[Hybrid approach to treatment of a patient with a thoracoabdominal aortic aneurysm]. / Gibridnyi podkhod k lecheniiu patsienta s anevrizmoi torakoabdominal'nogo otdela aorty.

Described in the article is a clinical case report concerning staged management of a patient presenting with a thoracoabdominal aortic aneurysm. The first stage consisted in complete lower debranching with prosthetic repair of all visceral arteries and the right renal artery. The second stage was endovascular repair of the aortic aneurysm. The chosen approach made it possible to avoid clamping of the thoracic portion of the aorta, which favourably contributed to a decrease in the traumatic nature of the operative procedure, simultaneously preserving the radicality of treatment after the two-stage intervention.

[Intraoperative fluid therapy during esophagectomy followed by repair]. / Intraoperatsionnaia infuzionnaia terapiia pri ézofagéktomii s odnomomentnoi plastikoi pishchevoda.

AIM: To optimize fluid therapy in transhiatal eshophagectomy by using of goal-oriented infusion therapy based on stroke volume variation. MATERIAL AND METHODS: Our trial enrolled 30 patients who underwent transhiatal esophagectomy followed by repair for the period 2011-2014. Patients were divided into 2 groups. The first group (LT) included 16 patients with liberal fluid therapy. The second group (GDT) consisted of 14 patients in whom goal-oriented fluid therapy was performed. Goal-oriented fluid therapy was implemented via stroke volume variation (SVV). RESULTS: Infusion rate was 6.7 ml/kg/h and 11.5 ml/kg/h in the main and control groups, respectively. Morbidity rate was 28.6% (n=4) and 62.5% (n=10) in the main and control groups respectively. Clavien-Dindo IV complications were lung atelectasis (n=2, 14%), pneumonia (n=1, 7%). Hydrothorax required puncture was noted in 1 (7%) case. Acute respiratory failure as complication IVa was in 1 (9%) patient. In the control group complications were registered in 10 (62.5%) patients. Complications I-II degree included lung atelectasis (n=4, 25%), cervical anastomosis failure (n=1, 6%); complications IVa were observed in 8 cases (50%). It was significant respiratory failure with reduced PO2/FiO2<300. Patients of the main group required less time for postoperative mechanical ventilation (120 [90-300] vs. 315 [215-810] min (p=0.02) and ICU-stay (0.83 [0.7-0.8] vs. 1.75 [1.25-2.75] (p=0.0022).

[The development of severe methemoglobinemia in patients receiving "Almagel A"].

This clinical case and the literature review show possible development of methemoglobinemia due to the use of local anesthetics, included in drugs for the gastrointestinal diseases treatment, in particular benzocaine, which is the methaemoglobin forming agent. These drugs are common and often taken by the patients themselves without any control. The aim of our paper is to draw the attention of physicians to the risk of the widely known drug administration which can be purchased without a prescription.

[Systemic multimodality postoperative analgesia in vascular surgery].

The study comprised a total of fifty-three patients after endured operations performed on the infrarenal portion of the aorta and large vessels of the lower extremities. The work was aimed at evaluating quality of postoperative analgesia in various regimens of multimodality analgesia based on non-narcotic analgesics. The following combinations of the drugs were used: ketoprofen + tramadol; lornoxicam + tramadol; paracetamol + tramadol; paracetamol + lornoxicam + tramadol. The use in the postoperative period of the above mentioned regimens of multimodality analgesics makes it/nmpfble to achieve a good analgesic effect without administration of narcotic analgesics. The inclusion of paracetamol into the postoperative multimodality analgesia results in a rapid onset of an analgesic effect and decreased requirements in prescribing tramadol. In patients running a high risk of an ulcerogenic effect of non-steroidal anti-inflammatory drugs, postoperative analgesia should be carried out based on paracetamol and tramadol whose combination appears to provide a beneficial analgesic effect.

[Postoperative analgesia].

Data of 53 patients, operated on infrarenal aorta and large vessels were analyzed. Different combinations of nonopioid drugs were compared, used postoperatively. These were: ketoprofen+tramadol; lornoxicam+tramadol; paracetamol+tramadol; paracetamol+lornoxicam+tramadol. All of the combinations provided good analgesic effect. Inclusion of paracetamol allowed faster pain relief and decrease of tramadol intake. In patients with an increased ulcer risk, postoperative analgesia should be based on paracetamol and tramadol.

[Our experience of non-invasive lung ventilation in surgical intensive care unit].

Non-invasive lung ventilation (NILV) is one of the most up-to-date methods of respiratory support at acute respiratory failure (ASF). The study is devoted to evaluation of efficacy, safety and tolerance (comfort) of this treatment mode for the patient. NIVL was carried out in 483 patients divided into 5 groups against the leading etiopathogenetic development mechanism of ASF. The greatest success of NIVL was achieved in the groups of patients with acute left ventricle failure and respiratory failure with restrictive-like ventilation disturbances. The greatest frequency of complications was noted in groups of patients with acute parenchymatous lung damage and chronic obstructive lung disease. Use of NILV allows to improve gas exchange indices and mechanical property of lungs noticeably. This treatment mode is an efficacious and safe enough alternative to intubation of trachea in patients with ASF in resuscitation units of multiply-discipline surgical hospitals.

[Prolonged pulmonary ventilation in critically ill patients].

Treatment results of 336 patients in critical state who had required prolonged (3-115 days) artificial pulmonary ventilation were analyzed. 3 groups were defined: 98 patients with complications after operations on thoracic and abdominal organs and organ failure development; 55 patients with surgical infection and sepsis; 183 patients with extensive burning injury III AB-IV degrees. Particular features of prolonged artificial pulmonary ventilation were studied. Optimum modes of respiratory therapy were determined. Frequency of complications was controlled.

[Effect of early enteral feeding on immune status in the immediate postoperative period]. / Vliianie rannego énteral'nogo zondovogo pitaniia na immunnyi status v blizhaishem posleoperatsionnom periode.

The effect of the balanced feeding formulas "Peptamen" and "Nutren" ("Nestle Swisse", Switzerland) on the immune status was studied in 30 patients immediately after pancreas surgery. 15 patients with full-fledged parenteral alimentation were controls. The catabolic trend of metabolic processes was detected in the early postoperative period. The use of "Peptamen" and "Nutren" inverts metabolism towards anabolism. Profound immunologic disorders were observed both in the cellular and humoral chains immediately after surgery. The early enteral feeding normalized, first, the immunity humoral chain (from the 1st postoperative day) and, then, the immunity cellular chain (by the 6th postoperative day).

[Choice of optimal ventilation maintenance]. / Nekotorye aspekty vybora vida optimal'noi respirator'noi podderzhki.

Twenty-nine angiosurgical patients with disordered ventilation-perfusion correlations were examined. Effects of CMV (controlled mechanical ventilation) + PEEP (positive end expiratory pressure) and IRV (inverse ratio of ventilation) on gas exchange and hemodynamics of the lungs were studied. Gas exchange improved in all patients, but sooner in the CMV + PEEP group. CI increase was more pronounced in the IRV group.

[Critical state medicine. Surfactant therapy of adult respiratory distress syndrome (results of multicenter studies)]. / Meditsina kriticheskikh sostoianii. Surfaktant-terapiia respiratornogo distress-sindroma vzroslykh (rezul'taty mnogotsentrovykh ispytanii).

The paper provides evidence for the pathogenetic approach to treating acute lung lesion (ALL) and adult respiratory distress syndrome (ARDS). An algorithm of the use of Russian lung surfactant preparations: CT-HL and CT-BL has been developed. In involves earlier (the first days following the onset of respiratory failure) use of surfactant, its combined bolus intratracheal or intrabronchial administration in doses of 200-400 mg/m2, followed by continuous (5-day) aerosol inhalation in doses of 20-30 mg/h for children and 30-75 mg/h for adults until pronounced clinical and X-ray effects are shown. Fifty three patients were found to develop ALL and ARDS in the presence of severe pneumonia, postperfusion lung disorders, reperfusion syndrome, pulmonary embolism, long-term artificial ventilation, combined car accident injury and gunshot wounds of the chest, heroine intoxication, septic shock, sepsis, postoperative sequels in cancer patients, and after hepatic transplantation or massive aspiration of gastric contents. Fifty patients were overcome their critical status, 44 survived. The duration of artificial ventilation (AV) ranged from 1 to 6 days. Earlier use of the drugs made it possible to transfer patients to safe AV regimens and to eliminate ALL and ARDS rapidly and to significantly reduce mortality due to critical states.

[Use of dalargin in the intensive therapy of critical conditions]. / Vozmozhnosti ispolzovaniia dalargina v intensivnoi terapii kriticheskikh sostoianii.

The paper analyzes whether the national synthetic leukenkephalin analogue dalargin can be used in the prevention and treatment of postoperative polyorgan deficiency. Dalargin has been experimentally demonstrated to be effective in preventing impairments in transcapillary fluid exchange, by stopping the development of pulmonary edema. The use of the drug in the intra- and postoperative period in patients undergone cardiac surgery during general assisted circulation reduced the incidence substantially and decreased the severity of respiratory distress syndrome. The experimental and clinical findings suggest that dalargin has pulmono-, hepato-, and pancreatoprotective properties. Thus, dalargin should be used in the multimodality intensive care of postoperative polyorgan deficiency.