[Variants of the treatment of critical states with consideration of the pathogenesis of the systemic inflammatory response syndrome]. / Varianty lecheniia kriticheskikh sostoianii s uchetom patogeneza SIRS-sindroma sistemnogo vospalitel'nogo otveta.

A total of 182 critical patients with sepsis (n = 62), prolonged compression syndrome (PCS) (n = 41), toxic allergic dermatitis (TAD) presenting as Lyell's and Stevens-Johnson's syndromes (n = 54), and stages I-II status asthmaticus (SA) (n = 25) were examined. Statistical computer processing of the data by the method of comparing the means and analysis of correlations revealed a cascade of numerous mediators and metabolites which can be regarded as manifestations of the systemic inflammatory response syndrome (SIRS). This syndrome develops as a reaction to infection, toxic products of microorganisms, ischemic reperfusion lesions, and humoral cytotoxic reactions and is responsible for the formation of multiple organ disorders. Inefficiency of 7-10-day traditional intensive care necessitated active repair of the natural defense mechanisms and addition to the therapeutic complexes of hemo- and plasmaxenosplenoperfusion variants developed by the authors. Despite multiple organ disorders, splenoperfusion decreased the period of critical state from 24 to 12 days in sepsis, from 28 to 18 days in TAD, from 14 to 10 days in PCS, and from 17 to 7 days in SA. The mortality in sepsis dropped from 32.4 to 8%, in TAD from 10.7 to 4%, in PCS from 38.8 to 14.7%, and in SA from 15.9 to 5%. No additional drug therapy or equipment was needed.

[A clinical and morphological study of status asthmaticus]. / Kliniko-morfologicheskoe issledovanie pri astmaticheskom statuse.

Clinical and morphologic studies were carried out in 230 patients suffering a grave course of an exacerbation of infectious bronchial asthma. A protracted attack of the condition was detected in 70 patients, in 80 patients status asthmaticus, Stages I-II was found, 50 patients suffered a Stage III status asthmaticus, and 30 patients were hospitalized in the terminal state and died within 12 hours since admission. The circulatory, metabolic, immunologic homeostasis parameters were studied, morphologic, examination of pulmonary, tracheal, cardiac, cerebral, splenic and hepatic tissue was carried out in 30 patients who died at the height of the status asthmaticus. The authors have analyzed the contribution of the homeostasis parameters to the formation of the critical state in status asthmaticus and the relationships of these parameters between each other and with the condition severity. The severity of the patients' condition was found closely related to the degree of respiratory, circulatory, and metabolic disturbances. Respiratory failure and circulatory disorders were the principal clinical manifestations of status asthmaticus, though the disorders of the metabolic and immunologic homeostasis also much contributed to the formation of a critical condition due to status asthmaticus. Characteristic histomorphologic changes of the viscera, detected at autopsy, were the morphologic equivalent of these clinical symptoms. The findings regarding status asthmaticus as a critical state that is characterized by the development of multiorgan insufficiency involving the formation of incompetence of natural detoxication routes.

[The treatment of leptospirosis complicated by severe liver-kidney failure]. / Lechenie leptospiroza, oslozhnennogo tiazheloi pechenochno-pochechnoi nedostatochnost'iu.

The authors examined 16 patients with severe forms of leptospirosis complicated by hepato-renal insufficiency. The treatment program included the following methods: hemodialysis, hemosorption, intraportal administration of drugs, gastrointestinal sorption via a heterospleen, hyperbaric oxygenation. As a result of this complex treatment lethality decreased by 15%.

[The efferent therapy of the critical state due to status asthmaticus]. / Efferentnaia terapiia kriticheskogo sostoianiia, obuslovlennogo astmaticheskim statusom.

A total of 200 patients with severe infection-induced bronchial asthma (BA) admitted to hospital with a diagnosis of status asthmaticus (SA) have been subjected to complex examination. It has been demonstrated that SA is a severe combined toxemia that leads to insensitivity of bronchial receptor apparatus to broncholytic effects and requires efferent therapy. 50 out of 130 patients with I to II and III degree SA were resistant to conventional intensive care procedures. The patients were successfully treated with urgent hemodynamic low-volume fraction extracorporeal hemosorption (EHS). EHS ensures positive hemodynamic and detoxicating effects, removing "critical" concentration of toxic ligands that block broncholytic adrenoreception. The use of efferent therapeutic techniques in SA makes it possible to reduce the mortality rate, promote the condition arrest, relieve the critical condition, reduce the doses of broncho- and spasmolytics, glucocorticoids, facilitate future drug withdrawal, and reduce the duration of the patients' stay in intensive care units.

[Detoxication in the critical state due to rhabdomyolysis]. / Detoksikatsiia pri kriticheskom sostoianii, obuslovlennom rabdomiolizom.

An examination of 92 patients with the crush syndrome and the position compression syndrome was made. All the patients were examined by clinico-biochemical methods, the cardiovascular system being also studied. The leading place is occupied by endogenous intoxication. The metabolic disorders were of a total character involving different links of metabolism. It required inclusion of efferent methods in the program of treatment. The most effective program of using efferent methods of treatment was developed on the basis of the state of hemodynamics and clinico-biochemical peculiarities.

[A clinico-experimental study of lymphogenous detoxification in acute renal and kidney insufficiency]. / Kliniko-éksperimental'noe izuchenie limfogennoi detoksikatsii pri ostroi pochechno-pechenochnoi nedostatochnosti.

Lymphogenous methods for detoxification were employed in 23 patients with acute concurrent renal and hepatic failure of various etiology. Pronounced changes in the composition of lymph and moderate to severe hyperhydration are indications for combined application of lymphosorption (LS) and lymphodialysis (LD). The combined use of LS and LD makes it possible to reduce the number of required hemodialyses three times as much as that of hemodialysis alone and to make the time of a hemodialysis shorter by 1.5-2 hours.

[Biological sorption in immunoneurologic diseases]. / Biologicheskaia sorbtsiia pri immunonevrologicheskikh zabolevaniiakh.

A study is presented of 17 patients--9 with myasthenia, 8 with the Guillain--Barré syndrome. The complex treatment program of intensive therapy and reanimation included in all patients the operation of extracorporal heterospleen. Forty-one perfusions were carried out. The operation of splenic sorption allowed to reduce treatment time under conditions of intensive care and reanimation 1.5 times, lethality--by 33%. Employment of biological sorption in patients with such immunoneurological diseases as myasthenia and the Guillain--Barré syndrome removes the humoral autoallergic factor and, thus, favours restoration of nervous system function.

[Central and organic hemodynamics during the treatment of infection by splenosorption]. / Tsentral'naia i organnaia gemodinamika pri lechenii sepsisa splenosorbtsiei.

Patients with sepsis have been found to have two types of alterations of central hemodynamics: hyperdynamic and hypodynamic ones, as well as alterations of the hepatic blood flow. The use of splenosorption results in normalization of the parameters of the central and hepatic hemodynamics. The positive hemodynamic effect of splenosorption seems to be associated with the increased nonspecific resistance as well as the activation of the endogenous mechanisms of defense.