The objective: to investigate the impact of anesthesia method on the severity of oxidative stress in patients after coronary artery bypass grafting with cardiopulmonary bypass.

Subjects and methods. Patients were randomized (seed 6556 as of 04.01.2016, www.randomization.com) to Volatile Induction and Maintenance Anesthesia (VIMA) with Sevoflurane group (n = 65) and Total Intravenous Anesthesia with Propofol and Fentanyl (TIVA) group (n = 66). The changes in oxidative stress markers in blood plasma were studied: carbonylated proteins, nitrotyrosine, oxidized forms of low-density lipoproteins – oxy-LDL.

Results. At the critical stage with 24 hours after the surgery, statistically significant differences in the carbonyls blood levels were found between VIMA with Sevoflurane and TIVA with Propofol groups: 0.88 (0.79–0.96) nmol/mg protein (nmol/mg) in TIVA group vs 0.81 (0.75–0.91) nmol/mg in VIMA group, p = 0.01; and oxy-LDL levels 0.96 ± 0.40 mg/ml vs 0.83 ± 0.33 mg/ml, respectively, p = 0.04. Nitrotyrosine demonstrated no diagnostic value.

Conclusion. It has been suggested that sevoflurane possesses antioxidant properties that can be regarded as a positive quality of VIMA in coronary artery bypass grafting with cardiopulmonary bypass. 

Patients with burns of the face and neck are more likely to develop unpredictable difficult airways, thus it is necessary to refine approaches to preoperative prediction of such a condition.

The objective: develop a method for airway assessment in patients with burns of the face and neck that can improve the results of tracheal intubation by reducing the incidence of unpredictable difficult airways.

Subjects and methods. This study was based on analysis of retrospective (42 patients) and prospective (42 patients) data. At the retrospective stage, before surgery all of the patients had their airways assessed as per El-Ganzouri scale. Based on the results, a cumulative rating scale (CRS) was developed, which effectiveness was assessed by prospective data.

Results. The area under the ROC curve was 0.67 (p = 0.027). Sensitivity, specificity, positive predictive value, and negative predictive value made 100%, 37%, 45,2%, and 100% accordingly. The assessment of the newly developed CRS: the area under ROC curve was 0.96 (p ≤ 0.05). Sensitivity, specificity, positive predictive value, and negative predictive value made 90.9, 100, 100, and 96.8% accordingly.

Conclusion: The developed cumulative rating scale (CRS) has a better predictive potential for assessing the airways in patients with burns of face and neck versus traditional approaches.

The objective: to evaluate the effectiveness of NIPPV (nasal intermittent positive pressure ventilation) and NHFOV (nasal high-frequency oscillatory ventilation) modes in newborns in the delivery room depending on the gestation period.

Subjects and methods. A prospective randomized study included 88 premature newborns with the body mass of 1,405 (1,085–1,760) gr. and gestation period 31 (29–32) weeks. In children of the first group, the NIPPV mode was used, and in the second group – NHFOV. Children of each group were divided into subgroups: subgroup 1 consisted of newborns with a gestation period of 30–32 weeks, subgroup 2 – 26–29 weeks.

Results. The need for the traditional ventilator was significantly greater in the group of NIPPV – 15 children, compared to the group of NHFOV – 2 children (p = 0.001). In the same subgroup, statistically significant differences were found in the frequency of bronchopulmonary dysplasia (BPD) and intraventricular hemorrhage (IVH) (p < 0.05). In particular, in the NIPPV group, BPD was registered in 33.3% of cases, while in the NHFOV group – 3.7% (p = 0.001). In children a gestation period of 26–29 weeks, the opposite results were noted. Retinopathy of prematurity was detected in 80% (12) of children on NHFOV and 12.5% (2) who received NIPPV (p = 0,001)). There were also statistically significant differences in the frequency of BPD formation – 9 cases in the first group, 13 cases in the second group (p = 0.04).

Conclusion. The use of NIPPV as a starting method of respiratory support is indicated to newborns with the gestation age of 26–29 weeks, and while in newborns with the gestation period of 30–32 weeks, the use of NHFOV is highly effective. 

Subjects and methods. The retrospective study included 37 patients (n = 37) diagnosed with severe viral pneumonia (SARS-CoV2) who were treated in the intensive care unit of Pavlov First Saint Petersburg State Medical University. To assess the significance of PADM as a biomarker of bacterial infection, patients were divided into two groups: the group of patients with viral pneumonia without sepsis (n = 24) and the group of those who developed sepsis and septic shock complicating the course of the new coronavirus infection (n = 13). PADM was assessed as a criterion for the severity of the disease in the groups of deceased (n = 19) and survivors (n = 18). Data were statistically processed in the computer mathematics system R, version 3.6.2, the prognostic significance of PADM was assessed using linear regression.

Results. The median PADM in the group without sepsis was higher than the reference value – 1.1 (0.5; 4.3) nmol/L, in patients with sepsis that complicated the course of viral pneumonia – 2.8 (1.1; 5.7) nmol/L (p = 0.0019). Significant differences were revealed between the baseline levels of PADM in patients with different outcomes: in the surviving group, the median was 0.99 (0.5; 3.14) nmol/L, and in the group of deceased – 2.70 (0.94; 5.86 ) nmol/L. In surviving patients, the changes in PADM levels had a linear distribution throughout the entire period of stay in the intensive care unit. In deceased patients, within 20 days before death, PADM tended to grow significantly and reached its maximum by the time of the outcome.

Conclusion. The assessment of the PADM blood level can be used to clarify the addition of a bacterial infection in patients with pneumonia caused by the SARS-CoV2 virus. The study of changes in its level makes it possible to objectify the prediction of the course of COVID-19 – favorable or unfavorable. Data accumulation is required to clarify specific PADM values that predict the outcome in COVID-19 patients. 

The objective: to study the hemostatic system of patients diagnosed with the novel new coronavirus infection and compare the data obtained with hemostatic system parameters in patients with advanced deep vein thrombosis/pulmonary embolism without COVID-19.

Subjects and methods. A single-center prospective study with retrospective control was conducted in Anesthesiological and Intensive Care Department No. 1 of Kuvatov State Medical University (Ufa) in April - May 2020, the objective of the study was to investigate the hemostatic system of patients with confirmed new coronavirus infection, patients diagnosed with venous thrombosis in 2012-2014, and a group of healthy volunteers.

Results. Evaluation of the hemostasis system in patients with thrombosis and patients with COVID-19 demonstrates the same type of changes: MA, Angle, G indices increase according to thromboelastography results, as well as D-dimer and fibrinogen levels increase, while antithrombin III activity decreases.

Conclusion. Thus, TAG may be crucial for accurate identification of patients with advanced increased risk of thrombosis and thus possibly avoid unnecessary anticoagulation in patients at low risk of thrombosis.

It is known that the greatest difficulties in predicting the outcome of severe community-acquired pneumonia occur in elderly patients with gram-negative pneumonia.

The objective: to compare the differentiating capacity of the PSI/PORT, SOFA, APACHE II, and MODS-2 scales in elderly patients with severe community-acquired pneumonia caused by K. pneumonia.

Subjects: The study has been designed as retrospective, multicenter, controlled, and non-randomized. Inclusion criteria: clinical and laboratory, x-ray diagnosis of community-acquired pneumonia associated with Klebsiella pneumoniae with SOFA scores as 2 and more points. The severity of the patient's condition and prognosis were assessed using the SOFA, MODS-2, and PSI/ PORT scales when the patient was admitted to the ICU, further changes in the state were assessed after 72 hours of intensive care and by the outcome. The time spent in the ICU, the frequency of detection of bacteremia, and the need for renal replacement therapy (RRT) were evaluated. The following parameters were analyzed: co-morbodities, structure of multiple organ failure, validity of the information value of SOFA, APACHE II, and MODS-2 scales.

Results. The age of the patient over 70 years increased the risk of death by 1.2 times (OR = 1.21). There were no significant differences in the frequency of individual nosologies of comorbidity. The development of multiple organ failure syndrome increased the possibility of patient death by more than three times (OR = 3.4). The probability of death of the patient when acute renal damage developed in the structure of multi-organ pathology was even more significant (OR = 8.5). Only the АРАСНЕ II (AUC ROC 0.677 ± 0.053) and SOFA (AUC ROC 0.708 ± 0.052) scales demonstrated moderate informational value in predicting the risk of death in the studied patients.

Conclusion: When assessing the prognosis of the outcome in elderly patients with severe community-acquired pneumonia caused by Klebsiella pneumoniae, it is advisable to use the SOFA and APACHE II scales.

The objective: to analyze the validity of recommendations of the special research committee of the European Society of Intensive Care Medicine (ESICM) and Society of Critical Care Medicine (SCCM) concerning the most important provisions for the management of patients with sepsis and septic shock identifying predictors of long-term need for medical care and lethality.

Subjects and methods. The article analyses the publications based on which experts in sepsis management identified the key provisions of the above recommendations.

Results. Attention is focused on six issues: empirical combined antibiotic therapy, individual infusion volume, express diagnosis of infection, assessment of organ and systemic dysfunction, identification of predictors of long-term need for medical care and lethality, and implementation attempts and prospects of precise/personalized medicine. It has been shown that the values of SOFA score, heart rate, syst. blood pressure, lactate and albumin levels should reflect the balance of the groups in these parameters. Molecular classification of patients with sepsis providing different endotypes allows better patients enrollment in clinical trials.

Difficult airways are the cause of dangerous, sometimes life-threatening complications in the practice of anesthesiology and intensive medicine. Careful detection of predictors is the key to early recognition of this situation.

The article describes different methods for identifying difficult airways predictors associated with both individual prognostic tests and an integrated approach based on the combination of methods for airways assessment. The most well-known scores are described: Wilson, LEMON, and El-Ganzouri. A separate section of the article describes objective methods using instrumental technology (X-ray, ultrasound, computed tomography), it notes the ultrasound and radiological signs associated with the development of difficult airways.

Neonatal sepsis continues to be one of the main problems in the treatment of premature infants due to the variability of the clinical signs, the lack of uniform diagnostic criteria, optimal markers that would not be affected by the course of pregnancy, gestational age, delivery, and the early neonatal period.

The objective: to analyze current data on serum markers of neonatal sepsis in newborns including children with extremely low and very low birth weight.

The article reviews traditional markers that are currently widely used in resuscitation neonatal practice – C-reactive protein, procalcitonin, and among the new ones – preadrenomedullin, and presepsin. It lists their positive and negative aspects, compares their characteristics, notes publications that describe the possibilities and limitations of their use for early diagnosis of neonatal sepsis.

It has been concluded that among all markers, presepsin is of the greatest interest due to its highest sensitivity and specificity compared to the others.

The effectiveness of antibacterial therapy is a critical factor to improve treatment outcomes in sepsis patients. Impaired renal function and renal replacement therapy lead to a significant change in the pharmacokinetic parameters of most intravenous antibacterial drugs, which in many cases is accompanied by insufficient or excessive concentration in the blood which results in antibacterial therapy failure. The article presents current views and describes the current problems of antibacterial therapy for sepsis during the use of extracorporeal detoxification methods.

The objective: to analyze publications on antibacterial therapy of sepsis during the extracorporeal detoxification.

Results: the most accessible and effective method for solving the problem of inadequate dosage of antibiotics when using extracorporeal detoxification is to develop local protocols based on the results of pharmacokinetic studies.

The letter draws attention to the provisions on the use of fat emulsion when systemic toxicity of local anesthetics develops that was published in the article titled Disputed Issues of Systemic Toxicity of Local Anesthetics. (Messenger of Anesthesiology and Resuscitation, no. 1, 2020). It is noted that the use of fat emulsion when systemic toxicity of local anesthetics develops is a method of therapy accepted worldwide and included in the protocols of cardiopulmonary resuscitation.