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The objective: to evaluate the effectiveness of neurometabolic therapy in patients with severe course of the new coronavirus infection of COVID-19 complicated by the development of encephalopathy.Subjects and Methods. A pilot prospective study was carried out with the participation of 61 patients with a severe course of COVID-19 complicated by encephalopathy. The patients were randomized into two groups: the study group (n = 34), the patients in which, in contrast to the control group (n = 27), received Cytoflavin in addition to the main therapy in a daily dose of up to 40 ml for 5 days. The dynamics of the general and neurological status was assessed on days 3‒4 and 6‒7 days of treatment using the NEWS (National Early Warning Score), Glasgow coma and ICDSC (Intensive Care Delirium Screening Checklist) scales. Additionally, the blood level of neuron-specific enolase (NSE) was investigated at baseline and on days 6‒7.Results. Patients in most cases were elderly or senile with a high comorbidity index (up to 4 points according to Charlson). The persistence of delirious symptoms correlated with their age and low SpO2 levels. In half of the cases (50.8%), the disease had an unfavorable outcome. In the study group, by the 6‒7th day of treatment, there was a significant positive dynamics of the general condition, assessed by the NEWS scale (p = 0.012), a tendency towards a faster recovery of the overall score on the Glasgow scale (p = 0.083), a tendency towards more rapid regression of delirious symptoms by ICDSC scale (p = 0.055) versus the comparison group.Conclusions. Given the high risk of an unfavorable outcome in patients with a severe course of COVID-19 complicated by the development of encephalopathy, the additional use of Cytoflavin is advisable since it contributes to the regression of the symptoms of encephalopathy and may have a positive effect on the course of the disease.

Identification of patients with obstructive sleep apnea syndrome and high respiratory risk, optimization of the screening algorithm for these patients and administration of preventive non-invasive lung ventilation, makes it possible to prevent the development of perioperative complications, reduce duration of hospital stay and reduce mortality in patients undergoing surgery and bariatric surgery specifically.The objective: to evaluate the effectiveness of STOP-BANG questionnaire for preventive targeted respiratory therapy to reduce the risk of complications in bariatric patients. Subjects and Methods. We examined 60 patients with BMI above 30 kg/m2 referred to elective secondary surgery, the age made 44.2 ± 10.1 years, 23 men and 37 women. Before the operation, patients underwent STOP-BANG questionnaire survey, night respiratory monitoring with the calculation of the apnea/hypopnea index (AHI) and/or saturation during sleep. The standard preoperative examination included clinical and biochemical analyzes.Results. Based on results of STOP-BANG survey, a correlation was revealed between the score and AHI as well as the score and average saturation. The higher score the patients had according to the STOP-BANG questionnaire, the higher AHI was (r = 0.4748, p = 0.002), and the lower mean SpO2 was (r = -0.6958, p < 0.001). Using the ROC analysis, we chose the optimal threshold value - 4 points according to STOP-BANG questionnaire, where the sensitivity of the method was 93% for the AHI, the specificity was 56%, and for the average saturation it was 100% and 63%, respectively. Of the total number of bariatric patients included in the study, 30% required preventive ventilation. In the high respiratory risk group, no significant intraoperative incidents and deaths were reported by the surgical and anesthetic teams. All patients were discharged on time (5‒7 days). Based on the results, a screening procedure has been offered for bariatric patients with high respiratory risk associated with obstructive sleep apnea syndrome.Conclusion. The STOP-BANG questionnaire is a reliable screening tool for high respiratory risk in morbid obese patients. Early diagnosis of high respiratory risk and implementation of preventive ventilation reduces the incidence of perioperative respiratory and cardiovascular complications.

The objective: to assess the incidence and influence of platelets level on the hemorrhagic complications during percutaneous dilated tracheotomy (PDT) in patients with thrombocytopenia.Subjects and Methods. The study included 85 consecutive patients with varying degrees of thrombocytopenia at the stages of hematopoietic stem cell transplantation. The control group included 56 patients who underwent classical tracheotomy. The study group included 29 patients who underwent PDT (Griggs method). The operations were performed for prolonged artificial pulmonary ventilation. When the platelets level was below 20 × 109/L, platelet concentrate transfusion was performed before the operation.Results. The incidence of hemorrhagic complications in patients with thrombocytopenia during PDT was 13.8% (95% CI 9.13–18.45%). In open tracheotomy, the bleeding rate was 3.8% (95% CI 2.65–4.49%). These results are comparable to the incidence of hemorrhagic complications in patients with normal platelet counts. The influence of the platelet level on the presence of hemorrhagic complications in both groups was not established.Conclusion. Thrombocytopenia is not a contraindication to performing PDT. However, platelet concentrate transfusion should be performed in patients with platelet counts less than 20 × 109/L. An experienced team of anesthesiologists and endoscopists can reduce the incidence of other complications.

Postoperative respiratory complications in patients undergoing cardiac surgery occur in 20‒30% cases, and the most of them can be associated with ineffective cough and bronchial mucus evacuation.The objective. Comparative assessment of effectiveness and safety of methods for stimulating the evacuation of bronchial secretions using oscillatory PEP-therapy (Acapella Duet), oscillatory chest compression insufflator-aspirator “Comfort Cough Plus”, and the traditional method of manual chest percussion in the early period after cardiac surgery.Subjects and Methods. The prospective study included 120 cardiac surgery patients. They were divided into 3 groups (40 in each), depending on the type of the applied respiratory procedure. Distribution into groups was carried out by random selection. All procedures were performed 10‒12 hours after tracheal extubation. Before the procedure and 20 minutes after it, the efficiency of sputum discharge was assessed, gas exchange indices on room air breathing and maximum inspiratory lung capacity (MILC) were measured.Results. Ineffective bronchial mucus evacuating in the early period after tracheal extubation was observed in 86.7% of the patients. A single procedure of both PEP-therapy (Group 1) and mechanical cough stimulation (Group 2) led to improved sputum passage, as evidenced by an increase in the number of patients with productive cough by 4.25 times (p < 0.0009) and 5.3 times (p < 0.0007), respectively. In patients of Groups 1 and 2, an increase in MILC was observed (by 42.2% and 60.0%, respectively, p = 0.000001), the difference between the groups was statistically significant. In Control Group 3, with manual physiotherapy, the average increase in MILC was only 11.6%. Mechanical respiratory therapy procedures led to significant improvement in gas exchange variables, as evidenced by an increase in SpO2 in Groups 1 and 2 (p = 0.000009 and 0.000001, respectively) and a decrease in the proportion of patients with impaired oxygenating lung function (SpO2 below 92%) by 11 and 12 times, respectively (p < 0.01). The most significant changes were revealed in case of mechanical stimulation with aspirator-insufflator due to combination of two methods (oscillatory chest compression and lung inflation). In Control Group, no significant changes of gas exchange variables were observed.Conclusion: Mechanical vibratory methods for stimulating the bronchial secretion evacuation have significant advantages over classical manual chest massage in patients after cardiac surgery. Their positive effect on sputum passage, ventilatory parameters and gas exchange was noted, and the most pronounced effect was observed after oscillatory chest compression with insufflator-aspirator. The procedures were well tolerated and there were no complications associated with them.

The objective: to establish the possible effectiveness of exogenous phosphocreatine as a component of pharmacological support during the resuscitation stage of rehabilitation measures in critically ill patients with COVID-19.Subjects and Methods. Within a randomized study, 21 patients diagnosed with COVID-19 were divided into two groups: Group 1 (patients received the infusion of exogenous phosphocreatine as part of intensive care) and Group 2 (patients received standard intensive care) against the background of rehabilitation measures. Patients were assessed for muscle strength using the MRC scale, exercise tolerance by Borg rating, oxygenation parameters, routine clinical laboratory blood tests, dependence on respiratory support, outcome on day 10 of therapy, and hospital outcome.Results. The effectiveness of the use of the exogenous phosphocreatine as a component of pharmacological support during the resuscitation stage of rehabilitation measures in critical patients has been confirmed by positive dynamics: an increase in muscle strength (the MRC score in the group receiving exogenous phosphocreatine on day 10 was 0.5 points higher) and an increase in exercise tolerance (Borg rating in the group receiving exogenous phosphocreatine on day 10 was 1.5 points higher), significant increase in oxygenation based on arterial blood saturation data, and significant increase in lymphocyte count by 25% in the group receiving exogenous phosphocreatine.Conclusion. Exogenous phosphocreatine is a candidate drug for pharmacological support during resuscitation stage of rehabilitation of critical patients with COVID-19.

Introduction. Nosocomial meningitis (NM) is one of the leading complications in neurosurgery due to high mortality and disability rates.Objective. The study was aimed to determine the reference values of laboratory parameters to diagnose NM in neurosurgical patients in the intensive care unit (ICU).Results. The incidence of NM in neurosurgical patients in ICU was 8.4 (95% CI 6.8–10. 0) per 100 patients. The dominant microbial agents of NM were coagulase-negative staphylococci, A. baumannii, and K. pneumoniae. We revealed the increase in leukocytosis, C-reactive protein, and blood procalcitonin in patients with infectious complications of other systems, regardless of NM presence. Episodes of hyponatremia and an increase in body temperature ≥ 38.0 occurred signifcantly more often in patients with NM. Changes in cerebrospinal fluid (CSF) cytosis, glucose, lactate, and the CSF/blood glucose ratio can serve as reliable criteria in the NM diagnosis.Conclusions. The diagnosis of NM is most likely when the increase in CSF cytosis > 65 cells/μL, CSF lactate > 4.2 mmol/L is observed, the decrease in the CSF glucose < 2.6 mmol, and CSF/blood glucose ratio < 0.45 is found.

The article is devoted to the consideration of a clinical case of providing artifcial one-lung ventilation for performing thoracoscopic plastic of the right dome of the diaphragm in a patient with grade 3 posttracheostomy cicatricial tracheal stenosis. The patient is presented after a new coronavirus infection COVID-19 from 2020, prolonged mechanical ventilation through a tracheostomy tube (74 days), the development of medium thoracic cicatricial tracheal stenosis of grade 3 (the lumen of the narrowest part of the trachea is 4 mm) after decannulation and the development of relaxation of the right dome of the diaphragm (according to CT data, the dome is located at the level of the IV intercostal space). The frst stage under conditions of combined general anesthesia and high-frequency ventilation of the lungs was performed to restore the lumen of the trachea by bougienage of the stenosis area with tubes of a rigid endoscope under the control of a fberoptic bronchoscope with further nasotracheal intubation with a thermoplastic single-lumen endotracheal tube with a diameter of 8.0 with a cuff. At the second stage, during thoracoscopic plastic of the right dome of the diaphragm, to provide artifcial one-lung ventilation, a bronchial blocker was used, introduced through the same endotracheal tube into the right main bronchus under the control of a fberoptic bronchoscope.

Objective: complex assessment of clinical and economic effectiveness as well as saving of the state budget assets within the therapy of patients with sepsis/septic shock based on different technologies of blood purification.Methods. Evaluation of direct and indirect costs of the eight blood purifcation methods. The target population includes adult patients 18+ with septic acute kidney injury. The study was conducted in compliance with acting Standards on Clinical Economic Studies used in the Russian Federation.The study methods included evaluation of existing randomized clinical studies and trials with data from network meta-analyses and systematic reviews of the target technologies. The direct medical and indirect non-medical costs were calculated and analyzed in respect of cost-effectiveness and budget impact analyses.Results. Direct and indirect costs were calculated for the sorption devices oXiris (Baxter International Inc.), Toraymyxin (Toray Medical Co.), Alteco LPS Adsorber (Alteco Medical AB), Toxipak (POKARD NPF), Desepta.LPS (BIOTECH M NPP), CytoSorb (CytoSorbents Inc.), HA330 (Jafron Biomedical Co.), Desepta (BIOTECH M NPP) for two time-horizons: 1-year period and 5-years period with discounting. For both periods, the use of oXiris hemoflter results in the least economic burden for the state budget.Conclusion. The use of blood purifcation in septic patients therapy is associated with considerable direct and indirect fnancial expenses, the amount of which and consequential budget saving depend on the technology of blood purifcation applied. The actual tariff compensation policy evidently demands revising.

Sepsis is a life-threatening condition, which is manifested by the development of organ dysfunction due to generalized inflammation caused by the infection of various nature. Timely lesion debridement combined with adequate antibiotic therapy are important components of the successful treatment of sepsis. At the moment, there is no consensus about the volume and time of intervention in the development of surgical sepsis. The article discusses modern approaches to solving the problem of adequate sanitation of the source of infection. The results of few randomized trials in this area are presented.Source control is absolutely essential for the successful treatment of sepsis. However, it is difcult to create a unifed algorithm for surgical control for all cases due to different approaches depending on the infection location. Properly designed clinical trials are necessary to determine the optimal timing of surgery for sepsis and septic shock as least.

Thrombotic thrombocytopenic purpura is a disease from the group of thrombotic microangiopathies, the early diagnosis of which is a real challenge in clinical practice. The article presents a clinical case that clearly illustrates the multisystem nature of the damage against the background of thrombotic microangiopathy, specific parameters of diagnosis, and emergency therapy Timely initiation of specific treatment significantly increases the chances of survival in this category of patients.

One of the options for solving the problem of a “non-standard” patient undergoing a major and traumatic operation, perhaps, is the protocol-personalized approach to hemodynamic management.The objective: to study the efficacy and safety of using a modified protocol-personalized approach to hemodynamic management during surgical interventions on abdominal organs in elderly and senile patients.Subjects and Methods. A randomized prospective-retrospective clinical trial was conducted in parallel groups: Group 1 (control) - standard management of the perioperative period; Group 2 - standard management supplemented by the protocol-personalized approach to hemodynamic management.Results. Patients in the main group had the best parameters as per MACE outcomes (RR: 0.462, [95% CI: 0.251-0.850] p = 0.038). In the intra- and postoperative period, patients in the control group had a relatively higher risk of arrhythmias (RR: 2.517 [95% CI: 1.218; 5,200] p = 0.017).Conclusion. The use of the protocol-personalized approach results in better MACE outcomes (RR: 0.462, 95% CI: 0.251-0.850; p = 0.038) during surgical interventions on the abdominal organs in elderly and senile patients, and also, reduces the risk of arrhythmias (RR: 2.517, 95% CI:1.218; 5.200) p = 0.017.

Pregnant and postpartum women are at a higher risk of infection with SARS-CoV-2 as well as a higher risk of adverse outcomes for the mother and fetus. Standard approaches to the management of COVID-19-associated multiple organ dysfunction may not always be implemented in this category of patients. In the clinical case of a patient, who developed multiple organ dysfunction syndrome (severe ARDS, coagulopathy) associated with COVID-19 in the postpartum period, we demonstrate the successful use of combined extracorporeal life support that included veno-venous extracorporeal membrane oxygenation, therapeutic plasma exchange and renal replacement therapy with the universal oXiris set.

Ferritin is one of the biomarkers requiring special attention; its blood level increases significantly especially in the severe course of COVID-19. Information on the effect of hyperferritinemia on the disease outcome is very contradictory as are the ideas about the causes of its development.The objective: to study the effect of hyperferritinemia on the disease outcome and analyse the possible causes of its development in severe COVID-19.Subjects and Methods. Data on 479 patients with severe course of coronavirus infection treated in intensive care units (ICU) were retrospectively analyzed. Of them, the proportion of patients with a favorable outcome (Group 1) was 51.0% (n = 241), and with an unfavorable outcome (Group 2) - 49.0% (n = 235). The following parameters were assessed: the levels of ferritin, C-reactive protein, fibrinogen, IL-6, IL-10, IL-18, procalcitonin, complement C5a, total, direct and indirect bilirubin, ALT, AST, and the blood level of lactate dehydrogenase (LDH). The changes of erythrocyte count and hemoglobin blood level were also monitored. In order to form a clear view of iron metabolism, free iron, transferrin, and myoglobin levels were assessed in several patients with high ferritin values (more than 1,500 pg/L).Results. In the unfavorable outcome, ferritin levels increase very significantly, reaching maximum by day 6 of patients' stay in ICU. The difference in the level of ferritin between the groups of survivors and deceased during this period is clear and significant (p = 0.0013). The association of ferritin values with the outcome is detected as early as day 1, but by day 4 it becomes highly significant (the cut-off point is 1,080 pg/l). No data have been obtained that would indicate the association of hyperferritinemia with impaired iron metabolism, the development of hepatic dysfunction, or cellular destruction. In contrast to survivors, those who died on day 6 had elevated IL-6 while C5a level remained unchanged. Conclusions. The rapid increase in ferritin blood levels to 1,000 pg/L or higher is an unfavorable prognostic sign indicating a high probability of a lethal outcome. When assessing genesis of hyperferritinemia in COVID-19, the crucial significance should be attributed to the cytokine storm rather than disorders of iron metabolism or hemotoxic effects of the virus. The persistent increase of ferritin level in blood during 4-6 days of stay in ICU should be considered as a reason to intensify anticytokine therapy.

Anesthetic provision of retroperitoneoscopic adrenalectomy for hormone-active adrenal tumors still requires overcoming certain difficulties. This is due to significant metabolic and functional disorders that persist even after thorough preoperative preparation. In addition, the endovideoscopic intervention itself requires certain conditions, each of which is fraught with additional stress on the circulatory and respiratory systems.The objective: to develop a technique for anesthetic management of aldosteroma surgery.Subjects and Methods. The study involved 57 patients (42 women and 15 men aged from 38 to 62 years) who underwent retroperitoneoscopic adrenalectomy for aldosteroma. The patients were divided into two groups depending on the method of anesthesia. In Group 1 (n = 30), the operation was performed under combined anesthesia with low-flow desflurane inhalation as a basis and perioperative analgesia with systemic opioid administration. Patients of Group 2 (п = 27) were operated under anesthesia with low flow desflurane inhalation as a basis in combination with 0.35% ropivacaine solution blockade of the fascial space of the erector spinae plane muscle on the surgery side (ESP erector spinae plane). In order to optimize myoplegia, Group 2 was divided into three subgroups (A, Б, and В), 9 patients each. In patients of subgroup A, muscle relaxation was achieved by continuous administration of rocuronium bromide at the dose of 0.4 mg • kg-1 • h-1 throughout the operation. In subgroups Б and В, muscle relaxation was achieved by bolus administration of rocuronium bromide intravenously at the dose of 0.15 mg * kg-1 * h-1. Patients from subgroup A underwent no decurarization. In subgroup Б, for the purpose of decurarization, atropine sulfate 0.01 mg/kg and proserin 0.05 mg/kg were administered. In subgroup Б, sugammadex was administered at the dose of 4 mg/kg. Neuromuscular conduction was monitored, parameters of central and peripheral hemodynamics, anesthesia adequacy, quality of postoperative analgesia, and frequency of postoperative complications were assessed.Results. Combined anesthesia with desflurane with ESP blockade allows achieving the required level of its depth, providing adequate analgesia in the postoperative period, avoiding the use of high doses of opioid analgesics after surgery and thereby preventing the occurrence of complications associated with their use. The use of rocuronium bromide in patients with aldosteroma provides complete muscle relaxation at all stages of the video endoscopic intervention. The use of sugammadex makes the myoplegia technique manageable, which allows by the end of the operation to restore neuromuscular conduction, transfer to spontaneous breathing and activate the patient, which to a certain extent ensures the prevention of postoperative complications.Conclusions. The use of ESP block with combined anesthesia is an effective method of perioperative analgesia for retroperitoneoscopic adrenalectomy for aldosteroma, and also reduces the consumption of opioid analgesics and reduces the number of postoperative complications associated with their use. Continuous infusion of rocuronium bromide without deteriorating the quality of the neuromuscular block significantly reduces the consumption of the relaxant, and the use of sugammadex makes myoplegia controllable which is very important for patients with aldosteroma.

Of all cases of acute kidney injury (AKI), 45-70% are associated with sepsis. Lethality in sepsis-associated AKI requiring renal replacement therapy (RRT) ranges from 40 to 50%, and in AKI combined with other organ dysfunctions - 60-80%. In order to improve the results of treatment of sepsis and septic shock, various methods of extracorporeal detoxification (ECD) have been developed. The effectiveness of these methods is controversial. In the treatment of sepsis, RRT is used not only to replace the impaired detoxification function of kidneys, but also to remove excess cytokines from the systemic bloodstream. The literature describes mainly positive results of the use of dialyzers with an adsorbing membrane, however, these data do not have the necessary degree of evidence. Currently, there are no clear criteria for the initiation of RRT, its duration and doses, the choice of methodology determined by specific clinical and laboratory parameters, and staging of this therapy. All this highlights the need for further research in this field.

Currently, in pandemic settings, the new coronavirus infection is the leading cause of adult fatalities and may cause death of children with comorbidities.The objective of the study is to identify predictors of the fatality of the new coronavirus infection in children.Subjects and Methods. 230 patients with the new coronavirus infections were examined. The main group of 94 patients with severe COVID-19, the fatal outcome occurred in 25 (26.6%) children. The comparison group consisted of 126 children with a moderate degree of severity, and there were no lethal outcomes.Results. Children older than 10 years of age (43%) prevailed in the study cohort. Every fifth patient in the main group suffered from shock, and 79 (84%) children had failure of two or more systems/organs. The presence of pronounced manifestations of the disease was associated with a 20-fold increase in the probability of a severe course of COVID-19 (OR = 0.04). Involvement of two organs and systems doubled the risk of death. An acceptable discriminatory ability of the pSOFA score for predicting COVID-19 outcomes in children was identified: sensitivity 83%, specificity 61%, cut-off point 5.6 points.Conclusion. Predictors of death in severe new coronavirus infection in children include failure of two or more organs and systems, acute renal injury and the pSOFA score above 5.

The objective: to compare efficacy and safety of Intellivent-ASV® with conventional ventilation modes during weaning in the patients after cardiac surgery.Subjects and methods. In this randomized controlled trial, 40 adult patients were ventilated with conventional ventilation modes and 40 with Intellivent-ASV after uncomplicated cardiac surgery. Eight physicians were involved in the study.Care of both groups was standardized, except for the modes of postoperative ventilation.We compared:- The physician’s workload, through accounting number of manual ventilator settings and time they spent near the ventilator in every group,- Duration of tracheal intubation in ICU,- Evaluation of ventilation safety by considering driving pressure, mechanical power, positive end expiratory pressure, and tidal volume level,- The frequency of adverse events, postoperative complications, and lethality.Results. There were significant differences in the duration of respiratory support in ICU: 226 ± 31 min (Intellivent Group) vs 271 ± 78 min (Control Group) (p = 0.0013).In Intellivent Group, the number of manual ventilator settings and time spent by physicians near the ventilator before tracheal extubation were significantly lower: 0 vs 4 (2–6), and 35 (25–53) sec vs 164 ± 69 sec respectively (p < 0.001 in both cases).Intellivent-ASV provided significantly more protective ventilation through reduction in the driving pressure, tidal volume, FiO2 and PEEP levels but no difference was noted between paO2/FiO2 ratio. ∆P and Vt were significantly lower in Intellivent Group – ∆P on mechanical ventilation was 6 (5–7) cm H2O vs 7.25 (6.5–9.5) cm H2O (p < 0.001); Vt on mechanical ventilation was 6 (5.2–7) vs 7 (6–9.5) ml/kg/PBW (p = 0.000003). PEEP and FiO2 levels were also significantly lower in Intellivent Group, PEEP on mechanical ventilation was 5 (5–7.5) cm H2O vs 7 (5–11.5) cm H2O and FiO2 level was 26 (22–30) % vs 34 (30–40) %.There were no significant differences between the groups in frequency of adverse events and duration of ICU and hospital stay.Conclusion. Application of Intellivent-ASV mode after uncomplicated cardiac surgery provides more protective mechanical ventilation and reduces the physician’s workload without compromising the quality of respiratory support and safety of patients.

The objective: to evaluate the international practice of using calcium salts when weaning from cardiopulmonary bypass after cardiac surgery in adult patients.Design: a multiple-choice survey about the current practice of calcium salts use when weaning from cardiopulmonary bypass based on the SurveyMonkey platform.Participants: cardiac surgical hospitals around the world.Estimation and main results. Totally 112 emails were sent to Russian and foreign centers inviting them to participate in the survey. 100 centers from 32 countries replied to this request. Generally, the majority of centers (88%) administer calcium salts during surgery with cardiopulmonary bypass, and in 71 (71%) centers out of 100, calcium salts are used to improve hemodynamics. Among 88 centers that use calcium salts during surgery, 66% (58/88) of respondents use calcium chloride, 22% (19/88) use calcium gluconate, and 12% (11/88) use both drugs. Most centers (55 (77%) out of 71) use doses of 5 to 15 mg/kg as a bolus or infusion for 1 min.Conclusion: Our survey shows that the majority of cardiac surgery centers use calcium in adult cardiac surgery patients especially during weaning from cardiopulmonary bypass. There is variability in the type of drug, dose, and route of administration.

With a traditional approach to treatment of hypoxemic respiratory failure, it is believed that SpO2 reduction below 88-90% during oxygen therapy requires emergency care including invasive mechanical ventilation. However, the manifestations of hypoxemic respiratory failure in COVID-19 patients have certain features that have led to the change in the traditional respiratory support procedure. The therapeutic goals of respiratory support in this category of patients require clarification.The objective: in patients with COVID-19, to study the relationship of transcutaneous saturation values with clinical indicators that characterize ARF, the state of acid-base balance and blood gas composition.Subjects and methods. A multicenter prospective observational study included 90 COVID-19 patients treated in ICU whose transcutaneous saturation (SpO2) values were below 93% despite treatment. Depending on the degree of impaired oxygenation, patients underwent oxygen therapy through a mask or nasal cannula, high-flow oxygenation or non-invasive ventilation, while it was not always possible to achieve the target values of oxygenation parameters. The patients were divided into the following groups: Group 1 ‒ SpO2 above 93%, Group 2 ‒ SpO2 within 93–90%, Group 3 ‒ SpO2 within 85–89%, Group 4‒ SpO2 within 80–84%, Group 5 ‒ SpO2 within 75–79%, and Group 6 – below 75%.Results. It was revealed that during ARF management by noninvasive methods, different values of transcutaneous saturation and corresponding changes in the acid-base balance (ABB) and blood gas composition were determined When transcutaneous saturation (SpO2) decreased to 85%, there was a corresponding moderate decrease in PaO2 while no metabolic changes occurred. As a rule, there were no obvious clinical signs of respiratory failure (silent hypoxia). In patients with SpO2 reduction down 80–85%, clinical signs of respiratory failure (dyspnea, tachypnea, agitation) and, as a rule, a moderate increase in PаCO2 with the development of respiratory acidosis and compensatory metabolic alkalosis were noted. When SpO2 decreased down to 75–79%, arterial hypoxemia was usually accompanied by moderate hypercapnia and the development of decompensated mixed acidosis and venous desaturation as well as increased lactate levels. With transcutaneous saturation going below 74%, these changes were even more pronounced and were observed in all patients of this group.Conclusion. The revealed changes are mostly consistent with generally accepted ideas about the relationship between values of transcutaneous saturation and blood gas composition and parameters of blood ABB in the case of ARF. Reduction of transcutaneous saturation down to 85% not accompanied by pronounced clinical signs of respiratory failure (dyspnea, tachypnea, agitation), development of acidosis and venous desaturation, and the elevated lactate level can be regarded as relatively safe.

Spontaneous pneumomediastinum is a rare complication of viral pneumonia. The prevalence of pneumomediastinum among coronavirus infection patients is unknown.Subjects and methods. Three cases of spontaneous pneumomediastinum among the COVID-19 pneumonia patients were analyzed. The researchers investigated and compared clinical, radiological and laboratory data.Results. According to the research results, no correlation was found between the development of pneumomediastinum and changes in values of blood laboratory tests. As well as there were no signs of correlation between drug treatment and pneumomediastinum frequency.Conclusion: The researchers suggest that the leading cause of spontaneous pneumomediastinum is viral pneumonia-associated severe alveolar damage.

Early prediction of disease severity helps clinicians prevent adverse events and/or minimize losses in the event of a life-threatening complication. This provision fully applies to refractory septic shock, in which norepinephrine administration at a dose exceeding 0.5 μg/kg-1/min-1 is needed to maintain mean arterial pressure.The objective: to determine predictors of lethal outcomes in patients with refractory septic shock.Subjects and methods. A retrospective study included 79 patients with refractory septic shock aged from 42 to 74 years (59.7 ± 7.8), with severity of the condition as per SOFA varying from 8 to 16 scores. The predictive value of indicators was assessed using univariate and multivariate analyses.Results. In multivariate analysis, the only significant predictor of an unfavorable outcome was the SOFA score (adj. OR: 1.626 [95% CI: 1.313; 2.014], p < 0.001). Other putative indicators (age, oxygenation index, lactate and procalcitonin concentrations, and norepinephrine dose) had no predictive value.Conclusion: The SOFA score is an independent predictor of lethality in adult patients with refractory septic shock (аdj. OR: 1.26 [95% CI: 1.313; 2.014], p < 0.001). According to the results of the ROC analysis, along with SOFA, norepinephrine dose was also a significant predictor (AUC 0.989 [95% CI 0.934; 1.000], p < 0.001).

Post-cardiac arrest syndrome is an extremely complex nosology, characterized by high mortality and the development of severe neurological disorders. Predicting the neurological outcome in this pathology is an urgent problem, since it allows determining the tactics of patient management and optimizing the scope of medical care, as well as preparing the patient's family members for expected results of treatment. Currently, clinical, laboratory and instrumental data are used as predictors of an unfavorable neurological outcome (e.g., pupillary responses, neuron-specific enolase levels, electroencephalography). There is no single criterion with high sensitivity and specificity for predicting neurological disorders; therefore, a multimodal approach is required. This article discusses several factors, the combination of which allows predicting the outcome of post-cardiac arrest syndrome with the greatest degree of reliability.

Introduction.Chronic venous insufficiency is one of the most common diseases, so finding the best treatment options is one of the most urgent tasks of surgery. One of the methods of implementing this direction is to apply a personalized approach. The aim of the study is to improve surgical care for patients with VVPC by introducing a personalized approach.Materials and methods.The study was based on clinical observations and special studies in 428 patients with uBVNC in outpatient settings. All of those surveyed were women. The average age of the patients was 42.3 ± 15.5 years. All patients were operated on — endovasal laser coagulation (EVLk) was performed in the traditional way. Clinical examination of patients, as well as special methods of research was carried out. A questionnaire was used to assess the quality of life of patients. The peculiarity of the study was the use of social and hygienic methods: survey, psychological testing, expert. Statistical analysis and mathematical processing of results were carried out with the help of modern computer technologies based on the Statisticala 6 application package.Results.It has been established that over the past five years in the Ivanovo region there has been an increase in the incidence of vessels of the lower extremities. The frequency of varicose veins exceeds 47 per 100 patients examined. The desire to perform surgery in the nonstate health sector is observed in 9.8 cases. In 85.0% of patients with VBNC, received for surgical treatment, have a lack of preparedness. Their information, clinical and psychological level is 65.0–89.0% of the due and direct influence on the formation of an unfavorable result.Conclusion.Thus, the implementation of a personalized approach to the surgical treatment of patients with chronic venous insufficiency by laser coagulation provides on a par with the reliable obliteration of altered veins the fastest clinical recovery of patients, improvement of their quality of life, satisfaction with results, good hemodynamic and cosmetic effects.

Introduction.The recurrent course of an ingrown toenail remains a serious problem to this day, despite the centuries-old history of its study. Among outpatient patients, the incidence of this disease reaches 10% and does not tend to decrease, and among the population, the incidence of ingrown toenail is 3.4%. Theaimof the work was to study the causes of recurrent ingrown toenail and the effectiveness of using a laser beam in the treatment of this pathology.Material and methods.The authors analyzed the causes of recurrent ingrown toenail in 66 patients after various surgical interventions for the period from 1990 to 2020.Results and discussion.The following causes of relapse of the disease were identified: removal of the entire nail plate not according to indications, carrying out marginal resection of the nail on the affected side with the preservation of the nail plate matrix, performing removal of granulations in the nail roller area with the preservation of the nail, underestimating the importance of anti-inflammatory drug treatment in the postoperative period, as well as the importance of correcting metabolic processes in patients with concomitant pathology. A clinical case is presented: a patient with a non-healing wound after four surgeries due to an ingrown toenail with a recurrent course. The patient underwent a Schmiden surgery with resection of the “ingrown edge” of the right first toe nail and removal of infected granulations using laser irradiation of the wound and careful treatment of the matrix area in the projection of the removed part of the nail. In the postoperative period, bandages with ointment based on chloramphenicol and methyluracil were used for local treatment. Recovery occurred on the fourteenth day.Conclusion.In order to reduce the number of relapses of the disease, it is recommended to perform a matrixectomy of the bed of the removed nail plate using laser or radio wave radiation.

Phlebotropic therapy is an important component of the pathogenetic treatment of chronic venous insufficiency (CVI) of the lower extremities. Venoactive drugs, which have proven their effectiveness and safety in a variety of studies, are widely represented in international and Russian clinical guidelines and standards. However, there is no consensus on the regulation of phlebotropic therapy and, above all, its duration in different clinical classes of CVI. In addition, there are no clear indications on the methods of treatment efficacy monitoring, which can be used in real clinical practice. The presented systematized review of the literature data on micronized purified flavonoid fraction not only reveals the possibilities of phlebotropic therapy of different clinical classes and forms of CVI, but also suggests effective regulations for the use of this drug in specific situations. The data concerning the efficacy of phlebotropic therapy in real clinical practice at the initial stages of CVI (C0s-C1s), in the treatment of C2s (varicose superficial veins with venospecific symptoms), C3 (chronic venous edema), C4 (trophic skin disorders), as well as in stages C5-C6 and C6r (venous trophic ulcers) are presented in details. In addition, the results of studies on the use of micronized purified flavonoid fraction in phlebosclerosing treatment are presented. The duration of phlebotropic therapy is in direct relation to the severity of the disease and the response to the ongoing treatment. The important role is played not only by personalization of treatment according to specific symptoms and syndromes, but also, if possible, by objective control of their dynamics.

An important place in the structure of the causes of postoperative respiratory failure in cardiac surgery is occupied by atelectasis of the lung tissue, which is formed during cardiopulmonary bypass (CPB). The incidence of this complication makes 54–92%.The objective: to evaluate the effectiveness of various respiratory support techniques during CPB.Subjects and methods. 60 patients were randomly included in the study. CPAP Group (positive airway pressure +5 cm H2O) and VC Group (lung ventilation during CPB with parameters: tidal volume 3 ml/kg, respiratory rate 6/min, positive end-expiratory pressure +5 cm H2O).Results. The oxygenation index in VC Group was higher than in CPAP Group at the stages after the end of CPB (289.6 ± 100.0 in VC Group and 223.1 ± 152.0 in CPAP Group), at the end of surgery (in VC Group 318,7 ± 73.8 and in CPAP Group 275.2 ± 90.0) The frequency of intraoperative (VC 16% and CPAP 43%) and postoperative recruiting lung maneuvers (VC 7% and CPAP 26%) in VC Group was lower versus CPAP Group. The incidence of atelectasis in VC Group (10%) decreased compared to CPAP (36.6%).Conclusion: Low-volume ventilation during cardiopulmonary bypass has a more favorable effect on the oxygenating function compared to respiratory support in the CPAP mode.

The objective of the study is to evaluate the discriminative ability of nSOFA in newborns with sepsis.Subjects: The study was designed as retrospective, observational, and one-center. End points included assessment of the severity as per nSOFA and pSOFA; 28-day survival. 121 patients were enrolled in the study. Microsoft Excel (Graphpad Software, San Diego, California, USA) and MedCalc (v 7.1.0.0; MedCalc Software, Belgium) were used for the analysis.Results. A study of the discriminative power of the scores showed that both assessment systems had a good model quality. However, nSOFA had a statistically more significant (p < 0.05) area under the ROC curve (0.981± 0.014).Conclusion. The high value of the discriminative ability of the nSOFA scale indicates the feasibility of its use in patients with sepsis in neonatal intensive care units

The use of high-adsorption membrane hemofiltration in COVID-19 positive patients to reduce the severity of a cytokine storm is clearly beneficial but at the same time, there are no certain procedures for its practical use.The objective:to study the change in the levels of IL-6 and IL-18 in response to prolonged (24-72 hours) high-adsorption membrane hemofiltration.Subjects and methods. We retrospectively analyzed the data on IL-6 and IL-18 levels and their changes in 69 patients who were COVID-19 positive and had different degrees of lung damage, they had received high-adsorption membrane hemofiltration during their stay at the intensive care unit. The extent of lung lesions was the following: 4 people had CT-2, 44 people had CT-3, and 21 patients had CT-4. 18 patients had an unfavorable outcome of the disease. High-adsorption membrane hemofiltration (Prismaflex) was used in the group of patients who had clinical signs of the rapid progression of the disease and also such laboratory findings as elevated values of C-reactive protein (above 100 mg/L), ferritin (more than 600 μg/L), and progression of lymphopenia. This intervention lasted for 24 hours at CT-2/3, and 48 hours at CT-4. The effluent dose was 30.0 ± 6.4 ml/kg/h. The levels of IL-6, IL-18, and procalcitonin were tested before and after the completion of the intervention, and the difference between their concentration before and after high-adsorption membrane hemofiltration was calculated. The potential association between received data (IL-6, IL-18, delta of IL-6, delta of IL-18) and degree of lung damage and outcomes was analyzed.Results.It was detected that the more the lungs were affected, the lower levels of IL-6 and IL-18 were and vice versa and this correlation was not associated with the use of tocilizumab (used in 44 people). The maximum decrease in the level of cytokines was observed in the group of patients with CT-2. There was a significant association between the delta of IL-6 (F = 6.69; p ≤ 0.05) and the outcome which was especially pronounced in people with a favorable outcome.Conclusion.As the inflammation progresses in the lungs, the levels of IL-6 and IL-18 decrease which may be a manifestation of the depletion of the cytokine storm. The use of prolonged high-adsorption membrane hemofiltration (24-48 h) allows reducing the level of cytokines. The delta value reflects a decrease in IL-6 concentration, it significantly correlates with the outcome which indicates the importance of using this method in a continuous mode.

The objective: to establish the prevalence of postoperative delirium (POD) and the influence of various factors in intra- and postoperative periods on its occurrence in children with septal congenital defects requiring surgical interventions with cardiopulmonary bypass (CPB).Subjects and methods: 40 children from 6 to 36 months and weighing from 7.5 to 15 kg were enrolled in the study; they underwent planned radical surgery of septal CHD with cardiopulmonary bypass. In the postoperative period, all patients were tested using the Cornell Assessment for Pediatric Delirium validated for children of this age. Cerebral damage was also assessed using three specific serum markers: protein S-100-ß, neuron-specific enolase (NSE) and glial fibrillar acidic protein (GFAP) before the surgery, upon bypass completion, and in 16 hours after the operation.Results. The study revealed the incidence of delirium in 22.5%. When analyzing many factors of the intra- and postoperative period, it was found that the use of donor blood components in the primary volume of CPB filling was statistically significantly more often observed in patients with established delirium: 7 (78%) and 13 (42%) (p = 0.049). Also, it was found that levels of S-100-ß, NSE, and GFAP were significantly higher in patients with confirmed POD.The study described the incidence of POD in children after surgical treatment of congenital heart disease under cardiopulmonary bypass and showed that intraoperative transfusion was a risk factor for the development of delirium. The role of markers of cerebral damage in the diagnosis of POD was also proven.

The role of coagulopathy in severe novel coronavirus infection remains to be clarified. Coagulopathy mechanisms can be summarised in two main pathways: inflammation-related and specific-virus related pathways. The incidence of thromboembolic events is high with pulmonary embolism being the most frequent thromboembolic complication. Low molecular weight heparin is considered the main prophylactic and therapeutic option in patients with COVID-19. Treatment of thromboembolic complications should be started without delay in all cases with certain or clinically suspected diagnosis, whether confirmed or not with specific diagnostic methods. The article reviews the following: mechanisms of development of coagulopathy in COVID-19 including those directly related to the action of the virus, the diagnostic value of biochemical markers and thromboelastography, the incidence of thromboembolic events, and approaches to the prevention and treatment of COVID-19-associated coagulopathy.

Microcirculation disorders caused by thrombosis are the most important factor determining the pathogenesis of organ damage in severe COVID-19 including the absence of obvious macrohemodynamic instability. However, there are very few publications demonstrating the results of intravital visualization of changes in the microcirculation system in this disease.The objective: to assess the state of microcirculation in patients with viral pneumonia associated with COVID-19 using nail bed microscopy.Subjects and methods. Eleven patients with COVID-19 were examined; they were admitted to the intensive care unit due to progressing acute respiratory failure. Vital microscopy of the microcirculatory bloodstream in the fingers’ nail bed was performed by admission and over time. When assessing microcirculation, the presence of aggregates in the lumen of capillaries and avascular zones, and the linear velocity of blood flow were taken into account. The results were summarized taking with the outcome consideration (6 people recovered, 5 died). Results. Microcirculation disorders were objectively confirmed in all patients. In 100% of cases, microaggregates were detected in the capillary lumen. The values of the mean linear velocity of capillary blood flow turned out to be extremely variable. However, the values of the maximum linear velocities of capillary blood flow in the patients who subsequently died were significantly lower versus survivors (190 μm/sec (135.5; 237) and 387 μm/sec (329.3; 407.5), p = 0.018). The irregularity of blood flow in the visualized field was revealed: when the value of the maximum linear velocity in some capillaries was less than 180 µm/sec, in others, disturbances in the form of pendulum-like movement were already noted. Further slowing down of the blood flow velocity led to the development of stasis and the formation of avascular zones.Conclusion. Impaired microcirculation (decreased blood flow rate in the capillaries, the presence of microaggregates and a lower number of perfused capillaries in the form of avascular zones) develops in all patients with severe COVID-19.

The review describes certain practical aspects of follicular puncture anesthesia. It presents data on the penetration of anesthetics and other drugs used during anesthesia into the follicular fluid as well as the effect of certain drugs and conditions on the reproductive outcome of treatment. Various options for anesthesia are described that can be used depending on the characteristics of the patient's psychoemotional state and the number of punctured follicles.

The objective: to evaluate the effect of high-flow oxygen and non-invasive ventilation on the mortality rate in adults with severe respiratory failure caused by the new coronavirus infection in the intensive care unit (ICU).Subjects and methods. A one-center retrospective study was conducted. Electronic medical files of patients treated in the ICU from April 1 to May 25, 2020, were analyzed. Totally, 101 medical files were selected, further, they were divided into two groups. Group 1 (n = 49) included patients who received oxygen insufflation, and should it fail, they received traditional artificial ventilation. No non-invasive respiratory therapy was used in this group. Group 2 (n = 52) included patients who received high-flow oxygen therapy and non-invasive ventilation. The mortality rate in the groups made a primary endpoint for assessing the impact of high-flow oxygen therapy and non-invasive ventilation. The following parameters were also analyzed: drug therapy, the number of patients in whom non-invasive techniques were used taking into account the frequency of cases when these techniques failed, and the number of patients in whom artificial ventilation was initiated.Results. In Group 2, non-invasive methods of respiratory therapy were used in 31 (60%) cases. High-flow oxygen therapy was used in 19 (36%) of them; in 13 cases this method allowed weaning them from the high flow. Non-invasive ventilation was used in 18 cases, in 12 patients it was used due to progressing severe respiratory failure during humidified oxygen insufflation, in 6 patients – after the failed high-flow oxygen therapy. In Group 1, 25 (51%) patients were intubated and transferred to artificial ventilation, in Group 2, 10 (19.2%) underwent the same. The lethal outcome was registered in 23 (47%) cases in Group 1, and in 10 (19.2%) in Group 2 (p = 0.004). Analysis of drug therapy in the groups revealed the difference in the prescription of pathogenetic therapy. Logistic regression demonstrated the effectiveness of the combination of tocilizumab + a glucocorticoid in reducing the frequency of lethal cases (p = 0.001).Conclusion. The use of non-invasive respiratory support in adults with severe respiratory failure caused by the new coronavirus infection combined with therapy by tocilizumab + a glucocorticoid can reduce the incidence of lethal cases.

The objective : to evaluate the effectiveness of NIPPV (nasal intermittent positive pressure ventilation) and NHFOV (nasal hig h-f requency oscillatory ventilation) modes in newborns in the delivery room depending on the gestation period. Subjects and methods. A prospective randomized study included 88 premature newborns with the body mass of 1,405 (1,085–1,760) gr. and gestation period 31 (29–32) weeks. In children of the first group, the NIPPV mode was used, and in the second group – NHFOV . Children of each group were divided into subgroups: subgroup 1 consisted of newborns with a gestation period of 30–32 weeks, subgroup 2 – 26–29 weeks. Results. The need for the traditional ventilator was significantly greater in the group of NIPPV – 15 children, compared to the group of NHFOV – 2 children ( p = 0.001). In the same subgroup, statistically significant differences were found in the frequency of bronchopulmonary dysplasia ( BPD ) and intraventricular hemorrhage ( IVH ) ( p < 0.05). In particular, in the NIPPV group, BPD was registered in 33.3% of cases, while in the NHFOV group – 3.7% ( p = 0.001). In children a gestation period of 26–29 weeks, the opposite results were noted. Retinopathy of prematurity was detected in 80% (12) of children on NHFOV and 12.5% (2) who received NIPPV ( p = 0,001)). There were also statistically significant differences in the frequency of BPD formation – 9 cases in the first group, 13 cases in the second group ( p = 0.04). Conclusion . The use of NIPPV as a starting method of respiratory support is indicated to newborns with the gestation age of 26–29 weeks, and while in newborns with the gestation period of 30–32 weeks, the use of NHFOV is highly effective.

Subjects and methods. The retrospective study included 37 patients ( n = 37) diagnosed with severe viral pneumonia ( SAR S -C oV2) who were treated in the intensive care unit of Pavlov First Saint Petersburg State Medical University. To assess the significance of PADM as a biomarker of bacterial infection, patients were divided into two groups: the group of patients with viral pneumonia without sepsis ( n = 24) and the group of those who developed sepsis and septic shock complicating the course of the new coronavirus infection ( n = 13). PADM was assessed as a criterion for the severity of the disease in the groups of deceased ( n = 19) and survivors ( n = 18). Data were statistically processed in the computer mathematics system R, version 3.6.2, the prognostic significance of PADM was assessed using linear regression. Results. The median PADM in the group without sepsis was higher than the reference value – 1.1 (0.5; 4.3) nmo l/L , in patients with sepsis that complicated the course of viral pneumonia – 2.8 (1.1; 5.7) nmo l/L ( p = 0.0019). Significant differences were revealed between the baseline levels of PADM in patients with different outcomes: in the surviving group, the median was 0.99 (0.5; 3.14) nmo l/L , and in the group of deceased – 2.70 (0.94; 5.86 ) nmo l/L . In surviving patients, the changes in PADM levels had a linear distribution throughout the entire period of stay in the intensive care unit. In deceased patients, within 20 days before death, PADM tended to grow significantly and reached its maximum by the time of the outcome. Conclusion. The assessment of the PADM blood level can be used to clarify the addition of a bacterial infection in patients with pneumonia caused by the SAR S -C oV2 virus. The study of changes in its level makes it possible to objectify the prediction of the course of COVI D -1 9 – favorable or unfavorable. Data accumulation is required to clarify specific PADM values that predict the outcome in COVI D -1 9 patients.

Neonatal sepsis continues to be one of the main problems in the treatment of premature infants due to the variability of the clinical signs, the lack of uniform diagnostic criteria, optimal markers that would not be affected by the course of pregnancy, gestational age, delivery, and the early neonatal period. The objective : to analyze current data on serum markers of neonatal sepsis in newborns including children with extremely low and very low birth weight. The article reviews traditional markers that are currently widely used in resuscitation neonatal practice – C-r eactive protein, procalcitonin, and among the new ones – preadrenomedullin, and presepsin. It lists their positive and negative aspects, compares their characteristics, notes publications that describe the possibilities and limitations of their use for early diagnosis of neonatal sepsis. It has been concluded that among all markers, presepsin is of the greatest interest due to its highest sensitivity and specificity compared to the others.

The effectiveness of antibacterial therapy is a critical factor to improve treatment outcomes in sepsis patients. Impaired renal function and renal replacement therapy lead to a significant change in the pharmacokinetic parameters of most intravenous antibacterial drugs, which in many cases is accompanied by insufficient or excessive concentration in the blood which results in antibacterial therapy failure. The article presents current views and describes the current problems of antibacterial therapy for sepsis during the use of extracorporeal detoxification methods. The objective : to analyze publications on antibacterial therapy of sepsis during the extracorporeal detoxification. Results: the most accessible and effective method for solving the problem of inadequate dosage of antibiotics when using extracorporeal detoxification is to develop local protocols based on the results of pharmacokinetic studies.

The objective : to study the hemostatic system of patients diagnosed with the novel new coronavirus infection and compare the data obtained with hemostatic system parameters in patients with advanced deep vein thrombosi s/p ulmonary embolism without COVI D -1 9. Subjects and methods. A singl e-c enter prospective study with retrospective control was conducted in Anesthesiological and Intensive Care Department No. 1 of Kuvatov State Medical University (Ufa) in April - May 2020, the objective of the study was to investigate the hemostatic system of patients with confirmed new coronavirus infection, patients diagnosed with venous thrombosis in 201 2-2 014, and a group of healthy volunteers. Results . Evaluation of the hemostasis system in patients with thrombosis and patients with COVI D -1 9 demonstrates the same type of changes: MA , Angle, G indices increase according to thromboelastography results, as well as D-d imer and fibrinogen levels increase, while antithrombin III activity decreases. Conclusion. Thus, TAG may be crucial for accurate identification of patients with advanced increased risk of thrombosis and thus possibly avoid unnecessary anticoagulation in patients at low risk of thrombosis.

Patients with burns of the face and neck are more likely to develop unpredictable difficult airways, thus it is necessary to refine approaches to preoperative prediction of such a condition. The objective: develop a method for airway assessment in patients with burns of the face and neck that can improve the results of tracheal intubation by reducing the incidence of unpredictable difficult airways. Subjects and methods. This study was based on analysis of retrospective (42 patients) and prospective (42 patients) data. At the retrospective stage, before surgery all of the patients had their airways assessed as per E l-G anzouri scale. Based on the results, a cumulative rating scale ( CRS ) was developed, which effectiveness was assessed by prospective data. Results . The area under the ROC curve was 0.67 ( p = 0.027). Sensitivity, specificity, positive predictive value, and negative predictive value made 100%, 37%, 45,2%, and 100% accordingly. The assessment of the newly developed CRS : the area under ROC curve was 0.96 ( p ≤ 0.05). Sensitivity, specificity, positive predictive value, and negative predictive value made 90.9, 100, 100, and 96.8% accordingly. Conclusion : The developed cumulative rating scale ( CRS ) has a better predictive potential for assessing the airways in patients with burns of face and neck versus traditional approaches.

It is known that the greatest difficulties in predicting the outcome of severe communit y-a cquired pneumonia occur in elderly patients with gra m-n egative pneumonia. The objective : to compare the differentiating capacity of the PS I / P ORT , SOFA , APACHE II , and MOD S -2 scales in elderly patients with severe communit y-a cquired pneumonia caused by K. pneumonia . Subjects: The study has been designed as retrospective, multicenter, controlled, and no n-r andomized. Inclusion criteria: clinical and laboratory, x-r ay diagnosis of communit y-a cquired pneumonia associated with Klebsiella pneumoniae with SOFA scores as 2 and more points. The severity of the patient's condition and prognosis were assessed using the SOFA , MOD S -2 , and PSI / PORT scales when the patient was admitted to the ICU , further changes in the state were assessed after 72 hours of intensive care and by the outcome. The time spent in the ICU , the frequency of detection of bacteremia, and the need for renal replacement therapy ( RRT ) were evaluated. The following parameters were analyzed: c o-m orbodities, structure of multiple organ failure, validity of the information value of SOFA , APACHE II , and MOD S -2 scales. Results . The age of the patient over 70 years increased the risk of death by 1.2 times ( OR = 1.21). There were no significant differences in the frequency of individual nosologies of comorbidity. The development of multiple organ failure syndrome increased the possibility of patient death by more than three times ( OR = 3.4). The probability of death of the patient when acute renal damage developed in the structure of mult i-o rgan pathology was even more significant ( OR = 8.5). Only the АРАСНЕ II ( AUC ROC 0.677 ± 0.053) and SOFA ( AUC ROC 0.708 ± 0.052) scales demonstrated moderate informational value in predicting the risk of death in the studied patients. Conclusion: When assessing the prognosis of the outcome in elderly patients with severe communit y-a cquired pneumonia caused by Klebsiella pneumoniae , it is advisable to use the SOFA and APACHE II scales.

The letter draws attention to the provisions on the use of fat emulsion when systemic toxicity of local anesthetics develops that was published in the article titled Disputed Issues of Systemic Toxicity of Local Anesthetics. ( Messenger of Anesthesiology and Resuscitation, no. 1, 2020). It is noted that the use of fat emulsion when systemic toxicity of local anesthetics develops is a method of therapy accepted worldwide and included in the protocols of cardiopulmonary resuscitation.

The objective: to present information about potential mechanisms of development of sepsis-associated encephalopathy, and its potential role in sepsis outcome.Neurohumoral regulation is the most important system that integrates many functions of variable values to achieve the final result that is beneficial for the host. The central nervous system (CNS) is the switch and control mechanism responsible for the functioning of this system. The increasing number of studies indicating the relationship between the development of sepsis and occurrence of qualitative and quantitative changes in the central nervous system suggests that it is the degree of damage to neurohumoral regulation mechanisms at the very beginning of the disease can significantly determine the severity of the course and prognosis of the outcome of multiple organ failure syndrome in sepsis.

The objective: to assess the impact of total intravenous and combined anesthesia (consisting of regional block and inhalation anesthesia with sevoflurane) on higher mental functions, frequency and nature of postoperative complications in carotid endarterectomy.Subjects and methods. A total of 190 patients with ipsilateral carotid stenosis exceeding 70%, or with the unstable atheromatous plaque were examined. CE was performed in 140 (73.6%) patients, while 50 (26.4%) patients underwent plasty with the autovenous patch. 60 patients had total intravenous anesthesia. The other 60 patients had combination anesthesia (cervical plexus block as per A. Yu. Paschuk + non-inhalation anesthesia with thiopental sodium). In 70 patients, low-flow inhalation anesthesia with sevoran and potentiation of the analgesic effect by bolus administration of fentanyl was performed. The parameters of central hemodynamics, cerebral blood flow, markers of cerebral damage, and state of higher mental functions were assessed.Results. Inhalation anesthesia with sevoflurane was characterized by decrease of total peripheral resistance index by 20% (p = 0.002) and SBP by 13% (p = 0.004) compared to baseline values. Moderate reduction of afterload was accompanied by normalization of cardiac and stroke indices. Optimization of the central hemodynamic parameters led to high levels of the linear velocity of cerebral blood flow and cerebral perfusion pressure which at the main stages of the operation did not differ from the control values. At the end of the operation, a statistically significant insignificant increase in intracranial pressure was noted (on average, by 4 mm Hg exceeded values at the previous stages, p = 0.014) and levels of markers of ischemic neuronal damage: the levels of antibodies to protein S-100 increased by 14% (p = 0.043), and NSE – by 2.8 μg/L. During inhalation anesthesia with sevoflurane, the lowest number of postoperative neurological and cardiac complications was recorded; they developed only in 6 (8.6%) patients and distributed equally. However, more pronounced postoperative cognitive dysfunction was noted when this method of anesthesia was used.Conclusion. Each method of anesthesia provided an unequal level of cerebral protection from ischemic damage which was manifested by a difference in the severity of disorders of higher mental functions, the number and nature of postoperative neurological complications.

There are certain debates regarding epidural anesthesia (EA) and analgesia in cardiac surgery.The objective: to evaluate functions of left ventricle (LV) and right ventricle (RV) function with echocardiography after off-pump coronary artery bypass grafting (OPCAB) using combined inhalation and epidural anesthesia.Subjects and methods: 68 patients were randomized into 2 groups, differed by anesthesia techniques. In Group 1 (GA, n = 34), we used general anesthesia with sevoflurane and fentanyl, while in Group 2 (CA, n = 34) – its combination with epidural anesthesia by 0.5% ropivacaine followed by infusion of 0.2% ropivacaine after OPCAB. Parameters of cardiac performance and ventricular function were assessed by echocardiography.Results. There were no differences in systolic function of LV, RV, diastolic function of LV between the groups. The difference in the left atrial strain was revealed before hospital discharge and made 18.0 (14.5‒21.5) % in CA Group and 24.0 (18.0–26.0)% in GA Group (p = 0.028).Conclusions. The use of epidural anesthesia and analgesia is not associated with clinically significant changes in inotropic and lusitropic functions of LV as well as RV systolic function after OPCAB.

According to the recommendations of the Surviving Sepsis Campaign (SSC), antibiotics should be administered within 1 hour after the onset of sepsis, and the centers for Medicare & Medicaid Services prescribe their administration within 3 hours.The objectiveof this publication is to analyze the literature data on the start time of ABT when a patient with sepsis is admitted to the ICU.Results. Currently, basing on literature analysis, it is impossible to conclude about advantages of administering an antibiotic within an hour after the patient with sepsis is admitted to a medical unit. In the vast majority of cases, an antibiotic should be administered up to three hours of the early IT complex (bundle). The change in the time algorithm for drug administration is due to the heterogeneity of the clinical situation, the lack of the unified "scenario" of interaction between the infection and host, and the need for more detail diagnostics.Conclusion. It is preferable to approach each case individually when deciding about the time to start ABT, considering the history, clinical and laboratory characteristics by the admission to the ICU. However, ABT should be started within 3 hours in any case.

Detailed psychological testing is needed to identify cognitive impairments after anesthesia and surgery. This problem can be solved by development of the program of combination psychological tests with their assessment based on the Z-score, also known as the standard deviation test.The objective: to determine reference values of psychological tests to assess the results of Z-score.Subjects and methods. The study was included 30 healthy volunteers and 43 patients who underwent surgery. The panel of psychological tests consisted of the clock drawing test, oral counting test, assessment of short-term memory, sequence set, Digit Symbol Substitution Test, and the classic Stroop test. The mean values and standard deviations were calculated for each of the groups to evaluate the test results by Z-score.Results. It was found that using standard deviations obtained in the group of healthy volunteers as reference values for Z-score resulted in a higher percentage of deterioration in the result of repeated tests compared to using reference values obtained in group of patients.Conclusion: When using Z-score for cognitive tests, it is better to use the means and SD obtained in a group of healthy volunteers taking into account the possibility of finding differences where there are none (type I error).

The use of modern blood-saving technologies is one of the effective methods of preventing intra-operative bleeding in obstetric practice, however, the effect of local use of terlipressin to reduce blood loss is not sufficiently investigated. The objective : to assess the efficacy of local preventive use of low doses of terlipressin to reduce of intra-operative blood loss in the cesarean section. Subjects and methods . 105 women who underwent the cesarean section under spinal anesthesia were examined. They were divided into 3 groups depending on the administered dose of terlipressin: Group 1 (n = 35) ‒ 0.2 mg, Group II (n = 35) ‒ 0.4 mg, Group III (n = 35) ‒ control one. The swab-weighing method was used to assess blood loss. Results . In Group I, the blood loss made 6.9% of the total blood volume, in Group II ‒ 7.7%, and in Group III ‒ 13.3%. The frequency of hemotransfusion in Group I was ‒ 0%, in II ‒ 2.9%, in III ‒ 14.3%. No complications and side effects associated with terlipressin use were observed. Conclusion . The use of low doses of terlipressin for prevention purposes has a sufficiently pronounced clinical effect and is not accompanied by any complications.

The objective of the review : analysis of innovations in the conceptual justification and methodological support of anesthetic protection of thoracic surgical interventions. Results : optimization of methods of anesthetic protection should be aimed at solving both surgical requirements such as creating conditions for surgical comfort and at the same time, ensuring the maximum achievable level of protection efficiency and patient safety. When solving the problems of patient protection in thoracic surgery in general and thoracoscopic surgery in particular, the special attention is paid to ensuring effective gas exchange and optimal anesthesia methods corresponding to them within the framework of the multi-component concept. It is important to consider that weaning from mechanical ventilation and the careful collapse of the operated lung are absolute indications for thoracoscopic surgery. This approach is used due to the need to provide space in the pleural cavity for instrumental manipulations during surgery.

It has been found out that methylation of nucleic acids, proteins and low-molecular substrates is necessary to renew cellular structures, their restoration and cytoprotection. Methionine plays the most important role in this process but whether its metabolism changes during anesthesia and how different anesthetics affect it, has not yet been studied. The objective : to study the metabolism of methionine during cardiopulmonary bypass when the direct myocardial revascularization is performed and the impact of the anesthetics used (propofol, desflurane, and sevoflurane) on methionine metabolism. Subjects and methods : 74 patients who underwent surgery due to coronary heart disease with cardiopulmonary bypass were enrolled in the study. The patients were divided into three groups by the anesthetic used (desflurane, sevoflurane, propofol). Levels of methionine, homocysteine, cysteine, and taurine were tested in the blood collected from veins and jugular vein before the aorta clamping and after the release of clamps. Results . In all three groups, lower levels of methionine and a higher level of homocysteine were observed after the release of clamps from the aorta, especially in the jugular vein. The most significant consumption of methionine was noted when propofol was used. In the same group, the exocytic release of homocysteine into the blood and the formation of cysteine were significantly lower. No significant difference was observed in the effect of desflurane and sevoflurane on methylation. Conclusion . During the anoxia, the consumption of methionine increases significantly but the intensity of demethylation/remethylation depends on the anesthetics used during anesthesia. The most significant decrease in the level of methionine as well as the remethylation of homocysteine into methionine occurs with the use of propofol, rather than inhalation anesthetics which may be a consequence of desflurane and sevoflurane cytoprotective properties.

The objective : to provide pathogenetic justification for the need for extracorporeal blood purification in the new coronavirus infection. Results : the article analyzes guidelines and the first experience of using extracorporeal methods in the new coronavirus infection in different countries. It has been demonstrated that methods of extracorporeal blood purification have complex pleiotropic (multiple) effects and can quickly normalize the level of cytokines and other pathogenic factors, thereby preventing/reducing the severity of organ disorders. The article specifies the criteria for choosing an extracorporeal method, as well as indications for its early and late use.