[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.

[Total intravenous anesthesia with propofol, fentanyl and clopheline in young children with occlusive hydrocephalus during ventriculoperitoneal shunting]. / Total'naia vnutrivennaia anesteziia s ispol'zovaniem propofola, fentanila i klofelina u detei rannego vozrasta s okkliuzionnoi gidrotsefaliei pri operatsiiakh ventrikuloperitoneal'nogo shuntirovaniia.

Total intravenous anesthesia with propofol, fentanyl, and clonidine was used in infants aged under 1 year operated on for occlusive hydrocephalus. The course of anesthesia in 18 patients with the hypertensive hydrocephalus syndrome is analyzed. Four of these patients with an extremely grave premorbid history and body weight of 1-3 kg were operated on before the age of 2 months. Propofol can be used in infants aged under 1 year, including physiologically immature small-for-date infants. Clonidine, an alpha 2-adrenoagonist, used in older neurosurgical patients and adults for stabilizing cerebral perfusion pressure, is allowed in infants, too. The authors analyze the time course of central hemodynamics during anesthesia with propofol, fentanyl, and clonidine and anesthesia by other drugs (combined anesthesia with ketamine and opioid analgesics, neuroleptanalgesia).