[Prognostic criteria of the premature infants weaning from mechanical ventilation during trigger ventilation].

UNLABELLED: Modern mechanical ventilation modes do not prevent ventilator-associated lung injury therefore respiratory cessation must be stopped as soon as possible. However extubation recommendations absence makes difficulties in process of weaning the infants from the mechanical ventilation. RESEARCH OBJECTIVE: To assess the prognostic criteria of the extubating and weaning from mechanical ventilation in premature infants during trigger ventilation (PSV/PSV + VG). METHODS: 66 Pediatric patients were divided into two groups during the period of weaning from mechanical ventilation: PSV + PG ventilation mode was used in the group 1 (n = 33), and PSV in the group 2 (n = 33). Basic characteristics were same in both groups: gestational age 31.1 +/- 2.5 weeks, mass of body 1586.2 +/- 356.8 grams. Extubation was successful if reintubation was not needed during 48 hrs. RESULTS: 90% of successful extubations were done when the compliance was over 1.1 ml mbar(-1). Compliance decrease under 0.75 ml mbar(-1) was an adverse prognostic criterion of the weaning from mechanical ventilation and extubation. Index breathing rate/breathing volume (RVR) can be used as general criterion of the weaning from mechanical ventilation. Progressive RVR increase to 8 is an adverse prognostic criterion of PSV/ PSV + VG mode use during the period of weaning from mechanical ventilation. Parameters of mechanical ventilation which maintain acceptable gas composition of blood and SpO2 mast be considered before extubation. CONCLUSION: Positive dynamics and stabilization of compliance and resistance are essential criteria of the successful weaning from mechanical ventilation and extubation. RVR can be used as objective criterion of an extubation.

[Controlled mechanical lung ventilation with guaranteed volume in newborns].

Mechanical ventilation with guaranteed volumes combines advantages of time-cyclic ventilation with limitation of pressure and constant flow, with volume control ventilation. This symbiosis allows to choose the optimal, stable breathing volume of the newborn, while maintaining pressure control. The review presents the principles of work, the main advantages and limitations of ventilation systems with the guaranteed volumes, as well as results and analysis of studies.

[Principles of nutritional support of critically ill premature infants].

The efficacy of the breast milk fortifier Friso versus breastfeeding only was studied in premature very low birthweight babies without congenital malformations. Product tolerability, blood biochemical parameters, physical developmental indices, and the length of respiratory support and intensive care unit (ICU) stay were estimated. Twenty-seven infants at 36 weeks post-conception age were followed up. Fortifier supplementation was found to improve physical development indices (body weight and head and chest circumferences) in the first month of life. Energy feeding output reduced the length of ICU stay and the time of parenteral feeding.

[Induction of anesthesia with halogen-containing anesthetic agents in children].

The study has comparatively evaluated the effectiveness and safety of halothane, enflurane, and isoflurane in children during induction. Seventy hundred and eight patients aged 1-14 years who had ASA I-II anesthetic risks were examined. Gas induction was performed as monoanesthesia through the semi-open circuit with high gas flow (100% O2 6 l/min) in combination with halothane (n = 236), enflurane (n = 236), or isoflurane (n = 236) without N2O. The authors have compared the following criteria: the speed and comfort of induction, the parameters of hemodynamics and external respiration, and the rate of adverse reactions and complications during induction. The studies have established that in terms of comfort, safety, and the rate clinical effect achievement, the drugs of choice for gas induction in children are enflurane and, to a lesser extent, halothane. Gas induction with isoflurane should not be performed in children since the agent rather frequently exerts an irritant action on the upper airways, which reduces the speed of initial narcosis and increases the likelihood of one or another adverse reactions; however; it has advantages as a less hemodynamic effect.

[Effects of polymer materials in a furniture factory on the development of mycoses in workers]. / Vliianie polimernykh materialov mebel'nogo proizvodstva na razvitie mikozov u rabochikh.

Workers engaged in furniture making suffer from foot mycosis 2.5 times more often than those having no contact with polymers; patients with occupational skin diseases suffer from this disease 2.4 times more often than other workers. The analysis of skin samples and specific allergic diagnosis show that sensitization to fungi and occupational allergens is significantly higher among those contacting with polymers used in furniture making. Mycotic infection greatly raises sensitivity to occupational allergens. Exposure to polymers significantly increases sensitizing effect of foot mycosis pathogens on workers' organisms. This factor can be regarded as a predisposition to the development of mycotic infection.

[Hemodynamic disorders and their correction in the newborn following abdominal surgery]. / Narusheniia gemodinamiki i ikh korrektsiia u novorozhdennykh posle operatsii na organakh briushnoi polosti.

Central hemodynamics was studied, using echocardiography and dopplercardiometry in 48 newborn operated on the abdominal organs. General regularities of hemodynamic changes in the first postoperative hours irrespective of the initial type of circulation have been established. Two types of cardiovascular system response to the operation stress are described; an increase and a drop in the cardiac output, which is extremely important for the diagnosis of impaired compensatory-adaptive mechanisms in the newborn. Special attention was paid to the assessment of the adequacy of the infusion therapy. Volume-load test facilitates the diagnosis of latent heart failure. Timely prescription of cardiotonic drugs and differential approach to infusion therapy prevent the onset of circulatory disturbances.

[A trial of the use of the Russian surfactant Surfactant HL for treating the respiratory distress syndrome in newborn infants]. / Opyt primeneniia otechestvennogo surfaktanta "Surfaktant HL" dlia lecheniia respiratornogo distress-sindroma novorozhdennykh.

HL surfactant was used for vital indications in 12 newborns with respiratory distress syndrome born at 28-36 weeks weighing 1000-2500 g at birth and postgestation age of up to 48 h, without apparent congenital diseases and evident signs of intrauterine infection and with intraventricular hemorrhages no more severe than of the second degree. Control group consisted of 12 babies with similar condition treated similarly but without surfactant. Surfactant HL was administered endotracheally in a dose of 50 mg/kg twice at 12-h interval. Good effect was attained in 4 newborns, stable deterioration in 2, and no effect in 6 children. The majority of artificial ventilation values were virtually the same in both groups, but 2 days after surfactant, FiO2 was significantly lower in the controls than in experimental group (0.37 +/- 0.05 vs. 0.64 +/- 0.4, p < 0.01), and VEI was higher in the controls (0.33 +/- 0.05 vs. 0.18 +/- 0.03, p < 0.05). VR, MAP, FiO2, and oxygenation index decreased slower in the test group than in the controls. The mean duration of treatment with hypoxic gaseous mixtures and artificial ventilation of the lungs in the test vs. control group were 143 +/- 60 and 288 +/- 45 h vs. 45.5 +/- 8.3 and 200.8 +/- 28.5 h, respectively. The incidence of air leakage syndrome was 83% (10 cases) in the test group and 17% (2 cases) in the control group, chronic pulmonary diseases developed in 3 (25%) babies in the test and in 1 (8.3%) in the control group. Seven (67%) children in the test group developed obstructive changes in the lungs vs. 1 child in the control group. One child (test group) died from causes other than pulmonary. Hospital stay was longer in the test group than in control (14.8 +/- 1.7 vs. 8.3 +/- 1.3 days, p < 0.01).

[Use of Exosurf Neonatal, a synthetic surfactant, in the treatment of respiratory distress syndrome in the newborn]. / Primenenie sinteticheskogo surfaktanta "Ekzosurf Neonatal" pri lechenii sindroma dykhatel'nykh rasstroistv u novorozhdennykh.

The efficacy of double endotracheal administration of a synthetic surfactant Exosurf Neonatal was assessed in the treatment of 47 newborns with grave forms of the respiratory distress syndrome. The drug was injected during the first day of life to babies born after gestation period of up to 36 weeks kept on forced ventilation of the lungs. The drug dose was 5 ml/kg b.w. Gaseous composition of the blood, parameters of ventilation and hemodynamics were monitored over the course of treatment. The surfactant improved the gas-exchange function of the lungs and the respiratory mechanics, which manifested by improvement of the alveolar-arterial index and the ventilation efficacy index. A rapid improvement of the parameters of artificial ventilation in infants administered this surfactant led to twofold reduction of the incidence of complications caused by air outflow from the lungs and threefold reduction of the incidence of bronchopulmonary dysplasia. By days 7 and 28 of life the survival of children administered the surfactant was two times higher than in the control group.

[Evaluation of the effectiveness of slow-flow anesthesia in children]. / Otsenka éffektivnosti metoda nizkopotochnoi anestezii u detei.

Combined total anesthesia by a slow flow of fresh gas (slow-flow anesthesia) was used in 98 children aged 1-14 years with various surgical diseases. The advantages of this method consist in a lower loss of humor and heat from the child's airways during surgery, a lower contamination of the air in the operation room, and a lower cost of anesthesia. If properly monitored, such anesthesia is a sufficiently effective and safe method of inhalation anesthesia, which can be used with good results in routine pediatric surgery.

[Laryngeal lesions in secondary cutaneous and mucosal syphilis]. / Porazheniia gortani pri vtorichnom sifilise kozhi i slizistykh obolochek.

Clinical variants of laryngeal lesions in patients with early syphilis are reviewed. A case of secondary syphilis with a laryngeal lesion is reported in a female who developed aphonia. Basing on laryngoscopic findings, an otorhinolaryngologist made the diagnosis "chronic laryngitis, singer's nodules". The authors infer that painless laryngitis of long duration without signs of inflammation and resistant to standard treatment should be tested for syphilitic etiology. Therefore, the patient's blood should be taken for Wasserman reaction while the patient should be consulted by venereologist.

[Comparative effectiveness of current pathogenetic methods of treating neurodermatitis]. / Sravnitel'naia éffektivnost' sovremennykh patogeneticheskikh metodov lecheniia neirodermita.

The authors compare various present-day pathogenetic methods used in the treatment of 258 patients with disseminated neurodermatitis (81 cases with the atopic form and 177 ones with the nonatopic form). Clinical and laboratory studies have demonstrated the efficacy of adrenoblockers, pyrroxan and butyroxan, included in multiple-modality therapy for patients with manifest disorders of the autonomic nervous system. Combinations of glycyrrham and voltaren and decimetric wave exposure of the adrenal area have been also effective, as well as parmidine, an antibradykinin drug, in a daily dose of 2.0 g. In the most severe and stubborn cases corticosteroids may be administered; the schemes of therapy should be sparing and physiological, with the drugs given every other day, this helping reduce the total dose of the drug.

[The immunocorrective and detoxifying actions of hemosorption, plasmapheresis and enterosorption in pemphigus]. / Izuchenie immunokorrigiruiushchego i detoksitsiruiushchego deistviia gemosorbtsii, plazmafereza i énterosorbtsii pri puzyrchatke.

Immunity system changes and intoxication characteristics were studied in two groups of patients with pemphigus treated with traditional methods (group 1, 14 patients) and routine therapy combined with hemoperfusion, plasmapheresis, and enterosorption (group 2, 12 patients). During exacerbation pemphigus patients develop manifest changes in the immunity status in the presence of endotoxicosis. Introduction of hemoperfusion, plasmapheresis, and enterosorption in the complexes of treatment of pemphigus patients activates erosion epithelialization, helps sooner reduce the doses of corticosteroids whose total dose is reduced by 39 percent, improves cell-mediated and humoral immunity parameters, and is conducive to a more favorable time course of the body intoxication parameters.