[The impact of BMI on the course of the acute SARS-COV-2 infection and the risks that emerge during the first year after the hospital discharge. Subanalysis evidence of the AKTIV and AKTIV 2 registries].

BACKGROUND: There is enough evidence of the negative impact of excess weight on the formation and progression of res piratory pathology. Given the continuing SARS-CoV-2 pandemic, it is relevant to determine the relationship between body mass index (BMI) and the clinical features of the novel coronavirus infection (NCI). AIM: To study the effect of BMI on the course of the acute SARS-COV-2 infection and the post-covid period. MATERIALS AND METHODS: AKTIV and AKTIV 2 are multicenter non-interventional real-world registers. The АКТИВ registry (n=6396) includes non-overlapping outpatient and inpatient arms with 6 visits in each. The АКТИВ 2 registry (n=2968) collected  the  data  of  hospitalized  patients  and  included  3  visits.  All  subjects  were  divided  into  3  groups:  not  overweight  (n=2139), overweight (n=2931) and obese (n=2666). RESULTS: A higher BMI was significantly associated with a more severe course of the infection in the form of acute kidney injury (p=0.018), cytokine storm (p<0.001), serum C-reactive protein over 100 mg/l (p<0.001), and the need for targeted therapy (p<0.001) in the hospitalized patients. Obesity increased the odds of myocarditis by 1,84 times (95% confidence interval [CI]: 1,13-3,00) and the need for anticytokine therapy by 1,7 times (95% CI: 1,30-2,30).The  patients  with  the  1st  and  2nd  degree  obesity,  undergoing  the  inpatient  treatment,  tended  to  have  a  higher  probability  of  a  mortality  rate.  While  in  case  of  morbid  obesity  patients  this  tendency  is  the  most  significant  (odds  ratio  -  1,78; 95% CI: 1,13-2,70). At the same time, the patients whose chronical diseases first appeared after the convalescence period, and those who had certain complaints missing before SARS-CoV-2 infection, more often had BMI of more than 30 kg/m2 (p<0,001).Additionally, the odds of death increased by 2,23 times (95% CI: 1,05-4,72) within 3 months after recovery in obese people over the age of 60 yearsCONCLUSION.  Overweight  and/or  obesity  is  a  significant  risk  factor  for severe  course  of  the  new  coronavirus  infection  and  the associated cardiovascular and kidney damage Overweight people and patients with the 1st and 2nd degree obesity tend to have a high risk of death of SARS-CoV-2 infection in both acute and post-covid periods. On top of that, in case of morbid obesity patients this tendency is statistically significant. Normalization of body weight is a strategic objective of modern medicine and can contribute to prevention of respiratory conditions, severe course and complications of the new coronavirus infection.

[ACTIV SARS-CoV-2 registry (Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients). Assessment of impact of combined original comorbid diseases in patients with COVID-19 on the prognosis].

AIM: Study the impact of various combinations of comorbid original diseases in patients infected with COVID-19 later on the disease progression and outcomes of the new coronavirus infection. MATERIALS AND METHODS: The ACTIV registry was created on the Eurasian Association of Therapists initiative. 5,808 patients have been included in the registry: men and women with COVID-19 treated at hospital or at home. CLINICALTRIALS: gov ID NCT04492384. RESULTS: Most patients with COVID-19 have original comorbid diseases (oCDs). Polymorbidity assessed by way of simple counting of oCDs is an independent factor in negative outcomes of COVID-19. Search for most frequent combinations of 2, 3 and 4 oCDs has revealed absolute domination of cardiovascular diseases (all possible variants). The most unfavorable combination of 2 oCDs includes atrial hypertension (AH) and chronic heart failure (CHF). The most unfavorable combination of 3 oCDs includes AH, coronary heart disease (CHD) and CHF; the worst combination of 4 oCDs includes AH, CHD, CHF and diabetes mellitus. Such combinations increased the risk of lethal outcomes 3.963, 4.082 and 4.215 times respectively. CONCLUSION: Polymorbidity determined by way of simple counting of diseases may be estimated as a factor in the lethal outcome risk in the acute phase of COVID-19 in real practice. Most frequent combinations of 2, 3 and 4 diseases in patients with COVID-19 primarily include cardiovascular diseases (AH, CHD and CHF), diabetes mellitus and obesity. Combinations of such diseases increase the COVID-19 lethal outcome risk.

[Features of the cell composition of inflammatory infiltrate in different phases of diffuse alveolar lung damage with COVID-19]. / Osobennosti kletochnogo sostava vospalitel'nogo infil'trata v raznye fazy diffuznogo al'veolyarnogo povrezhdeniya legkikh pri COVID-19.

BACKGROUND: Acute respiratory distress syndrome (ARDS) with COVID-19 has a worse prognosis than ARDS with other diseases. Mortality from ARDS with COVID-19 is 26.0 - 61.5%, and due to other causes - 35.3-37.2%. OBJECTIVE: To find of the correlation between polymorphonuclear leukocytes (PMNs), lymphocytes, and macrophages in the cellular composition of the inflammatory infiltrate at different stages and phases of diffuse alveolar damage (DAD) with COVID-19, analyzing the autopsy material. MATERIAL AND METHODS: The lung tissue of 25 patients who died from ARDS with COVID-19 without a secondary bacterial or mycotic infection, another thanatologically significant pathology of the lungs, was studied. To study the cellular composition of the inflammatory infiltrate and the dynamics of its changes a double immunohistochemical analysis of the expression of antibodies to CD15, CD3, and CD68 was used. RESULTS: The inflammatory infiltrate and intraalveolar exudate in the exudative phase of DAD was represented by 56.8% of PMNs (CD15-positive cells; hereinafter - the average value of the percentage of positive cells to the total number of cells of the inflammatory infiltrate), 6.9% - lymphocytes (CD3-positive cells) and 19.5% macrophages (CD68-positive cells). In the early stage of the proliferative phase: 14.1% PMNs, 38.7% lymphocytes and 13.5% macrophages. In the late stage of the proliferative phase: 11.3% PMNs, 14.5% lymphocytes and 39.3% macrophages. CONCLUSIONS: In the exudative phase of DAD a statistically significant predominance of PMN was revealed, which could determine the main volume of lung damage and the severity of ARDS with COVID-19. In the early stage of the proliferative phase of DAD, a statistically significant change in the composition of the inflammatory infiltrate was revealed to compare with the exudative phase: a significant decrease in the content of PMNs relative to the total number of cells in the inflammatory infiltrate; an increase in the number of lymphocytes, which is probably associated with the start of organization and repair processes. In the late stage of the proliferative phase of DAD, compared with its early stage, was revealed a statistically significant increase in the number of macrophages in ratio.

[Russian multicenter observational clinical study «Register of respiratory therapy for patients with stroke (RETAS)¼: a comparative analysis of the outcomes of stroke]. / Rossiiskoe mnogotsentrovoe observatsionnoe klinicheskoe issledovanie «Registr respiratornoi terapii u patsientov s ONMK (RETAS)¼: sravnitel'naya kharakteristika iskhodov insul'ta.

OBJECTIVE: To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death. MATERIAL AND METHODS: A multicenter observational clinical study «REspiratory Therapy for Acute Stroke¼ (RETAS) was conducted under the aegis of the «Federation of Anaesthesiologists and Reanimatologists¼ (FAR). The study involved 14 clinical centers and included 1289 stroke patients with respiratory support. RESULTS: We found that initial hypoxemia in the 28-day period was associated with higher mortality than in absence of hypoxemia (in patients with 20 or more NIHSS scores) (76.22% versus 63.45%, p=0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension compared with group of patients who were not treated with hyperventilation (in patients with 20 or more NIHSS scores) (79.55% versus 72.75%, p=0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIHSS scores) (p<0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (87.64% versus 62.33%, p<0.001). It has been proved that the absence of nutritional insufficiency in patients with stroke is associated with a higher probability of a positive outcome (GOS 4 and 5) in comparison with patients with signs of nutritional insufficiency, for the group with NIHSS less than 14 points (p<0.001). CONCLUSIONS: A group of factors associated with a deterioration in the prognosis of outcomes in patients with stroke who are undergoing ventilation has been identified: hypoxemia at the start of respiratory support, lack of instrumental monitoring of ICP, the use of hyperventilation to correct ICP, ventilation with volume control (VC), as well as the presence of nutritional insufficiency.

Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2¼).

Aim      To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods  The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion      In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

[International register "Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients (ACTIV SARS-CoV-2)"].

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[Extracorporeal membrane oxygenation in severe combined trauma complicated by fat embolism]. / Ékstrakorporal'naia membrannaia oksigenatsiia pri tiazheloi sochetannoi travme, oslozhnennoi zhirovoi émboliei.

It is presented the victim with severe combined injury complicated by fat embolism and acute respiratory failure. Veno-venous extracorporeal membrane oxygenation was successfully used to provide adequate extracorporeal gas exchange in refractory respiratory failure.

OPTIMUM LEVEL OF POSITIVE END-EXPIRATORY PRESSURE IN ACUTE RESPIRATORY DISTRESS SYNDROME CAUSED BY INFLUENZA A(H1NI)PDM09: BALANCE BETWEEN MAXIMAL END-EXPIRATORY VOLUME AND MINIMAL ALVEOLAR OVERDISTENSION.

THE AIM: to determine optimum level ofpositive end-expiratory pressure (PEEP) according to balance between maxi- mal end-expiratory lung volume (EEL V)(more than predicted) and minimal decrease in exhaled carbon dioxide volume (VCO) and then to develop the algorithm of gas exchange correction based on prognostic values of EEL K; alveolar recruitability, PA/FiO2, static compliance (C,,,) and VCO2. MATERIALS AND METHODS: 27 mechanically ventilatedpatients with acute respiratory distress syndrome (ARDS) caused by influenza A (HINJ)pdm09 in Moscow Municipal Clinics ICU's from January to March 2016 were included in the trial. At the beginning of the study patients had the following characteristic: duration offlu symptoms 5 (3-10) days, p.0/FiO2 120 (70-50) mmHg. SOFA 7 (5-9), body mass index 30.1 (26.4-33.8) kg/m², static compliance of respiratory system 35 (30-40) ml/mbar: Under sedation and paralysis we measured EELV, C VCO and end-tidal carbon dioxide concentration (EtCO) (for CO2 measurements we fixed short-term values after 2 min after PEEP level change) at PEEP 8, 11,13,15,18, 20 mbar consequently, and incase of good recruitability, at 22 and 24 mbar. After analyses of obtained data we determined PEEP value in which increase in EELV was maximal (more than predicted) and depression of VCO2 was less than 20%, change in mean blood pressure and heart rate were both less than 20% (measured at PEEP 8 mbar). After that we set thus determined level of PEEP and didn't change it for 5 days. RESULTS: Comparision of predicted and measured EELV revealed two typical points of alveloar recruiment: the first at PEEP 11-15 mbar, the second at PEEP 20-22 mbar. EELV measured at PEEP 18 mbar appeared to be higher than predicted at PEEP 8 mbar by 400 ml (approx.), which was the sign of alveolar recruitment-1536 (1020-1845) ml vs 1955 (1360-2320) ml, p=0,001, Friedman test). we didn't found significant changes of VCO2 when increased PEEP in the range from 8 to 15 mbar (p>0.05, Friedman test). PEEP increase from 15 to 18 mbar and more lead to decrease in VCO2 (from 212 (171-256) ml/min to 200 (153-227) ml/min, p<0,0001, Friedman test, which was the sign of overdistension. Next decrease of VCO2 was observed at PEEP increase from 22 to 24 mbar (from 203 (174-251 ml/min) to 185 (182-257) ml/min, p=0.0025, Friedman test). Adjusted PEEP value according to balance between recruitment and overdistension was higher than the one initially set (16(15-18) mbar vs 12(7-15) mbar, p <0.0001). We observed increase of SpO2 from 93 (87-96) to 97(95-100)% (p<0.0001 followed by decrease in inspiratory oxygen fraction from 60(40-80) to 50(40-60)%(p<0.0001). Low EELV VCO2 and VCO2/EtCO2 at PEEP 8 mbar has low predictive value for death (AUROC 0,547, 0706 and 0.596, respectively).Absolute EELV value at PEEP 18 and 20 mbar were poor predictors of mortality (AUROC 0.61 and 0.65 respectively) Alveolar recruit ability was measured by subtraction of EELV at PEEP 20 and at PEEP II mbar - value below 575 ml was a good predictor of death (sensitivity 75%, specificity 88%, AUROC 0.81). Lowering of VCO2 at PEEP 20 mbar to less than 207 ml/min was a marker of alveolar overdistension and associated with poor prognosis (sensitivity 83%, specificity 88%, AUROC 0,89). C has poor predictive value at PEEP 8 and 20 mbar (AUROC 0,58 and 0,74 respectively. Conclusion: PEEP adjustment in ARDS due to influenza A (H1N1) pdm09 in accordance with balance between recruitment and overdistension (based on EELV and VCO measurements) can improve gas exchange, probably, not leading to right ventricular failure. This value of "balanced" PEEP is in the range between 15 and 18 mbar: Low lung recruitabiilty is associated with poor prognosis. Measurements of EELV and VCO2 at PEEP 8 and 20 mbar can be used to make a decision on whether to keep "high" PEEP level or switch to extracorporeal membrane oxygenation in patient with ARDS due to influenza A (N1H1).

[RUSSIAN NATIONAL EPIDEMIOLOGICAL STUDY "RUVENT": THE USE OF ARTIFICIAL LUNG VENTILATION IN THE INTENSIVE THERAPY IN CHILDREN].

UNLABELLED: Purpose of this part of the "RuVent" research is to study the real use of the various modes and parameters of prolonged respiratory support in children in Russia. MATERIALS AND METHODS: The study included 104 children from 29 ICUs (28 in Russian Federation, 1 in Ukraine) under the age of 15 years with ALV duration more than 12 hours in the period from February 7 to 11, 2011. The collection of information performed through online forms. RESULTS: Total lethality was 20.7% (18 of 87 patients). The main reasons for prolonged respiratory support in children were the pathology of the respiratory system: acute respiratory distress syndrome (21.2%), community-acquired pneumonia (9.5%), sepsis (8.2%), and congenital disorders of the central nervous system (8.2%) and cardiac arrest (8.2%). According to the study "RuVent" doctors mostly prefer managed modes of respiratory support (SIMV 41.3%, A/C 28.8%, BIPAP 12.5%). Frequency of non-invasive respiratory support use amounted to 1%. Real respiratory volume based on ideal body weight calculation, averaged for boys 9.2 (7.3; 11.2) ml/kg (n = 54), for girls--8.7 (7.1; 10.1) m/kg (n = 38). PEEP median amounted to 4 mbar Tracheostomy was performed in 12 children out of 104 (11.5%), predominantly classic (n = 11), puncture dilated tracheostomy was performed in 1 child. The median of the tracheostomy installation in children was 24.5 days. The duration of respiratory support in children was 11 days (5; 25) (n = 43). The incidence of ventilator-associated pneumonia in children was 27.9% (12 of 43 cases). CONCLUSIONS: The results of the Russian national epidemiological study of the use of mechanical ventilation in the Intensive care unit ("RuVent") showed comparable data with real international clinical practice. The researchers noted significant differences during prolonged mechanical ventilation in children compared with adult patients.

[Significance of static pressure-volume loop for differential diagnostics and optimization of respiratory support in parenchimal respiratory failure].

PURPOSE OF THE STUDY: To determine significance of static pressure-volume loop (PV loop) for differential diagnostics of parenchymal respiratory failure, setting of positive end-expiratory pressure (PEEP) and recruit ability of the lung. MATERIALS AND METHODS: 76 patients (52 males) with parenchymal respiratory failure were included in the study (oxygenation index (PaO2/ FiO2) < 250 torr infiltrates on chest X-ray or CT-scan of the lungs, no data on left ventricular failure). We plot static PV loop by low flow technique in range of 0 to 40 mbar, fixing lower inflection point (LIP), linear compliance (Clin), upper inflection point (UIP), expiratory inflection point (EIP), compliance of linear deflation limb (C defl), hysteresis (Hyst) and volume of PEEP-induced recruitment of the lung (V(peep)). Then we plot another static PV loop with sustained inflation of 40 mbar for 30 seconds, fixing changes in lung volume at 40 mbar. After 10 minutes of sustained inflation we measured changes of oxygenation index. For 69 patient we performed lung CT-scan and defined diffuse (acute respiratory distress syndrome) or local lung injury (pneumonia, atelectasis). RESULTS: LIP value can differentiate diffuse and local lung injury. LIP more than 10 mbar corresponds to diffuse lung injury on CT scan (sensitivity 76%, specificity 85%, AUROC 0.81). LIP cannot predict PEEP-induced alveolar recruitment and changes of PaO2/FiO2 after sustained inflation maneuver (p > 0.05). Empirically set PEEP (by maximum PaO2/FiO2) was much higher than LIP (p < 0.0001), but LIP correlates with empirically set PEEP in diffuse lung injury (rho = 0.642, p = 0.003). Clin cannot differentiate diffuse from local lung injury (p > 0.05), but predicts PEEP-induced alveolar recruitment during static PV loop plotting (rho = 0.493, p < 0.0001). We did not find any statistically significant values of UIP and EIP for differential diagnosis, setting of PEEP or recruit ability of the lung. Hysteresis value (defined as volume difference at 20 mbar between deflation and inflation limbs) cannot predict influence of PEEP setting and sustained inflation maneuver on PaO2/FiO2 changes and recruit ability of the lung (p > 0.05). After static PV loop plotting combined with sustained inflation maneuver recruited volume of the lungs was 350 (250-450) ml. We didn't find significant differences between recruit ability of the diffuse and locally injured lungs (p > 0.05). Recruitment volume has no correlations with all points and segments of static PV loop. CONCLUSIONS: Static PV loop has limited prognostic value for differential diagnostics of diffuse or local lung injury and brings potential harm for setting PEEP according to LIP. LIP more than 10 mbar can predict diffuse lung injury. Clin can predict volume of PEEP-induced recruitment. In diffuse lung injury LIP correlates with empirically set PEEP.

[Positive end-expiratory pressure adjustment in parenchimal respiratory failure: static pressure-volume loop or transpulmonary pressure?].

OBJECTIVE: The aim of the study was compare the prognostic value, efficacy and safety ofpositive end-expiratory pressure (PEEP) adjustment in conformity with lower inflection point of static "pressure-volume" loop (LIP) or end-expiratory esophageal pressure (EEEP) in parenchymal respiratory failure. METHODS: We included in the study 56 patients (39 males) at age 47 +/- 17.8 years with parenchymal respiratory failure (PaO2/FiO2 < 250 mmHg, bilateral infiltrates on chest X-ray or lung CT scan, no signs of left ventricular failure), who were mecAanically ventilated for less than 48 hours. All patients were sedated and paralyzed. We measured intra- Sabdominal pressure, PaO2/FiO2, PaCO2, alveolar dead space (Vdalv), plotted static "pressure-volume" loop by low flow technique in range of 0 to 40 mbar, recording LIP Then we placed nasogastric tube with balloon for esophageal pressure measurement and measured esophageal pressure at PEEP range from 8 to 20 mbar (with 2 mbar steps) and recorded plateau pressure (Pplat), transpulmonary plateau pressure (Ptp plat), transpulmonary pressure at PEEP level (Ptp PEEP), static compliance of respiratory system (Cstat), lung compliance (Clung), chest wall compliance (Ccw) at every step. Also by volumetric capnography technique we measured end-tidal carbon dioxide concentration (EtCO2), minute volume of exhaled carbon dioxide (VCO2) volume of exhaled carbon dioxide by single breath (VtCO2) and calculate VC2/EtCO2 as a surrogate marker of pulmnonary perfusion. After that we set PEEP at EEEP level (at zero end-expirato- my ranspulmonary pressure) and recorded changes of PaO2/FiO2 and Vdalv. RESULTS: LIP value was 5 (6-10) mbar and it was less than empirically set PEEP in most of patients before enrollment and had no prognostic value for PEEP setting. EEEP level was 14 (12-18.25) mbar and it was higher than LIP in 96.4% patients. Distribution of EEEP values was close to normal unlike LIP Chest wall compliance was less than normal (100 ml/mbar) in 46% of patients. EEEP has correlation with body mass index (rho 0.554, p=0.002). We did not find any correlation between intra-abdominal pres- sure (IAP) and EEEP (p=0.376) or IAP and LIP (p=0.464). PEEP levels higher than 14 mbar led to significant decrease in Cstat and Clung (p<0.001). We observed significant decrease in VCO at PEEP levels more than 16 mbar, i.e., more than EEEP median. PEEP levels more than 16 mbar decreased VCO2/EtCO2, (decreased pulmonary perfusion) from 7.47 (6.54-8.7) at PEEP 14 mbar to 7.32 (6.35-8.76) at PEEP 20 mbar (p=0.004). PEEP setting at EEEP level increased PaO/FiO2 from 205 (154-235) to 280 (208-358) mmHg (p<0.001), did hot change Vdalv (p=0.093) and decreased Cstat and Clung in the most of patients (64.3%). CONCLUSION: L1P was lower than empirically set PEEP in most patients and did not help to optimize gas exchange. PEEP setting at EEEP level in patients with parenchimal respiratory failure increases PaO/FiO, (reflects opening of collapsed alveoli), decreases volume of expired carbon dioxide and decreases lung compliance (reflects overdistenion of opened alveoli). VCO2/EtCO2 ratio decreases (decreased pulmonary perfusion) at PEEP levels more than 16 mbar, which was more than EEEP.

["Evidance"--Russian national epidemiological study].

UNLABELLED: The article deals with results of epidemiological study of 2516 ICU patients received prophylaxis of a deep vein thrombosis (DVT) and venous thromboembolic complications (VTEC). RESULTS: The frequency of renal failure was 19.8%. Mortality rate in patients with acute renal failure (ARF) was 34% and in patients without ARF 17%. CONCLUSIONS: An analysis of drugs for prophylaxis of DVT and VTEC which were used in patients with ARF showed that the prophylaxis was performed without a taking in account a significance of such complication.

[Significance of static pressure-volume loop and lung computed tomography for differential diagnostics of parenchymal respiratory insufficiency].

UNLABELLED: Purpose of the study was to determine a significance of static pressure-volume loop and lung computed tomography for differential diagnostics of parenchymal lung failure developing during mechanical ventilation. MATERIALS AND METHODS: 75 patients (42 males and 33 females) with acute lung failure due to parenchymal lung injury during mechanical ventilation were included in to the research. Criteria of including into the research were age over 15, ARDS symptoms absence before respiratory support beginning and modified American-European Consensus Conference ARDS criteria presence during mechanical ventilation (AECC ARDS criteria, 1994--PaO2/FiO2 < 250 mmHg). Lung computed tomography (CT), static compliance and plateau measurement were performed in all patients. Static pressure-volume loop was plotted in 23 patients. RESULTS: diffuse alveolar damage was diagnosed by CT in 24.3% of patients and "wet sponge" symptom in 10.7% of patients. Dorsal atelectasis (77.3%) and ventilator-associated pneumonia (VAP) (82.7%) were diagnosed in most of patients with AECC ARDS criteria. Sensitivity and specificity of PaO2/FiO2 ratio were too low for diagnostics of ARDS (AUROC 0.67) Patients with diffuse alveolar damage had plateau pressure 25 mbar (95% CI 22-32), while patients with local lung injury (VAP or atelectasis) had significantly lower plateau pressure--20 mbar (95% CI 18-22) (p = 0.014). Elevation of plateau pressure over 30 mbar predicted diffuse alveolar damage with specificity of 100%. Lower inflection point values on the static pressure-volume loop was higher in patients with diffuse alveolar damage than in patients with local lung injury--12 mbar (95% CI 7-17) vs. 6 mbar (95% CI 5-10), (p = 0.042, n = 23). Effective (linear) compliance had poor prognostic value for differential diagnostics of acute respiratory failure due to parenchimal lung injury (p = 0.023). CONCLUSION: Lung CT plays leading role in differential diagnostics of parenchymal lung failure developing during mechanical ventilation. In the luck of CT scan elevation of plateau pressure over 30 mbar and values of lower inflection point on the static pressure-volume loop over 12 mbar can predict ARDS.

[Application of artificial lung respiration in intensive care units in Russia: national epidemiological research "RuVent"].

UNLABELLED: The purpose of the research is to study the real use of the various modes and parameters of prolonged respiratory support in Russia. MATERIALS AND METHODS: The study included all patients from ICU with no limitation by sex and age with ALV duration more than 12 hours in the period from February 7 to 11. 2011. 470 patients, including 104 children under the age of 15 years, from 101 ICU in Russian Federation, 2 ICU in the Republic of Belarus and 1 ICU in Ukraine (total 104 centres). The collection of information performed through online forms. RESULTS: Total lethality was 35.1% (139 from 396 patients), in case of the ARDS development - 44.9%. The frequency of ARDS development - 18.7%. According to the study "Ru Vent" doctors mostly prefer managed modes of respiratory support (SIMV 45.1%, A/C 20.2%, BiPAP 12.6%) which can partly be explained by a large proportion ofpatients with Central nervous system pathology, included in the study (39.8%). Frequency of non-invasive respiratory support use amounted to 1.1%. Real respiratory volume based on ideal body weight calculation, averaged for men 8.13 (6.84-9.33) ml/kg, for women - 9.1 (7.6-10.9) ml/kg, which is above the "ideal" respiratory volume 6 ml/kg in 1.35 times (1.14-1.56) for men (n=251) and in 1.51 times (1.27 - 1.81) for women (r=161). PEEP median amounted to 5 mbar, in case ofARDS development - 6 mbar. CONCLUSION: The results of the Russian national epidemiological research of ALV use in ICU ("RuVent) showed comparable data with real international clinical practice. The used tidal volumes are slightly overestated, and the values ofthe PEEP are understated in comparison with the national and international recommendations.

[Role of an anesthesiologist-resuscitation specialist in organ donation for transplantation].

There is an annual reduction in the number of donors worldwide. An anesthesiologist-resuscitation specialist is a key figure in the whole system of organ donation. The so-called transplantation, i.e., the organization of the whole process of interaction between a healthy care facility, a local organ donation center, and ancillary laboratory and diagnostic services is one of his/her primary roles in organ donation. The organizational, legal, and ethic issues of organ donation for transplantation are discussed from the viewpoint of an anesthesiologist-resuscitation specialist. There is a parallel between the treatment of a patient with multiple organ dysfunction and the management of a donor with brain death.

[Postinfusion complications by acute blood loss].

Highs and lows of infusion therapy for the treatment of the acute blood loss were studied experimentally and in clinic. Colloid and crystalloid solutions, being hemodilutants, do not transport oxygen, causing, therefore, several complications in recipient's organism. Dilutional anemic and lead to heart insufficiency, which, by-turn, cause the so called dilutional circulatory hypoxia.

[Experience in treating severe viral respiratory infection caused by influenza A (H1N1)].

The authors present their experience in treating 142 patients with severe viral respiratory infection caused by influenza A (H1N1), describe its clinical picture, and identify major syndromes observed in the treatment of these patients at an intensive care unit. A rapid development of acute respiratory distress syndrome, significant hypoxemia and hypercapnia with the low efficiency of various therapeutic measures and hence progressive organ dysfunction determine the essence of the severe course of the disease. Uniform guidelines for intensive care in this patient population are presented.

[Evaluation of the effectiveness and safety of synthetic colloid solutions in the treatment of severe abdominal sepsis: a randomized comparative study].

Infusion therapy, surgical debridement of an infection focus, and antimicrobial therapy are basic treatments for severe sepsis. At the same time there are no uniform guidelines on how to choose fluids for infusion therapy. The results of individual studies serve as the basis for refusing the use of synthetic colloid agents in the therapy of severe sepsis. The presented multicenter, randomized comparative study has evaluated different synthetic colloid solutions in early targeted therapy for severe sepsis. Evidence is provided for the identical effectiveness of the compared solutions in correcting hypovolemia and stabilizing hemodynamics in patients with severe sepsis and septic shock.