangiopathy was in 12 patients, which was concurrent with focal pneumonia in 7 of them, with pneumonitis and exudative pleuritis in 5. Hemorrhagic alveolitis detected at autopsy in combination with occlusions of the pulmonary arterioles was in 3 patients who had been diagnosed as having thromboembolism of small branches of the pulmonary artery. Thrombosis of the pulmonary arterial trunk was detectable in 2 patients, both patients died from respiratory failure. All 105 patients with pulmonary vascular pathology had blood serological markers of APS. There was a combination of elevated levels of aKL and VA in 61% of cases and in 28.5% in the group of patients without pulmonary vascular pathology (OR = 3.92; [2.38-6.48]). The rate of vascular lung pathology increased in the presence of both blood aKL isotopes (IgG and IgM). The number of patients position in both aKL isotopes was 48% whereas in Group 2, that was 19.5% (OR = 3.76; [2.24-6.31]).

Conclusion. More than a fourth of the patients with SLE and PAPS have pulmonary vascular pathology. The spectrum of pulmonary vascular diseases in SLE is broad and varies from thrombosis of the pulmonary arterial trunk to occlusive vascular lesion of the microcirculatory bed of the lung, and it is associated with aFL.

Objective. To comparatively study the efficiency of respiratory support in patients with acute lung lesion, by applying BIPAP, SIMV, and aIPPV.

Subjects. Twenty-six patients with acute lung lesion whose pattern included acute respiratory distress syndrome (n=16), pneumonia (и=6), and pneumonitis (n=4) were examined. The severity of disease was 18 to 21 APACHE II scale score.

Results. The use of BIPAP leads to a better adaptation of a patient to respiratory support, to a reduction in the number of used myorelaxants and sedatives, and to improvement of gas exchange in the lung and diminishes the negative impact of artificial ventilation on hemodynamics. As compared with other types of assisted ventilation, BIPAP accelerates transfer from total respiratory support to spontaneous breathing.

Mine explosion injury is referred to as a most severe battle surgical pathology. The severity of wounds is determined by the mutual lesion burden phenomenon and by the development of the systemic contusion-commotion syndrome. Abnormalities of vitally important organs and systems are detectable in the presence of the extreme degrees of shock, massive blood loss, and severe functional and metabolic disturbances. The manifestations of posthypoxic organopathy become the basic contents of traumatic disease. Respiratory failure is the leading syndrome in the pattern of organic impairments so respiratory support is one of the major components of intensive care.

The purpose of the present investigation was to improve the outcomes of intensive care in patients with acute respiratory distress syndrome after cardiac surgery under extracorporeal circulation.

Materials and methods. Respiratory therapy was analyzed in 43 patients with acute respiratory distress syndrome after surgery under extracorporeal circulation. According to the procedure of artificial ventilation (AV), the patients were divided into 2 groups: 1) those who had undergone routine tracheal intubation (n=23) AND 2) THOSE who had received noninvasive intubation through a nasal mask (n=20). The respiratory parameters, blood gas composition, central hemodynamic parameters, respiratory support time, and the pattern of complications were analyzed.

Results. Noninvasive artificial ventilation permits one to make the patients active in earlier periods and take a spontaneous breath, recovers the respiratory index earlier, reduces the level of positive end-expiratory pressure, the frequency of infectious complications of the tracheobronchial tree, and length of stay in an intensive care unit as compared with endotracheal AV.

Conclusion. The findings suggest that noninvasive AV is highly effective and yields better results of treatment in patients with acute respiratory distress syndrome.

The lung has various mechanisms of protection from damaging action. There is mechanical protection of the lung from foreign exposures, which consists in the structural functional and morphological features governing the aerodynamic system, kinetic mechanisms (respiratory apparatus movement, bronchial motility, current surface alveolar layer movement), and blood and lymph flows. There are also nonspecific humoral and cellular factors of decontamination of foreign material (enzymatic reactions, natural cytotoxicity, pino- and phagocytosis of micro- and macrophages). Specific immune mechanisms are involved in the protection of the lung. Moreover, amongst the mechanisms of protectiong of the lung, the DNA reparation processes promoting the diminution of mutational processes occupy a certain place. Virtually all of these mechanisms are genetically controlled, i. e. are variously expressed in different persons.