Goal: to investigate the frequency and specific features of respiratory disorders and their impact on the clinical course in the patients having coronary artery bypass graft operation. Materials. 454 patients expecting coronary artery bypass graft operation were enrolled into the prospective cohort study. External respiration function was evaluated prior to the surgery. Pathologic respiration patterns were assessed basing on forced expiratory volume per 1 second (FEV1 ) and forced vital lung capacity (FVLC). The pattern was evaluated as obstructive with the ratio of FEV1 /FVLC < 0.70; and the restrictive pattern was the combination of FEV1 /FVLC≥ 0.70 and FVLC < 80% of "must". Results. Obstructive and restrictive patterns were detected in 72 (15.8%) and 50 (11.0%) patients respectively. Out of 133 patients with compromised external respiration function chronic obstructive pulmonary disease was diagnosed only in 26 patients. Bronchial obstruction was related to the risk of auricular fibrillation, increase of duration of artificial pulmonary ventilation and prolonged hospital stay. Conclusion. It has been demonstrated that it is possible to improve clinical outcomes in the patients undergoing cardiac surgery through diagnostics of respiratory disorders, detection of risk groups and prevention of complications.

Cardiac surgery is often complicated by oxidative stress (the evidence of this is the increase of carbonyl proteins in blood plasma), however the relation between these changes and post-operative complications and unfavorable outcomes stills remains uninvestigated and lacks the relevant proof. The above facts served as a basis for this research. Goal of the article: to investigate the impact of oxidative stress assessed as per the level of carbonyl proteins in blood plasma on systemic inflammation response syndrome (SIRS), acute heart (AHF) and renal failure (ARF) in cardiac surgery. Methods. Prospective observational cohort study was conducted in order to investigate the relation of oxidative stress intensity, assessed as per the level of carbonyl peptides in blood plasma, and development of SIRS, AHF, ARF in the patients undergoing cardiac surgery. 67 adults patients admitted to Cardiac Intensive Care Department of M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow, were examined. Results. The significant positive correlation has been found between intensity of oxidative stress assessed as per the level of carbonyl peptides in blood plasma, and composite frequency of post-operative complications (SIRS, AHF and ARF) in cardiac surgery (Spearman rank correlation (r) = 0.6; p < 0.0001). It was found out that the area under ROC-curve made 0.81 and 0.83 for the risk of developing acute renal lesions and heart failure respectively (p < 0.01 in both cases) thus the investigated model can be evaluated as "a model of very good quality". Conclusion. The important role pf oxidative stress in the development of SIRS, AHF and ARF has been confirmed. No advantages of off pump technique when performing coronary artery bypass grafting have been detected. Testing carbonyl peptides in blood plasma during first hours after surgery can be recommended in order to predict the risk of developing SIRS, AHF and ARF.

Goal of the study: to evaluate the capability of pyruvate which is endogenously produced during myocardium anoxia to prevent the post-perfusion cardiac failure in the patients undergoing revasculization surgery with cardiopulmonary bypass. Materials and methods. 56 patients with coronary disease who underwent surgery with cardiopulmonary bypass were examined. The samples of blood for anaerobic metabolism tests were collected from the catheter of heart coronary sinus before aortic compression, before release of clamps and in 30 minutes after reperfusion. During the surgery the following rates of hemodynamic profile were registered (cardiac index, systolic output index, medium arterial tension, index of peripheral resistance and pulmonary vessels resistance, index of systolic output of the left and right ventricles, pulmonary capillary wedge pressure), oxygen transportation, consumption and extraction co-efficient, arteriovenous oxygen difference. In the early post-operative period the following rates were evaluated: need in inotropic support, duration of artificial pulmonary ventilation and stay in the intensive care department. The level of troponin I was tested in 12 and 24 hours. Patients were divided into groups depending on the increase of pyruvate level from the start of cardiopulmonary bypass before aortic compression. Group 1 (Pyrx1) included 30 persons with the pyruvate level increase less than twice and Group 2 (Pyrx2) included 26 persons in whom the pyruvate level increased more than twice. No significant differences were found between the groups. Results. Increase of pyruvate concentration in coronary sinus blood does not improve the heart performance in the post-perfusion period. Frequency and speed of consequent regress of post-perfusion heart failure were not principally different in both groups. Post-operative level of troponin I was the same and changed the same manner in both groups. Conclusion. Increased endogenous production of pyruvate in myocardium during anoxia does not improve post-perfusion restoration of the heart function.

Protective peri-operative ventilation can improve post-surgery outcomes and reduce the frequency of respiratory complications. The goal of the study was to evaluate the impact of ventilation with low respiratory volume solely or in combination with permissible hypercapnia (HC) on the outcomes of major pancreaticoduodenal surgery. Materials and methods. 60 patients were enrolled into prospective study who had planned pancreaticoduodenal operations lasting for more than 2 hours. All patients were randomly divided into 3 groups: mechanical ventilation with high respiratory volume (10 ml/kg of predicted body mass (PBM), HRV group, n = 20), low respiratory volume (6 ml/kg of PBM, LRV group, n = 20), and low respiratory volume with moderate HC (РаСО₂ 45–60 mm Hg., LRV+HC group, n = 20). Hemodynamic and respiratory parameters and frequency of complications were recorded in the peri-operative period. Results. Ratio of РаО₂ /FiO in 24 hours upon surgery completion was 15% higher in LRV group compared to HRV group. Higher frequency of atelectasis and prolonged hospital stay were typical of patients from HRV group. Lower concentration of arterial blood lactate was observed in the patients from LRV+HC group. Conclusion. Preventive reduction of respiratory volume in pancreaticoduodenal surgery improves the post-operative oxygenation, decreases the frequency of atelectasis and duration of hospital stay.

Goal of the study: to evaluate the possibility of using dexmedetomidine for drug sedation when performing intraluminal endoscopic surgery (ILES). Materials and methods. 136 cases of dexmedetomidine used were analyzed in 100 patients at the age of 58.0 ± 1.5 years old (Me = 59, Min = 22, Max = 87) during the first and repeated video-assisted bronchoscopies, esophagogastroscopies, duodenoscopies and colonoscopies lasting for 73 ± 3 min. (Me = 65, Min = 15, Max = 330). Results. Sole use of dexmedetomidine was effective only in short-term ILES causing minimal trauma. If ILES lasts longer and causes bigger trauma dexmedetomidine is to be combined with nefopam, fentanyl, trimeperidin, propofol, and ketamine. Combined use of dexmedetomidine resulted in the reduction of doses of the drugs, provided opportunity to manage the depth of sedation without depression of spontaneous respiration, post-operative and post-procedure agitation, algidity, nausea and vomit. Conclusion. Dexmedetomidine can be considered as the drug of choice for sedation in ILES.

Goal of the study: to develop the tactical score system for indicators for blood transfusions in those injured with the acute massive blood loss of extremely severe degree in the post shock period of trauma. Research methods included evaluation by score system of severity of trauma and patients' state and their relevant changes by the admission to hospital. Main patients' survival functions were monitored and clinical laboratory tests were performed. Results. Expansion of indicators for repeated blood transfusions in the post-shock period of trauma in those injured with the acute massive blood loss is not accompanied by increase of blood transfusion volume in general. The frequency of complications related to the syndrome of massive blood transfusions does not increase. Applying tactics of transfusion therapy with the use of developed tactic score of military field surgery and blood transfusion (Intensive Care Department) in those with the acute massive blood loss of extremely severe degree is accompanied by the fast improvement of hemodynamics, tissue respiration, and reduction of staying in the intensive care department.

Goal of the article: comparative analysis of correlation of liberal and restrictive tactics of anti-bacterial therapy (ABT) in newborns with respiratory distress syndrome (RDSS) and suspected congenial pneumonia with drug resistant bacterial population in neonatal intensive care department (ICD). Methods. The study was designed as prospective, controlled, one-center, non-randomized. Enrollment criteria were the following: gestational age of 25-32 weeks, body weight of 1001-2499 g., RDSS or suspected congenial pneumonia, artificial pulmonary ventilation (APV) from the first day of birth, procalcitonin level tests. The study lasted from 01.01.2015 to 26.12.2015. 697 newborns were included into the study. Restrictive ABT was used in the treatment group (n=515), prescription of antibiotics for preventive purposes was used in the comparison group (n=182). Samples were collected from sterile cavities of the host - tracheal aspirate, content of urinary bladder and stomach. Results. 2535 gram negative and 299 gram positive isolates of pathogenic microorganisms were examined. Kl. pneumonia was the most prevalent among gram negative microorganisms (1 202 isolates, 47.4% of all strains), St. aureus was the most prevalent among gram positive bacteria (207 isolates). Conclusions. Restrictive ABT tactics provided no impact on duration of the newborns' stay in the intensive care department and general hospital stay; the tendency for mortality reduction in the intensive care department was observed, the duration of APV reduced to statistically significant extend, and this allowed constraining drug resistance of certain nosocomial strains of microorganisms.

Goal of the study: to study the frequency of myocardial dysfunction in sepsis patients and its impact on the outcome of the disease. Materials and Methods. 177 sepsis patients were enrolled into the retrospective cohort study. Myocardial dysfunction was diagnosed by transthoracic ultrasonic cardiography in 28% of patients. Results. According to the findings of the study myocardial dysfunction does not increase in-hospital mortality but increases the duration of artificial pulmonary ventilation (APV), vasopressor support and duration of stay in the intensive care department and general hospital stay. Reduction of left ventricle discharge less than 45% and increase of end diastolic size of the left ventricle are unfavorable prognostic factors for sepsis patients. Conclusions. Myocardial dysfunction is diagnosed in 28% of sepsis patients. Its development does not increase the rate of hospital mortality, but increases the duration of APV, vassopressor/inotropic support and duration of stay in the intensive care department and general hospital stay.

Goal of the review: to build up the current understanding of electrophysiological specific features of various neuromuscular blockades. Having analyzed the results of multiple studies devoted to investigation of the impact of various medications including inhalation anesthetics on the neuromuscular neurility, the authors summarized the current opportunities to monitor neuromuscular blockade. It has been noted that the data for blockade monitoring when using traditional neuromuscular blocking agents are studied much better compared to the drugs providing the other types of blockade.

The article reviews the using recruitment maneuver (RM) under general anesthesia in abdominal surgery in the patients with initially intact lungs. Goal: to detect the most optimal ways of RM, required temporary characteristics of RM and groups of patients in whom RM will be especially useful. Conclusion. Using RM together with other elements of protective artificial pulmonary ventilation during general anesthesia with high risk of respiratory complications is an effective and safe tool allowing prevention of respiratory complications. Stepwise RM allows preventing unfavorable hemodynamic incidents while performing RM in the patients with high anesthetic risk.