The objective: to identify laboratory markers of systemic perfusion in newborns with functional single ventricle on mechanical ventilation after surgical correction.
Subjects and methods. Blood gas parameters were retrospectively analyzed in 52 newborns with congenital heart defects with univentricular hemodynamic after surgical correction. All samples were divided into three groups based on arterial blood saturation (SaO₂): Group 1 – hypoxia (SaO₂ ≤ 65%); Group 2 – normoxemia (SaO₂ = 65-85%); Group 3 – hyperoxemia (SaO₂ > 85%). Stroke volume and cardiac index were evaluated with echocardiography. The oxygen consumption and carbon metabolism were evaluated by arterial and venous blood gases.
Results. The mixed central venous pO₂ (PvO₂) > 29.5 mm Hg, mixed central venous O₂ (SvO₂) > 54.5%, arteriovenous difference in saturation (Sa-vO₂) < 15.8%, total oxygen content in venous blood (CvO₂) > 119 ml/l, oxygen extraction ratio (O₂ER) < 19% and the arteriovenous difference in partial pressure of carbon dioxide (dPCO₂) < 5.4 mm Hg are cut off criteria for adequate systemic perfusion. PvO₂ < 26 mm Hg, SvO₂ < 44.5%, Sa-vO ₂ > 27%, CvO₂ < 88 ml/l, O₂ER > 27.7%, dPCO₂> 7.9 mm Hg have been associated with decreased systemic perfusion. The logistic regression model including combination of O₂ER and dPCO₂ predicts adequate systemic flow accuracy of 94.3% (sensitivity 87.5%, specificity 94.7%, p = 0.001). Graphics allow to adapt the mathematical model to clinical practice to verify systemic hypoperfusion in newborns with functional single ventricle.
Conclusion: The following cut off parameters allow to assess systemic perfusion in newborns with functional single ventricle: PvO₂, SvO₂, CvO₂, Sa-vO ₂, O₂ER, and dPCO₂. The model for predicting the adequacy of systemic perfusion can be used as an effective tool to monitor hemodynamic status in newborns with functional single ventricle.

The objective: to analyze results of the use of combined anesthesia for coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG) in patients with visceral obesity (VO).
Subjects and methods. A randomized study of results of surgical treatment in patients with VO and coronary heart disease who underwent off-pump CABG was conducted. 197 patients were included in the study. The main group (n = 98) included patients who underwent combined anesthesia (with thoracic epidural analgesia (TEA)) and patients in the control group (n = 99) underwent total intravenous anesthesia (with narcotic analgesics).
Results. In patients from the main group, a significant decrease in the incidence of acute kidney injury (p = 0.0180), respiratory complications (p = 0.0177), atrial and ventricular arrhythmias (p = 0.0029) was recorded. With the use of TEA, the duration of treatment of patients in the intensive care unit (p = 0.0229) and duration of hospital stay (p = 0.0419) significantly decreased.
Conclusion: The use of combined anesthesia (with TEA) for off-pump CABG in patients with visceral obesity reduces the risk of early postoperative complications, the duration of hospital stay and treatment in the intensive care unit.

The objective: to assess changes in energy expenditures (EE) when reducing pressure support (PS) as a predictor of the patient’s readiness for transfer to spontaneous breathing.
Subjects and methods. The study included 33 patients who had been on mechanical ventilation for at least 7 days. PS reduced from 20 to 4 cmH₂O at the interval of 4 cmH₂O. At each level, the patient's EE were measured with indirect calorimetry. At the end of the study, spontaneous breathing trial (SBT) was performed.
Results. In 22 (67%) patients, at least one episode of a statistically significant increase in EE was observed upon transition to a lower level of PS (Group 1). In remaining 11 (33%) patients, with decreased level of PS, EE decreased or did not significantly change (Group 2). SBT was successful in 14 out of 22 patients from Group 1 and all 11 patients from Group 2. The absence of episodes of increased EE during decreased PS was a predictor of successful SBT (sensitivity – 44%, specificity – 100%).
Conclusion. The absence of episodes of a statistically significant increase in EE during the transition to a lower level of PS is a highly specific predictor of successful SBT.

The objective of the study: to study certain parameters of the autonomic nervous system (ANS) and cognitive functions in patients with acute alcohol intoxication of different severity degrees.
Subjects and methods. 312 patients with acute alcohol intoxication and chronic alcohol abuse were enrolled in the study. Manifestations, medical history, the duration of drinking bout, ethanol blood level were assessed. Blood panel included ALT, AST, LDH, and blood levels of free ammonia, lactate, and medium molecules. The subjects were divided into three groups: Group I - 78 patients with severe alcohol intoxication, Group II – 166 patients with moderate alcohol intoxication, and Group III – 68 patients with mild alcohol intoxication. The state of ANS was assessed according to the following indicators: heart rate, systolic and diastolic blood pressure, Kerdo vegetative index, and results of cardiointervalography by R.M. Baevsky (1986). The severity of intellectual impairment was assessed using the ММSE scale for 10 positions, the FAB scale for 6 positions, as well as the Reitan test in seconds on the 1st day.
Results. In patients of Group I, the alcohol level was 1.5 and 1.35 times lower versus patients in Groups II and III. All patients with severe intoxication had symptoms of toxic hepatitis, which was manifested by a significant increase in ALT, AST, LDH and bilirubin, exceeding the normal limits by 5.4, 5.4, 1.8, and 1.7 times, respectively. Ammonia blood levels in patients with severe intoxication exceeded the norm by 5.6 times, in patients with moderate severity of intoxication – by 3 times, and even in patients with a mild degree – by 1.5 times. The lactic acid level in patients of Group I was 3.2 times above the norm, in patients of Groups II and III – 2.0 and 1.4 times, respectively. In patients with severe intoxication, there was an increase in blood levels of medium molecules over 0.6 units of optical density which reflected severe endogenous intoxication. Assessment of ANS parameters in patients of three groups revealed development of hypersympathicotonia due to the increased tone of the sympathetic department of ANS in proportion to intoxication severity. Cognitive functions at admission were inhibited in proportion to the severity of the patient's condition. Intelligence level as per MMSE scale: at admission, patients of Groups III and II demonstrated mild and moderate cognitive impairment (25.8 ± 2.1 and 23.31 ± 1.80 points); in Group I, indicators for all items were 1.5 times lower versus Groups II and III. Intelligence as per the FAB scale: in patients with severe intoxication, deviations in conceptualization and dynamic praxis were noted. The Reitan test results were best in patients from Group III. Subsequently, 63 (80.7%) patients with severe alcohol intoxication developed alcoholic delirium.
Conclusion. Patients with alcohol intoxication demonstrated a decrease in cognitive functions and impaired intelligence proportional to the severity of intoxication and levels of lactate and free ammonia. Increased tone of the sympathetic division of the ANS is typical of acute alcohol intoxication during drinking bout. Cardiointervalography parameters can be used to assess the severity of alcohol intoxication.

The mortality of patients with hepatic failure remains high. Often the patient's life can be saved only with extracorporeal liver support (ELS). ELS systems – MARS^® и Prometheus^® have proved their efficacy but their widespread use is constrained by their very high cost. Introduction in clinical practice of new affordable ELS systems is a topical issue.
The objective: to compare clinical and laboratory effects of selective plasma exchange (SPE), plasmadialfiltration (PDF) with use of the selective membrane plasma separators EvaclioTM and MARS^® and Prometheus^® (FPSA) systems in the treatment of liver failure.
Subjects and methods: 15 extracorporeal procedures of each type were performed in 52 patients with acute liver failure (14) and acute-on-chronic liver failure (38): MARS, FPSA, PDF, SPE with use of Evaclio ЕС-2C, and ЕС-3C, ЕС-4C. The clinical and laboratory parameters (total, direct and indirect bilirubin, total protein, albumin, creatinine, urea, etc.), severity of the condition according to MELD score were determined before and after the session and the next morning. Changes, side effects and complications of procedures were assessed and compared.
Results. Reduction of concentration of direct bilirubin was comparable with FPSA, PDF and SPE on Evaclio ЕС-3C20 и ЕС-4C20 (38-42%), indirect bilirubin – with PDF and SPE on Evaclio ЕС-3C20 и ЕС-4C20 (29-34%). Low-molecular metabolites (urea, creatinine) were better removed with FPSA (35-44%) and PDF (40-42%). The reduction of their concentration with SPE was insignificant. The reduction of albumin level was the highest with FPSA (10.2%) and SPE on Evaclio ЕС-4C20 (14.3%). All investigated ELS methods did not exert a significant influence on the basic parameters of blood coagulation and quantity of blood cells. No side effects and complications were observed.
Conclusion: Selective plasma exchange and plasmadiafiltration are generally comparable in clinical and laboratory effects in the treatment of liver failure with MARS and Prometheus system provided significantly lower costs.

Many hospitals use β-blockers in adult patients, however, their use in children has not yet been determined.
The objective: to collect data on the use of β-blockers in children in intensive care units (ICU).
Methods: an anonymous survey containing 17 questions regarding the use of β-blockers was distributed through social networks, messengers and email. The answers were compared with published data.
Results. 48 respondents provided their replies. The survey has shown that 66.7% of them use β-blockers in children while 33.3% do not. Differences in the use of β-blockers in general and pediatric ICUs are statistically insignificant. Most clinics (50%) use β-blockers in patients with congenital heart defects, followed by sepsis (18.5%). Esmolol (34.4%) is the first-line drug, followed by propranolol (31.3%). The doses ranges vary significantly (excluding esmolol). Basic monitoring and echocardiography (40.6%) are most often used to monitor the use of β-blockers.
Conclusion: The survey results have shown that in Russia, the use of β-blockers in children in ICU is very limited. It is necessary to conduct big randomized, multicenter, placebo-controlled studies that will determine the effectiveness of β-blockers in children in various clinical conditions.

The review summarizes data on contemporary approaches to diagnosis, prevention and treatment of severe acute parenchymal respiratory failure of various origins including in acute respiratory distress syndrome (ARDS) caused by bacterial and viral pneumonia. It is based on the data of modern properly organized studies, an analysis of international clinical guidelines with a high degree of evidence, as well as the results of many years of own experimental research and clinical observations of treatment of patients with ARDS of various origin, including those with viral pneumonia in 2009–2016–2020. The article states scientifically-based procedures for prevention, differential diagnosis and personalized treatment of severe acute respiratory failure with the use of innovative medical technologies and a wide range of respiratory treatments. The authors did their best to adapt specific proposals for everyday clinical practice.

The objective: the article is devoted to specific parameters of pre-operative preparation for anesthesia in children above 1 month old which is significantly different from adult practice. Special attention is paid to ensuring the psychological comfort of the child, collecting history and physical examination, which allows to assess the physical status of the patient, concomitant diseases and risk factors of airway obstruction during anesthesia. The article presents basic principles of anesthesia risk assessment in children and modern scales used for this purpose. It describes possible complications of anesthesia due to concurrent hereditary pathology in the child. Special parts of the article are devoted to pre-operative starvation, the problem of choice of premedication, specific pre-operative management in case of acute respiratory infections and acute surgical diseases of the abdomen.

The objective: to analyze literature and to compile the most accurate and complete view of lactic acidosis and specific parameters of its treatment in anesthesiology and resuscitation practice.
Result. Lactate levels are commonly evaluated in critically ill patients. Hyperlactatemia is defined as a lactate level >2 mmol/L and it is common in the critical care setting. Hyperlactatemia and lactic acidosis may develop due to increase in lactate production, a decrease in lactate clearance, or a combination of both. The current review provides an overview of pathophysiology of lactate elevation followed by analysis of different etiologies of hyperlactatemia in critically ill patients.Additionally, approach to differential diagnosis and treatment of elevated lactate levels in this category of patients is discussed.

Massive obstetric hemorrhage is one of the most threatening complications of pregnancy, delivery and early postpartum period, which are part of the triad of leading causes of maternal mortality both in the world and in the Russian Federation. In recent years, to stop coagulopathy, which is one of the clinical manifestations of massive obstetric hemorrhage, recombinant and plasma factors of the blood coagulation system are successfully used, which include a concentrate of prothrombin complex and activated coagulation factor VII (eptacog alfa activated). The authors present results of successful consistent use of the blood coagulation system factors within comprehensive intensive care of coagulopathy in a patient with massive obstetric hemorrhage.