[Emergency obstetrics: the resuscitation mobile center experience].

This article is devoted to topical problem in obstetrics critical states therapy and reflects long-term experience of resuscitation mobile center of S.P. Botkin hospital. Epidemiology of critical state in obstetrics and modern approaches to treatment of these conditions are considered on a voluminous clinical data. Mobile telemedical complexes and multidisciplinary consultations are used for decision-making optimization in difficult clinical situations. The modern concept of anaesthesiology safety level increase is presented. This organizational approach, mobile forms of anaesthesiology and resuscitation care are utterly effective and economically reasonable in Moscow obstetric care system.

[Clinical effectiveness of the infusion therapy under control of the transesophageal dopplerography in acute period of severe combined trauma].

In 72 patients with combined trauma the impact of volume and consistence of infusion therapy on severity of the disease, frequency and severity of infectious complications, duration of MV and ICU stay was assessed. The patients were divided into 2 groups depending on the volemic status control method and infusion algorithm. The main group (35 patients) was controlled by transesophageal dopplerography Cardio Q apparatus ("Deltex Medical", GB) and the infusion therapy was carried out under the control of stroke volume and Ftc. In the control group (37 patients) the volemic status was assessed clinically: BP, CVP, HR, diuresis. The volume of the infusion therapy during the first 12 hours in the main group was significantly higher than in the control group which proved that patients were suffering from hypovolemia, which was not diagnosed by traditional clinical criteria. The ICU stay in the main group was significantly shorter compared to the control group 15.3 +/- 8.2 and 29.5 +/- 10.4 days respectively. Infectious complications occurred in 12 patients out of 35 in main group and 25 out of 37 in the control group. The conclusion of this study is that infusion therapy control with central hemodynamic parameters can shorten the MV time and ICU stay an lower the rate of infectious complications in patients with combined trauma. A mortality decrease in patients with transesophageal dopplerography controlled infusion is not shown.

[Hemodynamic efficacy of modified gelatin in patients with acute blood loss and sepsis].

The paper presents the results of a clinical trial using the new modified gelatin-based drug hemofusin to correct dyshidria in patients with blood loss and sepsis. Based on the findings, the authors provide evidence for the high clinical efficacy of this drug and the expediency of its incorporation into a complex of infusion therapy in this patient contingent.

[Effect of hyperosmolar solutions on partial pressure of oxygen in arterial blood].

The study was undertaken to define the effect of hyperosmolar solutions on arterial blood oxygen levels. Analysis of arterial blood oxygenation after hyperosmolar solution infusions revealed a drop in partial pressure of oxygen (132.14 +/- 70.36, 120.0 +/- 66.48, and 119.24 +/- 70.10 mm Hg). At the same time there was a reduction in the extravascular lung water index (p < 0.05) as compared with the baseline values (7.93 +/- 2.17, 7.31 +/- 1.7), and Z62 +/- 1.99 ml/kg), respectively. This effect is particularly marked in a group of patients in whom the arterial blood content of oxygen is in the lower normal range. To evaluate and eliminate the above effect in reducing the arterial blood level, it is necessary to estimate respiratory indices during hyperosmolar solution infusion.

[Use of albumin in infusion-transfusion therapy for acute brain injury].

The investigation is aimed at determining whether it is necessary to include 20% albumin preparations into infusion-transfusion therapy for acute intracranial hemorrhage. An insignificant improvement of central hemodynamic parameters was shown in a group wherein 20% albumin solution was used. At the same time there was a significant increase in the pulmonary extravascular water index as compared with a control group (10.1 +/- 0.5 and 9.0 +/- 0.22 ml/kg, respectively; with no differences in the severity of lung injury, LIS was 0.71 +/- 0.23 scores; while in the group receiving no albumin solution it was 0.65 +/- 0.06 scores. Thus, the routine use of 20% albumin preparation as part of infusion-transfusion therapy for acute intracranial hemorrhage is not effective and rather safe.