[Diagnostics of pneumothorax with ultrasound].

The article deals with a method of pneumothorax diagnostics based on verification of four ultrasound sings--lung sliding absence, B-lines absence, lung pulse absence and lung point presence. Use of ultrasound allows to quickly diagnose a pneumothorax and to monitor the condition of pleural space. Introduction of the ultrasound methods into routine work ICU specialists can increase safety of patients.

[Tracheostomy in the process of prolonged artificial pulmonary ventilation in patients with polytrauma].

One of modern tendencies of carrying out long ALV of patients with polytrauma is application of "early" tracheostomy. Thus optimum terms of early tracheostomy are defined indistinctly and vary from 2 to 10 days from beginning of ALV. It is established that at predicted long ALV of patients with polytrauma optimum terms of tracheostomy performance is the second period of traumatic illness (12-48 hours from the moment of getting trauma). Tracheostomy, executed for patients with polytrauma for the purpose of maintenance long AL V in early terms, promotes improvement of gases diffusion, microcirculation in lungs, improvement of system of external breath as a whole and it is accompanied by decrease in frequency of development life danger infectious pulmonary complications and lethality reduction.

[Use of noninvasive ventilation in patients at high postoperative risk for cardiopulmonary complications].

Sixty-two patients undergoing elective abdominal surgery with a high operative risk and anesthesia by the ASA scale (III/2-3), and with a high index of cardiopulmonary risk after S. Epstein were examined. The study group comprised 31 patients who had undergone noninvasive ventilation (NIV) in the early postoperative period for preventive purposes. In the control group (n = 30), moistened oxygen was insufflated after transition to spontaneous breathing. In patients with low functional reserves, the preventive use of NIV contributes to a rapider normalization of gas exchange, stabilization of hemodynamics, a reduction in the incidence of complications (from 66.6 to 25.6%) and in the length of stay in an intensive care unit.

[Artificial ventilation with pressure monitoring during lararoscopic operations].

The efficiency of artificial ventilation (AV) with volume and pressure monitoring was compared during laparoscopic interventions. Certain advantages of AV with pressure monitoring were established, which appeared as a lower negative effect on pulmonary gas exchange, better parameters in oxygenation and respiratory mechanics as compared with volumetric ventilation, including at the stage of carboxyperitoneum. There is evidence that with the use of this ventilation mode, the cardiac performance parameters, such as cardiac and stroke indices, decrease to a lesser extent. The authors show it possible to use ventilation with pressure monitoring in patients at high risk of cardiac ventilation. With the use of this mode, the trend in hemodynamic and respiratory changes is the same in such patients as in those without comorbidity and the risk of cardiac complications is not higher than when volumetric ventilation is made.

[Noninvasive lung ventilation in intensive care].

This is a brief review of the literature on the use of noninvasive ventilation in intensive care units. The physiological bases of the use of noninvasive ventilation and some technical aspects are discussed. The data on the clinical effectiveness of this mode of ventilation are given. In addition, indications for and contraindications to the use of noninvasive ventilation and the specific features of its application in patients of different nosological entities are considered.

[Semiquantitative evaluation of autoregulation of cerebral blood supply in norm]. / Polukolichestvennaia otsenka autoreguliatsii krovosnabzheniia golovnogo mozga v norme.

Elaboration of an informative, noninvasive method for evaluation of the reserve of the cerebral circulation is an urgent problem of angioneurology. The authors propose a method of dopplerographic estimation of the autogerulatory response by hyperthermic changes after short-term period of regional hypotension induced by digital compression of carotid artery on the neck. The indices acceptable in daily clinical practice were calculated. There was determined a range of their values at normal tonus of the resistive vessels, on the background of hypo- and hypertension induced by hypercapnic and hypocapnic loads, respectively. Test of carotid compression with registration of the linear velocity of blood flow in cerebral arteries is safe, significant and reproducible way for a semiquantitative estimation of the reserve of autoregulation. It may be used for evaluation of tonus of resistant vessels of the reservoir of the middle carotid artery as one of the most important index of the functional state of the system of cerebral circulation.

[Effects of several methods of general anesthesia on the cerebral blood flow and cerebrovascular reactivity: transcranial dopplerography data]. / Vliianie nekotorykh metodov obshchei anestezii na mozgovoi krovotok i tserebrovaskuliarnuiu reaktivnost' po dannym transkranial'noi dopplerografii.

Effects of some methods of total anesthesia on the cerebral bloodflow and cerebrovascular reactivity was studied by transcranial dopplerography. Ketamine appreciably increases the cerebral bloodflow if no benzodiazepines are injected simultaneously. In patients with intracranial abnormalities ketamine can increase intracranial hypertension and disorder the cerebral perfusion. Despite the manifest hypotensive effect of diprivan, the autoregulation reserve of the cerebral bloodflow is not changed, probably due to the indirect vasoconstrictive effect of the drug. Total anesthesia with N2O and fentanyl virtually does not influence brain circulation.