[Ethical and legal problems in critical medicine]. / Eticheskie i iuridicheskie problemy meditsiny kriticheskikh sostoianii.

The major ethical and legal problems in anesthesiology, intensive care, emergency and disaster medicine are discussed. Special attention is paid to violation of patient's rights, limits of intensive care and resuscitation, evaluation of iatrogenic complications and unfavorable outcomes from clinical physiological and legal viewpoints, and legal responsibility of anesthesiologists, intensive care specialists, and emergency physicians. Occupational hazards and protection of specialists in critical medicine are discussed.

[Compliance of the lung-thorax system in pregnancy complicated by pre-eclampsia]. / Rastiazhimost' systemy legkie--grudnaia kletka pri beremennosti, oslozhnennoi preéklampsiei.

Compliance of the lungs and thorax was studied in 65 pregnant women during cesarean section. The measurements were carried out in a group of healthy controls and in patients with preeclampsia. The detected changes indicated increased rigidity of the lungs even in normal pregnancy. Comparison of the results indicates an appreciable increase of rigidity of the lungs in patients with preeclampsia, this permitting us to regard it as a status involving interstitial pulmonary hyperhydration.

[The respirator injector as a possible cause of complications in high frequency artificial respiration of the lungs]. / Inzhektor respiratora kak vozmozhnaia prichina oslozhnenii vysokochastotnoi iskusstvennoi ventiliatsii legkikh.

Improper design of an injector can cause pulmonary overdistension, fall in venous return, alveolar hypoventilation, insufficient humidification of inhaled gas and oxygen toxicity syndrome during HFJV. Functional characteristics of widely used injectors were determined and their role in the development of serious complications of HFJV is discussed. Special attention is paid to the flow resistance of the injector, its inner volume, ejection ratio, and maximum inspiratory pressure generated by the injector. Practical steps to avoid these complications are recommended.

[Therapy in severe forms of pregnancy-induced arterial hypertension]. / Terapiia pri tiazhelykh formakh arterial'noi gipertenzii, obuslovlennoi beremennost'iu.

We have studied types of hemodynamics and results of arterial hypertension intensive care in 136 pregnant women in 32-38 weeks of gestation. Stroke and cardiac indexes, general peripheral vascular resistance, mean arterial pressure, cardiac work and other hemodynamic parameters were investigated by echocardiographic method. We worked out regression equations for each type of hemodynamics. Rational regimens of arterial hypertension therapy were selected according to hemodynamics types. In the hyperkinetic type a combination of propranolol with nifedipine was used, in eukinetic type--methyldopa with nifedipine and in hypokinetic type--clonidine with nifedipine. Using individualized therapy of arterial hypertension in women with gestoses we succeeded in improving the results of intensive care as a component of preparation for anesthesia in delivery ahead of time by cesarean section as well as in normal delivery at term.

[Occlusion pressure P100 as a criterion of the central regulation of respiration in respiratory insufficiency and anesthesiological care]. / Okkliuzionnoe davlenie P100 kak kriterii tsentral'noi reguliatsii dykhaniia dlia dykhatel'noi nedostatochnosti i anesteziologicheskom posobii.

Measurement of occlusion pressure in the airways within the first 100 msec of the inspiration (P100) is a simple noninvasive test for estimating the central inspiratory activity in patients. This test does not require any sophisticated diagnostic equipment, it is not burdensome and does not demand the patient's cooperation. The P100 criterion noticeably varies in healthy subjects, in patients with exacerbation of chronic respiratory failure, and in the immediate postoperative period. The use of the test has additional advantages in patients in critical conditions where the carrying out of different tests (hypoxia, hypercapnia) to estimate the central inspiratory activity is not feasible or unsafe for the patient.

[Gas exchange and respiration mechanics during high-frequency jet ventilation of the lungs]. / Gazoobmen i mekhanika dykhaniia pri struinoi vysokochastotnoi iskusstvennoi ventiliatsii legkikh.

Gas exchange and pulmonary mechanics in high frequency-jet ventilation (HFJV) were studied during intubation anesthesia in patients with normal respiratory organs. The HFJV frequency ranged from 100 to 400 per minute. The tidal volumes (VT) varied from 50 to 140 ml. Gas exchange was studied in 11 patients, the total number of regimens amounting to 69. The physiological dead space volume (VD) was determined by the Bohr method for different combinations of VT and frequency after 15-minute ventilation with each regimen. The values of VD and VA were found to have linear relationships with VT and no relation to the ventilation frequency. Linear regression equations were derived for these relationships. The dynamic pulmonary distension in HFJV was assessed in 9 patients using the interrupted HFJV techniques, up to 28 regimen being tested for each patient. An exponential relationship between the accumulated gas volume and VT was found at fixed frequency values and duration of the expiratory phase. The regimen capacity for inducing gas accumulation in the lungs is determined by the ratio of ventilation frequency to the expiration time (accumulation coefficient). The dynamic pulmonary distention in HFJV is attended with a rise in mean respiratory pressure which, however, remains lower than the mean alveolar pressure. The obtained evidence should be taken into account when choosing an optimal regimen for individual HFJV.