[Criteria for adequate respiratory support during transfer of patients to spontaneous respiration]. / Kriterii adekvatnosti respiratornoi podderzhki pri perevode bol'nykh na samostoiatel'noe dykhanie.

Time course of circulation, oxygen transport and consumption parameters were studied in patients with parenchymatous pulmonary diseases during their transfer to spontaneous respiration under conditions of pressure support ventilation after long forced ventilation of the lungs. The oxygen cost of respiration can serve as a reliable criterion of respiratory support adequacy when the use of a respirator is discontinued. With oxygen cost of respiration at least 14%, a decrease of respiratory support is hardly possible without decompensation of the respiration system and circulation, which dictates monitoring of this parameter during transfer of patients to spontaneous respiration.

[Optimization of artificial respiration parameters in patients with acute pulmonary parenchymal damage syndrome]. / Optimizatsiia parametrov IVL u bol'nykh s sindromom ostrogo parenkhimatozhnogo povrezhedeniia legkikh.

The relationship between the mean pressure in the trachea, generated in mechanical ventilation of the lungs (Ptr.m), and normal arterial oxygenation is linear in ventilated patients with severe bilateral acute parenchymatous damage to the lungs. Under conditions of mechanical ventilation of the lungs (MVL) with regulated volume, constant end-expiratory pressure (PEEP) and inspiratory pause (eIP) are effective methods for regulating Ptr.m. However, the efficacy of regulating Ptr.m by PEEP and IF for each clinical case is different. The algorithm of using PEEP and IF for optimizing the respiratory pattern in this category of patients is not clear, too. The results indicate that optimization of MVL with controlled volume should be started with selecting the optimal level of PEEP for each patient. The level of Ptr.m should not be increased immediately at by of prolonging eIP, because the probability of compromising the hemodynamics is higher in such a case than the probability of improving blood oxygenation. Only after selecting the optimal PEEP is it permissible to try to improve arterial oxygenation by prolonging xx, because under such conditions the efficacy of prolonged inspiration is notably increased. Our data indicate that eIP no higher than 30% of the respiratory cycle (inspiration/expiration = 1.5/1) is the optimal. A further increase of eIP gives rise to a tendency towards decrease of arterial oxygenation and oxygen transport to tissues.

[Tracheostomy in a resuscitation unit (methodology, tactics of postoperative management, long-term results]. / Trakheostomiia v otdelenii reanimatsii (metodika, taktika posleoperatsionnogo vedeniia, otdalennye rezul'taty.

The experience of management of 123 patients after tracheostomy and the following prolonged controlled lung ventilation has been summarized. The techniques of tracheostomy and postoperative management that made it possible to decanulate 118 patients without additional surgical interventions have been described. The studies performed using radiopharmacological agents have revealed considerable disturbances of the pulmonary flow, foci of chronic inflammation in tracheal and bronchial cartilages, mediastinal lymph nodes and pulmonary tissue, reduction in pulmonary tissue elasticity and increase of the lung area.