Objective: to compare central hemodynamic and microcirculatory changes in critical conditions caused by different factors and to reveal their possible differences for a further differentiated approach to intensive therapy. Subjects and methods. The study covered 16 subjects with severe concomitant injury (mean age 41.96±2.83 years) and 19 patients with general purulent peritonitis (mean age 45.34±2.16 years). Their follow-up was 7 days. The central hemodynamics was estimated by transpulmonary thermodilution using a Pulsion PiCCO Plus system (Pulsion Medical Systems, Germany). The microcirculatory bed was evaluated by cutaneous laser Doppler flowmetry using a LAKK-02 capillary blood flow laser analyzer (LAZMA Research-and-Production Association, Russian Federation). Results. The pattern of central hemodynamic and microcirculatory disorders varies with the trigger that has led to a critical condition. Central hemodynamics should be stabilized to ensure the average level of tissue perfusion in victims with severe concomitant injury. In general purulent peritonitis, microcirculatory disorders may persist even if the macrohemodynamic parameters are normal. Conclusion. The macrohemodynamic and microcirculatory differences obtained during the study suggest that a complex of intensive therapy should be differentiated and, if the latter is used, it is necessary not only to be based on the central hemodynamics, but also to take into consideration functional changes in microcirculation. Key words: severe concomitant injury, general purulent peritonitis, micro-circulation, central hemodynamics, type of circulation.

Objective: to evaluate the functional state of intestinal microcirculation in diffuse peritonitis caused by hollow organ perforation and to determine its possible relationship to skin microcirculation. Subjects and methods. Seventeen patients with diffuse peritonitis resulting from hollow organ perforation were examined. The patients’ mean age was 58.5±2.8 years; a control group consisted of 35 apparently healthy individuals. The functional state of the intestinal microcirculatory bed (the mid-transverse colon, the ileum at a distance of 60 cm from the ileocecal corner, the small bowel at a distance of 50 cm of the ligament of Treitz, and an area next hollow organ perforation) and skin was evaluated by laser Doppler flowmetry by means of a ЛАКК-02 laser capillary blood flow analyzer made in the Russian Federation (LAZMA Research-and-Production Association, Russian Federation). Results. Perforation of the affected intestinal portion became worse in patients with diffuse peritonitis. Blood flow stability was ensured by the higher effect of mainly active components of vascular tone regulation on the microvascular bed. Regulatory changes were equally pronounced at both the intraorgan and skin levels. Conclusion. The findings suggest that the patients with diffuse peritonitis have changes in microcirculatory regulation aimed at maintaining tissue perfusion. These changes are universal at both the intraorgan and skin levels. Key words: microcirculation, micro blood flow, intestine, peritonitis, tissue perfusion.

Objective: to study the state of systemic microcirculation and endothelial function in comas induced by acute cerebrovascular accident (ACA). Subjects and methods. The study was conducted within the first 7 days of ACA in 38 coma patients, who were divided into groups according to the etiology of stroke: Group 1 comprised 20 patients with hemorrhagic stroke; their mean age was 56.6±2.3 years; Group 2 consisted of 18 patients with ischemic stroke; their mean age was 58.5±2.2 years. A control group included 34 apparently healthy individuals; their mean age was 55.1±2.1 years. The microcirculatory bed was evaluated within 7 days, by applying cutaneous laser Doppler flowmetry using a LAKK-02 capillary blood flow laser analyzer made in Russia (LAZMA Research-and-Production Association, the Russian Federation). Coincidentally with recording of the microcirculatory blood flow, blood samples were collected to explore the serum concentrations of endothelin-1, stable nitric oxide metabolites, van Willebrand factor, and thrombomodulin. Results. Throughout the study, the patients with coma induced by ACA were found to have microcirculatory disorders consisting in higher microperfusion along with the markedly increased influence of active modulators of vascular tone, as well as endothelial functional structural changes. Conclusion. The data obtained in the study suggest that there were uniform changes in the state and regulation of systemic microcirculation in patients with ACA irrespective of the type of stroke (hemorrhagic or ischemic). Key words: stroke, microcirculation, microvascular bed, micro blood flow, tissue perfusion, endothelium.

Delirium can greatly complicate progressing of TBI. Early diagnosis and intensive therapy optimization can improve the outcome. Retrospective-prospective study was performed in patients with severe TBI and delirium. 27 patients (mean age-40,8±3,3 years) were involved in experimental group and 25 patients (mean age 49,0±4,5 years) in control group. The ISS and the APACHE II scores were similar in both groups. Reamberin (Polisan, Russia) infusion (800 ml/day for 7 days after injury) was included in the therapy plan for the experimental group. Modifi ed RASS score was equal in both groups on the fi rst day (1,67±0,37 in experimental and 1,88±0,28 in control group), but later RASS score was lower in experimental group (0,71±0,30 and 1,41±0,26 (p=0,042) on the third day; 0,45±0,20 and 1,09±0,36 (p=0,012) on the 5th day; 0,22±0,14 and 1,00±0,39 (p=0,008) on the 7th day). The correlation of the modifi ed Richmond Agitation Sedation Scale (RASS) score with the ISS score and with the length of stay in ICU was noted. Reamberin improves mental status in patients with severe TBI complicated by delirium, especially, with alcohol intoxication.

Objective: to evaluate the microcirculation system in critical conditions caused by abdominal sepsis for a further differentiated approach to intensive care. Subjects and methods. Twenty-four patients with abdominal sepsis (mean age 42.9±0.9 years) were examined; a control group consisted of 35 apparently healthy individuals (mean age 40.1±2.1 years). Over 11 days, the microcirculatory bed was evaluated by cutaneous laser Doppler flowmetry by means of a ЛАКК-02 laser capillary blood flow analyzer made in the Russian Federation (LAZMA Research-and-Production Association), by using a basic light guide for percutaneous microcirculation studies. Results. Throughout the study, tissue blood perfusion remained in the patients with sepsis due to the higher effect of mainly active components of vascular tone regulation on the microvascular bed. In a poor outcome, there was a reduction in both active and passive regulatory effects on tissue perfusion chiefly due to local (myogenic) factors. Conclusion. The findings suggest that the patients with sepsis have microcirculatory regulation changes aimed at maintaining tissue perfusion. A follow-up of the microcirculation may be useful in choosing intensive care tactics and predicting disease outcome. Key words: sepsis, microcirculation, microvascular bed, micro blood flow, tissue perfusion.