The constant mutation of the virus and the complicated epidemiological situation in other countries keep the probability of a third wave of the pandemic in the Russian Federation fairly high. It is important to summarize the gained experience as fast as possible to use it appropriately once it is needed.

The objective: to analyze the specific parameters of care for critically ill patients with the novel coronavirus infection in Pavlov Multidisciplinary Medical Center.

Subjects and methods. This is a result-based report on the work performed by the Infection Center, which was deployed twice in Pavlov Multidisciplinary Medical Center (from 28.04.2020 to 03.08.2020 and from 01.11.2020 to 15.03.2021). Totally, 3,830 patients with SARS-CoV-2 were managed (1,680 patients during the first deployment and 2,150 patients during the second one). In the preparatory period, the operation of the emergency department based on the inpatient emergency medical department (EMD) had been simulated to clarify its staff structure and the procedure for admission, examination, and treatment of patients. Here we compare the organizational approaches during the first and second waves of the pandemic and present the characteristics of the demographic data of the treated patients, the incidence of certain complications, and outcomes.

Results. The overall lethality in the Center made 6.2%. Despite the experience gained in the first wave, the results of treatment during the second wave (autumn-winter) did not improve (5.7% died in the first wave and 6.7% in the second one). Lethality in ICU and EMD was 40.0% and 49.6%, in ICU only – 38.5% and 46.9% respectively. A moderate lethality increase in ICU was due to the concentration of critically ill and most critically ill patients. There were 51.4% of patients with comorbidities and 53.5% were above 65 years of age. Refinement and differentiation of tasks performed by departments, simulation of the operation of the Center before opening made it possible to increase the throughput of the medical unit avoiding rush during admission and deterioration the quality of treatment.

Conclusion. Certain aspects of the organization of medical care affect the performance of a multidisciplinary medical institution transformed into an infectious diseases hospital. The experience gained under such circumstances can be useful in other emergencies with a large number of victims and patients.

The objective: To determine the level of satisfaction with their work and degree of burnout among anesthesiologists and emergency physicians working in the red zone of a COVID-19 hospital.

Subjects and methods. A prospective study was conducted as an anonymous survey of physicians performing their duties in intensive care units of the red zone. 65 specialists were interviewed: Group 1 (52.3%) – trainee physicians, Group 2 (47.7%) – anesthesiologists and emergency physicians.

Results. The majority of respondents in both groups noted relatively high satisfaction with their current work. At the same time, the majority of respondents (70.9%) in the group of anesthesiologists and emergency physicians would prefer the previous working conditions to current ones. Also, it was noted that both groups were highly emotionally exhausted.

Objective: to study the use of RRT methods and their influence on the results of treatment of patients with severe COVID-19.

Subjects and methods. We retrospectively analyzed the data of 283 patients with COVID-19 in the intensive care units of Moscow City Hospital no. 40 in 2020 who had received RRT as one of the treatment methods.

Results. Frequency of RRT in COVID-19 patients in ICU of Moscow City Hospital no. 40 for 2020 made 5.7% (504 out of 8.711 patients treated in ICU received RRT). In 86% of cases, RRT was performed for renal indications. At the time of initiation of RRT, the studied groups did not differ according to SOFA score. The frequency of using dialysis units with high and low cut-off point in the groups of survived and deceased patients differed significantly. The surgery itself started at relatively the same time from the onset and statistically significantly earlier in the group of survivors from the beginning of tracheal intubation (4.9 ± 0.5 vs 6.8 ± 0.3 days, p = 0.0013). Against the background of ongoing therapy, overall severity of the state progressed in the group of deceased patients to 9.9 ± 0.2 SOFA scores, while in the group of survivors there was an improvement to 6.1 ± 0.4 scores.

The use of high-adsorption membrane hemofiltration in COVID-19 positive patients to reduce the severity of a cytokine storm is clearly beneficial but at the same time, there are no certain procedures for its practical use.

The objective: to study the change in the levels of IL-6 and IL-18 in response to prolonged (24-72 hours) high-adsorption membrane hemofiltration.

Subjects and methods. We retrospectively analyzed the data on IL-6 and IL-18 levels and their changes in 69 patients who were COVID-19 positive and had different degrees of lung damage, they had received high-adsorption membrane hemofiltration during their stay at the intensive care unit. The extent of lung lesions was the following: 4 people had CT-2, 44 people had CT-3, and 21 patients had CT-4. 18 patients had an unfavorable outcome of the disease. High-adsorption membrane hemofiltration (Prismaflex) was used in the group of patients who had clinical signs of the rapid progression of the disease and also such laboratory findings as elevated values of C-reactive protein (above 100 mg/L), ferritin (more than 600 μg/L), and progression of lymphopenia. This intervention lasted for 24 hours at CT-2/3, and 48 hours at CT-4. The effluent dose was 30.0 ± 6.4 ml/kg/h. The levels of IL-6, IL-18, and procalcitonin were tested before and after the completion of the intervention, and the difference between their concentration before and after high-adsorption membrane hemofiltration was calculated. The potential association between received data (IL-6, IL-18, delta of IL-6, delta of IL-18) and degree of lung damage and outcomes was analyzed.

Results. It was detected that the more the lungs were affected, the lower levels of IL-6 and IL-18 were and vice versa and this correlation was not associated with the use of tocilizumab (used in 44 people). The maximum decrease in the level of cytokines was observed in the group of patients with CT-2. There was a significant association between the delta of IL-6 (F = 6.69; p ≤ 0.05) and the outcome which was especially pronounced in people with a favorable outcome.

Conclusion. As the inflammation progresses in the lungs, the levels of IL-6 and IL-18 decrease which may be a manifestation of the depletion of the cytokine storm. The use of prolonged high-adsorption membrane hemofiltration (24-48 h) allows reducing the level of cytokines. The delta value reflects a decrease in IL-6 concentration, it significantly correlates with the outcome which indicates the importance of using this method in a continuous mode.

An important place in the structure of the causes of postoperative respiratory failure in cardiac surgery is occupied by atelectasis of the lung tissue, which is formed during cardiopulmonary bypass (CPB). The incidence of this complication makes 54–92%.

The objective: to evaluate the effectiveness of various respiratory support techniques during CPB.

Subjects and methods. 60 patients were randomly included in the study. CPAP Group (positive airway pressure +5 cm H2O) and VC Group (lung ventilation during CPB with parameters: tidal volume 3 ml/kg, respiratory rate 6/min, positive end-expiratory pressure +5 cm H2O).

Results. The oxygenation index in VC Group was higher than in CPAP Group at the stages after the end of CPB (289.6 ± 100.0 in VC Group and 223.1 ± 152.0 in CPAP Group), at the end of surgery (in VC Group 318,7 ± 73.8 and in CPAP Group 275.2 ± 90.0) The frequency of intraoperative (VC 16% and CPAP 43%) and postoperative recruiting lung maneuvers (VC 7% and CPAP 26%) in VC Group was lower versus CPAP Group. The incidence of atelectasis in VC Group (10%) decreased compared to CPAP (36.6%).

Conclusion: Low-volume ventilation during cardiopulmonary bypass has a more favorable effect on the oxygenating function compared to respiratory support in the CPAP mode.

The objective: to compare the effectiveness of visceral and renal protection methods during thoracoabdominal aortic (TAA) repair: left atrial-femoral bypass (LAFB) and cardiopulmonary bypass (CPB) in conjunction with selective perfusion (SP) of these organs.

Subjects: 81 patients who underwent TAA repair were enrolled in retrospective analysis: LAFB was used in 29 patients (Group 1), CPB and SP ‒ in 52 patients (Group 2).

Results. In Group 2, there were lower intraoperative blood loss volume (1,500 ml vs 4,200 ml, p < 0.001), significantly lower levels of direct bilirubin, blood creatinine, blood alpha-amylase in postoperative period, significantly shorter duration of hospital stay, ICU stay and duration of mechanical ventilation. Also in this group, there were lower incidence of multiple organ dysfunction (11.5% vs 37.9%, p = 0.005), stroke (0 vs 10.3%, p = 0.043), lower need for requirement (3.8% vs 20.7%, p = 0.022) and mortality (3.8% vs 27.6%, p = 0.003).

Conclusion: During TAA repair, CPB in conjunction with selective visceral and renal perfusion is more beneficial for organ protection as compared with LAFB.

The objective of the study is to evaluate the discriminative ability of nSOFA in newborns with sepsis.

Subjects: The study was designed as retrospective, observational, and one-center. End points included assessment of the severity as per nSOFA and pSOFA; 28-day survival. 121 patients were enrolled in the study. Microsoft Excel (Graphpad Software, San Diego, California, USA) and MedCalc (v 7.1.0.0; MedCalc Software, Belgium) were used for the analysis.

Results. A study of the discriminative power of the scores showed that both assessment systems had a good model quality. However, nSOFA had a statistically more significant (p < 0.05) area under the ROC curve (0.981± 0.014).

Conclusion. The high value of the discriminative ability of the nSOFA scale indicates the feasibility of its use in patients with sepsis in neonatal intensive care units

The objective: to establish the prevalence of postoperative delirium (POD) and the influence of various factors in intra- and postoperative periods on its occurrence in children with septal congenital defects requiring surgical interventions with cardiopulmonary bypass (CPB).

Subjects and methods: 40 children from 6 to 36 months and weighing from 7.5 to 15 kg were enrolled in the study; they underwent planned radical surgery of septal CHD with cardiopulmonary bypass. In the postoperative period, all patients were tested using the Cornell Assessment for Pediatric Delirium validated for children of this age. Cerebral damage was also assessed using three specific serum markers: protein S-100-ß, neuron-specific enolase (NSE) and glial fibrillar acidic protein (GFAP) before the surgery, upon bypass completion, and in 16 hours after the operation.

Results. The study revealed the incidence of delirium in 22.5%. When analyzing many factors of the intra- and postoperative period, it was found that the use of donor blood components in the primary volume of CPB filling was statistically significantly more often observed in patients with established delirium: 7 (78%) and 13 (42%) (p = 0.049). Also, it was found that levels of S-100-ß, NSE, and GFAP were significantly higher in patients with confirmed POD.

The study described the incidence of POD in children after surgical treatment of congenital heart disease under cardiopulmonary bypass and showed that intraoperative transfusion was a risk factor for the development of delirium. The role of markers of cerebral damage in the diagnosis of POD was also proven.

The objective: to evaluate the effect of combined use of analgesics, dalargin and tissue metabolism correctors on endocrine-metabolic disorders in patients with thoracoabdominal trauma who were injured in road accidents.

Subjects and methods. A single-center prospective randomized study was conducted in 30 victims of road accidents with thoracoabdominal trauma and traumatic shock. In 15 patients of the main group, in addition to conventional therapy, dalargin, lornoxicam were administered intravenously, and remaxol was infused.

Results. The combined use of analgesics, dalargin and correctors of tissue metabolism contributed to the maintenance of cortisol concentration at the level of compensated stress in patients of the main group, which indicated more favorable adaptive capabilities of the body.

Conclusions. Intensive therapy in patients of the main group helps to reduce the severity of anaerobic processes, optimize energy processes at the cellular level, reduce the enzymatic activity of the liver, and reduces the hospital stay of patients by 5 bed-days.

Refractory septic shock develops in 6–7% of sepsis patients with short-term lethality rate of more than 50%. It is necessary to assess the effectiveness of intensive therapy methods used in this case.

The objective of the review: to analyze publications on the intensive care of refractory septic shock.

Results. 56 studies published in the period from January 1, 1990 to September 1, 2020 were analysed, they reflect the effectiveness of some methods used for management of refractory septic shock (treatment of the underlying disease, liquid bolus, the use of norepinephrine, adjuvant therapy, management of metabolic acidosis). The second part of this article will reflect the evaluation of the effectiveness of other approaches to the treatment of this complication.

The article describes a clinical case when a patient who was supposed to have a planned surgery on the spine developed anaphylactic shock. After 10 minutes of anesthesia introduction, the patient developed severe hypotension (resistant to the administration of adrenomimetics) and tachycardia; a decrease in the partial pressure of carbon dioxide at the end of expiration was noted. Due to the rapid development of a critical condition, the absence of specific skin manifestations and allergic history, as well as a direct association with the administration of a specific agent, it was necessary to carry out a differential diagnosis between acute myocardial infarction, pulmonary embolism, and anaphylactic shock. During the intensive care, the patient had echocardiography and ECG, blood gases were tested; the decisive diagnostic factor was the identification of bronchospasm signs. When the condition was stabilized, angiography of the vessels of the heart and lungs was performed; later, the agent that caused the development of anaphylaxis was established.

Identifying the cause of hypotension after induction of anesthesia is critical because therapy can vary significantly. The development of anaphylactic shock during general anesthesia is not common but delayed diagnosis and therapy can be fatal. The article discusses modern approaches to the diagnosis and therapy of perioperative anaphylaxis using the example of the presented clinical case.