The editorial considers the results and development trends of anesthesiology and resuscitation in this country after the 2nd Congress On Topical Issues of Critical Care Medicine which was held last year. Special attention is paid to the practical implementation of the concepts of enhanced recovery of the patient and perioperative medicine as well as acute kidney injury. It is noted that a change in the conceptual understanding of renal dysfunction results in re-consideration of principles of management of critically ill patients with special emphasis on factors that can cause (aggravate) kidney injury. The article focuses on the fact that the mechanistic implementation of any new techniques without regard to the consequences can bring not only benefits but also harm. It emphasizes that the prevention of the cohort of patients with chronic kidney disease from growing and adequate timely use of modern dialysis technologies can result in reduction of public spending on hemodialysis after discharge from the hospital. The effectiveness of interdisciplinary interaction of various professional communities jointly searching for solutions is illustrated by the example of the management of the antibiotic resistance problem.

The objective: basing on published data, to highlight the main issues of preparation of patients with concomitant lung pathology and a high risk of developing postoperative pulmonary complications for planned surgical interventions.

Results: changes made to international guidelines over the past 5 years based on evidence-based studies and meta-analyzes have been analyzed. The article presents data on preoperative management of patients with concomitant lung pathologies and a high risk of postoperative pulmonary complications, assessment of the risk of developing these complications based on evaluation of the functional status of patients. It analyzes the contemporary recommendations on the perioperative prevention of pulmonary complications, the use of physical exercises and respiratory gymnastics in the perioperative period in patients with a high risk of postoperative pulmonary complications. It is concluded that the implementation of comprehensive strategy aimed at reducing the risk of pulmonary complications should ensure decrease in their frequency and mortality due to them.

The objective: to summarize data from publications devoted to the problems faced by clinicians when managing patients with senile asthenia.

Results: the growing number of surgical patients of elderly and senile ages aggravates the negative statistics of complications and treatment results, thus it is necessary to search for a comprehensive effective solution to this problem. Understanding the pathophysiological models causing senile asthenia allows not only focusing on early diagnosis and management of potential complications but also preventing their development. Risk stratification, comprehensive diagnosis of functional status and geriatric syndromes in the light of a possible adverse postoperative period make it possible to choose the optimal analgesia and perioperative management of a patient with senile asthenia. The clinical organization of the treatment process and rehabilitation treatment based on multidisciplinary interaction in such patients improves postoperative results.

The objective: to present an overview of current approaches to pharmacological therapy of acute heart failure (AHF).

Results: the discussion focuses on drugs that are currently available and being actively studied in ongoing clinical trials. Disadvantages and adverse reactions of modern medications for the treatment of AHF are presented. Vasodilators cannot be used for arterial hypotension; inotropic drugs (catecholamines and phosphodiesterase inhibitors) produce proarrhythmogenic effect, increase the myocardial oxygen demand, and may cause excessive vasodilation. The mortality in patients receiving these medications and vasopressor agents remains high. The article presents data on the positive hemodynamic effect of levosimendan calcium sensitizer in patients with severe heart failure, as well as in some other categories of cardiac surgery patients but it emphasizes that the attitude to its effect on long-term survival of patients remains ambiguous. To remove contradictions, it is necessary to conduct the trial that is properly designed and does not contradict the indications and contraindications noted in the instructions for its use. It is suggested that in such trials, in particular, it is advisable to use temporary endpoints of the trial that are comparable to the duration of action of the studied drugs. In the nearest future, data will be obtained that will allow evaluating the possibility of wide clinical use of new groups of drugs: cardiac myosin activators, natriuretic peptides, vasopressin receptor inhibitors, drugs that affect the expression of calcium ATPase in the cardiac sarcoplasmic network (SERCA2a), including those developed using genetically engineered technologies.

The objective: based on the published data to describe the conceptual issues of the problem of perioperative cardiac complications in non-cardiac surgery.

Results: changes made to international guidelines over the past 3–4 years based on evidence-based studies and meta-analyzes have been analyzed. The article presents data on the etiopathogenesis of various postoperative cardiac complications, assessment of their risk based on the evaluation of functional activities of patients, cardiac risk indices, and modern biomarkers (B-type natriuretic peptides, cardiospecific troponins). The contemporary recommendations on adjuvant pharmacological cardioprotection and rational pharmacotherapy in the perioperative period are analyzed. The article describes specific parameters of diagnostic, treatment and prevention tactics in patients with coronary heart disease, hypertension, chronic heart failure, heart defects, and implanted electronic devices. It concludes that the implementation of the comprehensive strategy aimed at the reduction of risk of pulmonary complications should ensure the decrease in their frequency and mortality due to them. 

The objective: to present current information about definitions, etiopathogenesis, clinical, laboratory and hemodynamic manifestations of septic cardiopathy, based on published data and the results of our own research.

Results: septic cardiopathy is the most important pathogenetic component of sepsis, and cardiac dysfunction makes a significant contribution to its outcomes. It is found out that after staying in the intensive care unit for 3-4 days, the level of the inactive part of the precursor of the B-type natriuretic peptide (NT-proBNP) > 3,450 pg/ml indicates of the risk of death: area under ROC curve (AUC) 0.708 (p = 0.0041), sensitivity 63.6%, and specificity 66.7%. At the same time, NT-proBNP > 5,250 pg/ml is associated with the use of inotropic drugs: AUC 0.769 (p = 0.0007), sensitivity 76.9%, specificity 79.0%. The article describes the detection of septic cardiopathy using transpulmonary thermodilution and calculation of such indices as afterload-related cardiac performance and cardiac function index. Data on the age-related parameters of central hemodynamics and risk of pathological decrease in certain blood circulation indices characteristic of older patients are presented. The article discusses the feasibility of treating septic cardiopathy as a variant of acute heart failure, which can be manifested not only by a decreased systolic function (low left ventricular ejection fraction) but also by increased end-diastolic pressure in the ventricles (diastolic dysfunction) with a normal left ventricular ejection fraction. 

The objective: to describe the modern aspects of perioperative management of diabetes patients.

Results: glycemic level correction makes the main task of preoperative preparation. The article presents modern approaches to solving this problem in emergency and planned surgery, target parameters of blood glucose concentration, criteria of patients' readiness for surgery. The principles of choosing the anesthesia method, features of regional anesthesia, and infusion therapy are discussed. 

The objective is to present current data about the role of oral nutrition supplements (ONS) in cancer surgery. 

Results: this type of nutritional support should be considered as an integral part of the enhanced recovery after surgery.  Despite the apparent simplicity of prescription, it should be treated as one of the types of medical nutrition with its own indications, providing for the individual selection of specific formulas and evaluation of effectiveness. For the initial assessment of cancer patient nutritional status, European Society for Medical Oncology scale (ESMO, 2008) is the most appropriate. ONS should be combined with diet recommendations and physical activity maintaining.  Inability to provide with ONS > 60% of the daily energy requirements within 5–7 days, should be considered as an indication to start artificial nutrition – enteral and/or parenteral. 

The objective: to provide information and discuss the most justified and rational ways of anemia management in the perioperative period and in critically ill patients.

Results: anemia as a syndrome associated with the perioperative period and critical conditions occurs in patients of the intensive care unit in 30–70% of cases. Currently, there is a clear trend towards restrictive blood transfusion tactics, the individualization of the anemic status of the patient, as well as the personalization of the treatment. Alternative approaches to blood transfusion are encouraged to improve the oxygen transport function of the blood, including the use of iron supplements in adult patients with hypoferric anemia and treatment with drugs that stimulate erythropoiesis. 

The objective: to clarify the limits of using the term of endothelial dysfunction in research and clinical work.

Results: the concept of endothelial dysfunction has become ingrained in research activities while in clinical work, it is used rarely and fairly often inadequately. It is recommended that endothelial dysfunction should be understood as a persistent change in the structure and/or functional activity of endothelium resulting in vascular tone disorders, thrombosis and other complications. The concept of "dysfunction" and "activation" of epithelium should be differentiated. One means the injury, the other reflects changes in response to various provocative effects. The markers of endothelial dysfunction (instrumental and biochemical) and ways of its management with certain pharmacological agents (antioxidants, NADP-oxydases inhibitors, etc.) have been discussed.

The objective: to raise the awareness of medical professionals about one of the stages of investigation – pre-investigation check.

Results: the article presents the information on the legal aspects of the review of a report on medical crime (pre-investigation check). It outlines potential legal consequences for a physician at this stage of the legal proceedings. Lawyers' advice on the principles of conduct for a medical professional during pre-investigation checks is discussed. Physicians, who are the subject for the review of a report on medical crime are advised to take active participation in the proceedings, to clarify the circumstances of the case and potential legal consequences. At the same time, they are recommended to use affirmative defense based on existing regulations and get experienced lawyers involved.

The article tells about Armen A. Bunyatyan, the outstanding Soviet and Russian scientist, anesthesiologist, Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences (September 30, 1930 – February 19, 2020). It presents his background and reflects his contribution to the development of the specialty and science of anesthesiology and resuscitation.