Intra-operative acute normovolemic hemodilution or autologous blood transfusion, is one of the factors of the patient's blood conservation and reduction of the donor blood use.

The objective: to assess the value of acute normovolemic hemodilution for the normalization of intra-operative homeostasis, reduction of blood loss and transfusion of donor erythrocytes during cardiac surgery with cardiopulmonary bypass.

Methods. 270 patients undergoing surgery on heart valves and coronary vessels at the age from 18 to 79 patients were examined. 600−1,200 ml of autoblood were collected before cardiopulmonary bypass against the background of the patient's heparinization and installation of aortic cannula. The following parameters were studied: the frequency of normovolemic hemodilution use, volume of autohemoexfusion of blood, hemostasis rates in the early post-perfusion period, the volume of intra- and post-operative blood loss, frequency and volume of hemotransfusion.

Results. Intra-operative autologous blood transfusion from right atrial appendage against full heparinization of the patient in the volume of 600–1,200 ml before cardiopulmonary bypass allowed reducing intra-operative blood loss by 1.3 times, the volume of transfused erythrocytes by 1.3–1.7 times and the frequency of the demand for it by 4–6 times in the patients having surgery with myocardial revascularization and cardiac defect management. The analysis of coagulation parameters in the post-perfusion period after modified acute normovolemic hemodilution proved the reduction of hemostasis dysfunction mostly due to the platelet factor.

Conclusion. Intra-operative acute normovolemic hemodilution is an effective and safe way to reduce intra-operative blood loss, use of donor blood and restoration of hemostasis in the patients undergoing cardiac surgery with cardiopulmonary bypass.

Subjects and methods. The multi-center, prospective, and observational trial was conducted. The following data were analyzed in the patients admitted to intensive care wards: number of qSOFAscores, the presence of SIRS criteria, levels of lactate, procalcitonin, C-reactive protein in blood, the presence of sepsis according to Sepsis-3 criteria. The value of qSOFA scores, SIRS criteria, and biomarkers for sepsis diagnostics was assessed by means of ROC-analysis.

Results. The following areas under ROC-curves were defined during diagnostics of sepsis in the patients in intensive care wards: qSOFA – 0.679 (95%CI 0.646–0.712); SIRS – 0.714 (95% CI0.682–0.745), p = 0.099; when qSOFA exceeding 1 score: procalcitonin – 0.788 (95% CI 0.689–0.867), C-reactive protein – 0.787 (95% CI 0.688–0.866), p = 0.970.

Conclusion. qSOFA score is compatible with SIRS criteria for diagnostics of sepsis among the patients in intensive care wards. qSOFA score is highly sensitive, but it is of low specificity for sepsis diagnostics. Should there be at least 1 score of qSOFA, it is recommended to test levels of procalcitonin or C-reactive protein in order to increase the specificity of this score for diagnostics of sepsis.

In the patients staying in the intensive care wards, it is often necessary to differentiate the cause of systemic inflammatory response and multiple organ failure (infectious and non-infectious cause), which is often impossible unless various biomarkers are used.

The objective: to study the informativeness of presepsin versus traditional biomarkers (procalcitonin, C-reactive protein), to find benefits and drawbacks of these biomarkers when investigating the nature of the systemic inflammatory response in critical states of various etiology.

Subjects and methods. The retrospective-prospective study trail was conducted. 95 patients were included into the trial, they all were admitted to intensive care wards with symptoms of systemic inflammatory response and multiple organ failure, assessed as 2 and more SOFA scores and who had their levels of procalcitonin, presepsin and C-reactive protein tested. In order to assess sensitivity and specificity of presepsin for diagnostics of infections in the patients with disorders of excretory function of the kidneys and those with neutropenia, and the patients after massive traumatic surgeries, the following categories of patients were prospectively included in the study: patients with chronic kidney disease receiving hemodialysis (n=17), those with oncohematological disorders (n=8), and patients undergoing cardiac surgery (n=20) with cardiopulmonary bypass and without it (of pump).

Results. It was demonstrated that presepsin was more sensitive and specific for diagnostics of sepsis versus other investigated biomarkers. It was found out that in the patients with sepsis and disorders of excretory function of the kidneys, the level of presepsin (IU 10 876 (2 030; 15 972) was nearly 8 times higher than in the patients receiving no substitutive renal therapy with hemodialysis Patients with neutropenia (IU of white blood count ‒ 0.4 (0.3; 0.5) and infectious complications had the level of presepsin compatible with the one in the patients undergoing surgery with no neutropenia: IU of presepsin in the patients with local infection made 324 (191; 601) pg/ml, and in the patients with sepsis it made 3,176 (1,514‒4,837) pg/ml. During the peri-operative period, the changes in the biomarkers level in the patients undergoing cardiac surgery demonstrated that their level significantly increases in 12 hours after surgery versus pre-operative level, despite the absence of the systemic infection. And the fold of procalcitonin increase (22-fold rise) was much higher versus presepsin (3-fold rise). The tendency to normalization of presepsin level was observed in 24 hours, the fact of cardiopulmonary bypass provided no significant impact on the changes in presepsin level.

Conclusion. As an infection biomarker, presepsin possesses high sensitivity and specificity. It can be used for diagnostics of infection in the patients with neutropenia and without it. But it should be noted that its level can be increased in case of a critical state not related to the development of infectious complications. When interpreting the obtained clinical data it is important to understand which mechanisms can cause the elevation of its level in blood in a certain situation. For the most difficult cases, the most adequate result can be obtained when the levels of different biomarkers are tested simultaneously.

The objective of the study: to assess the effect of two types of general anesthesia on lipid peroxidation and to establish a correlation between the degree of its activation and the number of post-operative neurological disorders.

Subjects and methods. 130 patients (84 men and 46 women) at the age from 48 to 68 years were examined, they all were admitted to hospital for carotid endarterectomy due to atherosclerosis of internal carotid artery. The blind envelopes method was used for randomization. The patients were divided into 2 groups. The control group included 20 practically healthy persons (the median age made 50 ± 2 years).

Propofol was used for anesthesia in 60 patients (Group 1), while sevoflurane was used in 70 patients (Group 2). Student test was used for statistical processing of data. The critical significance level corresponded to p < 0.05. The groups were considered representative based on 12 attributes.

During the surgery, the following parameters were monitored: oxidant and anti-oxidant statuses, markers of neuronal damage; post-operative neurological complications were assessed.

Results. When comparing and assessing the rates of the general pro-oxidant activity and general anti-oxidant activity in the patients from both groups, the initial rates of oxidant and anti-oxidant statuses did not confidently differ, which can be explained by the homogeneity of the patients' examinations.

The activation of general pro-oxidant activity and general anti-oxidant activity was higher in Group 1 at the moment of carotid clamping. The same tendency was observed during the restoration of cerebral blood flow.

The intensity of lipid peroxidation activation correlated with the frequency of post-operative neurological disorders and it was lower in Group 2.

The objective: to assess the accuracy of cardiac output measurement by ultrasonic cardiac output monitor (USCOM) versus echocardiography (ECHO) in the children after cardiac surgery.

Subjects and methods: A prospective observational trial was conducted (288 patients were assessed for eligibility, and data from 88 patients were analyzed). Cardiac output was measured by USCOM and ECHO.

Results. The age of the patients was 305 ± 177 days. Cardiac output measured by USCOM, was 1.310 ± 0.605 [1.182; 1.438] L/min, while the one measured by ECHO made 1.298 ± 0.608 [1.169; 1.427] L/min. ANOVA demonstrated no statistically significant difference (p = 0.89). A significant positive correlation was found between cardiac output rates measured by two methods (r = 0.945 [0.918, 0.964], p < 0.0001). The Bland-Altman plot demonstrated the shift of 0.012 ± 0.200 L/min. and agreement limits from -0.38 to 0.4 L/min. There was no correlation between the shift and median values of cardiac output (r = -0.015 [-0.224, 0.195], p = 0.89).

Conclusions. USCOM credibly measures the cardiac output versus the reference method of ECHO. Despite the known limitations, both methods can be used in children after cardiac surgery: USCOM − for screening, ECHO ‒ for deeper examination.

Anatomical landmarks and palpation are traditionally used for radial arterial catheterization in emergency units. Despite the successful use of ultrasound monitoring for central venous access, there is a lack of evidence about the benefits of the ultrasound guidance for peripheral arterial cannulation.

The objective: to compare two methods of radial arterial catheterization (the traditional one based on palpation and the method under ultrasound guidance) in the patients undergoing planned surgery.

Subjects and methods. 40 patients participated in the prospective cohort study, all of them had planned surgeries. In Group 1, the traditional method was used for arterial catheterization (the palpation group), and in Group 2 it was done under ultrasound guidance (the ultrasound group). The following parameters were recorded for both groups: number of attempts, number of puncture sites, complications and their type, time of catheterization. The number of cannulation attempts was taken as a primary endpoint.

Results. The statistically significant correlation was found between the method of catheterization and the number of attempts (Pearson's chi-squared test = 29.562, df = 6, p < 0.001), places of puncture (Pearson's chi-squared test = 10.365, df = 3, p = 0.015). In the ultrasound group, the first attempt of cannulation was a success in 19 cases (95%; CI 73−99%), while in the palpation group, the first attempt was a success in 2 cases (10%; CI 2−33%). The one catheterization site was used in 95% of cases in the ultrasound group (CI 73−99%; 1 observation). While in Group 2 (the palpation group), two sites of cannulation and more were required in 50% of patients (CI 30−17%; 10 observations). Among complications there were hematomas, and no statistically significant correlations were found between the method of puncture and their number in the groups (Pearson's chi-squared test = 2.7706, df = 1, p = 0.09601). The time spent on catheterization in the ultrasound group was shorter versus the palpation group (W = 344, p < 0.001) and it made 101 sec. (51; 144) and 194 sec. (153; 311) respectively.

Conclusion: Compared to the traditional (palpation) method, the radial arterial catheterization guided by ultrasound possesses such benefits as high chances of successful cannulation with the first attempt, fewer sites required to provide arterial access and total time required for the manipulation.

The objective: to work out recommendations on the optimization of intensive care for those with severe concurrent abdomen injuries.

Subjects Specific features of intensive care tactics were analyzed in 210 patients with severe concurrent trauma. The detail characteristics of Groups 1 and 2 are presented in report one on this issue [6]. In order to achieve the objective of the study, the specific course of the trauma disease was analyzed in 54 patients with severe concurrent abdomen trauma.

Results. The difference in the intensive care tactics during the first period of the trauma disease depended on the volume of acute blood loss. In the post-shock period of the trauma disease, the specific parameters in the intensive care in those with a severe abdomen injury, dominating over other injuries, are defined by the infectious complications; the damage control is more often used in them versus patients with the same severity of trauma but without abdomen injury. The main activities of the intensive care of severe sepsis include augmented anti-bacterial therapy, treatment of endotoxicosis and multiple organ failure, use of extracorporeal haemocorrection.

Conclusions. The forecast is the most unfavorable for the period of the maximum probability of complications in the patients with severe concurrent abdomen injury versus those with other severe concurrent injuries. The first period of trauma disease in such patients is characterized by a high volume of infusion-transfusion therapy with a higher frequency of blood reinfusions. In Trauma Center of the first level, the conservative management tactics for not severe injuries of parenchymal abdomen organs seems to be promising for surgery of injuries.

The review is devoted to one of the most critical issues of modern intensive care – the diagnostics of sepsis in children. The article describes the modern definition of sepsis and presents the review of the recent publications devoted to pediatric sepsis. It speculates on the benefits and drawbacks of Sepsis-3 recommendations for pediatric intensive care. The special emphasis is put on the early detection and assessment of organ failure severity in the children with an infection using special scores of qSOFA or PELOD-2.

Protection of myocardium from ischemic and reperfusion lesions continues to be an important issue in the modern cardiac surgery. Russian and foreign publications contain a significant number of data about the protective impact of pre- and post-conditioning with inhalation anesthetics (sevoflurane, isoflurane, and desflurane) on the myocardium. The article highlights that this protective action is maximum when these drugs are used during the whole operation and it means during cardiopulmonary bypass as well. Therefore, currently, the listed above inhalation anesthetics are used fairly frequent during cardiopulmonary bypass. However, the technology of inhalation anesthesia during perfusion has a number of specific features: changes in the pharmacokinetics of drugs (which provides impact on the dosing of anesthetics), design of oxygenator, which plays a certain role when the anesthetics are supplied to the blood, monitoring during inhalation anesthesia, technical assistance for this technology and important safety issues. This review describes the above-mentioned aspects.

The review describes modern approaches to pain relief in the patients after total knee and hip replacement. It covers the principles of multi-modal analgesia, benefits and drawbacks of such ways of pain relief as intravenous analgesia with opioids, spinal and epidural analgesia; it compares different variants of peripheral blocks, and puts some light on a relatively new method of local periarticular infiltration anesthesia.

The authors agree that further research is needed to optimize post-operative pain relief after total knee and hip replacement.

HMG-CoA (3-hydroxy-3-methyl-glutaryl-coenzyme A) reductase inhibitors, which are more known as statins, reduce the level of low density lipoproteids and total cholesterol in blood plasma. Their efficiency for primary and secondary prevention of cardiovascular disorders has been proved by numerous trials. Additionally to the main mechanism of actions, statins possess pleiotropic properties, including anti-inflammatory endothelium protection, platelet stabilization, reduction of fibrinogen concentration and prevention of neurodegenerative and oncological disorders. Despite the vigilance of side effects, which has been growing of late, statins remain to be the drugs which are prescribed most often in the whole world. The article describes different strategies of statins use in the peri-operative period in the patients undergoing cardiac and general surgery.