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Biomedical subjects

V V Moroz

Publications and source records attributed to V V Moroz.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

[Current issues of resuscitation].

Reanimatology is a science dealing with prevention and correction of severe homeostasis disorders, nonspecific reactions of the organism to disease, injury, wounding, with general regularities of vital functions fading in the course of dying and their recovery after resuscitation. Five main sections of reanimatology are formulated: resuscitation, intensive care, anesthesiology, urgent medicine, and medicine of disasters. Specialization in reanimatology is determined by methods of treatment. Four trends are distinguished among the pressing problems of reanimatology: fundamental studies, development of methods for prevention and treatment of critical, terminal, and post-reanimation states, ethical and legal problems, and management. Results of recent studies are presented and prospects for the future are discussed.

Animals↗
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[Complement system during hemofiltration in patients with multiple organ failure].

Nine patients (8 men and 1 woman) were treated. Sepsis was diagnosed in 7 of them. All patients were subjected to forced ventilation of the lungs, 6 were in need of inotropic support. The severity of clinical status was 31 +/- 0.8 according to APACHE II score. One patient survived. The main method of substitute renal therapy (SRT) was permanent hemofiltration with spontaneous arteriovenous perfusion. The results indicate manifest depletion of the complement system augmenting with the progress of multiple organ failure (MOF). Extracorporeal perfusion in SRT had no additional negative effects on the complement system damaged by disease. Nonselective penetration of individual complement fractions into the filtrate in the course of perfusion was noted. Therefore, the complement system is severely damaged in patients with MOF; it can modulate the SRT because of penetration of its individual fractions.

APACHE↗
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[Lactate kinetics during constant hemodiafiltration in critically severe patients with the systemic inflammatory response syndrome and multiple organ failure].

High-volume hemodiafiltration is a new approach to the treatment of critical patients with generalized inflammatory reaction and multiple organ failure. Increase of the liquid exchange during the procedure is fraught with the development of secondary metabolic disorders in cases when lactate-based buffer is used (with high amounts of lactate). This study was undertaken to evaluate the consequences for the acid-base balance in patients with hypoxia and circulatory failure. Twelve patients (6 men and 6 women) with APACHE II score 25 were examined. The major treatment modality was continuous hemodiafiltration. The results indicate that lactate-buffered solutions can be used in critical patients, because they do not cause a notable increase in the blood lactate levels due to its good utilization. Moreover, it is associated with correction of disorders in acid-base balance. No negative clinical consequences were observed after using lactate anion in high concentrations as the major buffer compound.

Acid-Base Equilibrium↗
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[High-volume hemodiafiltration in the treatment of sepsis and multiple organ failure: 2 methods of the elimination of TNF-alpha].

Permanent hemodiafiltration (PHDF) as a method for treating patients with sepsis and multiple organ failure (MOF) corrects the severity of generalized inflammatory reaction, which is caused by hyperproduction of bioactive substances. Cytokines can be eliminated from circulation by 2 methods of kidney-replacing therapy: convection and adsorption on hemofilter membrane. Despite the slight adsorption clearance, our results indicate that experimental data not always correspond to the clinical situation. Pronounced cytokinemia persists in patients with sepsis and MOF during PHDF. In addition to correction of the main hemostasis parameters, kidney-replacing therapy eliminates an appreciable amount of TNF-alpha and other proinflammatory cytokines. Estimation of TNF-alpha balance indicates its good adsorption on the surface of hemodiafilter membrane.

Adult↗
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[Acute lung injury syndrome and hemodiafiltration].

Acute lung injury syndrome is one of the most frequent components of polyorgan failure, particularly resultant from sepsis. Replacing renal therapy can correct uremic disorders in the hemostasis and gaseous exchange disorders in the lungs by eliminating excessive fluid in case of hyperhydration and by eliminating inflammation mediators. The present study demonstrated a favorable impact of hemodiafiltration on ventilation oxygen status of patients with acute lung injuries, which was confirmed by positive changes in blood oxygen pressure, intrapulmonary shunt, alveolar-arterial oxygen difference, etc. Changes in oxygen transport corresponded to those in patients with sepsis and shock without hemodiafiltration.

Acute Disease↗
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[Dynamics of indicators of blood coagulation and fibrinolysis in patients with diffuse peritonitis].

Blood coagulation and fibrinolysis were studied in 34 patients with diffuse peritonitis treated in intensive care wards of common profile. Forced ventilation of the lungs was carried out for 2-26 days in 32 of 34 patients. The causes of peritonitis were perforating gastroduodenal ulcers (22 cases), acute perforating ulcers of the small intestine (5 cases), and acute phlegmonous perforative cholecystitis (7 cases). Disseminated intravascular coagulation, depressed fibrinolysis first in the plasma and then in whole blood were observed early (2-16 h) after surgery in all patients (17 survived and 17 died). These changes progressed by days 3-5 of treatment in all patients, being the most pronounced in cases with complications (failure of sutures after gastroduodenal ulcer suturing, acute gastroduodenal ulcers complicated by hemorrhages, acute perforating ulcers of the small intestine, etc.), particularly in the patients who died.

Adult↗
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[Indicators of lipid metabolism in patients in critical condition].

Plasma lipid metabolism was studied in critical patients with severe combined injuries. Decrease in cholesterol concentration and increase in triglyceride concentrations were more pronounced in patients with lethal outcomes. The authors conclude that plasma cholesterol and triglyceride concentrations can be used as prognostic signs in patients with severe combined injuries.

Cholesterol↗
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[Comparative evaluation of methods of analgesia after operations on the stomach].

A general somatic syndromal approach to evaluation of clinical status by SAPS II and APACH II scores was used in 41 patients operated on for gastric cancer. Epidural analgesia in these patients promoted rapid regression of the severity of condition, did not require high opioid doses, had a positive effect on the peristaltic activity of the intestine, and accelerated treatment in intensive care wards.

APACHE↗
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[Use of position tests for detecting oxygen status disorders and correction of them in patients with severe blunt chest injury].

Relationship between alteration of body position and parameters of central hemodynamics and oxygen status were studied in patients with severe blunt chest injury. Use of position tests in this patient population helped detect disorders in the central hemodynamics, oxygen transport and consumption. Argument increase of volumetric loading promoted an increase in oxygen delivery.

Acidosis↗
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[Oxygen debt as a prognostic criteria in patients with multiple organ failure].

Signs of oxygen debt were studied in 28 patients with systemic inflammatory response and polyorgan failure. The parameters of oxygen debt, oxygen consumption, saturation of mixed venous blood, and heart rate can be used as criteria of therapy efficiency. The probability of a favorable outcome is increased if the mean 24-h oxygen debt is less than 30 ml/min x m2, oxygen consumption more than 158 ml/min x m2, mixed venous blood saturation less than 64%, and heart rate less than 114 stroke/min.

Heart Rate↗
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[Systemic hemodynamics in constant hemofiltration in patients with septic shock].

Hemodiafiltration (HDF) is a method of pathogenetic therapy for the systemic inflammatory response syndrome in patients with sepsis and shock irrespective of renal failure. Systemic hemodynamics was examined in 18 patients with septic shock treated by HDF (2 groups). HDF was associated with stabilization of systemic hemodynamics in 50% patients (cardiac index, total peripheral resistance, index of the left heart work increased and the number of heart beats, central venous pressure, mean pressure in the pulmonary artery, pulmonary capillary wedging pressure decreased, oxygen consumption index increased, etc.), which allowed a reduction of the initial dopamine and norepinephrine doses 3-fold and lower by the end of days 3-4 of HDF treatment. An opposite tendency was observed in group 2 (refractory shock). Despite high (72.2%) mortality which was mainly caused by the progress of multiple organ dysfunction or untimely surgical intervention, it is obvious that HDF created conditions for surviving the critical period of disease in patients with progressive sepsis.

APACHE↗
PubMedDate not supplied

[Acute hemorrhage. View on the problem].

Acute hemorrhage is a main cause of reduction of blood oxygen capacity. The main aim of correction of sequels of acute hemorrhage is to maintain effective gas exchange by restoring central circulation and microcirculation, the rate of diuresis, by normalizing water-salt exchange, to eliminate anemia, hypoproteinemia, and acute blood coagulability disorders. The values of oxygen budget with calculated oxygen delivery and consumption and those of hemoglobin and hematocrit which are of great value only after recovery of circulating blood volume are considered to be major indications for hemotransfusion. A relationship is established between the extraction and uptake of oxygen and its delivery. The concept of the critical level of oxygen delivery is considered, ways of correcting oxygen indebtedness are presented. Alternatives to the use of hemotransfusions by employing the solutions of modified hemoglobulin and perfluorocarbon-containing emulsions are under consideration. A possible algorithm of aid rendering in acute hemorrhage is given.

Acute Disease↗