На основании собственных наблюдений, исследований, а также данных литературы обсуждается современный взгляд на проблему и обосновывается актуальность дальнейшего изучения респираторной терапии острого респираторного дистресс-синдрома у пациентов с черепно-мозговой травмой, а именно уровня положительного давления в конце выдоха (ПДКВ) у пациентов с внутричерепной гипертензией, а также технологии подбора этого параметра, поскольку неправильная регулировка параметров механической вентиляции легких может существенно ухудшить результаты лечения. Проведен ретроспективный анализ результатов лечения 23 больных с черепно-мозговой травмой (как компонентом политравмы), которые были разделены на две группы по уровню ПДКВ. Выявлен более быстрый неврологический регресс у пациентов первой группы, в которой ПДКВ составило 8 ± 2 см вод.ст. Согласно результатам, можно утверждать, что проблема технологии механической вентиляции легких у больных с черепно-мозговой травмой требует дальнейшего исследования, остаются нерешенными вопросы о роли церебрального и легочного комплайенса, влиянии ПДКВ на внутричерепное давление.

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Purpose: Several studies tried to assess the influence of rheumatoid arthritis (RA) on peripheral arteries and found an association with later development of intimal thickness and atherosclerosis. We tried to uncover the prevalence of subclinical peripheral vascular disease (PVD) in rheumatoid arthritis patients. Materials and Methods: This case control-study had involved sixty patients who were diagnosed with rheumatoid. Forty age, gender, and body mass index-matched healthy individuals were selected as the control group. All participants were non-smokers, non-hypertensive, and non-diabetics and had a normal lipid profile. The presence of peripheral arterial disease was evaluated by measuring the ankle-brachial pressure index (ABPI) at the level of each artery of the lower limbs. An index of ≤0.9 was considered abnormal and a possible reflection of an underlying PVD. Results: Twenty three (38%) out of the 60 RA patients demonstrated one or more abnormal arteries while only 3 (7.5%) out of the 40 control individuals had abnormal results (p-value <0.001). A statistically significant association was noted between abnormal ABPI and RA disease severity as indicated by C-reactive protein (P-value <0.003), ESR (P-value <0.002), and positive serum rheumatoid factor (P-value <0.01). However, age, gender, and disease duration showed no link with abnormal ABPI. Conclusion: A higher prevalence of abnormal ABPI, and hence a possible higher incidence of subclinical atherosclerosis, was found in patients with RA. Further analytic studies are required to assess the relationship of RA with PVD.

Background. One of the main technologies of modern anesthesiology is mechanical ventilation (MV). At present, the protective technology of MV is widely recognized. The feasibi-lity of using this technology in the operating room, especially in patients with intact lungs, is not so obvious. Most of the scientific sources that cover this problem relate to patients with abdominal pathology, and less coverage remains in patients with neurosurgical pathology. However, patients who are operated on for neurosurgical pathology belong to the group of patients of high surgical risk, which forced us to conduct this study. The study was aimed to examine the feasibility of using protective MV during surgery in neurosurgical patients. Materials and methods. We examined 46 patients who were hospitalized in KNP 8 MKL in Lviv for spinal pathology and who underwent surgery for vertebroplasty with spondylodesis. Patients were divided into two groups: in the first group (34 patients), MV was performed by S-IPPV technology — synchronized intermittent positive pressure ventilation with volume control; and in the second group (12 patients), MV was performed by PCV technology — controlled ventilation pressure. Results. We retrospectively determined the incidence of post-operative pulmonary complications (POPC) in patients of the first and second groups. Of the 34 patients of the first group, the signs of POPC were detected in 17 patients (50 %), and of 12 patients of the second group, POPC were detected in 4 patients (33.3 %). It should be noted that MV in patients of both groups did not differ in such parameters as respiratory rate, end-alveolar pressure, and the fraction of oxygen in the respiratory mixture. Conclusions. A relatively small number of patients clearly do not allow the conclusions to be drawn, but it should be noted that MV (especially volume-controlled) contributes to postoperative pulmonary complications in patients with intact lungs in the preoperative period. And pressure-controlled MV tends to reduce the incidence of postoperative pulmonary complications in the postoperative period. Given that respiration rate, end-alveolar expiratory pressure and oxygen fraction in the respiratory mixture were comparable in patients of both groups, it can be assumed that the factor influencing the incidence of POPC is the mechanics of pulmonary ventilation.