Ventilatory strategy in ARDS focusing on pressure controlled ventilation

This thesis focuses on comparison of different modes of ventilation in animals and patients with ARDS. The aim is to determine the immediate advantages of one mode over the other in terms of gas exchange, airway pressures,' hemodynamics and ventilation inhomogeneity

Семантичні особливості номінацій на позначення інфекційних кишкових хвороб (на матеріалі говірок Кіровоградщини)

В статье сделан лексико-семантический анализ названий на обозначение инфекционных кишечных заболеваний, зафиксированных в говорах Кировоградской области. В этой тематической группе выделены семемы, выявлен количественный состав репрезентантов семем. Выявлены ареалы распространения лексических и фразеологических единиц. Проанализированы общность и различие семантического значения собранного материала и литературного языка.У статті проведено лексико-семантичний аналіз назв на позначення інфекційних кишкових хвороб, зафіксованих у говірках Кіровоградщини. У зазначеній тематичній групі виокремлено семеми, виявлено кількісний склад репрезентантів семем. Визначено ареали поширення лексичних і фразеологічних одиниць. Проаналізовано спільність і відмінність семантичного значення зібраного матеріалу і літературної мови.The lexico-semantic analysis of the names of the skin infectious diseases fixed in the Kirovohrad dialects is carried out in the article under consideration. In the mentioned thematic group sememes are singled out and the quantitative analysis of the representatives of the sememes is held. The areal expansion of the lexical, phraseological units was defined. The community and the difference of the semantic meaning of the collected material and the literary language were analyzed

Selective decontamination of the digestive tract reduces mortality in critically ill patients

Several emotional responses may be invoked in critical care physicians when confronted with selective decontamination of the digestive tract (SDD). Although recent meta-analyses have shown that the use of SDD reduces the occurrence of ventilator-associated pneumonia and improves ICU survival, the effectiveness of SDD has remained controversial. We recently concluded a large randomized, controlled trial on the use of SDD that showed improved survival of ICU patients treated with SDD. A second concern regarding use of SDD has been the fear for the emergence of antimicrobial resistance. Interestingly, a recently published study did not confirm this fear, and our recently finished study even demonstrated a decline in colonization with P. aeruginosa and enterobacteriaceae that were resistant against tobramycin, ceftazidime, imipenem and ciprofloxacin. The hopes are that this study will at long last end the debate about the efficacy and safety of SDD in critically ill patients

Computed tomography assessment of exogenous surfactant-induced lung reaeration in patients with acute lung injury

Introduction: Previous randomized trials failed to demonstrate a decrease in mortality of patients with acute lung injury treated by exogenous surfactant. the aim of this prospective randomized study was to evaluate the effects of exogenous porcine-derived surfactant on pulmonary reaeration and lung tissue in patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS).Methods: Twenty patients with ALI/ARDS were studied (10 treated by surfactant and 10 controls) in whom a spiral thoracic computed tomography scan was acquired before (baseline), 39 hours and 7 days after the first surfactant administration. in the surfactant group, 3 doses of porcine-derived lung surfactant (200 mg/kg/dose) were instilled in both lungs at 0, 12 and 36 hours. Each instillation was followed by recruitment maneuvers. Gas and tissue volumes were measured separately in poorly/nonaerated and normally aerated lung areas before and seven days after the first surfactant administration. Surfactant-induced lung reaeration was defined as an increase in gas volume in poorly/non-aerated lung areas between day seven and baseline compared to the control group.Results: At day seven, surfactant induced a significant increase in volume of gas in poorly/non-aerated lung areas (320 +/- 125 ml versus 135 +/- 161 ml in controls, P = 0.01) and a significant increase in volume of tissue in normally aerated lung areas (189 +/- 179 ml versus -15 +/- 105 ml in controls, P < 0.01). PaO2/FiO(2) ratio was not different between the surfactant treated group and control group after surfactant replacement.Conclusions: Intratracheal surfactant replacement induces a significant and prolonged lung reaeration. It also induces a significant increase in lung tissue in normally aerated lung areas, whose mechanisms remain to be elucidated.Univ Paris 06, Multidisciplinary Intens Care Unit, Dept Anesthesiol & Crit Care Med, La Pitie Salpetriere Hosp,Assistance Publ Hop Par, F-75013 Paris, FranceZhejiang Univ, Sch Med, Affiliated Hosp 2, Dept Emergency Med, Hangzhou 310009, Zhejiang, Peoples R ChinaUniversidade Federal de São Paulo, Dept Anesthesiol, Escola Paulista Med, BR-04024002 São Paulo, BrazilUniv Med Ctr Utrecht, Dept Intens Care Med, NL-3584 CX Utrecht, NetherlandsUniversidade Federal de São Paulo, Dept Anesthesiol, Escola Paulista Med, BR-04024002 São Paulo, BrazilWeb of Scienc

Становлення та функціонування сучасних наукових шкіл

Background. Several studies have shown that the use of selective digestive tract decontamination (SDD) reduces mortality. However, fear for increasing multidrug resistance might prevent wide acceptance. A survey was performed among the units registered in the European Registry for Intensive Care (ERIC), in order to investigate the number of ICUs using SDD and the factors that prevented the use of SDD. Methods. One invitation to the electronic survey was sent to each ERIC unit. The survey focused on department characteristics (intensive care type, local resistance levels), local treatment modalities (antibiotic stewardship) and doctors' opinions (collaborative issues concerning SDD). All ICU's in countries participating in the European Centre for Disease Prevention and Control resistance surveillance program were analysed. Results. Seventeen percent of the ICUs registered in the ERIC database used SDD prophylaxis. Most of these ICUs were located in the Netherlands or Germany. ICUs using SDD were four times more likely to use antibiotic stewardship. Also larger ICUs were more likely to use SDD. On the contrary, resistance to antibiotics was not related to the use of SDD. Also the doctor's opinion that SDD is proven in duster-randomized trials was not a determinant for not using SDD. Conclusion. SDD is used in a minority of the European ICUs registered in the ERIC database. Larger ICUs and ICUs with a prudent antibiotic policy were more likely to use SDD. Neither antibiotic resistance nor the duster randomized study design were determinants of the non-use of SDD

Схема когенерации с размещением противодавленческой и гидропаровой турбин на общем валу с газопоршневой установкой

Показана перспективність використання когенераційних технологій для підвищення рентабельності вугільних підприємств. Розглянуто схему з розміщенням турбіни з противотиском і гідропарової турбіни на одному валу з газопоршневою установкою. Використання даної схеми для утилізації надлишкового тепла шахтних енергокомплексів дозволить отримати коефіцієнт корисної дії 64 % та зменшити витрати палива.In this paper the perspective use of cogeneration technology enhance the profitability of coal enterprises was discussed. The scheme with setting back-pressures and steam-water turbines on one shaft of gas engine was considered. Using this scheme for utilization of surplus heat mine energy complexes will provide efficiency of 64% and reduce fuel

Cellular infiltrates and injury evaluation in a rat model of warm pulmonary ischemia–reperfusion

INTRODUCTION: Beside lung transplantation, cardiopulmonary bypass, isolated lung perfusion and sleeve resection result in serious pulmonary ischemia–reperfusion injury, clinically known as acute respiratory distress syndrome. Very little is known about cells infiltrating the lung during ischemia–reperfusion. Therefore, a model of warm ischemia–reperfusion injury was applied to differentiate cellular infiltrates and to quantify tissue damage. METHODS: Fifty rats were randomized into eight groups. Five groups underwent warm ischemia for 60 min followed by 30 min and 1–4 hours of warm reperfusion. An additional group was flushed with the use of isolated lung perfusion after 4 hours of reperfusion. One of two sham groups was also flushed. Neutrophils and oedema were investigated by using samples processed with hematoxylin/eosin stain at a magnification of ×500. Immunohistochemistry with antibody ED-1 (magnification ×250) and antibody 1F4 (magnification ×400) was applied to visualize macrophages and T cells. TdT-mediated dUTP nick end labelling was used for detecting apoptosis. Statistical significance was accepted at P < 0.05. RESULTS: Neutrophils were increased after 30 min until 4 hours of reperfusion as well as after flushing. A doubling in number of macrophages and a fourfold increase in T cells were observed after 30 min until 1 and 2 hours of reperfusion, respectively. Apoptosis with significant oedema in the absence of necrosis was seen after 30 min to 4 hours of reperfusion. CONCLUSIONS: After warm ischemia–reperfusion a significant increase in infiltration of neutrophils, T cells and macrophages was observed. This study showed apoptosis with serious oedema in the absence of necrosis after all periods of reperfusion