In the next issue of „Postępy Nauk Medycznych” we are presenting papers concerning the most essential issues faced by physicians working on intensive care units. Infections in patients staying in these units often constitute the direct cause of hospitalization (e.g. in the course of sepsis). In successive papers the authors describe various clinical pictures of disease entities frequently entangled with infections of the respiratory system, and also ways of monitoring these infections as well as proposals for their treatment.

Very interesting points are raised by Doctor Ewa Miller in her paper on the monitoring of the function of surfactant in various disease entities. The range of studies indicates that independently of the original aetiology, surfactant disorders are one of the factors of development of lung function disorders connected with acute lung injury. This paper draws attention to the possibilities to use the assessment of surfactant function in monitoring injuries of the respiratory system.

The next papers draw attention to the influence of burns on the respiratory system. The acute burn is a systemic disease. Its consequences are not limited only to the skin and adjoining tissues but manifest themselves in morphological and functional changes of numerous internal organs, such as the liver, kidneys, lungs, alimentary canal and central nervous system. More and more people suffer from burns, both in Poland and worldwide. The risk of having the respiratory system injured is continually rising. The common use in industrial production of plastics, from which everyday tools are made as well as household equipment, causes in the case of fire higher and higher risk of interaction of gaseous hydrocarbons with the respiratory system. They all interact very aggressively with the mucous membrane of the respiratory tract, having moreover properties of anaesthetizing the respiratory tract, and they contribute to deeper penetration of thermal energy. Then the burns affect not only the upper sections of the respiratory tract but also peripheral sections – the segmental and subsegmental bronchi as well as the respiratory bronchioli and pulmonary alveoli. Directly after the burn it leads to disorders in ventilation as well as oxygenation. This early injury of the respiratory system is connected with inhalation of smoke that appears during the fire. This is accompanied by the inhalation of carbon monoxide, injury of the area located above the glottis, followed by oedema, injury of the respiratory tract within the thorax, and in the case of burns of the thorax itself deterioration of its compliance.

The second group of patients that are very difficult to treat are those with a disorder of the coagulation system. In very ill patients in shock it very frequently leads to disorders in coagulability and respiratory insufficiency due to atelectasis and changes in functioning of surfactant, and the other papers are devoted to these issues.

Prof. dr hab. med. Jacek Jastrzębski

Prof. dr hab. med. Michał Pirożyński