[Diagnosis and treatment of early bleedings after open-heart surgery]. / Diagnostika i lechenie rannikh krovotechenii posle operatsii na otkrytom soerdtse.

On the basis of practical experience of the clinic for Cardiovascular Surgery and up-to-date literature data the causes of early bleedings after open-heart surgery are summarized. The main clinical, roentgenological and laboratory features of the bleeding and the methods for the assessment of their origin are demonstrated. The authors consider pathophysiologic causes of hemocoagulation disturbances after surgery with artificial circulation. Characteristics of clinical and laboratory tests for coagulation and hemostasis disturbances and the algorhythms for their interpretation are described. Both nonspecific and pathogenetic methods for management of coagulopathy bleedings in early postoperative period have been described and discussed.

[Continuous inhalation administration of surfactant-BL for control of adult respiratory distress syndrome after reconstruction of the abdominal aorta]. / Dlitel'noe ingaliatsionnoe vvedenie surfaktanta-BL dlia kupirovaniia respiratornogo distress-sindroma vzroslykh razvivshegosia posle rekonstruktivnogo vmeshatel'stva na briushnoiaorte.

A 62-year-old patient with Leriche's syndrome and critical ischemia of the low extremities has undergone the surgery of aortofemoral grafting. A patient has developed the severe ARDS on the second day of reperfusion (bilateral diffuse infiltrates, PO2/FiO2 < 100, lung injury score was 3). Different ways of administration of bovine surfactant (SURFACTANT BL, Russia) were used during the treatment. Total application time was 84 hours, total dose was 4000 mg (50 mg/kg). Considerable improvement of lung function occurred after start of the continuous inhalation of surfactant with a constant rate of 63 mg/h. Two hours after this step PO2/FiO2 reached 400 mm Hg and remained stable 12 hours more, up to the end of surfactant administration. The patient was soon successfully extubated and discharged on the 25th day after surgery. It is supposed that in spite of a small total dose of bovine surfactant the success was achieved due to an early start of the surfactant replacement, continuous inhalation and its definite rate.