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Острыйреспираторный дистресс синдром (ОРДС) -частое осложнение критических состояний, обусловленное развитием некардиогенного отека лег ких в результате повреждения (дистрофия, некроз, апоптоз) эндотелия, альвеолярного эпителия, их ба зальных мембран (включая структуры аэрогематичес кого барьера) и повышения проницаемости сосудов ге момикроциркуляции при воздействии экзогенных или эндогенных факторов агрессии. С учетом общности этиологии, факторов риска и патогенеза острое по вреждение легких следует рассматривать как первую и обратимую стадию ОРДС [1-3].Acute respiratory distress syndrome (ARDS) is a prevalent complication of critical illness caused by a dam age (dystrophy, necrosis, apoptosis) of the vascular endothelium, alveolar epithelium and their basal mem branes (including structures of aerohematic barrier). This damage is caused by exogenous or endogenous factors and leads to an increase of vascular permeability and develop ment of noncardogenic pulmonary edema. Taking into account the similarity of etiology, risk factors and patho genesis, the acute lung injury is currently considered as a first and reversible stage of ARDS [1-3]. Редакционная статья посвящена разработке алгоритма диагностики и прогноза течения острого респираторного дистресс синдрома (ОРДС), основанного на использовании данных, полученных в НИИ общей реаниматологии им. В. А. Неговского в 2012-2014 гг. Представлены современные подходы к диагностике и лечению ОРДС. Приведены собственные данные и данные зарубежной литературы последних лет, свидетельствующие о потенциале количест венного определения сурфактатных белков SP A и SP D, продуцируемых клетками дыхательного эпителия, для раннего диагноза и прогноза течения ОРДС. Предложен новый алгоритм ранней диагностики и прогноза развития ОРДС, основанный на использовании поэтапного определения количественного содержания SP A и SP D в плазме больных при критических состояниях. Циркулирующие молекулы SP A и SP D рассматриваются в качестве кан дидатных биомаркеров, имеющих существенную ценность для создания мультипараметрической панели биомарке ров для диагноза и прогноза ОРДС как жизнеугрожающего критического состояния. Editorial dedicated to the development of the algorithm of diagnosis and prognosis of acute respiratory distress syndrome (ARDS), based on the use of recent data (2012-2014) from the V. A. Negovsky Institute of General reanimatology. Modern approaches to the diagnosis and treatment of ARDS are discussed. Available modern data including results of own recent investigation have clearly demonstrated the potential of quantifying surfactant proteins SP A and SP D, which pro duced by cells of the respiratory epithelium, for the early diagnosis and prognosis of ARDS. A new algorithm for diagnosis and prognosis of ARDS based on a sequential quantification of SP A and SP D molecules in the plasma of patients in crit ical conditions is suggested. Circulating SP A and SP D are considered as valuable candidate biomarkers for developing multiparametric panel of biomarkers for diagnosis and p...
Острыйреспираторный дистресс синдром (ОРДС) -частое осложнение критических состояний, обусловленное развитием некардиогенного отека лег ких в результате повреждения (дистрофия, некроз, апоптоз) эндотелия, альвеолярного эпителия, их ба зальных мембран (включая структуры аэрогематичес кого барьера) и повышения проницаемости сосудов ге момикроциркуляции при воздействии экзогенных или эндогенных факторов агрессии. С учетом общности этиологии, факторов риска и патогенеза острое по вреждение легких следует рассматривать как первую и обратимую стадию ОРДС [1-3].Acute respiratory distress syndrome (ARDS) is a prevalent complication of critical illness caused by a dam age (dystrophy, necrosis, apoptosis) of the vascular endothelium, alveolar epithelium and their basal mem branes (including structures of aerohematic barrier). This damage is caused by exogenous or endogenous factors and leads to an increase of vascular permeability and develop ment of noncardogenic pulmonary edema. Taking into account the similarity of etiology, risk factors and patho genesis, the acute lung injury is currently considered as a first and reversible stage of ARDS [1-3]. Редакционная статья посвящена разработке алгоритма диагностики и прогноза течения острого респираторного дистресс синдрома (ОРДС), основанного на использовании данных, полученных в НИИ общей реаниматологии им. В. А. Неговского в 2012-2014 гг. Представлены современные подходы к диагностике и лечению ОРДС. Приведены собственные данные и данные зарубежной литературы последних лет, свидетельствующие о потенциале количест венного определения сурфактатных белков SP A и SP D, продуцируемых клетками дыхательного эпителия, для раннего диагноза и прогноза течения ОРДС. Предложен новый алгоритм ранней диагностики и прогноза развития ОРДС, основанный на использовании поэтапного определения количественного содержания SP A и SP D в плазме больных при критических состояниях. Циркулирующие молекулы SP A и SP D рассматриваются в качестве кан дидатных биомаркеров, имеющих существенную ценность для создания мультипараметрической панели биомарке ров для диагноза и прогноза ОРДС как жизнеугрожающего критического состояния. Editorial dedicated to the development of the algorithm of diagnosis and prognosis of acute respiratory distress syndrome (ARDS), based on the use of recent data (2012-2014) from the V. A. Negovsky Institute of General reanimatology. Modern approaches to the diagnosis and treatment of ARDS are discussed. Available modern data including results of own recent investigation have clearly demonstrated the potential of quantifying surfactant proteins SP A and SP D, which pro duced by cells of the respiratory epithelium, for the early diagnosis and prognosis of ARDS. A new algorithm for diagnosis and prognosis of ARDS based on a sequential quantification of SP A and SP D molecules in the plasma of patients in crit ical conditions is suggested. Circulating SP A and SP D are considered as valuable candidate biomarkers for developing multiparametric panel of biomarkers for diagnosis and p...
The issues of practicality in using perfluorocarbon gas transport emulsions (or pure perfluorocarbons) in severe virus-associated pneumonia treatment were considered, including those caused by coronavirus infection. Perfluorocarbons are fully fluorinated carbon compounds, on the basis of which artificial blood substitutes have been developed gas transport perfluorocarbon emulsions for medical purposes. Perfluorocarbon emulsions were widely used in the treatment of patients in critical conditions of various genesis at the end of the lastthe beginning of this century, accompanied by hypoxia, disorders of rheological properties and microcirculation of blood, perfusion of organs and tissues, intoxication, and inflammation. Large-scale clinical trials have shown a domestic plasma substitute advantage based on perfluorocarbons (perfluoroan) over foreign analogues. It is quite obvious that the inclusion of perfluorocarbon emulsions in the treatment regimens of severe virus-associated pneumonia can significantly improve this categorys treatment results after analyzing the accumulated experience. A potentially useful area of therapy for acute respiratory distress syndrome is partial fluid ventilation with the use of perfluorocarbons as respiratory fluids as shown in the result of many studies on animal models and existing clinical experience. There is no gas-liquid boundary in the alveoli, as a result of which, there is an improvement in gas exchange in the lungs and a decrease in pressure in the respiratory tract when using this technique, due to the unique physicochemical properties of liquid perfluorocarbons. A promising strategy for improving liquid ventilation effectiveness using perfluorocarbon compounds is a combination with other therapeutic methods, particularly with moderate hypothermia. Antibiotics, anesthetics, vasoactive substances, or exogenous surfactant can be delivered to the lungs during liquid ventilation with perfluorocarbons, including to the affected areas, which will enhance the drugs accumulation in the lung tissues and minimize their systemic effects. However, the indications and the optimal technique for conducting liquid ventilation of the lungs in patients with acute respiratory distress syndrome have not been determined currently. Further research is needed to clarify the indications, select devices, and determine the optimal dosage regimens for perfluorocarbons, as well as search for new technical solutions for this technique.
Fat embolism syndrome is one of the many complications in traumatology, which carries a serious danger due to the difficult diagnosis at the early stages of its development. In many medical sources, fat embolism syndrome is described as a severe condition characterized by obturation of blood vessels by embolus, which are represented by fat droplets larger than 7-9 microns. Fat embolism is usually caused by trauma, accompanied by crushing of tissues. This is especially common in fractures of the tubular bones as a result of high-energy trauma. As exemplified in the medical literature about 6-7 % of isolated fractures and 37 % of combined injuries lead to the appearance of fat embolism syndrome. Much more often, fat embolism develops in open fractures, and the frequency of its occurrence increases with a combination of open and closed fractures. Due to the fact that fat embolism is a life-threatening condition, early detection of this pathology is necessary. The purpose of this literature review is to study the pathogenesis of fat embolism, as well as the possibilities, problems and methods of early diagnosis of this pathology in trauma practice...
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