[Legal aspects of government sanitary and epidemiologic surveillance of the armed forces of the Russian Federation].
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Environmental Exposure↗
Biomedical subjects
A V Vlasenko
Publications and source records attributed to A V Vlasenko.
[Universal homogenizer with a cooling device].
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Refrigeration↗
[Optimization of artificial respiration parameters in patients with acute pulmonary parenchymal damage syndrome].
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.
Acute Disease↗
[Postural therapy during mechanical pulmonary ventilation with PEEP in patients with unilateral lung damage].
Mechanical ventilation of the lungs (MVL) with positive end expiratory pressure (PEEP) is difficult in patients with unilateral lung damage because of uneven distribution of volumes and pressures in the involved and intact lungs. Harmful effects are easier manifested under such conditions. Selective MVL with selective PEEP is widely used abroad for optimizing MVL, but this method is rather expensive and is not devoid of shortcomings. Our study carried out in 32 patients with unilateral lung involvement showed that traditional MVL with general PEEP can effectively (in 75% cases) regulate gaseous exchange and decrease its untoward effects if MVL is performed with the patient lying on the healthy side and not supine. MVL in patients with unilateral lung injury lying on the healthy side can be a simpler and cheaper alternative to selective MVL with selective PEEP.
Acute Disease↗
[Liquid pulmonary ventilation, its possibilities and prospects (current state of the question)].
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Child↗
[Oxygen debt as a prognostic criteria in patients with multiple organ failure].
Signs of oxygen debt were studied in 28 patients with systemic inflammatory response and polyorgan failure. The parameters of oxygen debt, oxygen consumption, saturation of mixed venous blood, and heart rate can be used as criteria of therapy efficiency. The probability of a favorable outcome is increased if the mean 24-h oxygen debt is less than 30 ml/min x m2, oxygen consumption more than 158 ml/min x m2, mixed venous blood saturation less than 64%, and heart rate less than 114 stroke/min.
Heart Rate↗
[Role of autoPEEP in the optimization of the respiratory pattern in patients with acute parenchymatous lung diseases].
The paper presents the results of a study of the impact of autoPEEP (positive end-expiratory pressure) on gas exchange in the lungs, their biomechanical characteristics, the transport and consumption of oxygen by inverting the inspiration/expiration ratio under the volume-controlled mechanical ventilation of the lung (VCMVL) in patients with acute parenchymatous lung lesion, as well as how to choose the optimum inspiration/expiration ratio in VCMVL by analyzing the pattern of total PEEP (the sum of positioning and autoPEEP) in this group of patients.
Acute Disease↗
[Effect of perftoran on the oxidant-antioxidant system in patients with severe trauma and blood loss].
Diminution of reperfusion and re-oxygenation lesions is an important task in the treatment of patients with severe injury and blood loss. From this standpoint the influence of perforan on the condition of the oxidant-antioxidant system was studied in patients with severe combined trauma. The application of perftoran in the early post-trauma period was found to intensify the processes of lipid peroxidation and, simultaneously, to normalize the parameters of the antioxidant-protection system.
APACHE↗
[Assessment of unbalance in water compartments of patients with gestosis].
The water-sector misbalance was studied in 53 puerperants. The method of bio-impedance spectrometry was made use of to determine the total body water, extra-cellular- cellular- and interstitial water as well as the circulating blood volume. The levels of extra-cellular and interstitial water were found to be reliably higher in patients with moderate gestosis on day 1 after delivery versus healthy subjects. Stable trends towards normalizing the volumes of extra-cellular and interstitial water were registered by day 5. As for patients with sever gestosis, a reliably increasing total body water as well as extra-cellular and interstitial water persisted in them by day 5 after delivery versus the controls.
APACHE↗
[Use of orthostasis during artificial pulmonary ventilation in patients with acute parenchymal pulmonary lesion].
The paper contains the results of a study involving an inclined body positioning (45 degrees orthostasis) under the conditions of artificial pulmonary ventilation applied to patients with acute parenchymatous pulmonary lesion of different etiologies. The impact of the method produced on pulmonary gas exchange, hemodynamics, transport and consumption of oxygen as well as its efficiency and disadvantages, indications and contraindications are in the focus of attention.
Adolescent↗
[Dynamics of prekallikrein and kallikrein inhibitors in development of acute pulmonary lesion (experimental study)].
The reaction of the kallikrein-kinin blood system was studied in an experimental acute pulmonary lesion caused by a prolonged intravenous infusion of thrombin solution. It was established that the progressing of the acute pulmonary lesion brings about an increasing activation of the kallikrein-kinin blood system with a limited check by the lungs. It is displayed by lower levels of prekallikrein and its inhibitors observed first in the venous and later in the arterial blood. Bradykinin was shown to exhaust and impair the metabolic pulmonary activity. The conclusion is that the indices of the kallikrein-kinin blood system reflect the integrity of the pulmonary metabolic activity and can be biochemical markers of an acute pulmonary lesion.
Acute Disease↗
[Choice of the parameters of artificial ventilation in patients with acute respiratory distress syndrome].
The paper presents the results of use of two modes of controlled artificial ventilation (ALV) in adult patients with acute respiratory distress syndrome of various genesis: 1) ALV with its controlled volume, the descending pattern of inspiratory flow, the limitation of respiratory volume in the airways (RV, 6-8 ml/kg; Ptr.peak < 30 cm H2O), 2) ALV with its controlled volume, the orthogonal pattern of inspiratory flow (RV, 12-15 ml/kg, Ptr.peak > 35 cm H2O). It also shows the advantages and disadvantages of these respiratory procedures in this group of patients.
Adult↗
[Postpartum emergencies: some aspects].
The critical states occurring during pregnancy, labor, and early puerperium were analyzed. Seventy puerperas treated at intensive care units (ICU) were examined. The patients were divided into 5 groups: 1) those with preeclampsia (n = 15); 2) eclampsia (n = 22); 3) massive blood loss (n = 17); 4) pyoseptic complications (n = 10); 5) acute respiratory failure (n = 6). The APACHE II scale severity was 22 +/- 5.3 scores. The mean age of puerperas is 29.2 +/- 7.2 years. Total mortality was 14.3%. Parametric and non-parametric statistic methods were used to analyze the reasons for referral of the patients to ICU, their age composition, the association of an outcome to the time of their referral to ICU, the duration of stay there and at hospital, mortality, the time of controlled ventilation, the incidence of multiorgan failure. The common reasons for referral of the puerperas from maternity homes to ICU were eclampsia, preeclampsia, and massive blood loss. Acute respiratory distress syndrome (52.9%), encephalopathy (44.3%), coma (47.1%), and intestinal insufficiency (38.6%) were predominant in the pattern of multiorgan failure in intensive care obstetric patients. When emergencies occurred in puerperas, earlier referral from maternal homes to ICU caused a reduction in mortality from 33.% at referral on day 3 after their occurrence to 23.5% at referral on day 2, and to 11.5 at referral on day 1.
Adult↗
[Use of the solutions of hydroxyethyl starch and reamberin in the combined treatment of severe gestosis].
The effects of the solutions of hydroethyl starch (HES) and reamberin on hemodynamics, metabolism, and water-sector disorders were studied in patients with severe gestosis. The study covered 42 puerperas who were divided into 3 groups: 1) 10 patients with severe gestosis and normal acid-alkali balance (AAB); 2) 10 with severe gestosis and metabolic acidosis; 3) 22 pueperas with physiological single pregnancy (a control group). Group 1 patients were given infusions of 6% HES solution, 5-6 ml/kg; Group 2 received in addition to 6% HES solution in the above dose infusions of 1.5% reamberin solution, 5 ml/kg. In patients with severe gestosis, hemodynamic, water-sector, and metabolic monitoring on puerperal days 1-5 were found to identify changes in oxygen supply and consumption, water balance, and AAB. In Group 1 patients, HES infusion on days 1-2 after delivery decreased the content of systemic water, extracellular and interstitial fluid, increased oxygen supply; in Group 2, combined infusion therapy with GES and reamberin on puerperal days 1-2 led to an increase in oxygen supply and consumption and a reduction in interstitial hyperhydration and to normalization of AAB.
Acid-Base Equilibrium↗