Arterial Blood Gas Composition Research Articles

Silent hypoxemia – A specific sign of COVID-associated pneumonia?

Introduction. Pneumonia is a frequent manifestation of coronavirus infection. COVID-associated pneumonia is a disease characterized by a non-standard course and a number of clinical phenomena that complicate timely diagnosis and treatment.Aim. To investigate the phenomenon of mute hypoxemia in COVID-associated pneumonia.Materials and methods. The study included 214 patients who were divided into 2 groups. The study group included patients with confirmed COVID-associated pneumonia, and the control group included patients with interstitial lung diseases (idiopathic pulmonary fibrosis, nonspecific interstitial pneumonia, hypersensitivity pneumonitis). The subjective condition of the patient, presence of concomitant pathology, high-resolution computed tomography data, arterial blood gas composition, and spirometry data were evaluated.Results. In patients with COVID-associated pneumonia, “silent hypoxemia” was encountered 1.3 times more frequently than in patients with non-COVID-associated pneumonia. When comparing patients with silent hypoxemia and hypoxemia with dyspnea in COVID-associated pneumonia, statistically significantly higher values of PaCO2 and lower values of respiratory rate are observed. Such patterns are not detected in non-COVID-associated pneumonia. In patients with silent hypoxemia in non-COVID-associated pneumonia, the respiratory rate is statistically significantly higher compared to patients with COVID-associated pneumonia. Univariate logistic regression analysis demonstrates that in patients with non-COVID-associated pneumonia, silent hypoxemia is associated with BMI increase (OR = 1.380 (95% CI: 1.058–1.801); p = 0.017).Conclusion. The phenomenon of “silent hypoxemia” may manifest not only in pulmonary impairments resulting from SARS-CoV-2 infection but notably in COVID-associated pneumonia, where the absence of patient-reported dyspnea is substantiated by the lack of tachypnea. Owing to the subtleties of “silent hypoxemia”, clinical presentations may exhibit delays, diverting attention from significant pulmonary compromise, which could subsequently precipitate the failure of compensatory mechanisms.

Acute chemical pulmonary edema with inhaled nitrogen dioxide intoxication

Nitrogen dioxide is released by the interaction of some metals with nitric acid. Inhalation intoxication with nitrogen dioxide leads to chemical pulmonary edema. This study presents the case of a patient who had acute inhalation exposure to an unidentified brown gaseous substance (presumably nitrogen dioxide) when he etched a metal product with nitric acid. Twenty-four hours after contact with the gas, he manifested signs of intoxication, such as chest pain, tachypnea, and decreased saturation. Laboratory tests revealed hemoconcentration, hyperfermentemia, and arterial hypoxemia. The X-ray image of the entire lung surface revealed a sharp increase and deformation of the pulmonary pattern due to the vascular component. The diagnosis was T65, i.e., toxic effect of other and unspecified substances. With treatment, the patients condition improved. On day 4 after therapeutic exposure, with decreased oxygen fraction in the inhaled gas mixture to 0.3, the saturation increased to 98%, and tachypnea disappeared. On day 6, with ongoing treatment (oxygen therapy, use of antioxidants, antihypoxants, anti-inflammatory, and antibacterial drugs), the inflammatory reaction stopped, the rheological properties of the blood improved, and the gas composition of arterial blood normalized, i.e., the oxygenation index was 436, which indicated the disappearance of arterial blood oxygenation disorders. During the radiological examination, the normal radiological picture of the lungs was determined. Thus, on day 6 after the start of therapy, signs of intoxication were completely stopped. Specific changes in the lungs during radiation research techniques, hemoconcentration, inflammation, and hypoxemia during laboratory blood tests should be considered prognostic signs of chemical pulmonary edema. As a pathogenetic therapy, treatment must be supplemented with drugs that stop the cascade of free radical oxidation reactions (acetylcysteine and sodium thiosulfate). Individuals exposed to nitrogen dioxide should be considered a high-risk group for lung damage and hospitalized for dynamic observation for at least 2 days. Taking into account the genotoxic effects of nitrogen dioxide, affected patients should be classified as at risk of developing neoplasms and undergo further dynamic monitoring.

The effect of halogen-containing anesthetics on the indicators of the gas composition of the blood of horses

The aim of the work was to determine the parameters of the gas composition and acidbase state (CBS) of blood to assess the adequacy of general anesthesia of horses with halogen-containing anesthetics in clinical and instrumental studies. The object of the study was 18 horses aged four to six years, which were castrated. The paper compared the dynamics of blood gas composition indicators at various stages of inhalation anesthesia with fluorotane, isoflurane and sevoflurane in order to prevent and timely detect hypoxemia and hypercapnia in horses. Based on a comprehensive assessment of the clinical examination data, laboratory studies of the gas composition of arterial blood, objectively determine the severity of hypoxemia and hypercapnia, which made it possible to provide the necessary assistance to the animal in a timely manner. The study of blood gas composition indicators has established that the amount of carbon dioxide tension in arterial blood (РaСO2) with both types of anesthesia is subject to the greatest changes during induction and during awakening. During the induction period, it increased both with the inhalation of fluorotane and with the use of isoflurane and sevoflurane, respectively, by 41%, 3.1% and 3.4% compared to the initial values. During the period of awakening, the value of РaСO2 returned to the initial level with anesthesia with isoflurane, with anesthesia with sevoflurane and fluorotane remained above the initial values by 21.8% and 42.8%, respectively. Early detection of signs of hypoxemia and hypercapnia made it possible to avoid the development of further complications during general anesthesia in horses

Pulmonary contusion: clinical reasoning

According to statistics, chest injuries rank third in prevalence and are characterized by high mortality, which is 35 – 45%. This article presents a patient diagnosed and treated for bilateral pulmonary contusion with post-traumatic pneumonitis after a combined mine-explosive injury. Purpose. Of particular interest to the clinician is the understanding of lung injury from the standpoint of interpretation of diagnosis, methods of diagnosis, and differential diagnosis with pneumonia, prevention of complications, and rational treatment tactics. The terms “pneumonitis” and “pneumonia” are not synonymous. In modern terminology, it is customary to use the term pneumonitis for a pathologic process in the alveoli without an infectious process in the vast majority of cases, and infectious forms of pulmonary inflammation are referred to as pneumonia. In this clinical case (and in similar situations), it is advisable to take into account the pathogenesis of changes in lung tissue after pulmonary contusion, leading to post-traumatic pneumonitis, which often requires additional specific therapy and rehabilitation for rapid recovery of lung function. Proper tactics in prescribing anti-inflammatory and antibacterial drugs are critical, as is treatment aimed at preventing complications, including prevention of fibrous changes in the lung. Conclusion. Given the relevance of this topic, it is currently advisable to introduce monitoring of CRP and procalcitonin levels, coagulogram, and gas composition of arterial blood, if necessary, in the patient management. It is advisable to use computed tomography to clarify the nature of the changes. The problem of follow-up and rehabilitation of patients with chest injuries and pulmonary contusion is relevant.

ВЛИЯНИЕ ВИДА АНЕСТЕЗИИ НА ПОКАЗАТЕЛИ КРОВООБРАЩЕНИЯ У КРЫС

The study aims to detect the effects of non-inhaled anesthetics of two different types on the parameters of the central hemodynamics and microcirculation in an occlusive reactive hyperemia test in two groups of male Wistar rats weighting 400–500 g. The “ChH” group received 6 % chloral hydrate solution at a dose of 300 mg/kg intraperitoneally, while the “zol + xyl” group received 20 mg/kg of tiletamine/zolazepam (Zoletil 100, France) mixed with 5 mg/kg of xylazine (Xylanit, Russia) intraperitoneally. The following parameters were measured: blood pressure, average heart rate, duration of PQ, QRS, and QTc intervals according to the electrocardiography, cutaneous blood flow with laser Doppler flowmetry, arterial blood gas composition and acid-base state. The mean value of perfusion was recorded simultaneously with electrocardiography and blood pressure. The parameters of a post-occlusive reactive hyperemia were analyzed to conduct an occlusive reactive hyperemia test. Blood pressure was statistically significantly lower in “ChH” group than in “zol + xyl” group when analyzing the central hemodynamics parameters. The “ChH” group demonstrated higher maximum asodilation in reactive hyperemia (CVCmax) and time of its achievement (Tmax). Both types of anesthesia demonstrated compensated and subcompensated mixed acidosis and moderate arterial hypoxemia when comparing parameters of arterial blood gas composition and acid-base state in rats.

Comparison of Efficacy of Spontaneous Breathing with Pressure Support and Volume-Controlled Mandatory Ventilation during General Combined Anesthesia without Muscle Relaxants

To compare efficacy of spontaneous breathing with pressure support and volum e-c ontrolled mandatory ventilation during combined general anesthesia using desflurane and without muscle relaxants. Subjects and Methods. 100 patients were included in the study. All underwent lo w-t raumatic operations on the lower limbs under general combined anesthesia using supraglottic air devices without muscle relaxants. Immediately prior to the induction of anesthesia, patients were randomly divided into two groups: Group 1 ( VCV ) where a mandatory volume control mode was used ( n = 50) and Group 2 ( PSV ) where a pressure support mode was used ( n = 50). The following parameters were assessed: hemodynamics, gas exchange, depth of anesthesia before induction, during and after the end of general anesthesia; arterial blood gas composition one hour after induction of anesthesia; indicators of pressure in the respiratory tract during mechanical ventilation, as well as time parameters of awakening. Results. In patients of Group 2 ( PSV ), according to the analysis of arterial blood gases, a higher level of PaO 2 ( p = 0.006), Horowitz index ( p = 0.005), and carbon dioxide level ( p < 0.0001) were noted. In Group 1 ( VCV ), higher mean and peak airway pressures were found one hour after induction and 10 minutes before the end of surgery ( p < 0.05). Also in the groups, there were statistically significant differences in the time parameters of awakening (233 ± 58 sec and 352 ± 83 sec in the PSV and VCV groups, respectively), supraglottic airway device removal time (268 ± 62 sec and 398 ± 84 sec in the PSV and VCV groups, respectively) and transfer to the ward (395 ± 60 sec and 571 ± 66 sec in the PSV and VCV groups, respectively) ( p < 0.0001). There were no significant differences in the main parameters of hemodynamics and depth of anesthesia, the consumption of anesthetics used during induction and maintenance of general anesthesia. Conclusion: The use of spontaneous breathing with pressure support during general combined anesthesia without muscle relaxants has a number of advantages versus mandatory ventilation mode. These include better oxygenation rates, lower airway pressure, faster awakening, supraglottic airway device removal time, and transfer of the patient to the ward. At the same time, acceptable ventilation, stable hemodynamic parameters and depth of anesthesia are maintained.

Long-Term Conditioning of a Donor Heart by Autoperfusion

The aim of research was to study parameters of homeostasis and conditions for stable operation of the autoperfused heart-lung complex ex vivo.Materials and methods. A series of acute experiments (n-3) was carried out to create a functioning heart-lung complex and study parameters of homeostasis ex vivo. A large mammal (mini-pig weighed 20-30 kg) was used as an experimental model. During the experiment, invasive blood pressure in the aortic root, pulmonary artery, central venous pressure, temperature of the left ventricle of the heart, gas composition of arterial blood (in the aortic root) and venous blood flowing from the coronary sinus was monitored.Results. The series of experiments evidenced the fundamental possibility of an isolated heart-lung complex ex vivo stable functioning. During 4-hours autoperfusion of the "heart-lung" complex, the parameters of hemodynamics, gas and biochemical blood composition remained within the reference values.Conclusion. The analysis of literature data and the results of experiments on laboratory animals allow us to state that the autoperfusion can be successfully used as an option of safe and long-term conditioning of a donor heart. This technique can be used to improve the results of heart transplantation with prolonged ischemia of the donor organ. Extending the survival of a donor heart ex vivo functioning will significantly expand the geography of donor bases, reducing the ischemic period to a minimum.

AND INHALED ANESTHETICS ON THE INDICATORS OF THE GAS COMPOSITION OF THE BLOOD OF PIGS

The physiological characteristics of the pig organism determine the difficulties of general anesthesia. In this regard, the actual problem in providing adequate anesthesia in this type of animal is the prevention and control of respiratory and circulatory disorders. The aim of the work was to assess the adequacy of anesthesia in pigs according to the gas composition and acid-base state (CBS) of blood, which underwent surgical manipulations under general anesthesia during experimental studies. The object of the study was 16 pigs (6 boars, 10 sows) aged from four to six months. The work is devoted to comparing the dynamics of blood gas composition indicators at various stages of intravenous anesthesia with zoletil and inhalation anesthesia with isoflurane in order to prevent and timely detect hypoxemia and hypercapnia in pigs. The division of hypoxemia and hypercapnia by severity based on clinical symptoms, laboratory studies of the gas composition of arterial blood made it possible to objectively assess the condition of the animal and provide it with the necessary assistance in a timely manner. The study of the acid-base state of the blood showed that with both types of anesthesia, the greatest changes during induction and during awakening are affected by the amount of carbon dioxide tension in arterial blood (РaСO2). During the induction period, it increased both with the introduction of the zoletil and with the use of isoflurane, respectively, by 26.6% and 14.1% compared with the initial values. During the awakening period, the value of PaCO2 decreased by 10.7% compared to the previous value with anesthesia with zoletil and by 7.2% with inhalation of isoflurane.

Respiratory support in severe traumatic brain injury (literature review)

Patients with traumatic brain injury (TBI) are the largest group of victims at the emergency departments. Up to 20% of patients with severe TBI require endotracheal intubation and prolonged mechanical ventilation. The ventilation parameters choice should be focused on the normal arterial blood gas composition. Hypoxia causes secondary damage to the brain tissue, and hyperoxia carries risks of oxygen toxicity. Hypercapnia leads to cerebral vasodilatation, increased intracranial pressure (ICP) and the risk of cerebral edema. Hypocapnia promotes cerebral vasoconstriction, which reduces cerebral blood flow and ICP, but also leads to cerebral tissue ischemia, so prolonged hyperventilation in TBI is not currently recommended. Patients with TBI often require sedation to synchronize with the respirator. The drugs of choice are propofol and midazolam. Routine use of muscle relaxants is not recommended. The initial ventilation mode should provide a certain respiration rate to achieve normocapnia, while allowing the patient to make breathing attempts. Support ventilation modes are used while weaning from mechanical ventilation. Promising in predicting extubation success is the assessment of the VISAGE score, which includes visual pursuit, swallowing, age, and the Glasgow coma score. Modern principles of respiratory support in severe TBI include: tracheal intubation by Glasgow coma score ≤8 ; early mechanical ventilation; PaO2 80-120 mm Hg (SaO2 ≥95%); PaCO2 35-45 mm Hg; tidal volume ≤8 ml/kg; respiratory rate ≈20/min; PEEP ≥5 cm H2O; head elevation by 30°; sedation in poor synchronization with the respirator; weaning through support ventilation modes; extubation when reaching 3 points on the VISAGE scale; early (up to 4 days) tracheotomy in predicted extubation failure.

ASSESSMENT OF ARTERIAL BLOOD GAS COMPOSITION DEPENDING ON THE DEGREE OF MORBID OBESITY IN PATIENTS IN BARIATRIC SURGERY

Abstract. The work is devoted to the study of arterial blood gas parameters and comparison of capnographic determination of carbon dioxide at the end of exhalation (EtCO2) and the real pressure of carbon dioxide in arterial blood (paCO2) depending on the degree of morbid obesity in patients who were to undergo surgical bariatric interventions in 2012-2021. The study included 61 patients, whose age ranged from 22 to 69 years, body mass index from 40 to 91 kg/m2. The patients were divided into 3 groups depending on the degree of morbid obesity: group 1 - 20 patients with body mass index ≥ 40 (grade 3); group 2 - 25 patients with body mass index ≥ 50 (grade 4); group 3 - 16 patients with body mass index ≥ 60 (grade 5). Based on the data obtained, it was found that the state of the arterial blood gas composition indicates the presence of respiratory function disorders in patients with morbid obesity, which significantly reduce the compensatory capabilities of the body. Arterial hemoglobin saturation with oxygen (SaO2) tended to decrease, reaching a minimum in patients of the 1st group. The studied parameters of the arterial blood gas composition in patients of group 1 tended to worsen, and in patients of groups 2 and 3 they significantly worsened with an increase in the degree of morbid obesity. The maximum disruption of arterial blood gases was found in patients with a body mass index ≥ 60. The partial pressure of carbon dioxide at the end of exhalation (EtCO2) in patients with morbid obesity does not correspond to the partial pressure of carbon dioxide in arterial blood (paCO2).

Evaluation of the clinical efficacy of inhaled nitric oxide synthesized from natural air in conditions of thoracic surgical intervention on the lung tissue

Introduction. Despite the significant development of an-esthetic procedures in the XX–XXI centuries the problem of optimal one-lung ventilation (OLV) of comorbid pa-tients isn’t resolved. Occasionally, there would be a situa-tion when the resectable patient is functionally inoperable or has high risk of intra- and postoperative complications. This article provides one possible solution of this problem. Purpose of the study. To analyze the use of inhaled nitric oxide (INO) on the dependent lung in order to increase the oxygenation index in the clinical practice of thoracic surgery. Materials and research methods. This is a prospec-tive study of the influence of INO on oxyge nation during thoracic operations on the organs of the respiratory sys-tem. The study participants were divided into 2 groups, each comprised of 10 individuals. Group A received INO intraoperatively as part of a combined multicomponent general anesthesia; group B received standard combined multicomponent general anesthesia. All patients under-went analysis of the gas composition of arterial blood at 2 control points: the 1st one was 10 minutes after the be-ginning of OLV; the 2nd — 40 minutes after INO entered the respiratory circuit (immediately after receiving the result of the 1st control point). Research results. In the INO group an increasing of oxygenation index was observed in 8 out of 10 cases (p=0.022). In the control group an increasing of oxygenation index occured in 2 cases out of 10 (p=0.037). Conclusions. Based on the available data a positive cor-relation was found between the raise of oxygenation in-dex and the use of INO in conditions of ALV for thoracic interventions. It could potentially help to increase the number of operable patients, reduce operative risks and intraoperative time for the borderline operability group.

Establishing prognostic significance of hypoxia predictors in patients with acute cerebral pathology

ABSTRACT Objectives This research aims to study the prognostic role of serum S100 as a predictor of mortality in vascular and traumatic brain injuries. Methods This prospective cohort study involved 219 patients. In the blood serum, neuron-specific markers (S100, NSE) and glucose, acid-base state and gas composition of arterial blood were obtained at admission, on the 3rd, 5th and 7th days of patients' stay in the intensive care unit. Results The most significant risk factor for an unfavorable outcome is the marker S100 with a cut-off point of 0.2 mcg/l. The analysis results indicate a statistically significant direct relationship between S100 > 0.2 mcg/l and NSE ≥ 18.9 ng/ml compared to other variables, while the chance ratio (OR) is 11.9 (95%CI:3.2927-1.6693;). With blood sugar increase above 7.4 mmol/l, the OR is 3.82 (95% CI: 2.1289-0.5539;); with a Glasgow scale below 13 points, the OR is 3.69 (95% CI: 2.1316-0.4819;); with an increase in pCO2 < 43.5 mm Hg, the OR was 3.15 (95% CI: 1.8916- 0.4062;). The obtained model certainty measure according to pseudo R2 Nagelkerke criterion is 263.5, showing the excellent quality of the mathematical model’s predictive ability. The developed prognostic model, including the dependent variable S100 and independent variables as predictors of a poor outcome of NSE, pCO2, GCS and Hb, reached a cut-off point of 84.51%, AUC - 0.88 with high levels of sensitivity and specificity: 91.89% and 64.14%, respectively. Novelty This model can be used to predict the outcome in patients with acute cerebral pathology.

Analysis of blood gas composition indicators in premature babies with neonatal sepsis

The aim of the study was analysis of oxygen status of patients with neonatal sepsis during monitoring of premature infants.Materials and methods. Indicators of oxygen status of capillary blood were assessed in premature infants with neonatal sepsis who were treated at the Regional Perinatal Center in Khmelnytsky during 2017–2018. The study included mostly deeply premature babies, including those with extremely low weight. A full range of clinical and laboratory studies, including determination of oxygen status of capillary blood.Research results. Our results allow us to conclude that while such indicators as pH, pO2, BEb3, % SO2 do not change significantly, the trouble can be detected using indicators such as AdDO2, RI, PI, which reflect the state of oxygenation with impaired ventilation. -perfusion ratios, increased blood shunting and the processes of delivery and consumption of oxygen at the tissue level. The calculated indicator "PIP×FiO2" was less sensitive to assess changes in the lungs and did not correspond to the clinical picture of the severity of the patient's condition.Conclusion. Thus, the determination of AdDO2, RI, PI capillary blood can be used as informative indicators for determining the oxygen status in premature infants, which is of significant practical importance in terms of limited monitoring of the gas composition of arterial blood

Curcumin protects the pancreas from acute pancreatitis via the mitogen‑activated protein kinase signaling pathway.

Curcumin has been demonstrated to reduce markers of inflammation during acute pancreatitis (AP). However, the underlying mechanisms of the protective effects of curcumin are unknown. In the present study the effects of curcumin in an AP animal model and cell models was examined and the underlying mechanisms were investigated. An AP animal model was established by injection of 5% sodium taurocholate into the biliopancreatic duct of rats, and the cell model was established by treatment with 0.5 nM cerulein with an optimal concentration of lipopolysaccharide in AR42J rat pancreatic cancer cells. Amylase activity and arterial blood gas composition were assessed by automatic biochemical and blood gas analyzers. Pathological alteration of the pancreas was determined by hematoxylin and eosin staining. Interleukin (IL-6), tumor necrosis factor (TNF)-α and C-reactive protein (CRP) levels were measured by ELISA. Cell viability was determined by Cell Counting Kit-8 and protein expression levels were assessed by western blotting. Curcumin reduced the ascites volume after 12 and 24 h, the weight of pancreas after 12, 24 and 36 h of surgery, but also attenuated injury to the pancreas. Serum expression levels of TNF-α and CRP were reduced by curcumin. In addition, curcumin decreased the cell viability, amylase activity and the phosphorylation of p38 in AR42J cells, but did not affect the intracellular levels of IL-6 and TNF-α. Curcumin may lower the severity and inflammatory response via the mitogen-activated protein kinase-signaling pathway, to some extent. However, future studies are required to fully understand the protective effects of curcumin on AP.

Показатели кислотно-основного равновесия и газовый состав артериальной и венозной пуповинной крови в норме и при гипоксии плода

Показатели кислотно-основного равновесия и газовый состав артериальной и венозной пуповинной крови в норме и при гипоксии плода

ВЛИЯНИЕ ДЛИТЕЛЬНОЙ КИСЛОРОДОТЕРАПИИ НА КЛИНИЧЕСКОЕ ТЕЧЕНИЕ ЗАБОЛЕВАНИЯ И ФУНКЦИЮ ДИАФРАГМЫ У БОЛЬНЫХ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ С ГИПОКСЕМИЧЕСКОЙ ДЫХАТЕЛЬНОЙ НЕДОСТАТОЧНОСТЬЮ (ОПЫТ ТРЕХЛЕТНЕГО НАБЛЮДЕНИЯ)

The objective: to determine the effect of prolonged oxygen therapy (POT) on changes in the clinical and functional status of patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemic chronic respiratory failure. Subjects and methods. 30 patients with COPD were examined during the period of remission of the disease, the average age was 64.8 ± 6.9 years. After the initial examination, patients were prescribed POT at home for 16 hours/day. As a basic therapy, all patients received a combined bronchodilator of long-acting indacaterol/glycopyrronium at a dose of 110/50 μg once a day in combination with beclomethasone dipropionate (BDP) at the dose of 200-400 μg/day. The patients were examined repeatedly 3 times with a 1-year interval. Clinical indicators, gas composition of arterial blood, results of spirometry and ultrasound examination of the diaphragm were evaluated. Results. Initially, disorders of the functional state of the diaphragm were detected in COPD patients with hypoxemia (decrease in the thickening fraction and relaxation rate). After the first year of using POT, an increase in the rates of contraction and relaxation of the diaphragm muscle under tidal respiration was observed. On the 2nd and 3rd year of using POT, it was noted that indicators of the functional state of the diaphragm stabilized. As a result of POT, the number of exacerbations went down and mortality in COPD patients with hypoxemia decreased. Against the background of basic therapy with indacaterol/glycopyrronium in combination with low doses of BDP, no adverse events were observed for the entire period of follow-up. Conclusions. POT in combination with a double long-acting bronchodilator and low-dose inhaled glucocorticosteroids in COPD patients with hypoxemic chronic respiratory failure helps to reduce dyspnea, the number of severe exacerbations, as well as improve pulmonary ventilation functions, blood gas content, and the diaphragm function during the first year of its use. Further, the indicators continued to stabilize.

Optimization of choice of respiratory support the intensive care severe community-acquired pneumonia.

The purpose of study is the optimization of the choice of method of respiratory support in patients with severe community-acquired pneumonia (CAP) on admission to intensive care unit (ICU) on the basis of acid-alkaline indicators and arterial blood gas analysis. Material and methods. Depending on the method of the choice of respiratory support two groups of 350 people were formed. The first group (n = 350) - by the results of pulse oximetry (SatO2). The second group (n = 350) - in terms of acid-base and arterial blood gas analysis (pH, PO2, PCO2). To determine hypoxemia, pulse oximetry (heart monitor GOLDWAY G40), acid-alkali and gas composition of arterial blood (gas analyzer «MEDICA EasyStat») were used. In the ICU there were conducted three types of respiratory support: 1) oxygen therapy via orinasal mask 2) non-invasive mechanical ventilation (respirators «VENTimotion 2» and «Bipap Vision») 3) mechanical ventilation («Engstrom Carestation»). The criterion of effectiveness: recovery performance pulse oximetry, acid-base balance, and arterial blood gas analysis, the presence of positive clinical dynamics. Results. Choice of method of respiratory support in the gas composition of blood allowed to expand the indications for use NIV as a method of respiratory support in the treatment of patients with severe CAP, to ensure timely transfer and reduce the time finding patients on mechanical ventilation, to avoid damage due to hypoxia bodies - «target» with the development of multiple organ failure, and thus 4.3 times to reduce mortality and length of stay in the ICU of 1.7.

THE EDEMATOUS SYNDROME IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE OF LUNGS: MECHANISMS OF DEVELOPMENT AND APPROACHES TO TREATMENT

The problem of chronic obstructive pulmonary disease of lungs is actual and has no tendency to be resolved. The chronic obstructive disease of lungs is characterized by multitude of systemic manifestations. However, mechanisms of development of edematous syndrome under chronic obstructive pulmonary disease of lungs are studied insufficiently. The purpose. To study pathogenetic mechanisms of development of edematous syndrome in patients suffering of chronic obstructive pulmonary disease of lungs. Material and methods. The sampling of 35 patients with exacerbation of chronic obstructive disease of lungs was used to analyze structure and functions of heart, gas composition of arterial blood, functional conditions of kidneys. The cohort of patients was separated on group A and group B depending on response to start therapy. The patients with weak response to start therapy continued to receive respiratory support as an addition to medicinal therapyThe results. The groups of patients are comparable on anamnestic and clinical parameters. The patients of group B suffered from intensive edematous syndrome, and more intensive cyanosis. The patients from group A suffered from less intensive edema. The edema was present not in all patients. The parameters characterizing functional condition of heart had no group difference. The disturbances of gas composition of arterial blood and function of kidneys were less intensive in group B than in group A. The analysis of correlations established that intensity of edematous syndrome is directly related to velocity of glomerular filtration and velocity of glomerular filtration depended on parameters of gas exchangeConclusion. In patients with exacerbation of chronic obstructive pulmonary disease of lungs at retained systolic function of left ventricle development of edematous syndrome is conditioned by renal dysfunction.

Correlation analysis of gas and acid-base indices of arterial blood in the pathogenesis of experimental hepatopulmonary syndrome

The correlation analysis of indices of gas and acid-base composition of arterial blood in the pathogenesis of experimental hepatopulmonary syndrome was studied in the article. It was established a strong negative correlation between partial pressure of oxygen and AaDO2, positive moderate correlation between the plasma osmolarity and AaDO2 in animals of both experimental groups, the positive moderate correlation between the concentration of lactic acid and AaDO2 in animals with carbon tetrachloride-induced cirrhosis and strong correlation interaction between these parameters in rats the on 31st day after common bile duct ligation.

Use of the IntelliVent-ASV mode for maintaining the target EtCO2 range in patients with severe TBI

the study purpose was to evaluate the efficacy of the IntelliVent-ASV mode in maintaining the target range of PaCO2 in patients with severe TBI. The study included 12 severe TBI patients with the wakefulness level scored 4-9 (GCS). This was a crossover design study. Two ventilation modes were consecutively used: IntelliVent-ASV and P-CMV, for 12 h each. When using the P-CMV mode, the ventilation parameters were set to maintain PaCO2 in a range of 35-38 mm Hg. The IntelliVent-ASV mode involved the Brain Injury ventilation algorithm. The target range of EtCO2 was set in accordance with the delta PaCO2-EtCO2 to maintain PaCO2 in a range of 35-38. At the beginning of each ventilation period and every 3 hours, the arterial blood gas composition was analyzed. When PaCO2 occurred out of the 35-38 range, appropriate adjustments were made to the ventilation parameters. In the P-CMV mode, the Pinsp and RR parameters were adjusted to achieve the target PaCO2 range. In IntelliVent mode, a shift of the target EtCO2 range was adjusted in accordance with a changed PaCO2-EtCO2 difference. In all patients, ICP, blood pressure, and EtCO2 were monitored; the arterial blood gas composition was analyzed every 3 h; the frequency of manual settings of ventilation parameters was recorded. The EtCO2 and PaCO2 parameters were found not to be significantly different in the P-CMV and IntelliVent modes, but the spread in these parameters was significantly lower in the IntelliVent ventilation mode. The PaCO2 parameter occurred out of the target range significantly less often in the IntelliVent mode than in the P-CMV mode. The mean frequency of manual respirator settings needed to maintain the target EtCO2 range was significantly lower in the IntelliVent-ASV mode than in the P-CMV mode. The IntelliVent-ASV mode provides more efficient maintenance of PaCO2 in the target range compared to traditional artificial ventilation using fewer manual settings of the ventilation parameters.