Thirty-two adult patients after off-pump coronary artery bypass grafting were enrolled into a prospective observational study. All patients received positive end expiratory pressure test (PEEP-test), mini-fluid challenge test (mFCT) and standard fluid challenge test (sFCT). Pulse pressure variation using two monitoring systems (PPVPiCCO, PPVNK), Stroke volume variation (SVV), heart-lung index (HLI) and plethysmogram variability index (PVI) were assessed before and after sFCT. The patients with an increase in cardiac index by ≥15% after fluid challenge were defined as fluid responders. According to receiver operating characteristic analysis, changes in mean arterial pressure induced by PEEP-test identified fluid responsiveness with AUC 0.73 (p= 0.03). The reduction in PPVPiCCO and SVV during mFCT predicted positive response to the fluid load with AUC 0.77 and 0.75, respectively (p< 0.05). Response to sFLT can be predicted by the assessment of PPVPiCCO (AUC 0.84), PPVNK (AUC 0.71), SVV (AUC 0.77) and HLI (AUC 0.77) (p< 0.05).

Acute post-operative respiratory failure is a dangerous complication developing after thoracic surgery.

The objective of the study: to assess the potential use of albuminemia, glycemia and leukocytosis as markers of acute post-operative respiratory failure after thoracic surgery.

Subjects and methods. A retrospective study was conducted enrolling 300 patients, which were divided into two groups – those who developed acute post-operative respiratory failure (n=150) and those who didn't (n=150). The post-operative level of glycemia and leukocytosis and the degree of albumin level reduction were comparatively analyzed in the early post-operative period.

Results. The correlation was found between the degree of reduction of the post-operative albumin level and the ratio of PaO2/FiO2 – the strong inverse correlation (r = -0.9); the strong inverse correlation (r = -0.7) was found between the leukocytosis level and the ratio of PaO2/FiO2; while it was the median inverse correlation (r = -0.7) between glycemia level and the ratio of PaO2/FiO2; and between the degree of the post-operative reduction of albumin and glycemia level, it was the median direct correlation (r = 0.7).

Conclusion. The higher levels of peri-operative glycemia and leucocytosis during the first 24 hours after the surgery and more intense reduction of the post-operative level of albumin demonstrate the intensity of stress-reaction to the surgical trauma and make valuable markers of the acute post-operative respiratory failure development in the patients after thoracic surgery.

The objective of the study: to define the informative value of qSOFA score in the prediction of sepsis outcomes in the patients admitted to the intensive care wards of medical units in the Russian Federation.

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 qSOFA and SOFA scores, the presence of SIRS criteria, levels of lactate, and the outcome of the admission to the intensive care wards. The informative value of different scores and lactate level was analyzed using ROC-analysis.

Results. The following areas under ROC-curves were defined for prediction of a lethal outcome in the patients with sepsis: qSOFA – 0.644 (95% CI 0.593–0.693); SOFA – 0.731 (95% CI 0.683–0.776); SIRS – 0.508 (95% CI 0.456–0.560); [qSOFA + lactate ≥ 4 mmol/L] – 0.713 (95% CI 0.646–0.774).

Conclusion. To predict a lethal outcome in the patients with sepsis admitted to intensive care wards, qSOFA surpasses SIRS criteria, but it is not as good as SOFA score. The informative value of the prediction model [qSOFA+lactate ≥ 4 mmol/L] surpasses qSOFA score in the prediction of the outcome in sepsis patients, and it is as good as SOFA score.

The tragic statistics reflecting lethality and survival in children with burns have significantly changed over the last 70 years. A retrospective, non-randomized trial was performed aimed to detect factors providing an impact on survival in a pediatric burns center (1382 children at the age from 0 to 18 years were enrolled in the trial). The inclusion criteria were thermal injuries with hot liquid or flame of more than 20% of the total body surface area, and the area of 10-20% including eyes, ears, face and extremities. The patients were admitted to the intensive care wards of Speransky Children Municipal Clinical Hospital no.9, during the first 72 hours after thermal injury for the period from January 1, 2009 to December 31, 2017.

The survival was analyzed using the log-rank test, Kaplan – Meier curves, and Cox regression analysis, and the results demonstrated the significance of the number of factors: early transfer of pediatric patients to a special unit, thermal inhalation injuries, ≥ 12 scores as per ABSI scale, and female gender. The tender age is not one of the factors providing the impact on the survival of such patients.

Anesthetic management of surgery in patients with large mediastinal mass remains a topical issue of thoracic anesthesiology, since such patients often develop superior mediastinal compression (SMC) which results in a high risk of hemodynamic and respiratory disorders during induction. The degree of compression does not always depend on the mass size, and the prediction of SMC progression during induction becomes a challenge.

The method to evaluate the degree of mediastinal compression through the functional orthoclinostatic test was developed – the patient is to be placed in Fowler position for 45 degrees in order to follow changes in the cardiac index.

It was found out that the patients with SMC detected during the test (increased cardiac index in Fowler position) had their arterial blood pressure reduced after induction, and the number of critical incidents was statistically significantly higher. The test proved to be a non-invasive and safe method of pre-operative prediction of the risk of SMC development and progression during induction.

From the time when special tools for delivery of volatile anesthetics in the intensive care units (ICU) became available, inhalation sedation is getting more and more popular among emergency physicians. Despite some persisting questions, it should be acknowledged that currently there are no technical problems when providing inhalation sedation. Currently, it is recognized that inhalation sedation is simple, reliable, convenient to use and it causes no significant unfavorable consequences. The above is fairly enough to recommend this method for the intensive care when it is necessary. The contemplated therapeutic properties of halogen-containing anesthetics could be an additional reason to use inhalation sedation. However, the clinical value of anesthetic pre-conditioning and anti-inflammatory effect is still doubtful. New clinical trials are needed in order to define the place of inhalation sedation in ICU.

Acute kidney dysfunctions in critically ill patients make a frequent complication. For the last 10 years, significant conceptual changes have occurred in this respect: the definition of acute kidney failure (stating a renal catastrophe) has been replaced with acute kidney injury; the stage of acute kidney disease, preceding the development of the chronic condition has been defined. It highlights the rate of changes developing in kidneys after injury, and now it is possible to focus on approaches to diagnostics, prevention of kidney failure, and use of kidney replacement therapy. The review presents the information on the stages of kidney dysfunction, diagnostic criteria, approaches to its prevention and treatment.

The pain relief in labor is one of the key components of the modern obstetrics. The multiple trials have been devoted to searching for the best way of pain relief, new methods are being developed and improved.

The review tells about modern aspects and international experience when using the different variants of neuraxial methods of pain relief in labor, their impact on the satisfaction of the mother, maternal and neonatal outcomes.

From the beginning of this century, clinicians started to pay more attention to the right ventricular dysfunction. It is related to the thorough studying of pathologies, during which the right ventricular dysfunction plays the key role, such as pulmonary hypertension, congenital heart disorders, and thromboembolia of the pulmonary artery. Currently, it has been proved that acute right ventricular failure makes 3-9% of all acute heart failures, the hospital lethality in these clinical situations makes from 5 to 17%. The objective of the literature review is to provide anesthesiologists and emergency physicians with information on modern approaches to diagnostics and treatment of acute right ventricular failure.

The review presents data on normal anatomy and physiology of the right ventricle, morphological and functional changes when various forms of acute right ventricular failure develop. Diagnostics and comprehensive intensive care are described for the two most frequent types of acute right ventricular failure, which are reduction of right ventricular contractility and its overloading with afterload.

Currently, there is a global trend of growing frequency of concurrent lung malignant tumors and cardiac vascular pathology, in particular, ischemic heard disease. The literature review demonstrates, that development of surgery, anesthesiology and intensive care allows expanding limits for treatment of such patients through simultaneous surgery when lungs and heart are operated at the same time.

The article analyzes the personal experience of the authors and international publications, it contemplates on safe performance of simultaneous and multi-organ surgeries, involving respiratory and blood circulation systems, different approaches to surgery, its specific features, benefits, and limitations. Specialists from Russian Surgery Research Center named after B.V. Petrovsky find it preferable to perform simultaneous staged surgery of the lungs, mediastinum and cardiac vascular system. There is a certain sequence of stages. It demonstrates that the first stage may include isolation of abnormal masses of the lung (mediastinum) and lung hilus, if necessary. After that cardiac surgery is performed, and as a final stage, the whole abnormal focus is isolated and resected.