[THE DIAGNOSTIC AND THERAPEUTIC BRONCHOSCOPY IN CARDIAC PATIENTS UNDERGOING MECHANICAL VENTILATION IN THE POSTOPERATIVE PERIOD].

The review presents an analysis of domestic and foreign literature on the use of bronchoscopy in patients with obstructive respiratory failure in the ICU. Separately considered the issue of additional research when performing bronchoscopy and create an algorithmfor the application of diagnostic and therapeutic bronchoscopy in cardiac surgical patients undergoing mechanical ventilation.

[Pharmacological and mechanical support of the myocardium in perioperative period in cardio-surgical patients with chronic heart failure].

The article deals with a retrospective study devoted to the combined methods of myocardial support in cardiosurgical patients with chronic heart failure (III-IY FC according to NYHA) and low myocardial reserves capacity (LVEF 28.3 +/- 9.4%). This methods include pharmacologic (Levosimendan) and mechanical support (IABP). During the work we have analyzed data of 116 patients and measured pressure in the pulmonary artery (mmHg), end-systolic volume (ESV ml), end-diastolic volume (ED, ml), stroke volume output (SVO, ml), left ventricular ejection fraction (LVEF, %). We evaluated the level of valvular insufficiency and pulmonary hypertension (PH) and BNP concentration (pg/ml). The following indications for the usage of pharmacological and/or mechanical myocardial support were identified: I) Preventive usage of pharmacological and/or mechanical myocardial support is recommended for patients with CHF III-IY FC (NYHA) and low left ventricular EF(< or = 35%), significant valvular insufficiency, PH, PICS (postinfarction cardiosclerosis); 2) The certain method of the support can be chosen with the help of Levosimendan infusion testing; 3) In case one of the above mentioned indications (point 1) or in case of mild reaction to levosimendan infusion in patients with the lesions of more than 2 coronary arteries (including the trunk of the left coronary artery) the usage of combined support is recommended; 4) In case of < or = 6 scores according to EUROSCORE scale, lesions of 2 or more coronary arteries, tricuspid insufficiency (TriI), PH, and high pressure in pulmonary artery (higher than the 2nd degree), high end-diastolic volume, end-systolic volume of LV the isolated usage of levosimendan is recommended; 5) In case of significant ischemic heart disease, PICS, lesions of more than 2 coronary arteries, (including the trunk of the left coronary artery) but without significant decrease of pressure in the pulmonary artery, end-diastolic volume, end-systolic volume and TriI the isolated usage of IABP is recommended.

[Case of successful prevention of multiple organ dysfunctions in 74 years old patient with sepsis after Crawford surgery complicated with pleural empyema, chest wall tissues infection and osteomyelitis of ribs].

The article deals with a clinical case demonstrating that patient's elderly age is not an absolute contraindication for complex surgery in spite of high risk of postoperative complications. Early diagnostics, target treatment of the infection cite with vacuum-assisted therapy for wounds and the treatment of infectious complications based on individual characteristics of elderly patient with sepsis as an outcome of prosthetic thoracoabdominal aortic repair allowed avoiding multiple organ dysfunctions in the patient.

[Postoperative period pecularities in patients of 70 years and older with ischemic heart disease after myocardial revasculization].

A comparative analysis of preoperative risk factors and postoperative period flow in patients older than 70 years (58 people) in comparison with control group aged 40-63 years (62 patients), undergoing myocardial revasculization was conducted. . Significantly higher rates of rhythm disturbances, arterial hypertension, lung diseases, chronic renal insufficiency, atherosclerotic carotid artery disease, lower limb atherosclerotic disease were found in patients older than 70 years preoperatively. It leads to postoperative complications and requires special preoperative correction. Complications incidence after CABG was higher by 1.7 times in patients older than 70 versus control group. The most frequent complications were: rhythm disturbances (in 5 times more often, than control group), respiratory failure (which in 70% of cases was caused by COPD), cerebral complications (in 2,5 times more often, than in control group). Myocardial revasculization surgery in elderly patients is effective treatment method and can be performed with good immediate results.

[The multiple organ failure syndrome after cardiac surgery with artificial blood circulation].

The 10-year study of etiology, pathogenesis, diagnostic, treatment and prevention of the multiple organ failure syndrome (MOFS) after cardiovascular operations with artificial blood circulation was conducted in the SCS. 4383 patients, aged 16-75 years, were observed. Of them, MOFS was diagnosed in 206 (4.7%) patients. Extracorporal detoxication was used in 385 patients. When used in patients with complicated postoperative period, the extracorporal detoxication prevents MOFS and decreases lethality in 3 times (from 59.3 to 19.2%). The method is indicated to patients with MOFS severity estimated of 13.5 points and damage of 5-6 organ systems. Herewith the duration of veno-venous ultrahemodiafiltration should not exceed 80 hours and the number of sessions should not be more then 3.

[The evolution of surgical and functional operability in thoracic oncology].

The authors own the experience of 4157 operations on the reason of malignant lung tumors, of them 429 (10.3%) operations were combined. The extracorporeal membrane oxygenation is considered to be reasonable by extended thoracic resections. Surgical lung volume reduction by emphysema shows good functional results, which allows to use its principles in oncologic patients with low functional repiratory reserves. The overall multidisciplinary approach in thoracic oncology allows better treatment results and gives hope to the earlier inoperable patients.

[Use of levosimendan in cardiosurgical patients with chronic heart insufficiency].

The impact of administration of the calcium sensitizer levosimendan on hemodynamic parameters, dose of intraoperative and postoperative cardiotonic maintenance, length of intensive care unit stay, and hospital mortality was studied in cardiosurgical patients with dilated cardiomyopathy, second-fourth degree mitral valve insufficiency, or NYHA Class IV circulatory insufficiency. Levosimendan was administered to 25 patients 3-5 days prior to surgery. A control group of 22 patients did not receive levosimendan. The use of the agent caused statistically significant reductions in pulmonary artery pressure and pulmonary wedge pressure and increases in cardiac index and left ventricular ejection fraction. The levosimedan-treated patients needed smaller doses of sjmpathomimetics, less length of intensive care unit stay and showed lower mortality rates (p < O.05 for all indices).

[Unintended cooling, active warming, and microcirculation in cardiosurgical patients].

The study was undertaken to compare various methods to maintain a patient's body temperature and to evaluate their impact on microcirculation during myocardial revascularization under normothermal extracorporeal circulation (NTEC). The study enrolled 50 patients with NYHA Functional Classes III-IV coronary heart disease, who underwent aortocoronary bypass surgery under NTEC. A HICO-AQUATHERM 660 water-warming unit (Hirtz, Germany) was used in Group 1 patients (n=30). A Bair Hugger air-warming unit (Arizant, U.S.A.) with a mattress located under a patient was employed in Group 2 (n=20). Intraoperative microcirculation monitoring was carried out by a laser analyzer (Lazma, Moscow).

[Peculiarities of the professional sport occupation and risk of developing accelerated aging].

A study of professional occupational activity of the sportsmen and its effect on the risk of developing accelerated aging was conducted. Despite relatively small proportion of sport injuries and occupational diseases in the structure of morbidity (though sports are acknowledged as an occupation) it is a question of vital importance to study reasons for these injuries and diseases, and ways for their prevention and follow-up rehabilitation.

[A case of successful treatment for secondary multiple organ dysfunction evolving in a patient after a combined operation replacing the mitral and aortic valves in combination with aortocoronary bypass surgery and endarterectomy from the internal and external carotid artery].

The paper describes a case of successful treatment in a patient with secondary multiple organ dysfunction (mainly hepatic and renal failure), by concurrently using different methods of efficent therapy (ultrahemodiafiltration, plasmapheresis) and infusion of the hepatic protectant heptral.

[Impact of preoperative levosimendan therapy on the volemic status and vascular tone of patients with chronic heart failure during anesthesia].

The impact of preoperative levosimendan therapy on the volemic status and vascular tone was studied in patients with chronic heart failure (CHF) during anesthesia and the ways of correcting the occurring changes were defined. The study included 21 patients with CHF in the presence of dilated cardiomyopathy, who underwent mitral valve replacement and tricuspid valvoplasty. Group 1 patients (n = 11) were given levosimendan (Simdax) in a dose of 0.05-0.1 mg/kg x min 2 days prior to surgery; Group 2 (n = 10) was control. Central hemodynamics was monitored by the transpulmonary thermodilution technique (PiCCO-Plus, Pulsion Medical System). Intraoperative monitoring of microcirculation was made using a laser microcirculation analyzer. It has been established that the preoperative administration of levosimendan causes an increase in stroke index at critical surgical stages. With the use of levosimendan, peripheral microcirculation improves and nutritional blood flow increases. The preoperative use of levosimendan causes a reduction in the tone of resistance vessels during anesthesia, which can require vasopressor support in the postperfusion period; a levosimendan-induced decrease in preload requires infusion correction of relative hypovolemia.

[Intraaortic balloon counterpulsation in the treatment of perioperative cardiogenic shock-complicated myocardial infarction during aortocoronary bypass surgery].

The paper presents the results of use of intraaortic balloon counterpulsation (IABC) in complex therapy for cardiogemic shock in 31 patients with perioperative myocardial infarction (PMI) developed during aortocoronary bypass surgery under extracorporeal circulation (EC) and cold cardioplegia. The diagnosis of PMI was confirmed by the ECG data (the emergence of new Q waves) and by the high level of CPC-MB (more than 6%). IABC was performed, by using a Kontron M-7000 apparatus. The time elapsed from the onset of myocardial infarction to the start of IABC averaged 15.7 + 4.3 hours and the duration of the latter did 105 +/- 13 hours. IABC was initiated in 4 (12.9%) patients in the operating room before EC, in 20 (64.5%) during disconnection from EC, in 7 (22.6%) patients, who were unresponsive to pharmacological therapy, 6-26 hours after surgery. All the patients were divided into 2 groups: (1) 22 patients who had benefited from complex therapy using IABC; they were all successfully disconnected from the balloon pump; (2) 9 patients with refractory heart failure who had died during IABC. The latter has been shown to be one of the effective treatments of PMI and cardiogenic shock during aortocoronary bypass surgery, which achieves hemodynamic stabilization in 70.9% of cases. The results of complex therapy for cardiogenic shock depend on the site and extent of myocardial infarction. Lesions to the anterolateroposterior or anteroseptal area of the left ventricle belong to poor predictors. The outcomes of treatment are poor if there are significant hemodynamic disorders that require, besides cardiotonic agents, the administration of large doses of agents having a potent vasopressor effect (adrenaline and noradrenaline). Improvements in left ventricular pump function, cardiac output, and a significant reduction in the doses of sympathomimetics within the first 12 hours of IABC should be considered to be a good predictor. With the complex treatment of cardiogenic shock, by using counterpulsation after aortocoronary bypass surgery is 51.6%. The early initiation of IABC within 6 hours following the development of myocardial infarction allows mortality to be reduced.