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Ventilation impairment, due to ineffective elimination of the mucous-hemorrhagic content from the tracheobronchial tree (TBT), obstructs the upper airways with the ensuing ventilation reduction giving rise to atelectases and progressive alveolar block. There is evidence of transudation and exudation into the pulmonary pathways and pleural cavity. A series of 276 patients presenting closed chest trauma are subjected to fibrobronchoscopy (FBS) and follow-up study. In 92 of them bronchoscopy is performed 2 to 15 times per patient, accordingly: in 75-twice, in 10-five times and in 15-twice. One-hundred twenty-nine of the total of 276 cases under study are on mechanical ventilation. In 56 instances FBS is carried out through a tracheostomy cannula, in 73-by intubation, in 18-through the mouth, and in two--through the nose. Based on the obtained results, algorithms for assessment of the rheological properties of tracheobronchial secretion and degree of impairment of TBT drainage function during emergency FBS in closed chest injuries are worked out, having an essential practical bearing on the diagnostic and therapeutic approach to closed thoracic trauma.

Out of 566 children with closed abdominal trauma, treated in the EMI "Pirogov" over a five-year period, 79 present serious impairment of the basic vital functions (respiration, hemodynamics and the like) connected with the trauma and not infrequently with massive blood loss, necessitating the undertaking of resuscitation measures and intensive care. Of the latter 67 are restored to health, and in twelve the outcome is fatal. In terms of hemodynamic parameters a significant tachycardia along with maintaining normal or even increased arterial pressure are the most characteristic, whereas hypotension is present in 6.4 per cent of successfully cured children only on the first day. Regardless of the fact that merely 13.4 per cent of them have direct chest traumas, the gas exchange is considerably disturbed by hypoxemia--in 89 per cent on the first, and in 100 per cent of the children on the third postinjury day; in one-fourth of the cases the hypoxemia is markedly expressed--below 8.0 kPa (60 mm Hg). Along with the decrease in hemoglobin level the latter accounts for pronounced oxygen transport impairment. During the first postinjury day, the acid-base metabolism is characterized by metabolic acidosis development (in 44 per cent of children), with metabolic alkalosis becoming manifest during the next few days. Twelve children presenting severe combined injuries die within several hours of the accident with signs of a serious traumatic-hemorrhagic shock, or within 2-3 days thereafter with evidence of multiple organ failure.

Data are reported on a study of the informative value of ten clinical and laboratory parameters, which have a bearing on the vital prognosis of severe combined trauma. The presentation is part of a more comprehensive study, aimed at creating an expert system for prognosticating this type of pathology. Case material from the Clinic of Anesthesiology, Resuscitation and Intensive Treatment at the "Pirogov" Emergency Hospital in Sofia was used (1986-1988). Included in the study were 455 patients with severe combined traumatic injuries, of whom 210 died and 245 survived. The following methods were used for quantitative assessment of the informative value: for determining the descriptive informative value--informative criterion by Mel'nikov and informative criterion by Bykhovskiĭ [correction of Bihovski]; for the distributing informative value--the method of Kulback and modification of this method, as described by Genkin-Gubler. Simultaneous use of all four methods allowed to precise the values being obtained and to perform with maximal exactness the intervals relevant to the prognosis. This furnished the opportunity to distribute the individual parameters in highly informative groups, designated for entrance to the projected expert system.