[Relationship of disorders of transcapillary fluid exchange in the lungs and respiratory mechanics in postoperative pulmonary complications]. / Vzaimosviaz' narushenii transkapiliarnogo obmena zhidkosti v legkikh i mekhaniki dykhaniia s posleoperatsionnymi legochnymi oslozhneniiami.

The central hemodynamics, external respiration function, and transcapillary liquid exchange in the lungs were assessed in 23 patients operated on the lungs and in 18 subjected to open heart surgery. The content of extravascular liquid in the lungs was increased during the first hours postoperation in the patients with a complicated course of the postoperative period, in contrast to those with an uneventful course thereof. Disorders of transcapillary liquid exchange did not depend on the status of the central hemodynamics and probably reflected the increased permeability of the alveolocapillary membrane.

[Significance of the energetic value of respiration in the assessment of the degree of strain of compensatory mechanisms in respiratory insufficiency]. / Znachenie énergeticheskoi stoimosti dykhaniia pri otsenke stepeni napriazheniia kompensatornykh mekhanizmov pri dykhatel'noi nedostatochnosti.

A total of 170 examinations of the external respiration function were carried out in 114 patients with postoperative respiratory insufficiency (RI). The patients were examined during air respiration (FiO2 0.21). Pulmonary function was computer monitored. Thirty-four parameters were analyzed, which characterize pulmonary ventilation, gas exchange, respiratory mechanics, and metabolism. Three groups of patients were distinguished: with moderate, expressed, and maximal stages of energy compensation of RI. Augmentation of RI in the course of the postoperative period was found to be characterized by reduction of lung compliance and increase of aerodynamic resistance of the airways and specific and minute Decompensation of RI develops due to fatigue of the respiratory muscles under conditions of increased energy value of respiration, which is proved by the appearance of a reliable inverse correlation between the minute respiratory volume and increased inhalation and exhalation resistance and between respiratory volume and increased inhalation resistance and of a direct correlation between respiratory volume and lung compliance in patients during the maximal energy compensation of respiratory insufficiency. Hence, the energy value of respiration objectively reflects the strain of the compensatory mechanisms during respiratory insufficiency.

[Dynamics of the content of the pulmonary extravascular fluid during extracorporeal detoxication in critical state patients]. / Dinamika pokazatelia ob"ema vnesosudistoi zhidkosti legkikh pri provedenii ékstrakorporal'noi detoksikatsii u bol'nykh v kriticheskikh sostoianiiakh.

Time course of the content of interstitial, cellular, and total fluid in the lungs, of plasma osmolality and sodium concentration was studied in 20 patients with acute renal failure after repair surgery on the heart, thoracic and abdominal organs. Water balance of the lungs was studied by dissolution of electroimpedance indicators before and after removal of 2000-2500 ml of ultrafiltrate. Ultrafiltration of the blood in the course of hemodialysis (group 1) did not lead to a reliable reduction of the volume of intravascular fluid, whereas in group 2 a reliable reduction of the volume of interstitial fluid of the lungs by 34% and of the total liquid volume of the lungs by 29% occurred in the course of hemofiltration.

[Relationship between pulmonary circulation and respiratory mechanics in patients artificial pulmonary ventilation]. / Vzaimosviaz' legochnogo krovoobrashcheniia s mekhanikoi dykhaniia u bol'nykh na IBL.

Thirty-four patients in the early postoperative period after surgery on the lungs and mediastinum and 23 patients after cardiopulmonary bypass surgery have been examined. 187 studies of central hemodynamics and pulmonary function during cardiopulmonary bypass have been performed to investigate the correlation between pulmonary hemodynamics and parameters of respiratory mechanics in the early postoperative period after thoracic surgery. The studies have revealed reverse dependence of lung and chest compliance (C) on pulmonary artery diastolic pressure (PAPdiast) (r = -0.61, p < 0.05) in patients after thoracic surgery with clinical signs of cardiopulmonary failure. When analogous studies were performed in patients with intact lungs after aortocoronary bypass, C/PAPdiast correlation was more close (r = 0.880, p < 0.05). At the same time there is a correlation between C and extracellular fluid volume (r = -0.7). The above correlations to a great extent predetermine the pathogenesis of respiratory failure in the postoperative period.

[Clinical aspects of the use of nubain, tramal and moradol in patients in the early postoperative period]. / Klinicheskie aspekty primeneniia nubaina, tramala, moradola u bol'nykh v rannem posleoperatsionnom periode.

Opioid analgesics were used in 282 patients on the first-third day after heart, lung and abdominal surgery. The main indication for their use was pain syndrome. Adequate analgesia with tramal, nubain and moradol was noted in 73, 76 and 81% of cases. In marked pain syndrome after thoracotomy the most effective agents were moradol and morphine. Computer monitoring of the respiratory function in tramal analgesia has shown a decrease in lung ventilation, esophageal pressure, inhalation volume, O2 production. Tramal, nubain and moradol in analgesic doses did not inhibit respiration. In adequate analgesia there was a decrease in lung ventilation which was not accompanied by shifts in acid-base balance of the arterial blood. The above analgesics had no considerable effect on systemic hemodynamics, though the use of tramal decreased systemic blood pressure and the use of moradol decreased systemic blood pressure and total peripheral vascular resistance. Tramal was most effective for synchronization of spontaneous respiration with a lung ventilation device in prolonged ventilation, as well as for the arrest of muscular tremor in the postoperative period. Tramal was effective in 95% of patients in the early post-anesthesia and postoperative period.

[Possibilities of the method of dilution of electro-impedance indicators in the assessment of volume dynamics of extravascular lung fluid in intensive care and resuscitation units]. / Vozmozhnosti metoda razvedeniia élektroimpedansnykh indikatorov dlia otsenki dinamiki ob"ema vnesosudistoi zhidkosti legkikh v praktike otdeleniia intensivnoi terapii i reanimatsii.

The possibility of using impedance plethysmography to assess changes in the volume of the extravascular lung fluid in intensive therapy and resuscitation patients is discussed. Changes in the volume of the fluid during extracorporeal detoxication are analysed. A correlation was found between these changes and lung distensibility (r = -0.7). A significant diminution of the fluid volume was observed in response to therapeutic doses of Lasix and Nitroglycerin. Data are cited on the increasing (85 percent) volumes of the fluid in preclinical pulmonary edema in patients with left ventricular insufficiency.