A complex therapy of acute empyema and pyopneumothorax increases an efficacy of the pathogenic therapy and improves an outcome. It involves cryoplasma and anti-ensyme complex, plasmapheresis, correction of metabolic, coagulant and proteolytic activities of blood and focal (at the inflammation zone) phagocytes, intrapleural application of proteolytic inhibitors and activators depending on the phase of the inflammation.

A pulmonologic healthcare system was organized at the Altai region including a regional pulmonology center, pulmonology department of city hospitals, referable pulmonology wards and asthma-schools working as outpatient departments for asthmatic patients. A new structure of a regional pulmonology center was created which involves an intensive care unit for pulmonary pathology and respiratory support and a regional asthmacenter with ambulatory working mode providing oxygen therapy at home. Due to this, early-stage detection of respiratory pathologies was improved, a number of admissions to hospitals was reduced for certain diseases and a mortality of severe lung pathologies was decreased.

This paper proposes a scheme for optimize treatment of patients with acute lung abscesses and gangrene and developed stepped-block method for their reference. The method consists in determining the key block pathogenetic problems at each stage of the patient and the optimal use of complex treatments corresponding to this block. Complex treatment of acute lung abscess and gangrene using cryoplasm-antienzyme therapy, plasmapheresis treatment methods videobronchoscopical selective catheterization transtracheal bronchi segmental-subsegmental sanation of lung, implementation method step-block management of patients reduces mortality, complications, number of operations, the number of methods of evacuation of purulent content and improves the immediate and long-term results of the disease.

The use of cryosupernatant plasma fraction in the complex treatment of acute lung abscess and gangrene in comparison with a standard conventional complex treatment reduced the number of complications by 20 % and the number of methods of evacuation of purulent fluid from the cavity by 28 %, increase the level of AT III by 11%.Using cryosupernatant plasma fraction in the complex treatment of acute lung abscess and gangrene has reduced according to the number of bronchoscopy in patients with purulent phlegm in the bronchial tree by 36.9 %, from the lack of it in the bronchi by 56.8 %, increase the number of patients with a pale pink bronchial mucosa by 30.1 %, while those with diffuse edema and hyperemia 2 tbsp. By 20.0 %, with edema and diffuse hyperemia 3 tbsp. By 9.9 %.Achieved the following outcomes in the treatment of acute pulmonary abscess and gangrene : the main group of patients recover fully observed more frequently by 24.3 %, the transition process in the chronic process at least 12 % lower than in the comparison group.

The aim of the study was to determine the efficacy of plasmapheresis with replacement of plasma loss with cryosupernatant fraction of plasma in combination treatment of acute pulmonary abscess and lung gangrene. The study included a total of 210 patients assigned into two groups. The first group (n=150) received conventional treatment with fresh frozen plasma. The second group (n=60) received the combination treatment with plasmapheresis and replacement of plasma loss with cryosupernatant fraction of plasma. Data of the study showed that the combination treatment with plasmapheresis and replacement of plasma loss with cryosupernatant fraction of plasma increased the level of antithrombin III (by 10.6%) and decreased the numbers of complications (by 20%), pulmonary drainages (by 34.7%), and pulmonary decortications with subtotal parietal pleurectomy (by 3.3%). The number of patients who achieved a full recovery increased by 19.0% in comparison with the control group.

Complex treatment of acute abscesses and gangrene of the lungs, including intensive therapy and resuscitation, nonoperative treatment with the use of methods for releasing microcirculation from blocking, inhibition of proteolysis in the focus, differentiated correction of the functional activity of phagocytes in the focus of affection, etc., is conducive to reduction of the frequency of the development of a chronic process and drop of mortality.

With an adjuvant course of plasmapheresis, a combined treatment of severe acute abscesses and gangrene of the lungs brought about a marked short-term clinical response in 48 out of 50 treated patients. The responders had their temperature returned to normal, amount of sputum significantly reduced. They recovered good appetite and gained weight. There was also attenuation of DIC syndrome and endotheliosis, improvement of cellular and humoral immunity. Upon the discharge 35 patients had complete or partial response, 10 patients developed a chronic process. Lethal outcomes reached 10%.

Experience in the treatment of 94 patients with sepsis is discussed. Studies showed that microcirculatory disorders occurring around the inflammatory focus are among the main causes of insufficient efficacy of antibiotic therapy. For correction of the microcirculatory changes, the authors suggest (in addition to vasodilators, inhibitors of proteases and heparin used earlier for this purpose) transfusion of chilled plasma which is a antithrombin-III donator. As the result of such treatment mortality reduced from 45.8 to 16.7%.