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During the care of patients with novel coronavirus infection at the Lomonosov MSU Medical Research and Education Center from April 21 to June 13, 2020, we observed cases of spontaneous mediastinal emphysema (spontaneous pneumomediastinum) as a manifestation or a probable complication of COVID-19.The aim of the paper. To provide clinical case descriptions and approaches to the management of patients with spontaneous pneumomediastinum in COVID-19 associated pneumonia, as they are not addressed in the current clinical guidelines, and therefore are worthy of special attention.Among 224 patients with laboratory-confirmed diagnosis of the novel coronavirus infection COVID-19, five cases of pneumomediastinum without pneumothorax were identified. Of these, in two cases the pneumomediastinum developed during noninvasive lung ventilation (NLV) (one case) and invasive lung ventilation (one case). In three cases, spontaneous mediastinal emphysema was not associated with lung ventilation. By the time of publication, one case of pneumomediastinum was completed, and four patients remained hospitalized. All five patients were males aged from 52 to 84 years.This paper presents in depth the description of two cases of mediastinal and subcutaneous emphysema in patients with COVID-19.

This paper highlights published hypotheses on the possibility of coronavirus SARS-CoV-2 entry into the bloodstream, its interaction with vascular endothelium, red blood cells, hemoglobin and its fragments. As a result of such interaction, iron ions may be released into the bloodstream and, subsequently, a cytokine storm may occur. In this context, it is important to find a cytoprotective agent capable of blocking such processes. The perfluorocarbon emulsion could be a candidate for this role.The aim of the paper is to show the feasibility of biophysical methods to study the molecular mechanisms of action of SARS-CoV-2 on human red blood cells and hemoglobin as well as the restorative and cytoprotective effect of the perfluorocarbon emulsion during Fe2+ oxidation in heme.Materials and methods. High resolution spectroscopy, atomic force microscopy, atomic force spectroscopy, electroporation were used. Blood was exposed to oxidizing agents of different nature. Perfluorocarbon emulsion was added in various concentrations and its effect at various incubation times was studied. Concentration of hemoglobin derivatives was calculated considering multicollinearity, and statistical analysis of the results was performed.Results. The perfluorocarbon emulsion was shown to have an effective restorative and cytoprotective action in iron ion oxidation in the heme: Fe3+ was restored to Fe2+. The degree of MetHb reduction to HbO2 and Hb depended on the concentration of the oxidizing agent and incubation time. We observed a change in MetHb content from 80-90% to 5-12%. The perfluorocarbon emulsion in clinical concentrations helped eliminate local membrane defects and restored normal erythrocyte morphology.Conclusion. In the light of the studied hypotheses, the use of perfluorocarbon emulsion can become an effective method for blocking the consequences of coronavirus effect on the blood cells and restoring a normal gas exchange.

Pulmonary artery thromboembolia (PATE) is not a clinical entity as such, but a complication of different diseases and conditions leading to deep thrombosis in the low tension circulation system, right cardiac chambers or causing local thrombosis in the pulmonary artery system. PATE is characterized by complex pathogenesis of respiratory failure of varying severity, which makes it difficult to choose a respiratory support technique.Purpose of the overview: to show advantages of different respiratory support techniques and prospects of high-flux oxygen therapy with regard to PATE pathophysiology.82 sources were selected based on the principle of combining clinical and experimental data from papers published over the recent 5 years and earlier that are still relevant for medical practice.The overview presents the structure of main causes and prevalence of PATE and considers thrombogenesis stages and predominant manifestations of respiratory failure during PATE occurring due to inconsistency between pulmonary ventilation and perfusion. Review discusses five methods of respiratory therapy in PATE patients: low-flux and high-flux oxygen therapy, non-invasive and invasive artificial lung ventilation, extracorporeal blood oxygenation. Finally, the paper shows the efficacy and limitations of these methods.Conclusion. High-flux oxygen therapy seems to be the most effective and promising technique in PATE patients thanks to absence of adverse cardiohemodynamic consequences, subjective comfort for patients, and relation to minimal risks of secondary infectious complications.Nevertheless, the clinical experience accumulated is insufficient to make an absolute choice of one particular technique for respiratory support during PATE. It is necessary to continue investigating the clinical efficacy of high-flux oxygen therapy in the specific population of patients who experienced PATE.

The review dwells on the analysis of anesthetic techniques for pediatric eye surgery, including the use of drugs used and methods of anesthesia. While preparing the paper, Cyberleninka (www.cyberleninka.ru), PubMed, Medline databases were used with the targeted search using the following keywords: propofol, sevoflurane, paracetamol, regional anesthesia, ophthalmology, children. The search was not restricted by the date of paper publishing; the focus was made on papers published within the last 10 years. The purpose of the review was to assess the scope of various anesthetic techniques (general anesthesia and regional blockades), anesthetics (sevoflurane, propofol, paracetamol, local anesthetics) in pediatric eye surgery.

Hypoxia and mitochondrial damage are a key component of the pathogenesis and tanatogenesis of a critical condition, suggesting the need for its prevention and maximally rapid elimination. Objective: to analyze the efficacy and safety of infusion antihypoxants used in critically ill children from the results of researches. Materials and methods. Available investigations dealing with infusion therapy in children and papers on the use of infusion antihypoxants in adults in 2005 to 2013 were sought in the medical databases PubMed and Cochrane Library with their free availability and analyzed. Results. The analysis included 70 trials. The pathophysiology and pathobiochemistry of hypoxia in critically ill children are given; the current principles of its correction by infusion therapy are considered in detail. Particular emphasis is placed on trials evaluating the efficacy and safety of succinic acid solutions in children. Main indications for and contraindications to their use are demonstrated. Conclusion. The use of Krebs cycle substrate-based infusion antihypoxants (malate, succinate) is an effective and promising procedure for the intensive therapy and correction of hypoxia in both adults and children with critical conditions. Considering the fact that papers on the use of infusion antihypoxants in children are scanty, there is a need for further investigations.

The paper presents the currently available data in the literature on sudden cardiac death (SCD), including its definition, epidemiology, etiology, risk factors, predisposition to the development of SCD, the ways of assessing the risk of SCD. It outlines myocardial morphological changes in the development of SCD, the pathogenesis of the major links of the origin of ventricular fibrillation in myocardial ischemia, and the mechanisms responsible for the development of SCD. A relationship has been established between coronary heart disease and the risk of developing SCD. Particular attention is given to the topicality of the problem of SCD to inpatients: at the stages of anesthetic management during extracardiac surgical interventions. Emphasis is placed on the importance of preoperative meticulous examination of the patients. A number of the drugs that are most frequently used in anesthesiology and negative affect the myocardium and systemic hemodynamics are listed, which is extremely important to patients having initially cardiovascular diseases. The detection of the predictors of SCD in the preop-erative period and the methods of studying the patients, among which scale, instrumental, and biochemical methods being emphasized, feature in the paper. Recommendations to improve the quality of perioperative management and to increase the safety of anesthetic maintenance are listed.

This paper is simultaneously a brief biographic sketch of British obstetrician James Blundell (1970—1878) and an attempt of the authors to open new earlier unknown pages of the history of hemotransfusion. This paper presents James Blundell not only as a physician who was the first to successfully transfused blood from man to man, but also as an outstanding obstetrician and a founder of pediatric reanimatology. The paper places great emphasis on Blundell’s predecessors undeservedly forgotten by medicine historians, on Doctor John Henry Leacock in particular. The empirical stage in the development of hemotransfusiology was over due to the performance of a number of animal experiments on blood transfusion by this physician in 1816. Unfortunately, information has not been at the disposal of even foreign investigators and it will be first published for Russian language-speaking readers.

The Editorial Board of the journal «Obshchaya Reanimatologiya» intends to publish a series of papers dedicated to the history of the science «Anesthesiology and Reanimatology». In the first paper, the authors attempted to gather historical facts concerning the development of anesthesia. This makes it possible to analyze the course of development of the thought of scientists and physicians, the time of striking discoveries in our specialty, to reflect the most important points that impulses the expansion and optimization of methods of anesthesia and resuscitation. The authors understand clearly that they have no sufficient number of factors associated with the history of anesthesiology and reanimatology and they will be grateful in receiving any comments and additional information on historical aspects, specialized sections of the science, bibliographic data of Russian and foreign sciences dealing with this specialty. The to offer apologies for possible inaccuracies since controversial questions occasionally arise as to authorship and priority of ideas and usage of any methods in practice. There are not sometimes coincidences in the dates of the same events in different references used by us. The authors believe that the proposed historical analysis will generally provide a keen insight into the overall picture of development of world anesthesiology and reanimatology.

The paper deals with the problem of anesthetic maintenance during surgical correction of coronary blood flow. The basis for this is the results of the investigations conducted at the V. A. Negovsky Research Institute of General Reanimatology, the objective of which was to improve the results of surgical treatment in patients with different forms of coronary heart disease (CHD), by optimizing the anesthetic maintenance of open heart surgery. Clinical and special examinations were made in 367 patients who had undergone surgical treatment (aortocoronary bypass surgery; formation of a mammary coronary anastomosis; resection and plastic repair of left ventricular aneurysms; thrombectomy from the heart chambers) for CHD and its complications. The main methodological approach to this study is to personalize intensive therapy and general anesthesia, which are relied on both evidence-based medicine and an individual pathophysiological approach. The paper details how to choose the basic mode of general anesthesia depending on the form of CHD and myocardial contractile function. Furthermore, the authors propose methods for optimizing the perioperative period: postoperative analgesia; correction of the aggregate state of blood; operative hemodilution; prevention and correction of critically reduced blood oxygen capacity

Advances in intensive care have enabled patients to survive an acute critical condition, producing a growing population of patients in a chronic critical condition with long-term dependence on intensive care. These patients make up 5–10% of all patients with acute respiratory failure and require a disproportionate share of resources in the intensive care units, with an overall yearly survival rate of 40–50%. The aim of review is to identify the impact of comorbid complications on the course and outcome of patients with severe brain injury. Ninety-six sources were selected according to the data characterizing the clinical (syndromic) model of the patient with consciousness disorders after coma of different etiologies. This model takes into account the stages and phases of the syndrome as well as a number of comorbid conditions that determine the course and outcome of the disease. The list of sources includes papers addressing the issues of comorbidity in patients with brain injury and conditions such as strokes, consequences of severe brain injury and brain surgery. The sources reflecting the most significant mechanisms of consistent development of comorbidities were examined. These include metabolic disorders with subsequent protein and energy deficiency and comorbidities of the gastrointestinal tract. The role of microbiome in the development of comorbidity in patients in chronic critical condition was also identified. C onclusion. The comorbidity development starts from the moment of brain injury and extends until sustained stabilization or multi-organ failure and death. Timely detection and correction of comorbidities allows optimizing treatment and increasing efficiency of rehabilitation in patients with severe brain injury.

The aimof the paper: to identify promising diagnostic and prognostic biomarkers of pathological processes development based on the red blood cell membrane morphology and nanostructure in patients with brain disorders in the Intensive Care Unit.Materials and methods. The study included 24 patients from the anesthesiology and resuscitation ward of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology. Blood was acquired from the patients for standard tests, and all further tests were performed in vitro. The images of red blood cells were obtained using the atomic force microscope «NTEGRA Рrima» (NT-MDT, Russia) in semi-contact mode.Results. Patients from the anesthesiology and intensive care ward with traumatic brain injury, ischemic and hemorrhagic stroke, cerebral edema, and post-hypoxic encephalopathy had different blood cell shapes and localized defects of different topology on the surface of erythrocyte membranes including defects of pallor, torus, and nanostructure.Conclusion. In this pilot study we have shown that several defects represent the trigger mechanisms for the development of a total membrane damage. Local topographic defects of nanostructures and abnormalities of erythrocyte morphology are irreversible. The number and quality of these abnormalities may eventually be used as a diagnostic and prognostic biomarker of pathological processes.

The paper describes two patients with prolonged disorders of consciousness (PDC) because of non-traumatic brain injury, in whom a clear neurodynamic response to Zolpidem was observed.In order to illustrate systemic cerebral responses to administration of this drug in LIC patients, an analysis of clinical and electrophysiological changes has been undertaken.It has been shown that the result of Zolpidem applications in patients with prolonged disorders of consciousness (PDC) should be assessed not only by consciousness dynamics, but with the help of electroencephalogram (EEG) monitoring, too. Distinct response to Zolpidem during different periods of recovery in one patients was found.Zolpidem can render various effects in patients in vegetative state/with unresponsive wakefulness syndrome (VS/UWS) and in minimally conscious state (MCS). In one patient, sedation with EEG activation was observed, which was a sign of favorable prognosis. The other patient developed more than once local convulsions after Zolpidem administration followed by contact augmentation on the next day.The mechanism of action, necessary doses of drugs, and markers of forecasting the successful effect of that drug are yet to be further studied.

The article summarizes the international experience of using different types of anesthesia for the surgical treatment of carotid artery lesions. The anesthesiology support of surgery on the carotid basin includes general and combined anesthesia of various types. The regional anesthesia is a separate field in the carotid surgery. The paper presents the advantages and disadvantages of each anesthetic technique. The recent publications show the superiority of regional anesthesia in terms of its cost-effectiveness, less frequent use of temporary intraluminal shunt, the possibility to constant monitoring of patient’s neurological status throughout the operation, and lower incidence of neurologic and cardiac complications. Complications of the regional anesthesia and the methods of their correction are described in detail. There is still no consensus about the choice of the optimal type of anesthesia for carotid endarterectomy, hence further large-scale randomized trials are needed.

Radical changes in the composition, diversity and metabolic activity of gut microbiome in critically ill patients most probably affect adversely the outcome of treatment. Microbiota dysfunction may be a predictor and presumably the main cause of infectious complications and sepsis. Clinicists use objective scales for evaluation of patient condition severity including specific parameters of disorders of organs and systems; however, microbiota function is not considered specific and, hence, not evaluated. Technical capabilities of the recent decade have allowed characterizing the intestinal microbiota and that helped understanding the ongoing processes. The authors have analyzed data about the role of intestinal microbiota as a metabolic 'reactor' during critical states, possible complications related to misbalance of 'harmful' and 'beneficial' bacteria, and examined potential of a targeted therapy aimed directly at correction of intestinal microbiota. Search for papers was carried out using Scopus and Web of Science databases 2001 to 2018 years: (Gut Microbiota) AND (Critically ill OR Intensive care unit), key words taken for the search were: intestinal microbiota, metabolism, sepsis, antibiotics, critically ill patients, multiple organ failure. A number of questions in understanding of the interaction between gut microbiome and host remain open. It is necessary to take into account interference of microbial metabolism while assessing metabolome of patients with sepsis. Among low-molecular compounds found in blood of sepsis patients, special attention should be paid to molecules that can be classified as ‘common metabolites’ of humans and bacteria, for example, degradation products of aromatic compounds, which many-fold rise in blood of septic patients. It is necessary to take into consideration and experimentally model changes in the human internal environment, which occur during radical transformation of microbiome in critically ill patients. Such approach brings in new prospects for objective monitoring of diseases by evaluating metabolic profile at a particular moment of time based on integral indices reflecting the status of microbiome/metabolome system, which will supply new targets for therapeutic intervention in future.

The purpose of this review is to present the most significant modifications and transformations of a hemoglobin molecule potentially related to developing a strategy of resuscitation and treatment of lifethreatening forms of anemia. Hemoglobin is one of the wellstudied proteins. The paper reviews the history of hemoglobin studies from 1839 untill present. Methodically, the hemoglobin studies included electrophoresis, spectrophotometric method, Xray diffraction method, atomicforce microscopy. The basic forms of hemoglobin include oxyhemoglobin, deoxyhemoglobin and methemoglobin. Data on protein crystallization and polymerization are discussed. Many forms of hemoglobin have the ability to form crystals or polymers in vitro, some pathological forms can be modified in vivo. The studies of structural features of various hemoglobin forms represent a contemporary task for fundamental researches.

The course of critical conditions in neurology and neurosurgery has specific features associated with the complex pathogen esis of brain injury, which in turn determines the specificity of resuscitation care. For a brief description, general resuscita tion methods in neurology and neurosurgery should be characterized by the term of neuroresuscitation. The paper presents the latest trends in multimodality monitoring and specific therapy in neuroresuscitation. Furthermore, it gives the data show ing the great importance of infection monitoring for the treatment of critically ill neurological and neurosurgical patients.

Objective: to evaluate the impact of highfrequency jet ventilation (HFJV) and traditional positive endexpiratory pressure (PEEP) ventilation on blood oxygenation, gas exchange, and hemodynamics on an experimental model of acute lung injury. Material and methods. Thirty albino outbred laboratory male rats weighing 200—300 g were randomly selected for investigations and further divided into groups: 1) traditional ventilation (TV) (n=15); 2) HFJV (n=15). The rats were anesthetized with intraabdominal ketamine (6—8 mg/kg) and sibasone (15—45 mg). Anesthesia was maintained by the bolus administration of ketamine (1 mg/kg every 15—20 min). Tracheostomy was carried outwith a 0.2—0.4 mm diameter endotracheal tube that was then fixed using surgical thread 2—2.5 cm deep to the cricoid cartilage. Results . Acute respiratory distress syndrome (ARDS) has clear histological criteria for lung tissue structural injury; it is widely prevalent in clinical practice and associated with high mortality rates. The paper describes anexperimental ARDS model, the essence of which is 45—55% aspiration of the circulating blood volume for 10—15 minutes. A Reosorbilact® solution was used to compensate for the volume of blood loss, which was followed by the administration of autothromboplastin (16—20 mg/kg animal weight). PEEP was studied for its impact on gasexchange, hemodynamics, and blood oxygenation during HFJV and TV. Gas exchange parameters during TV and HFJV were comparatively analyzed. Conclusion. The use of PEEP for ARDS was ascertained to improve blood oxygenation due to decreased pulmonary shunt, better respiratory muscle performance, lower infiltrated and atelectatic tissue volumes, and higher lung functional residual capacity

Objective: to clarify the causes and changes of body temperature in relation to the type of stroke and the presence or absence of pyoinflammatory complications. Subjects and methods. The case histories were retrospectively analyzed in 211 survivors and deceased patients with acute cerebrovascular accident at the age of 38—87 years. In the patients from different groups and subgroups, changes in their temperature were assessed from its curves during their hospital stay. Indicators, such as initiation of hyperthermia (hours), duration of hyperthermia (days) and unrelieved hyperthermia (hours), were estimated. The pattern and number of pyoinflammatory complications in each patient were taken into account. Results. The paper deals with the retrospective analysis of a temperature response in the survivors and deceased patients with myocardial infarction and intracerebral hemorrhage. It shows body temperature changes in relation to the type of stroke and the presence or absence of pyoinflammatory complications, such as pneumonia, meningitis, purulent tracheobronchitis, etc. The main causes of hyperthermia in stroke were elucidated. Conclusion. Hyperthermia affects negatively the outcome of stroke and increases the length of hospital stay regardless of the type of stroke. In patients with acute cerebrovascular accident, the causes of hyperthermia are a focus of brain injury, blood in the cerebrospinal fluid system, and pyoinflammatory complications.

The paper discusses promises for clinical use of substrate antihypoxants. Objective: to investigate the efficacy of succinate containing substrate antihypoxants on systemic oxygen consumption, blood buffer capacity, and changes in the mixed venous blood level of lactate when they are used in gravely sick patients and victims with marked metabolic posthypoxic disorders. Subjects and methods. The trial enrolled 30 patients and victims who had sustained an episode of severe hypoxia of mixed genesis, the severity of which was evaluated by the APACHE II scale and amounted to 23 to 30 scores with a 46 to 70.3% risk of death. The standard infusion program in this group involved the succinate-containing drug 1.5% reamberin solution in a total dose of 800 ml. A comparison group included 15 patients who had undergone emergency extensive surgery for abdominal diseases. 400 ml of 10% glucose solution was used as an infusion medium. Oxygen consumption (VO 2 ml/min) and carbon dioxide production (VCO 2 ml/min) were measured before infusion and monitored for 2 hours. Arterial blood gases and acid-base balance (ABB) parameters and mixed venous blood lactate levels were examined. Measurements were made before and 30 minutes after the infusion of reamberin or glucose solution. Results. Infusion of 1.5% reamberin solution was followed by a significant increase in minute oxygen consumption from 281.5±21.2 to 310.4±24.4 ml/min. CO 2 production declined (on average, from 223.3±6.5 to 206.5±7.59 ml/min). During infusion of 10% glucose solution, all the patients of the comparison group showed a rise in oxygen consumption from 303.6±33.86 to 443.13±32.1 ml/min, i.e. about 1.5-fold. VCO 2 changed similarly. The intravenous infusion of 800 ml of 1.5% reamberin solution raised arterial blood buffer capacity, which was reflected by changes in pH, BE, and HCO 3 . There was a clear trend for lactate values to drop in the mixed venous blood. The intravenous injection of 400 ml of 10% glucose solution caused no significant changes in major ABB indicators, which reinforced the statement that there is a difference in the metabolism of these substrates. Conclusion. The succinate-containing drugs are able to compensate for metabolic acidosis. Their use is followed by increased oxygen consumption and activated aerobic oxidation processes. The basis of their antihypoxant properties was thought to be recovered intracellular aerobic metabolic processes due to corrected intracellular metabolic acidosis and increased blood buffer capacity.

Цель исследования — оценить противогипоксическое и антиоксидантное действие Мексикора у больных с желудоч� но�кишечными кровотечениями язвенной этиологии. Материалы и методы. В статье представлены материалы, полу� ченные в процессе лечения 53 больных язвенной болезнью с неварикозными желудочно�кишечными кровотечения� ми, госпитализированными в состоянии геморрагического шока II—III ст. Результаты. Установлено, что включение Мексикора в комплексную программу интенсивной терапии острых желудочно�кишечных кровотечений снижает в организме больных активность прооксидантных процессов, выраженность проявлений тканевой гипоксии и систем� ного воспаления, улучшает показатели системной гемодинамики и клиническое течение раннего постгеморрагическо� го периода. Заключение. Применение Мексикора у пациентов с желудочными кровотечениями снижает число ослож� нений, сокращает длительность лечения больных в отделении реанимации. Ключевые слова: Мексикор, желудочно�кишечное кровотечение, гипоксия. Objective: to evaluate the antihypoxic effect of Mexicor in patients with gastrointestinal bleeding of ulcerative etiology. Materials and methods. The paper presents the materials obtained during the treatment of 53 patients with nonvaricose gastrointestinal bleeding who were hospitalized with grades II—III hemorrhagic shock. Results. Incorporation of Mexicor into the comprehensive program for the intensive therapy of acute gastrointestinal bleeding was ascertained to reduce the

Trophic homeostasis together with oxygen provision is known to form the basis for the body’s vital activity and a prerequisite to the elimination of many abnormalities [1]. Support of trophic homeostasis along with its intrinsic factor is determined not only by the capabilities and reality of providing an organism with essential nutrients, but also by the relevant conditions for their effective assimilation, particularly in the presence of a severely progressive pathological process [1, 2]. The last decades of the 20th century were marked by the rapid development of clinical nutrition science, giving rise to the whole industry of manufacturing various formulas for both the parenteral and enteral feedings of patients (the injured). Due to the fact that there is a great variety of feeding formulas (FFs), we have now a right to tell not only about the adequate substrate provision of patients in all directions, but also about the fact that we can perform differential nutritive metabolic therapy for an existing pathological condition. At present we have a good chance of implementing the qualitative nutritive support (NS) for any category of patients. At the same time, it should be noted that recently physicians of different specialties in our country are much better aware of the importance and necessity of timely using active NS in seriously ill patients (victims) [1—3]. This paper presents the comparative characteristics of the most popular and Russia’s registered balanced polymer FFs. All information on the properties of the products has been taken from either their original package, or the advertising matters distributed by this or that manufacturer. The key properties of FFs, such as chemical composition, osmolarity, formulations, and package, have been compared. hypermetabolism; feeding formulas; composition; osmolarity; choice

The paper presents the results of a study of blood gas composition and acid-base balance (ABB) in the use of the Russian drug Surfactant BL in preterm neonatal infants with respiratory distress syndrome (RDS). The surfactant was given to 57 preterm neonates. A control group consisted of 52 children with RDS who had received a course of treatment before the use of the drug in the hospital. Statistical analysis indicated the virtual similarity of the study and control groups. The study demonstrated that that in Surfactant BL-treated patients, blood oxygenation (pO2, %SO2c, A-a DO2, respiratory coefficient) improved much more rapidly and the mean values of these parameters remained statistically significantly better from the end of 24 hours of treatment than in the control neonates up to the end of therapy in the intensive care unit of the maternity hospital. Studies of blood ABB showed that the neonates of both groups had moderate metabolic acidosis at the initiation of therapy. With the therapy performed, the parameters of ABB generally reached normal values within the first 24 hours of therapy. There were no obvious differences in the changes of blood ABB parameters in the neonatal infants of both groups. Analysis of the results of treatment in neonates with ABB showed a statistically significant advantage in terms of positive outcomes of treatment in the group of Surfactant BL-treated patients.

The paper analyzes the data available in the literature on the diagnostic value of biological markers of acute lung lesion (ALL) in critical conditions. The study of the diagnostic and prognostic values of biological markers of ALL is shown to be a promising line in the section of critical conditions. The biological markers of ALL will have the highest effectiveness in evaluating the development of ALL at the preclinical stage, in differentiating the exudative and proliferative stages of ALL/acute respiratory distress syndrome, and defining indications for respiratory support. The biological markers of ALL are capable to predict the development of ventilator-induced lung lesion. The analysis of gene expression and the study of an array of DNA nucleotide sequence in the cells are of the greatest diagnostic and prognostic value in determining the predisposition of cytokines and intercellular signal molecules to synthesis.

The paper estimates the hypoxic sensitivity of isolated isovolumetrically contracting hearts of non-inbred albino male rats experiencing 4-min clinical death from acute blood loss. In the early postresuscitative period, the inhibited contractility of the myocardium and its increased hypoxic sensitivity has been ascertained to be due to impaired bioenergetics and activated lipid peroxidation processes. A four-fold pO2 reduction in the Krebs-Henseleit solution causes a more rapid and more marked development of myocardial contractures and oxygenized solution-induced reperfusion brings about greater myocardial damages.

The paper presents the results of use of the combined antihypoxant Cytoflavin during operations under extracorporeal circulation. Twenty-nine patients operated on for rheumatic mitral valvular disease were examined. The examinations have shown that the use of Cytoflavin positively affects the restoration of cardiovascular performance and improved tissue oxygen transport in the postperfusion period.

The paper deals with the study of protective and fixed means in the prevention of bacterial contamination at the standing site of catheters used for different purposes and the reliability of their fixation. The study covered 136 patients and victims. Special means for fixing and protecting central venous and epidural catheters were applied in the study group. Adhesive plaster and gauze were used to protect and fix the standing site of catheters in the control group. High-technology protective fixed means have evident advantages, such as effective protection from bacterial contamination, reliable fixation of catheters used for different purposes, comfort for patients, safety, and serviceability in the work of medical staff. The routine use of fixation as an adhesive plaster and gauze fails to provide a valid protection and a reliable fixation in critically ill patients.

The paper contains information on the currently available methods for intensive care for acute myocardial infarction (AMI), by using hyperbaric oxygenation (HBO), antihypoxants, and antioxidants. The presented information is based on the data available in the literature and on the results of the authors’ own studies made in 428 patients with AMI, in whom the time course of changes was determined in blood gas and in the biochemical parameters characterizing energy metabolism and free radical lipid peroxidation. Along with the conventional treatment (thrombolysis, restriction of a necrotic area, myocardial hemodynamic unloading, Labori mixture, anticoagulants, disaggregants, etc.), multimodality therapy for AMI used HBO sessions and antioxidants. The studies have provided evidence that it is possible and expedient to effectively and safely use HBO in AMI. Criteria for selecting the patients to undergo HBO, the time of its use, the choice of barotherapy regimes, and the nature of concomitant therapy are given. The application of the currently available methods for intensive care for hypoxia in AMI (HBO in combination with antihypoxants and antioxidants) can reduce the length of stay at hospital and in resuscitative and intensive care units and considerably decrease mortality rates.

The paper presents the results of a clinical trial of Surfactant-BL in adult patients with acute respiratory distress syndrome. Pulmonary biomechanics and gas exchange are shown to improve, the duration of respiratory support and the length of stay at an intensive care unit decrease, and the frequency of pyoseptic pulmonary complications reduces with early endotracheal administration of Surfactant-BL under artificial ventilation in acute respiratory distress syndrome.

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 paper presents the results of a comparative study of different routes of intrapulmonary administration of perfluorane under artificial ventilation in patients with acute respiratory distress syndrome of various genesis. It shows the advantages and disadvantages of these routes, their impact on gas exchange, pulmonary biomechanical properties, cardiac hemodynamics, the transport and uptake of oxygen, the duration of respiratory support, and the length of stay in an intensive care unit.

The paper shows that the treatment of brain traumatic lesions is a topical problem. Moreover, the complications associated with the development of cerebral recompression play a particular role in the posttraumatic period. The purpose of the present study was to reveal the regularities of reorganization of cyto- and synaptoarchitectonics of different layers of the cerebral cortex in patients with cerebral recompression in the acute period of brain injury. Cerebral cortical biopsy specimens taken in 6 patients from the perifocal area (subdural hematoma and a contusion focus with intracerebral hematoma) were examined. The results were statistically processed, by using a package of the applied programs «StatSoft Statistica 6.0». Based on the findings, the authors suggest that it is necessary to make an early diagnosis and a complex intervention that promotes the improvement of the ultimate results of treatment.

Postoperative complications have been a cardinal problem of reparative operations on the esophagus for many years. Attempts to make an artificial esophagus have frequently ended with anastomotic failure or pyoseptic complications, which is largely associated with significant metabolic disturbances in patients. The adequate preoperative and postoperative parenteral and enteral feeding programs developed at the Russian Surgery Research Center, Russian Academy of Medical Sciences, show their considerable impact on the results of surgical activities. The paper gives a clinical example of the specific features of management of a female patient with an excess neck enteric graft loop after retrosternal enteric esophagoplasty.

Transition from micron to nanometric image sizes creates many problems associated with the emergence of non-uniform scale heterogeneities of objects. To recognize the structural units of membrane heterogeneities is a complex pathophysiological and biophysical task. Objection: to show main methodological approaches to analyzing the heterogeneities of membrane nanostructures when using microscopy and to demonstrate the need for an expert evaluation when investigating red blood cell membranes in health and the influence of exogenous and physicochemical factors on blood. The paper discusses the limits of applicability of optical and atomic force microscopy. It shows the heterogeneities of cell distribution over the ensemble, surface of an individual cell, by the pattern and extent of local membrane damages and by a number of others. To take into account all the types of heterogeneities, to form the qualitative monolayers of cells, and to choose scanning nanoscales adequately with the tasks may contribute to the successful implementation of the research goals set. Key words: membranes, heterogeneities, local defects, optical, atomic force microscopy.

Heart transplantation in patients after implantation of mechanical cardiac support devices entails an extremely high risk for perioperative bleeding. Recombinant activated coagulation factor VII is presently used to reduce the volume of bleeding in this patient group. There are parallel data on its administration-induced thromboembolic events in the literature. This paper describes a case of using a prothrombin complex concentrate in a patient during explantation of a left ventricular bypass system and subsequent orthotopic heart transplantation in the presence of significant hypocoagulation. At the end of a surgery, 1200 IU of the agent was used at a remaining bleeding rate of more than 1000 ml/hour. Within the first 24 hours after surgery, the rate of discharge drainage was less than 100 ml/hour. A control plain chest X-ray study revealed massive left-sided hydrothorax on day 2 postsurgery. The left pleural cavity was revised under thoracoscopic guidance and 1000 ml of blood clots were evacuated. Although the administration of prothrombin complex concentrate did not guard against re-intervention, its use seems a promising strategy in life-threatening bleedings in patients after explantation of mechanical cardiac support devices. Further multicenter investigations are required to determine the efficacy and safety of prothrom-bin complex concentration in cardiac surgery. Key words: Recombinant activated coagulation factor VII, prothrombin complex concentration, mechanical cardiac support device, orthotopic heart transplantation.

to improve treatment results in premature infants with neonatal respiratory distress syndrome (NRDS), by establishing developmental mechanisms and elaborating methods for its early diagnosis, treatment, and prevention. Material and methods . The paper analyzes the results of a clinical observation and laboratory, instrumental, immunological, morphological, and radiological studies of 320 premature neonates at 26—35 weeks gestational age. The following groups of neonates were identified: 1) 40 premature neonatal infants without NRDS and with the physiological course of an early neonatal period (a comparison group); 2) 190 premature neonates with severe NRDS in whom the efficiency of therapy with exogenous surfactants, such as surfactant BL versus curosurf, was evaluated; 3) 90 premature newborn infants who had died from NRDS at its different stages. Results . The poor maternal somatic, obstetric, and gynecological histories in the early periods of the current pregnancy create prerequisites for its termination, favor the development of severe acute gestosis, and cause abnormal placental changes. Each gestational age is marked by certain placental changes that promote impaired uterineplacentalfetal blood flow and premature birth. Alveolar and bronchial epithelial damages, including those ante and intranatally, microcircula tory disorders play a leading role in the tanatogenesis of NRDS. Intranatal hypoxia and amniotic fluid aspiration are one of the important factors contributing to alveolar epithelial damage and NRDS in premature neonates. Exogenous surfactants prevent the development of hyaline membranes and are useful in the normalization of ventilation-perfusion relationships and lung biomechanical properties. Conclusion. This study could improve the diagnosis and treatment of NRDS, which assisted in reducing the duration of mechanical ventilation from 130±7.6 to 65±11.6 hours, the number of complications (the incidence of intragastric hemorrhages decreased from 28.8 to 9%), the stay length of the neonates in an intensive care unit, and early neonatal mortality rates from 9.3 to 0.9‰ and in improving demographic indicators.

The paper analyzes the results of the investigations made at the V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences, on the pathophysiology and applied aspects of cardiac performance and the anesthetic maintenance of cardiac operations. The main tasks presented to its investigators were to improve electric cardiac defibrillation and cardioversion, to elaborate the optimal infusiotransfusion therapy tactics during cardiac surgery, to optimize intraoperative myocardial protection, to maintain lung functions under extracorporeal circulation, to search for the most effective and safe schemes of general and epidural anesthesia in cardiosurgical patients, and to substantiate algorithms for their postoperative activation. The findings could solve the problem of treating circulatory disorders in the practice of critical care medicine on a new plane. At the same time new areas of a further scientific search have been identified.

The paper provides the results of the 1990—2010 experimental and clinical studies on the optimization of the efficiency of electrical ventricular defibrillation using the Russian bipolar quasi-sinusoidal impulse. The comprehensive study of the influence of major cardiac and extracardiac factors, such as heart failure, the type and duration of fibrillation, its amplitude and frequency characteristics, chest resistance, electrode sizes, administration of antiarrhythmic drugs, and phase 2 impulse amplitude on the efficiency and safety of defibrillation, could formulate a number of new propositions and solve some methodological and methodic issues. The dose-dependent effectiveness of the quasi-sinusoidal impulse has been first investigated in patients with induced, spontaneous primary and secondary fibrillation and ventricular tachycardia. Low-energy (Key words: defibrillation, bipolar quasi-sinusoidal impulse.

The authors consider the role of genetic studies in modern medicine. The high death rates due to critical conditions (sepsis, multiple organ dysfunction, acute respiratory distress syndrome, nosocomial infections) initiate a search for prognostic models. The paper presents the results of the investigations made at the V.A. Negovsky Research Institute of General Reanimatology jointly with the V. N. Vavilov Institute of General Genetics. The panel of genetic markers, which is associated with the increased risk of both community-associated and nosocomial pneumonia (combinations of polymorphic variants in the xenobiotic detoxification gene (CYP1A1), cytokines (IL-6), and renin-angiotensin-converting enzyme (ACE), has been revealed. Genetic factors are essential in determining a response to drugs; 20—95% of the individual variability in the efficiency of their metabolism has been ascertained to result from genetic variability. An associative study has revealed differences in the efficiency of antibacterial therapy in terms of the GSTP1 and ABCB1 genes. Thus, it can be said that the possibilities of molecular genetic methods open prospects for developing the new area in reanimatology — critical care genetics. Identification of groups at increased risk for life-threatening conditions is particularly important in preventing their development and detecting their early markers for the timely determination of the required volume of specialized medical care. Key words: multifactorial diseases, gene polymorphism, xenobiotic detoxification genes, community-associated pneumonia, nosocomial pneumonia.

The paper describes a rare case of successful surgical treatment for mitral insufficiency due to heart valvular apparatus damage in the acute period of severe concomitant injury. Prosthetic mitral valve replacement was done on day 3 after injury. The patient was switched to spontaneous breathing on day 7 postoperatively and transferred to a surgical unit on day 11. Timely diagnosis, a comprehensive therapeutic approach, active surgical policy, the availability of up-to-date medical equipment, and the presence of high-quality physicians allowed severe cardiopulmonary insufficiency to be eliminated and the patient was discharged from hospital in a satisfactory state on day 25 after injury. Key words: severe concomitant injury, blunt chest injury, mitral valve damage, cardiac surgery.

The present paper gives information on cytokines during pregnancy, their role in its physiological course and development of adaptation in premature neonates in the postnatal period. Key words: cytokines, preterm labor, innate immunity, premature neonate, respiratory distress syndrome.

Objective: to reveal the features of perioperative metabolic disturbances in patients with lung cancer after pulmonectomy and a possibility of their correction with perioperative «Standard» formula sipping and with postoperative intravenous cytoflavin. Subjects and methods. The paper presents the results of a prospective randomized study of the efficiency of correction of metabolic disturbances in patients with lung cancer with perioperative enteral «Standard» formula sipping (5 days before surgery and 12 days after surgery). The study was conducted in 326 men aged 36 to 68 years. Arterial blood metabolic parameters (glucose, lactate, and pyruvate) and daily urine urea were estimated. Results. There was an association of preoperative metabolic disturbances with body mass index (BMI). Inclusion of sipping into perioperative therapy did not exert a considerable impact on the cause of postoperative metabolic disturbances. Key words: lung cancer, pul-monectomy, body mass index, sipping, cytoflavin.

The paper gives the results of a study of peripheral circulatory features during high-frequency jet ventilation (HFJV). The main specific features of peripheral circulation and oxygen transport during HFJV are formulated on the basis of a study of cardiac output (impedance cardiography), peripheral vascular resistance, peripheral vascular blood filling (photoplethysmogram analysis), adaptive peripheral blood flow reactions (spectral analysis of peripheral vascular pulsation). HFJV gives rise to the peculiar pattern of peripheral hemodynamics and tissue gas exchange, which is characterized by higher oxygen uptake without a decrease in mixed venous blood saturation, with normal extraction coefficient and preserved low peripheral vascular resistance. During HFJV, unlike traditional ventilation, the main peripheral hemodynamic feature is the increased capillary bed blood volume caused by the blood flow involvement of reserve capillaries under control of volume (parasympathetic) regulation of adaptive peripheral hemodynamic reactions. Key words: high-frequency jet ventilation, oxygen transport, peripheral hemodynamics.

This paper gives information on intrauterine lung development in health and under poor conditions influencing the prenatal morphogenesis of lung tissue: threatening miscarriage, gestosis in the first and second halves of pregnancy, and placental insufficiency. It considers the development of the lung depending on fetal gender and a season. Key words: premature delivery, prenatal lung morphogenesis, premature neonates, surfactant, respiratory distress syndrome.

The paper describes the way medical and intensive cares are organized to patients with complicated forms of A/H1N1 and seasonal influenzas in the Trans-Baikal Territory in the fall of 2009.

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.

The paper considers the basic principles of the pathophysiology, as well as the diagnosis and treatment of patients with severe acute pancreatitis. Key words: acute pancreatitis, pathophysiology, diagnosis, treatment.

Thyroid diseases are most common in endocrinology. Thyrotoxicosis induces dysfunction of virtually all organs and systems, the blood circulatory system being subjected to considerable changes. Cardiovascular diseases affect not only the quality of life in a patient, but significantly increase a risk from surgery that is the only radical treatment. For this reason, most authors consider thyrotoxicosis to be a contraindication to elective surgical intervention. At the same time it is known that drug compensation of thyrotoxicosis may be attained in not all patients. In this case, the results of treatment and a patient’s safety during surgery depend on the type and quality of anesthetic protection. The capabilities of anesthetic maintenance of thyroid surgery have recently expanded substantially. The paper deals with the preparation of patients with thyrotoxicosis for surgical intervention and the perioperative management of these patients. Key words: thyroid, toxic goiter, thyrotoxicosis, premedication, anesthetic mode, sevoflurane, xenon.

The paper reviews data on novel and combined maintenance/replacement therapies used to treat multiple organ failure/dysfunction, including those of septic origin. The basis of using these treatments is a new ideology of applying the earlier known and newly developed methods of efferent therapy that substantially improves the results of treatment in most seriously ill patients at intensive care units.

Objective: to study the incidence of labor fever under epidural analgesia (EA) and to evaluate its impact on the courses of puerperium and early neonatality. Subjects and methods. The paper presents the data of a prospective study of the course of labor, puerperium, and early neonatality in 397 women in whom labors occurred at the Republican Peritoneal Center in 2006. A study group included 324 parturients in whom labor pain was relieved by EA. A comparison group comprised 55 parturients in whom no analgesics were used at labor. Results. There were no significant statistical differences between the groups in the incidence of labor fever and complicated puerperium and in that of neonatal pyoseptic diseases. Key words: labor hyperthermia, epidural analgesia, labor pain relief.

Objective: to develop a variant of the clinicostatistical model PIRO, by making retrospective and prospective analyses of cases of sepsis, severe sepsis, and septic shock, to carry out its clinical trial, and to estimate its prognostic value and expert capacities. Subjects and methods. Critically ill patients with multiple organ dysfunctions, who had signs of an active systemic inflammatory response by the ACCP/SCCM criteria (1992), the severity of the underlying condition of an APACHE II Score of 10 or more, and manifestations of multiple organ dysfunctions by the SOFA scale, were enrolled for the study. Among them, the men and women were 69 and 57%, respectively; their mean age was 42.0±1.6 years. While developing a variant of the PIRO model, the authors determined the domains of its parameters as values in the presence of these or those signs of premorbidity (Charlson Comorbidity Index, 1987), infection (the classification worked out by R. A. Weinstein in 2001 and modified by the author), a systemic response to infection (the classical signs of SIRD and the diagnostic markers of sepsis, proposed by M. M. Levy et al. (SSC), multiple organ dysfunctions/failures (SOFA scale) in a specific patient. Results. The data given in the present paper suggest that the use of the new diagnostic markers of sepsis in addition to the classical criteria of SIRS allowed its diagnosis to be made in the highly specific fashion; the PIRO model variant designed by the authors has heuristic, predictive, and expert capacities; it made it possible to reliably determine the outcome of the disease at an early stages of sepsis, by using the basic parameters affecting the progression and outcome of the disease and to establish that the patients who had experienced a septic episode had persistent organ dysfunction, more severe premorbid state, and poorer quality of life. Conclusion. The application of the PIRO model makes it possible not only to choose a timely and full intensive therapy strategy, but also to prevent the progression of persistent organ dysfunction/failure after a sustained septic episode. Key words: sepsis, multiple organ dysfunction, PIRO system.