In-patient emergency department is a new division, being organized in medical units providing emergency care. In this country, its role and place within medical care system are not fully definite. Goal: to compare work of intensive care departments in hospitals providing care for emergency patients depending if an in-patient emergency department with the intensive care ward is available or absent. Materials. Summarized data on the patients admitted for emergency care to Dzhanilidze St. Petersburg Research Institute of Emergency Care (2010–2012) and Pavlov First Saint Petersburg State Medical University (2014–2016) where the in-patient emergency department is available. Results. Establishment of the in-patient emergency department with the intensive care ward results in the 2-fold reduction of patients' admission to the hospital intensive care department thus reducing the admission of patients with diseases beyond the hospital's specialization. Thus the excessive workload of the intensive care department personnel is reduced and care options are expanded since the duration of the patients' stay is increased while the number of beds remains the same. Conclusion: Adding the in-patient emergency department to the structure of a multi-specialty hospital allows changing the system of medical care, concentrating the efforts and funds on the treatment of patients with absolute indications for admission to the intensive care wards.

Peri-operative bleeding in surgeries with cardiopulmonary bypass results in the increase of post-operative complications and mortality. Fibrinolysis hyperactivation is the common cause of non-operative bleeding. Materials and methods. 60 patients who had cardiac surgery with cardiopulmonary bypass were enrolled into the study. The antifibrinolytic agent (tranexamic acid) was administered to all patients: 32 patients (TA1) received an intravenous loading dose of tranexamic acid basing on 15 mg/kg during 20 min. with the consequent infusion of 1 mg/(kg × h^-1) + 500 mg during cardiopulmonary bypass; 28 patients (TA2) received intravenous loading dose of tranexamic acid (15 mg/kg for 20 minutes) with the consequent infusion of 1 mg/(kg × h^-1) + 500 mg during cardiopulmonary bypass + 1000 mg administered into the pericardial cavity and sternum before its closure. The peri-operative blood loss and volume of blood transfusion (erythrocyte suspension, fresh frozen plasma, platelet concentrate) were assessed. Results. Intra-operative blood loss made 815 (800–862) ml in TA1 group and 700 (650–735) ml in TA2 group. The volume of the post-operative blood loss in TA2 group was confidently lower compared to TA1 group: 170 (100–240) ml versus 275 (180–307) ml respectively. The frequency of erythrocyte suspension transfusion in the post-operative period did not differ significantly and the frequency of fresh frozen plasma transfusion was 2.5 lower in TA2 group compared to TA1 group. Conclusions. Blood-saving effect of the system administration of tranexamic acid is enhanced by local its administration into the pericardial cavity and sternum.

When discussing the issue of learning the subject matter of training many researchers still easily replace the following notions and equate their meaning: simulation training, simulation training session and simulation clinic. And they insist that it is easy to develop cognitive skills in doctoring putting special emphasis on manual skills. No simulator or simulation technology can construct the real life situation including relations between the trainer and trainee. Training is an integrated complex of perceptions, thinking and effects. And it is the shift from reality during training that promotes incorporation of doubtful research information into education. Simplification of the problems with priorities given to marginal elements of training results in ineffective decisions especially when high quality treatment is required and medical training sessions cannot solve the problem of lacking medical personnel to provide high-tech medical care.

Fluid therapy is one of the major components of targeted management of critically ill patients. The targeted approach allows optimizing the cardiac output, improving the oxygen delivery to tissues and its utilization by cells. Basing on changes in the preloading and functional tests it is possible to predict the early hemodynamic response to fluid administration, and the above parameters can be recommended as landmarks for fluid therapy optimization.

The review is devoted to one of the most critical issues of modern intensive care – personalized management of sepsis. The current definition of genomics has been given, and data available on the above issue have been analyzed, advantages and limitations of this approach in the intensive care have been discussed. The special emphasis is put on the prospect of using genetic biomarkers for sepsis severity score and prediction of sepsis outcome.

The brain tissue manifests high metabolic activity and its damage results in disorders in oxygen and nutrients supply, accompanied by a severe life-threatening condition, i.e. cerebral edema. There are several stages of cerebral edema and each stage has unique pathogenic mechanisms. At the stage of cytotoxic edema, the fluid is redistributed into intracellular compartment. Ionic edema is characterized by functional disorder of blood-brain barrier with redistribution of fluid into interstitium. Stages of vasogenic edema and hemorrhagic conversion are manifested through anatomic lesions of blood-brain barrier. Traditional management of cerebral edema such as use of diuretic agents, hyperosmolar solutions, hyperventilation, decompressive craniotomy proved to be ineffective. Current data on pathophysiology of cerebral edema can promote discovering new promising treatment methods.

Goal of the review: to study theoretical and applied aspects of using omega-3 fatty acids in the high risk patients undergoing cardiac surgery in order to reduce the intensity of system inflammatory response, caused by cardiopulmonary bypass and forming the basis of organ dysfunctions in the post-operative period.

The goal of this review is to inform doctors about new opioids currently used for routine medical practice in the most developed countries. This publication contains brief history, describes main mechanisms of opioid action, types and specific functioning of opioid receptors, it presents pharmacological parameters of the most frequently used opioids and their specific use in the clinical practice. In the light of increased interest towards pain management with opioids, the article will be useful for broad audience of doctors treating acute and chronic pain.

Sepsis remains to be a global medical problem associated with high mortality level. Due to this, there is constant interest towards investigation of its pathogenesis and introduction of new management techniques. Current recommendations contain clear instructions for intensive care including substitutive renal therapy in case of renal dysfunction, however other methods of extracorporal detoxification including selective sorbtion of endotoxin are still being discussed. Goal: to demonstrate the opportunities of selective LPS-sorbtion in the combined therapy of those suffering from septic shock using a specific clinical case. Results: Immediately after selective hemosorption the patient with septic shock demonstrated the following positive changes: reduction of body temperature down to low-grade fever, stabilization of hemodynamic rates, reduction of noradrenaline dose from 0.2 to 0.05 mkg (kg ∙ min-1), reduction of lactate level from 2.3 to 1.7 mmol/L and improvement of respiratory function rates. The renal function improved against the background of stabilization of hemodymanic rates, thus serum creatinine reduced from 0.309 to 0.150 mmol/L. The substitutive renal therapy was fully stopped on the 9th day. The intensity of clinical manifestations of multi-organ dysfunction reduced from 10 to 4 according to SOFA score. Conclusion. Clinical follow-up demonstrated the positive experience of using selective LPS-sorbtion in the combined therapy of septic shock, caused by gram-negative bacteria. Express test for endotoxin activity level in the septic shock patients enhances the objectivity of choice of extracorporal hemocorrection methods.

The article describes a clinical case of bilateral keratoscleritis caused by Ps. aeroginosa in a female patient suffering from occlusive hydrocephaly and intracranial hypertension with duration of coma and artificial pulmonary ventilation (APV) for 20 days. Materials and methods. At the moment of examination (in 7 days after purulent keratoscleritis started and rapidly progressed) the patient had lagophthalmos, purulent corneal ulcer, purulent xerotic sclera of OU, keratorrhexis of OS. On the same day directly in the intensive care unit, emergency penetrating sclerokeratoplasty was performed on OU in order to save eyes as organs. Forced instillations of antibiotics and antiseptics were used in the post-operative period. In 2 years 2 penetrating keratoplasties were performed in OD for optic purposes. Results. Emergency theurapetical penetrating sclerokeratoplasty with instillation of anterior segment and intraocular administration of a high dilution antibiotic were the only chance to save vision in OD. OS, where keratorrhexis developed due to advanced purulent sclerokeratitis and purulent iridocyclitis was lost despite all the efforts. After three surgeries (sclerokeratoplasty and 2 keratoplasties) vision acuity in the only right eye makes 0.1, which can be regarded as a satisfactory outcome. Conclusions. A malicious course of the disease, peracute progress and extremely severe consequences are typical of the advanced corneal ulcer caused by Ps. aeroginosa. Special attention is to be paid to the eyes of patients being in an intensive care unit in a coma and having continuous artificial pulmonary ventilation due to the high risk of developing purulent corneal ulcer and eye loss.