The aim of the study was to investigate the feasibility of predicting the need for mechanical ventilation in patients with severe COVID-19 disease using ultrasound assessment of diaphragm function.Material and methods. An open prospective pilot study included 60 patients diagnosed with the novel coronavirus infection, who, at the time of admission to the intensive care unit (NEWS score > 6), underwent ultrasound assessment of diaphragm excursion, thickness and the diaphragm thickening fraction. Group 1 (n=30) included patients who did not require mechanical ventilation, and group 2 (n=30) consisted of patients who were subsequently transferred to mechanical ventilation.Results. Patients in group 2 had significantly lower diaphragm function parameters (left excursion value (P<0.001), right excursion value (P<0.001), diaphragm thickness on inspiration (P=0.043), and thickening fraction (P<0.001) than patients in group 1.Conclusion. Decreased diaphragm excursion of less than 17.1 mm on the right side is a predictor of initiation of mechanical ventilation in patients with the COVID-19 infection (sensitivity 93.3%, specificity 76.7%). Morphological examination in deceased patients of group 2 revealed pericellular and perivascular edema, venular thrombosis, endoneurial edema, and sludge in the lumen of arterioles.

The purpose of the study is to assess in vitro the effect of colloidal blood substitutes on fat globules in the blood of patients with severe polytrauma.Materials and methods. Perftoran, 5% albumin solution, dextran-40, dextran-60, modified gelatin, hydroxyethyl starches 200/0.5 and 130/0.42 were added to the blood of 19 patients with severe polytrauma at ratios 1:20, 1:10, 1:5 and 1:3, respectively, which corresponded to the addition of 0.015 ml, 0.03 ml, 0.06 ml, 0.1 ml of the blood substitute under test to 0.3 ml of blood in a tube. Microscopy of the samples with assessment of the number and area of fat globules was carried out using a transmitted-light medical microvisor mVizo-101 (LOMO, Russia) 30 minutes after the blood and blood substitute exposure and subsequent staining with Sudan IV. The findings were processed using JMicroVision 1.2.7 software.Results. Dextran-60, hydroxyethyl starch 200/0.5 and 130/0.42 in vitro lead to a decrease in fat globules in the blood of patients with severe polytrauma in proportion to the dilution degree. Modified gelatin, dextran-40, 5% albumin solution and Perftoran have a significant additional emulsifying effect on the fat globules. The maximum emulsifying effect was obtained after addition of Perftoran to the blood.Conclusion. The experimental data on the effect of 5% albumin solution, modified gelatin, dextran-40, and Perftoran on fat globules justify the prospect for their further clinical application for prevention and treatment of fat embolism in an extended clinical trials.

Цель исследования. Изучить значимость биохимических показателей и жировой глобулемии в прогнозировании развития жировой эмболии при тяжелой сочетанной травме.Материалы и методы. В исследование были включены 637 пациентов с тяжелой сочетанной травмой (615 пациентов -без развития жировой эмболии и 22 пациентас жировой эмболией). Определяли взаимосвязь повышения глюкозы, лактата, неэтерифицированных жирных кислот, жировой глобулемии в момент поступления в стационар с развитием жировой эмболии.Результаты. Наличие гипергликемии и гиперлактатемии не влияет на прогнозирование жировой эмболии. У 20 из 22 пациентов с жировой эмболией значения неэтерифицированных жирных кислот при госпитализации превышали 1,3 ммоль/л. Тяжелая сочетанная травма с оценкой по шкале Injury Severity Score ≥ 17 баллов в 100 % случаев сопровождается жировой глобулемией. Определена зависимость между количеством глобул размером более 50 мкм в момент поступления в стационар и развитием жировой эмболии.Заключение. У пациентов с тяжелой сочетанной травмой в момент поступления в стационар повышение содер-

The research tested changes of organ disorders in 22 patients with fat embolism syndrome in the early posttraumatic period. It was found that early multiple organ failure is related to traumatic shock. At Day 1 and thereafter, in patients with the severe combined injury, multiple organ failure was associated with manifesting fat embolism. We confirmed the efficacy of multiple substrate antihypoxant fluid to prevent multiple organ failure related to fat embolism manifesting in the early post-traumatic period.

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