Outbreaks of viral infections have become a global healthcare challenge over the last decade. The 2009—2010 flu A (H1N1) outbreak resulted in global pandemia, associated with high morbidity and mortality reaching 31%. Another flu A (H1N1) outbreak occurred in 2015—2016. There is a strong probability that it may be repeated in the future. This infection is associated with its high incidence among pregnant women. There are some published reports describing the efficacy and safety of veno%venous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome that is refractory to standard therapeutic options. The article presents a clinical case of a successful use of extracorporeal membrane oxygenation and intermittent renal replacement therapy in a puerpera with acute respiratory distress syndrome caused by flu A (H1N1)-related severe viral and bacterial pneumonia. The positive effects of the combination of veno%venous extracorporeal membrane oxygenation and modern detoxification techniques have been demonstrated. Revealed organizational problemswere related to selection criteria for prescription of extracorporeal gas exchange, as well as to carrying out the procedure in an institution in the deficiency of the experienced staff and corresponding equipment.

Purpose. To assess dynamic of hemodynamic and hydrodynamic parameters and procedures’ efficacy in different time periods of initiated renal replacement therapy for systemic inflammatory response syndrome of infectious or non-infectious etiologies. Material and methods. 242 patients with systemic inflammatory response of infectious and non-infectious genesis were enrolled in a prospective randomized multicenter study. Results. The changes in the parameters of central hemodynamic, hydrodynamic status and gas transmission during renal replacement therapy of constant veno-venous hemofiltration were identified. Conclusion. Early renal replacement therapy initiation (up to 24 hrs from the time the indications were presented) was proved by the authors to be advantageous.

Objective: to determine the impact of early initiation of renal replacement therapy on the manifestations of a systemic inflammatory response (SIR) and on the prevention of progression of organ dysfunction (OD). Subjects and methods. A prospective study was conducted in the intensive care units of the Kemerovo Regional Clinical Hospital and the Research Institute for Integrated Problems of Cardiovascular Diseases, Siberian Branch of the Russian Academy of Medical Sciences, in the identical period (2003—2009). Three hundred and fifty-four patients underwent a set of invasive hemodynamic studies, biochemical tests, and transpulmonary thermodilution. Conclusion. Renal replacement therapy prevents the progression of OD in patients with SIR irrespective of the etiology of the latter (infectious versus noninfectious SIR); the earlier initiation of continuous renal replacement therapy (within 24 hours after the determination of indications for its session) is most effective. Key words: renal replacement therapy, organ dysfunction.

Objective: to improve the results of treatment for severe obstetric sepsis by pathogenetically founded continuous renal replacement therapies as extracorporeal homeostatic correction. Subjects and methods. Forty-two women with severe abdominal sepsis were divided into 3 groups: 1) 14 women with severe extragenital abdominal sepsis who received standard intensive care (a control group); 2) 12 women with severe obstetric sepsis who had standard intensive care (a study group); 3) 16 with severe obstetric sepsis who had the standard intensive care supplemented with continuous renal replacement therapy (an intervention group). Results. In Group 2, endogenous intoxication and multiple organ dysfunction were controlled later than in Group 1, mortality rates being 41.7 and 7.1%, respectively. Clinical laboratory differences were due to gestosis recorded in 100% of the patients with severe obstetric sepsis. When continuous renal replacement therapy was incorporated into the complex therapy of severe obstetric sepsis, there was a prompter regression of endogenous intoxication and multiple organ dysfunction, mortality was decreased by an average of 35% as compared with that during standard therapy. Conclusion. The inclusion of continuous renal replacement therapy into the complex treatment program for severe obstetric sepsis made it possible to reduce control time _ for endogenous intoxication and multiple organ dysfunction and to decrease mortality by an average of 35% as compared with that during standard intensive care. Key words: obstetric sepsis, abdominal sepsis, gestosis, endogenous intoxication, multiple organ dysfunction, renal replacement therapy.

Lipid peroxidation products and antioxidative system components were studied in 56 patients with a systemic inflammatory response of various genesis. The arterial blood levels of prooxidants were found to be associated with a poor outcome. The findings that there is an inverse correlation between lipid peroxidation products and the respiratory index allow the diagnostic and prognostic value of blood free radical oxidation products to be determined as markers of acute lung lesion.systemic inflammatory response; acute lung lesion; lipid peroxidation; diagnostic and predictive markers