[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.

[Our experience in the use of a Russian preparation of pulmonary surfactant in the treatment of acute respiratory distress syndrome and severe pneumonia in children]. / Nash opyt primeneniia otechestvennogo preparata legochnogo surfaktanta dlia lecheniia sindroma ostrogo povrezhdeniia legkikh i tiazhelykh pnevmonii u detei.

Six critical patients aged 2 months to 13 years with lung diseases were treated by pulmonary surfactant preparation. Three of these children developed the acute respiratory distress syndrome in the presence of grave pneumonia (1 case), asphyxial drowing (1 case), and small-small intestinal invagination (1 case), three others developed acute bilateral large focal pneumonia with or without repeated atelectases. The drug Surfactant-BL was administered in a dose of 400 micrograms/m2 by instillations (2 cases) or by inhalation aerosols. The drug improved blood gases, lung compliance, x-ray picture, and clinical status of all patients, permitting a decrease in IMV/SIMV parameters within 12-48 h after the last administration and discontinuation of IMV/SIMV in 3 patients within 24 h after 1 or two administrations. Five children survived, 1 (with asphyxial drowning) died with brain edema and wedging syndrome. Surfactant-BL is a safe and effective drug; administration through alveolar nebulisers should be preferred.

Effect of hemocarboperfusion on organ blood flow and survival in porcine endotoxic shock.

OBJECTIVE: To evaluate the effects of hemocarboperfusion on hemodynamics, organ blood flow, and survival in endotoxin shock. DESIGN: Prospective, placebo-controlled, animal trial. SETTING: Research laboratory in a major university teaching hospital. SUBJECTS: Pentobarbital-anesthetized pigs. INTERVENTIONS: Twenty-eight pentobarbital-anesthetized pigs (18.5 to 22.3 kg) received 100 micrograms/kg of Escherichia coli endotoxin (lipopolysaccharide 0127) over 30 mins. Group 1 animals (n = 14) were controls and had blood diverted through an extracorporeal circuit without activated charcoal for 60 mins after lipopolysaccharide infusion. Group 2 animals (n = 14) underwent nonpulsatile hemocarboperfusion (activated charcoal SCN-1K). MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure, cardiac output, systemic vascular resistance, mean pulmonary arterial pressure, pulmonary vascular resistance, oxygen delivery, and regional blood flow (radiolabeled microsphere technique) were determined at baseline and every 30 mins for 150 mins. Results are presented as mean +/- SD. Parameters in the two groups were compared by two-way analysis of variance. A p < .05 was considered significant. The survival rate was ten (71%) of 14 animals in group 1 compared with 14 (100%) of 14 animals in group 2 (p < .05, Fisher's exact test). The mean cardiac output at the end of hemocarboperfusion was 1.6 +/- 0.6 L/min in group 1 compared with 3.0 +/- 0.9 L/min in group 2, and remained lower in group 1 animals throughout the experiment. Pulmonary arterial pressure and pulmonary vascular resistance were lower in the hemocarboperfusion-treated animals during and after hemocarboperfusion. Systemic vascular resistance increased by 70% after lipopolysaccharide infusion and returned to baseline values in the hemocarboperfusion group but remained increased in controls. Oxygen delivery was lower in group 1 at 90 and 150 mins (287 +/- 34 vs. 478 +/- 48 mL/min and 251 +/- 24 vs. 356 +/- 21 mL/min, respectively). Blood flow rates to the brain (38.5 +/- 7.5 vs. 27.1 +/- 5.4 mL/min/100 g), large intestine (26.6 +/- 1.1 vs. 17.7 +/- 2.5 mL/ min/100 g), and adrenal cortex (200 +/- 45 vs. 139 +/- 41 mL/min/100 g) were higher in the hemocarboperfusion group at the completion of carboperfusion but not at later time points. CONCLUSION: These data suggest that hemocarboperfusion may be of value in the treatment of septic shock.

[Treatment of septic conditions in children using perfusion through a pig donor spleen]. / Lechenie perfuziei cherez donorskuiu svinuiu selezenku septicheskikh sostoianii u detei.

A technique of perfusion through pig donor spleen has been described with regard to peculiarities of the young age. Good therapeutic effect was observed during 12 splenoperfusions performed to 8 patients with septic conditions aged 12 days to 14 years. The technique suggested is simple and can be used under adequate anesthesiologic supply in children's hospitals.

[Clinico-pathogenetic aspects of infectious toxicosis in infants caused by acute pneumonia]. / Kliniko-patogeneticheskie aspekty infektsionnogo toksikoza u detei rannego vozrasta, vyzvannogo ostrymi pnevmoniiami.

Altogether 101 children under one year of age with infectious toxicosis due to acute pneumonia were examined for the clinical, roentgenomorphological and biochemical aspects of the given condition. The clinical aspects were delineated on the basis of the universal status covered by the formalized case report. The biochemical processes were analyzed according to the content of peroxidation products of membrane lipids, the concentration of hydrogen peroxide, phospholipase activity, antioxidant and antiperoxide defence of the blood as well as according to the physical constants of red blood cell membranes. A direct relationship was discovered between the clinical picture (the degree of toxicosis) and membranopathological processes. The data obtained make it possible to conceive the model of infectious toxicosis as a membranopathological one, induced by the syndrome of the deficiency of antioxidant and antiperoxide enzymes.

[Structure of the surface of erythrocytes in a clot in hemolytic disease of the newborn]. / Struktura poverkhnosti éritrotsitov v sgustke pri gemoliticheskoi bolezni novorozhdennykh.

Scanning electron microscopy of blood clots of 6 patients with hemolytic disease of newborn has shown specific large ball-shaped red cells with small round excrescences on their surface. After hemosorption the number of such excrescences reduces but a great number of deformed cells appears. In experimental hemolysis of healthy newborns' blood no such excrescences have been detectable on the red cell surface.

[Specific features of postoperative infusion therapy depending on kidney function in newborn infants with developmental defects]. / Osobennosti posleoperatsionnoi infuzionnoi terapii v zavisimosti ot funktsii pochek u novorozhdennykh s porokami razvitiia.

Results of examination of partial functions of the kidneys in 113 newborns have shown the reaction of the kidneys on a surgical aggression to be dependent on the age and stage of the postoperative period. The reaction manifests itself by renal economy of water and electrolytes on the 1-3 days after operation followed later by the osmotic dilution of urine and lower reabsorption of sodium and potassium. The maximum amount of sodium admissible for administration in the postoperative period has been established with special reference to age.

[Prolonged dopmin infusion in severe respiratory insufficiency in newborn infants]. / Dlitel'naia infuziia dopmina pri tiazheloi dykhatel'noi nedostatochnosti u novorozhdennykh.

An effective use of continuous infusion of Dopmin in dose of 2-3 mkg/(kg/min) is described. Dopmin was used in 13 newborns with severe respiratory insufficiency due to postasphyxial syndrome, disease of hyaline membranes and congenital diaphragmal hernia. Continuous infusion of microdoses of Dopmin with artificial ventilation of lungs against the background of a decreased respiratory insufficiency according to clinico-laboratory evidence resulted in decreased value of bloodflow shunt from right to left and oxygen concentration in the inhaled mixture to 45%.