Looking back at the 60-year period of anesthesiology and critical care development in this country, the author paid special attention to some considerations that largely reflect the ideology and psychology of specialists working in this field, who, from his point of view, interfered with further development of this specialty as an independent medical field in Russia. Special emphasis was put on some problematic issues of interdisciplinary interaction, training, and organization of care. It was noted that the experience of predecessors was to be taken into account since the essence of many current problems was in many ways the same as it had been before. The author suggested that moving forward was possible only if the efforts of the entire professional community were consolidated.

Показана эволюция становления реанимации и интенсивной терапии в мире и в России и роль отдельных специалистов в ее формировании и развитии. Продемонстрировано значение специальности и службы в современной клинической медицине. Отмечено, что роль медицины критических состояний с течением времени возрастает. Будет наблюдаться рост числа коек интенсивного этапа оказания помощи в стационарах, возникнет необходимость в структурировании отделений интенсивной терапии и реанимации в зависимости от тяжести состояния пациентов и объема оказания помощи. Следует констатировать более рациональное отношение врачей к использованию многих лечебно-диагностических методов и лекарственных средств. Среди обозримых перспектив развития специальности необходимо выделить определение ее финансирования в соответствии с затратами, создание в лечебно-профилактических учреждениях группы ранней мобилизации и реабилитации, улучшение профилактики инфекционных осложнений.

The article describes the main tendencies in anesthesiology, which have undergone the greatest changes in the last decade, according to the author. The article speculates on the choice of tactics and the qualitative components of peri-operative infusion therapy. The author gives an assessment of the current stage of studying the phenomenon of anesthetic preconditioning and acute heart failure management. And, finally, the challenges and achievements of the evidence-based medicine in anesthesiology are analyzed.

The article describes the achievements of pediatric anesthesiology and intensive care in recent years. The author focuses on the humanization of critical medicine in children, effects of anesthesia on the developing brain, pain management in children, and also examines problems of respiratory support, diagnosis and intensive therapy of sepsis in children and newborns, nutritional support in critically ill children.

The lecture is devoted to transfusion-related acute lung injury (TRALI), which is rarely encountered and therefore poorly studied by clinicians. With late diagnosis and inadequate management, the injury can be fatal. In some countries, it is ranked third among causes of death associated with complications developed due to blood transfusions. The lecture discusses issues of etiology, pathogenesis, symptoms, and diagnostics of TRALI. Special attention is paid to prevention, in particular, improvement of the blood transfusion service.

Peri-operative myocardial infarction (MI) is the most severe complication of non-cardiac surgery associated with a high post-operative mortality rate. The main risk factors responsible for the development of this complication include concurrent cardiovascular pathology, as well as intra-operative hypertension and tachycardia. Diagnosis MI in the postoperative period is complicated due to an insignificant pain syndrome because of administration of analgesics and the lack of routine monitoring of troponin levels. Maintaining a balance between myocardial oxygen delivery and consumption is a key factor in the prevention of this complication.

The lecture is devoted to the current state of pharmacological cardiac protection in patients with a high cardiac risk undergoing non-cardiac and cardiac surgery with cardiopulmonary bypass. It describes the main etiopathogenetic mechanisms of ischemic reperfusion myocardial damage. The possible cardioprotection mechanisms when using inhalation anesthetics, β-adrenoreceptor blocking agents, calcium channel blockers, statins, nitrates, α2 -agonists, ACE inhibitors and sartans, levosimendan, phosphocreatine, and glucose-insulin-potassium mixture are analyzed. New research data are reviewed, including recent meta-analyses and extensive randomized studies aimed to assess the efficacy of the above medicines. It presents contemporary clinical guidelines on the use of pharmacological cardioprotection in various clinical situations. It has been concluded that the range of drugs recommended for cardioprotection is constantly changing in accordance with latest data, and updating the scientific information on this issue is an important to improve the professional competence of anesthesiologists and emergency physicians.

Rehabilitation technologies and provision of conditions for their implementation in surgery units, as well as in resuscitation and intensive care wards make an integral part of the modern medical practice. Currently, the efficacy of these approaches has been proven and formalized to a certain extent in the form of enhanced recovery after surgery in the intensive care units. Despite the different context and categories of patients on rehabilitation, these approaches have much in common both from a scientific and clinical point of view.

The lecture describes the mechanisms of deterioration of respiratory exchange during exacerbation of chronic obstructive pulmonary disease (COPD). It has been demonstrated that the rapid diagnosis and treatment of exacerbations is an important part of COPD management. The restriction of expiratory airflow followed by the increased dynamic pulmonary hyperinflation seems to be the most important pathophysiological mechanism in COPD exacerbation, which has catastrophic consequences for the respiratory system with respect to respiratory mechanics and gas exchange. In some patients, associated disorders of cardiopulmonary interactions also undoubtedly play an important role.

The report is devoted to the problem of acute kidney injury (AKI) in critically ill patients. Currently, the clinical definition of AKI is based on the assessment of increasing serum creatinine, but this method has a number of significant drawbacks. Perhaps the use of biomarkers for early detection of renal injury will improve diagnostic results. Up to date, no specific drug therapy for AKI has no available. The therapeutic tactics are based on the assessment of the risk of development AKI in critically ill patient, hemodynamic optimization, revision of drug therapy to exclude nephrotoxic drugs and the use of renal replacement therapy (RRT). Despite the numerous studies and the presence of multiple researches of AKI, there are many unclear issues related, for example, how to choose tactics of infusion therapy, the use of vasopressor support in patients with AKI, the time of the beginning and the choice of the mode of RRT, the feasibility of combining several technologies of extracorporeal hemocorrection. It is important to define how to improve the short-term prognosis and the long-term consequences of renal dysfunction.

Sepsis is a potentially life-threatening state caused by an infection and an inadequate, dysregulated host immune response. Focusing on cardiac surgery, the prevalence of sepsis is low, after procedures situated between 0.39% and 2.5%. Nevertheless, the current life-expectancy of septic patients are poor, mortality varying from 65% to 79%.

Pathophysiology and immunopathology of sepsis is still unclear. Actually we consider sepsis as a dynamic process with two different sides. Both immune hyperactivity and immune suppression are presented during the progression. Although immunomodulation is not a fresh idea in the treatment of sepsis. Currently the diagnosis of sepsis is based on clinical signs. The biomarkers and molecular diagnostic tools are insufficient.

The actual concept of immunopathophysiology in sepsis is based on the idea of a dynamic parallel immune response, both pro- and antiinflammatory processes are presented from the beginning. Equilibrium may be the key in the immune response of sepsis. Immune system tries to maintain the homeostatic environment during sepsis via pro- and antiinflammatory processes. In case of an unbalanced, dysregulated and radical (in both directions) response mortality become frightfully high. Infectional source control, adequate antibiotic therapy and organ support are the three corner stones in the treatment of sepsis since the definition of sepsis born.

In our review we would like to add a detailed overview on two promising modalities of immunomodulation: (1) extracorporeal blood purification; (2) immunostimulation.

The purpose of present article is to give an up-to-date, comprehensive review on the utilization of extracorporeal blood purification techniques and immunostimulation in septic patient after cardiac surgery.