[Polyneuropathy in intensive care patients].

Critical illness polyneuropathy is an acquired critical illness syndrome of neuromuscular problems as polyneuropathy and/or myopathy that is caused by long-term immobilization, clinically manifested by general muscle weakness and a main reason for difficulty weaning from the ventilator. The review gives an update on the history, epidemiology, etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, course, outcome, prevention, and treatment of critical illness care polyneuropathy.

[Peculiarities of adaptive hemodynamic processes during high-frequency jet lung ventilation].

This study concerns poorly known features of adaptive hemodynamic reactions of the heart pump function during traditional and high-frequency jet lung ventilation. Spectral analysis of slow-wave oscillations of stroke volume and left ventricular diastolic filling wave in 36 patients with craniocerebral injury and acute cerebral insufficiency showed that beneficial adaptive reactions were realized through a rise in the general spectrum power and entropy. High-frequency jet lung ventilation ensured better effect on the adaptive processes than the traditional technique.

[Acute cerebral insufficiency syndrome as a concept of neuroreanimatology].

The introduction of concepts of acute cerebral insufficiency syndrome into the clinical practice of a number of therapeutic-and-prophylactic institutions raises a lot of questions as to its clinical interpretation and approaches to diagnosing, monitoring, and treating patients who meet its criteria. By attempting to have methodologically adequate solutions of this problem, neuroresuscitators are making a complex scientific developments of reproducible modes of neuromonitoring and cerebrotropic intensive therapy. The theory of acute cerebral insufficiency and a cerebral protection complex becomes an area that determines researches in the development of new methods of intensive cerebrotropic therapy, as well as the ways of neuroreparation and neuroprotection as components of complex pathogenetic therapy for neuropathological syndromes resulting from the formation of pathological systems in response to abnormal determinants.

[Problems of inhalation gas mixture conditioning in high-frequency jet apparatuses for mechanical lung ventilation].

The problem of inhalation gas mixture conditioning, an important problem of technological implementation of high-frequency jet apparatuses for mechanical lung ventilation (MLV), is discussed. Methods of heating and humidification of inhaled gas mixture are considered along with conventional methods used in anesthetic MLV apparatuses.

[The history of oximetry].

Presently, pulsoximeters are very common devices used in every surgical operation. Unique properties of pulsoximeter (safety, accuracy, and efficiency) enable physician to monitor oxygen-transporting function of blood, which is a vitally important function of human body. The history of pulsoximetry dates back to several generations ago, researchers of many countries being involved in the invention of this device. The idea of pulsoximetry has been updated at each stage of technological progress. The history of pulsoximetry illustrates progressively increasing importance of spectrophotometric method in medicine and its perspectives for the future.

[Ways of improvement of the accuracy of arterial pressure oscillometry].

The history of the auscultation method of arterial pressure (AP) measurement dates back to more than century ago. Nevertheless, the problem of the accuracy of measurement is still on the agenda. Standards of the accuracy of measurements and data processing are subjects of regular revision and update. The accuracy and reliability of AP monitoring in complex clinical cases are competitive advantages important for manufacturers of medical monitors. A new Triton ElectronicS module for AP measurements based on original technology and results of its testing are considered in this work. An original algorithm of the module operation provides an opportunity for more accurate and convenient monitoring, particularly in case of disordered hemodynamics.

[Automated monitoring in intensive therapy of critical states].

Progress in information technologies significantly modified conventional approaches to monitors of vitally important parameters of patient. Monitoring systems are not autonomous devices anymore. Instead of that, these systems provide access to electronic case histories, automated monitoring of drug therapy, and many other important functions. Cordless radio and infrared interfaces provide a physical basis of implementation of new user functions. New trends in the development of central monitoring networks (CMN) available from various manufacturers are reviewed in this work. These trends are illustrated taking the Triton ElectronicS CardioNet CMN as an example.

[Hemodynamic status of the mother and fetus in pregnant women with gestosis during abdominal delivery under different anesthesia methods]. / Gemodinamicheskii status materi i ploda u beremennykh s gestozom pri abdominal'nom rodorazreshenii v usloviiakh razlichnykh vidov anesteziologicheskogo posobiia.

Pregnants in the third trimester with medium- and severe gestosis were divided into 3 groups according to types of maternal and fetal hemodynamics: 1) controls (n = 58 pts); 2) eukinetic type (n = 54 pts); and 3) hypokinetic type (n = 55 pts). Each group was subdivided into 3 subgroups according to administered types of anesthesia for cesarean section (epidural, spinal, and general). Central hemodynamics of the mother, fetus, and fetoplacental complex was studied. Use of different anesthesias in woman with normal pregnancy did not affect the hemodynamics, and therefore any type of anesthesia can be used in cesarean section. In pregnants with gestosis, the eukinetic hemodynamic and compensated or subcompensated placental insufficiency the optimal anesthesia was epidural and spinal. For pregnant with hypokinetic circulation and subcompensated or decompensated placental insufficiency epidural anesthesia is preferable.

[The concept of the development of multiple organ failure in a model of gestosis]. / Kontseptsiia razvitiia poliorgannoi nedostatochnosti na modeli gestoza.

Mechanisms of development of multiple organ failure (MOF) in gestosis have been studied. Analysis of the findings of examinations of 95 women with gestosis hospitalized in intensive care wards of Institute for Maternity and Neonatality Protection demonstrated that elements of the systemic inflammatory response syndrome (SIRS) underlie the development of MOF syndrome in gestosis, which can be diagnosed starting from early terms of gestation.

[Prognosis, monitoring and intensive therapy in the prevention of the development of hemorrhagic complications in labor]. / Prognoz, monitoring i intensivnaia terapiia v profilaktike razvitiia gemorragicheskikh oslozhnenii v rodakh.

Blood clotting system has been studied over the course of pregnancy. The detected close correlations between hemostasiograms and labor hemorrhages suggested the possibility of predicting hemorrhagic complications. Based on informative signs, the authors formulate the rules for predicting hemorrhagic complications of labor starting from the first trimester and define the algorithm of monitoring the hemostasis system. Application of this system helped decrease the incidence of labor hemorrhages by half by means of appropriate preventive therapy.

[Main principles of rapid diagnosis and intensive care in emergency states: their realization in expert systems]. / Osnovnye printsipy ékspress diagnostiki i intensivnoi terapii neotlozhnykh sostoianii: ikh realizatsiia v ékspertnoi sisteme.

A retrospective analysis of 543 case histories over 1980-1990 in the town of Yekaterinburg and analysis of published data permitted the authors to single out the signs characterizing the most frequent syndromes requiring urgent intensive care. By either diagnostic value, these signs are distributed into main, accessory, and ruling out. An expert system has been created, making use of the productive-Freimont's approach to representing information on the basis of blurred multiplicities and ambiguous logics. The diagnosis was made by stages: first the main signs were analyzed, determining the severity of patient's status, then (after first aid was rendered) accessory and ruling out signs, which help make the diagnosis more precise. The system was tried in 231 patients, 102 of these with acute respiratory failure, 63 with acute hemodynamic insufficiency, and 66 with acute cerebral insufficiency. Primary diagnosis of the underlying syndrome was correct in 87-89% of cases, of the concomitant syndrome in 92-97%. Repeated evaluations (in 1-3 and 24 h) taking account of the time course of the symptoms and of the results of unsophisticated instrumental examinations increased the share of correct diagnoses to 92-96%.

[Variants of intravenous anesthesia during lung surgery in conditions of high-frequency artificial ventilation]. / Varianty vnutrivennoi anestezii pri operatsiiakh na legkikh v usloviiakh vysokochastotnoi iskusstvennoi ventiliatsii.

Basic systemic hemodynamic parameters were compared during intravenous anesthesia with calypsol (ketamine) and diazepam, promedol and diazepam, fentanyl and diazepam, fentanyl and sombrevin in 120 patients operated on the lungs with conventional and high-frequency jet ventilation. The studies have shown that in conventional controlled lung ventilation there were no distinctions in hemodynamic parameters depending on the type of the anesthesia. In high-frequency jet ventilation, specific hemodynamic effects of calypsol were observed. Unlike other anesthetics, calypsol administration is associated with elevated central venous pressure, increased cardiac output and enhanced left ventricular work, which can be accounted for by higher venous return.

[The prognosis of disorders of gas exchange and hemodynamics in the early period following pneumonectomy]. / Prognozirovanie rasstroistv gazoobmena i gemodinamiki v rannem periode posle pnevmonéktomii.

The study demonstrated that patients having the baseline low arterial blood oxygen tension and high bronchial resistance showed the most unfavorable changes in the main integral values of gas exchange and hemodynamics on day 4 after pneumonectomy. Considerable progression of the obstructive syndrome, aggravation of arterial hypoxemia, significant rise of arterio-pulmonary blood pressure and perceptible drop of cardiac motor function are observed in these cases. The data may be used to predict gas exchange and hemodynamic disturbances in the early period after pneumonectomy.