The retrospective cohort comparative study was conducted in order to evaluate efficiency and safety of using 6% hydroxyethyl starch (HES) 130/0.4 for managing burn shock. The enrollment criteria were as follows: men and women above 18 years old, thermal burns from 20 to 80% of the body surface, the need of infusion therapy, expected duration of the patient’s stay in the intensive care department for more than 3 days, the absence of acute renal failure at the moment of hospital admission. All patients were divided into two groups. The 1st group (HES+) included 24 patients who received infusion therapy for 3 days with Ringer’s solution and 6% HES 130/0.4 additionally, the 2nd group (HES-) included 25 patients who were treated only with Ringer’s solution. Hospital mortality in the group (HES+) made 45.8% (11 patients died), and in the group (HES-) it made 28.0% (7 patients died), p = 0.3182. The extended surface of lesion was the independent factor of acute renal failure development in those suffering from severe burn injury: OR = 1.09 (1.01–1.19), p = 0.04; Baux OR greater index = 1.09 (1.01–1.19), p = 0.02 and the need in catecholamines – OR = 12.7 (1.2–144.9), p = 0.04. The study showed no confident difference in the frequency of acute renal failure, in the need of substitution renal therapy and mortality in two groups of patients receiving and not receiving HES. Using HES solutions in doses not exceeding the recommended ones did not facilitated the reduction of infusion therapy volume.

The value of changes in the acidogenic function of stomach as well as blood circulation disorders in the genesis of erosive ulcer lesions of gastrointestinal tract were evaluated in those suffering from severe thermal injury. The changes in the rates reflecting the blood circulation state (stroke volume, cardiac index, global end-diastolic volume, index of general peripheral vascular resistance) were monitored during the early period of the burn injury. The acidogenic function was tested with the help of endoscopic pH-metry in 24 ± 4 hours and on the 7th and 14th days from the moment of burn injury. It was found out that erosion and acute ulcers complicated by hemorrhage occurred in 12% of those suffering from severe thermal injury in the acute period of the burn disease. And all of them manifested severe blood circulation disorders during the burn shock period despite the anti-shock therapy. At the same stage of treatment hyperacidity occurred in not more than 7-14% of those severely burned, and the major part of patients manifested hypoacidity and unacidity. Changes association evaluation proved that in case of ischemia the protection factors of mucous coat were expressly inhibited and the minimum quantity of chlorohydric acid was enough to damage the mucous coat. The obtained results allowed justifying the pathogenic approach to prevention of erosive ulcer lesion of the mucous coat of the gastrointestinal tract in the patients with burn shock, which is to include first of all the adequate management of the shock, fastest restoration of microcirculation and effective anti-secretion therapy providing unacidity state.

Forty patients after elective off-pump coronary artery bypass grafting (OPCAB) were enrolled into a prospective observational study and monitored using SpO₂, EtCO₂, pulse rate and respiratory rate. In addition, the Integrated Pulmonary Index (IPI, Capnostream^TM 20p, Covidien) was registered prior tracheal extubation and at 2, 6, 12, and 18 hrs after extubation. The hemodynamics was monitored using continuous non-invasive cardiac index (esCCO, Nihon Kohden) and left ventricular ejection fraction (EF) before and after the intervention. The value of IPI registered during the respiratory support correlated with cardiac index (p = 0.04). In the subgroup of the patients with IPI below 8 at 2 hrs after extubation, we found lower ejection fraction (p = 0.007). In addition, the IPI value ≤ 9 was a predictor of complicated early postoperative period (AUC = 0,7; p = 0, 04). Thus, IPI reflects the hemodynamic status and the course of postoperative stay after OPCAB.

Pre-surgery infusion with levosimendan with the rate of 0.05–0.1 mkg*kg-1 min-1 to the elder patients (60–75 years old) with lower ejection fraction of the left ventricle (less than 50%) results in its increase by 16.7% (p < 0.01), cardiac index – by 10.3% (p >< 0.01) and reduction of NT-proBNP level in blood by 24.1% (p >< 0.1) in 24 hours after the medication infusion start. The changes persist for at least 24 hours after the surgery. Key words: levosimendan, cardiac failure, peri-operative period, pre-surgery preparation, cardiac surgery, reduction of NT-proBNP level.>< 0.01), cardiac index – by 10.3% (p< 0.01) and reduction of NT-proBNP level in blood by 24.1% (p < 0.1) in 24 hours after the medication infusion start. The changes persist for at least 24 hours after the surgery. Key words: levosimendan, cardiac failure, peri-operative period, pre-surgery preparation, cardiac surgery, reduction of NT-proBNP level.>< 0.1) in 24 hours after the medication infusion start. The changes persist for at least 24 hours after the surgery.

The article presents the outcomes of studying lactate concentration depending on clinical laboratory status in newborns in critical state. The study included 128 newborns with body mass of 1500 (1300-1740) gr. and gestation period 30.5 (29-32) weeks. It was found out that lactate concentration in blood plasma from 2 to 4 mM/lt. pointed out in the majority of cases at the respiration disorders and insignificant perfusion disorders, while its increase above 4 mM/lt. supposed the mixed hypoxia and requires hemodynamic management.

The randomized controlled trial was conducted to compare intravenous and intra-articular injection of tranexamic acid (dose of 15 mg/kg) in the combination with three hour closure of the drainage in case of total endoprosthesis replacement of knee joint. The local use of the medication proved to have the significant blood saving effect.

The articles presents the review of data about pathogenesis of stress erosive ulcer lesions of mucous coat in gastro-duodenal area. Imbalance between protection factors of mucous coat and aggression factors towards the latter (ischemia of mucous coat, microcirculation disorders in it, activation of free radical oxidation, acidopeptic factor etc) is recognized as a main pathogenic moment. The presented data are discussed from the point of view of sympathetic nervous system (SNS) for nervous trophism and its disorders – neurogenic dystrophia of internal organs caused by stress hyperactivation of SNS and consequent atrophy of its mediator of norepinephrine in the tissue of internal organs. These norepinephrine balance disorders are crucial regarding development of erosive ulcer lesions of mucous coat. Spinal anesthesia, epidural anesthesia and combined spinal-epidural anesthesia prevent development of numerous post-surgery complications when used during surgery.

Abstract. Artificial blood circulation is a main supporting technique of cardiac surgery. This review is devoted to the management aspects of main physiological parameters during artificial blood circulation in the adult patients from the position of the evidence based medicine.

Abstract Pharmacological support of the circulation remains to be a corner stone when managing patients with myocardial dysfunction. The article reviews the current theoretical and practical aspects of using levosimendan in cardiac surgery as an inotropic medication with the unique action mechanism and cardio-protective properties.

Cerebral oxymetry is one of the monitoring techniques aimed at the early detection of changes in the brain state. Currently it is being actively introduced into practice, management algorithms for cerebral oxygenation disorders are being developed basing on it, including the ones for cardiac surgeries. Certain data show that this allows decreasing the frequency of post-surgery neurological complications, the duration of patients stay in the intensive care department and general duration of hospital stay. However it is recognized that not all aspects of its using have been provided with the relevant evidence, especially in the respect of cardiac surgical patients with high surgical risk. The main purpose of this research is to draw the attention to the problem and present the protocol of the trial which has been started in our unit. The special emphasis is made on the methodological components of the research, starting with the formulation of research hypothesis, defining finite primary and secondary points, preliminary calculation of sampling and defining statistical analysis methods. We would very much appreciate the feedback from our colleagues and hope that that the other researchers will follow our example when starting big research projects.