[Dilatation tracheostomy in patients with hemorrhagic syndrome]. / Osobennosti dilatatsionnoi trakheostomii u bol'nykh s gemorragicheskim sindromom.

Specific features of dilatation tracheostomy (DTS) were studied in 45 patients with hemorrhagic syndrome; 37 of them had thrombocytopenia; 6 patients had thrombocytopenia and disseminated intravascular coagulation (DIC); and 2 patients had congenital coagulopathy. Besides, there were patients, among the examined ones, with hemoblastosis (36), with idiopathic thrombocytopenic purpura (1), with aplastic anemia (1), with HELLP-syndrome (1), with diabetes mellitus (1), with rheumatoid arthritis, with stomach cancer (2) and with hemophilia A (2). Commercial sets were made use of for DTS ("Portex"). DTS can be safely made provided the blood platelets' level is not below 40-50 x 10(9), and the time of bleeding is below 3 min; in hemophilia, the procedure is possible after the administration factor's preparations; and in DIC--after plasma transfusion and after ensuring the normal coagulation. Obturation of lumens of the trachea and bronchi with blood grumes is an often complication in DTS, which makes it necessary to make bronchoscopy immediately after DTS.

[Noninvasive ventilation of the lungs in the treatment of acute respiratory failure in immunocompromised patients]. / Neinvazivnaia ventiliatsiia legkikh v lechenii ostroi dykhatel'noi nedostatochnosti u immunokomprometirovannykh bol'nykh.

The purpose of this study was to evaluate the efficiency and place of noninvasive ventilation of the lungs (NVL) in the treatment of hypoxemic acute respiratory failure (ARF) in patients with tumorous diseases of the blood. The study was carried out in 12 patients (3 men and 9 women) with tumorous diseases of the blood system, in whom NVL was used for treating ARF. Central hemodynamic and oxygen transport parameters were studied using Swan-Hanz catheter. NVL was uneventfully carried out in 5 (41.7%) of 12 patients (group 1). Group 2 consisted of 7 patients intubated after the beginning of NVL: 2 had to be transferred to forced ventilation of the lungs (FVL) because of loss of consciousness and 5 because of augmenting severity of ARD. All patients transferred to FVL died. During the first 3 h of NVL, oxygen delivery increased from 371.3 +/- 84.9 to 443.9 +/- 92.7 gm/m2 and oxygen consumption from 123.9 +/- 35.9 to 173.5 +/- 34 m/m2, oxygen alveolar-arterial difference decreased from 400.8 +/- 165.3 to 210 +/- 57.5 mm Hg, pulmonary shunt from 41.8 +/- 11.9 to 19 +/- 7.9%, PaO2/FiO2 from 140.4 +/- 210 +/- 84.9, left-ventricular stroke index increased from 38.2 +/- 14.9 to 50.6 +/- 21.8 ml/m2, left-ventricular output index from 37 +/- 19.5 to 47.4 +/- 23.7 gm/m2, and heart rate decreased from 119.2 +/- 17.5 to 111.4 +/- 23.8 min-1. In group 2 greater fraction of inhaled oxygen and higher positive pressure at the end of inspiration were required than in group 1. Heart rate and oxygen alveolar-arterial difference were higher in group 2. Side effects of NVL were skin maceration, hematomas on the bridge of the nose, and conjunctivitis. A specific complication associated with thrombocytopenia was the hemorrhagic syndrome (nasal bleeding, hemorrhagic stomatitis). Hence, NVL is the first stage of respiratory support in hypoxemic ARF. In immunocompromised patients NVL is effective only in cases when the cause of damage to the lung is rapidly diagnosed and effective pathogenetic therapy promptly started.

[Comparative evaluation of different tracheal accesses for artificial ventilation of the lungs in patients with depressed hematopoiesis]. / Sravnitel'naia otsenka razlichnykh dostupov k trakhee dlia provedeniia IVL u bol'nykh s depressiiami krovetvoreniia.

The purpose of this study was to analyze the complications and errors in tracheal intubation and tracheostomy, development of algorithm of steps for provision of endotracheal access in patients with hematological diseases. Provision of endotracheal access in 115 patients with blood system diseases is analyzed retrospectively. A total of 113 orotracheal, 50 nasotracheal intubations, and 48 tracheostomies were carried out. In 6 patients fibrobronchoscope was used for intubation because of pronounced hemorrhagic syndrome, inflammatory changes, and soft tissue edema of the face and neck; in 2 patients tracheostoma was inserted under local anesthesia. In 12 patients nasotracheal intubation was complicated by nasal bleeding. The most frequent and serious complication in patients with a tube in the trachea was obturation of the tube with sputum (9.7% of orotracheal intubations, 30% of nasotracheal intubations, and 15% of tracheostomas). Extubation/decannulation was carried out in 20 patients. One patient developed cicatricial stenosis of the trachea after tracheostoma. Hemorrhagic tracheobronchitis was endoscopically diagnosed most often (in 55 cases). Autopsy showed hemorrhages in the mucosa in 68.2%, in soft tissues adjacent to tracheostoma in 41.4%, and suppurative inflammation in 15.2% cases. Hence, hemorrhagic tracheobronchitis, hemorrhages in the mucosa, soft tissues of the trachea and bronchi are the most frequent clinical and morphological complications in patients with depressed hemopoiesis. Indications for nasotracheal intubation in this patient population should be limited. Early tracheostomy is recommended. Algorithm of steps ensuring the patency of airways in patients subjected to forced ventilation of the lungs is offered.

[The initial experience of using isolated ultrafiltration of the blood for the correction of severe respiratory failure in hemoblastosis patients]. / Pervyi opyt primeneniia izolirovannoi ul'trafil'tratsii krovi dlia korrektsii tiazheloi dykhatel'noi nedostatochnosti u bol'nykh gemoblastozami.

To correct acute respiratory failure in patients with hemoblastoses and taking into consideration the low efficacy of standard techniques, 8 operations of isolated ultrafiltration combined with low-flow extracorporeal oxygenation in 6 patients were performed. The first results have been analyzed. To attain the maximum positive result, it is recommended that the method may be included earlier in a complex of intensive therapy measures.

[Systemic oxygen transport in patients with myelotoxic agranulocytosis]. / Sistemnyi transport kisloroda u bol'nykh s mielotoksicheskim agranulotsitozom.

The paper presents data on central hemodynamics, blood pulmonary shunting and evaluation of oxygen transport in 30 patients with myelotoxic agranulocytosis. In early agranulocytosis (fourteen cases) there was evidence of a drastic increase in pulmonary shunting, reduced stroke and cardiac indices, oxygen transport and its tissue utilization. By day 5-6 the disturbed parameters returned to normal values. It is noted that a phasic course of agranulocytosis implies time-related differential therapy.

[Intensive therapy of critical states in the hematology clinic]. / Intensivnaia terapiia kriticheskikh sostoianii v gematologicheskoi klinike.

An attempt was made to outline a program of intensive care on the basis of experience with 396 patients with hematologic diseases admitted in a critical condition (shock of various genesis, mainly bacterial, acute liver and renal insufficiency, spontaneous hemorrhage, etc.) taking into account the characteristic signs of such patients. The percentage of patients transferred to the hematology department rose from 36.2 to 47.9% as a result of 14-year experience. A conclusion was made of the appropriateness of such a department in each major inpatient hematologic clinic.