Objective: complex assessment of clinical and economic effectiveness as well as saving of the state budget assets within the therapy of patients with sepsis/septic shock based on different technologies of blood purification.

Methods. Evaluation of direct and indirect costs of the eight blood purifcation methods. The target population includes adult patients 18+ with septic acute kidney injury. The study was conducted in compliance with acting Standards on Clinical Economic Studies used in the Russian Federation.

The study methods included evaluation of existing randomized clinical studies and trials with data from network meta-analyses and systematic reviews of the target technologies. The direct medical and indirect non-medical costs were calculated and analyzed in respect of cost-effectiveness  and budget impact analyses.

Results. Direct and indirect costs were calculated for the sorption devices oXiris (Baxter International Inc.), Toraymyxin (Toray Medical Co.), Alteco LPS Adsorber (Alteco Medical AB), Toxipak (POKARD NPF), Desepta.LPS (BIOTECH M NPP), CytoSorb (CytoSorbents Inc.), HA330 (Jafron Biomedical Co.), Desepta (BIOTECH M NPP) for two time-horizons: 1-year period and 5-years period with discounting. For both periods, the use of oXiris hemoflter results in the least economic burden for the state budget.

Conclusion. The use of blood purifcation in septic patients therapy is associated with considerable direct and indirect fnancial expenses, the amount of which and consequential budget saving depend on the technology of blood purifcation applied. The actual tariff compensation policy evidently demands revising.

Objective: identifcation of the peculiarities of the emotional states of anesthesiologists and intensivists in different periods of the COVID-19 Pandemic.

Material and Methods. The study was conducted using an anonymous questionnaire survey in the frst and second waves of the pandemic COVID-19 among anesthesiologists and intensivists of the Arkhangelsk region: in May 2020 (in the frst wave of the COVID-19 pandemic), 58 doctors participated; the average age was 32.7 ± 1.7 years (M ± SD); in October 2020 (during the second wave of the COVID-19 pandemic), 43 doctors were involved; the average age was 28.0 ± 1.2 years (M ± SD). The repeated questionnaire survey was conducted among the same doctors.

Results. During the second wave of COVID-19, male doctors more often noted poor health, signifcant heaviness and intensity of their work versus the frst wave, while women on the contrary during the frst wave had a poorer emotional state and higher level of emotional burnout. During the second wave of COVID-19, anesthesiologists and intensivists involved in caring for patients with COVID-19 were more likely to experience poor emotional state, anxiety, low mood, irritability, and a high level of burnout compared to the frst wave.

Summary. The second wave of COVID-19 is accompanied by further exhaustion of emotional resources of anesthesiologists and intensivists.

Objective: comparison of general anesthesia (GA) and intravenous conscious sedation during left atrial appendage occlusion (LAAO).

Materials and Methods. The study included 120 patients from LAAO Register at the National Medical Research Center of Cardiology, who were divided into GA (n = 100) and intravenous sedation (n = 20) groups. In-hospital outcomes were assessed, as well as outcomes and data of transesophageal echocardiography (TEE) at 45 days and 6 months.

Results. 3 patients required intraoperative conversion of the anesthetic method to GA. The duration of the procedure, the time of fluoroscopy, the amount of contrast medium, and the technical success did not differ signifcantly between the two groups. The incidence of in-hospital complications in the GA group was 10%, and 15% in the intravenous sedation group (p = 0.453). There were no statistically signifcant differences between the groups in long-term outcomes and TEE data after 45 days and 6 months.

Conclusion. Combined intravenous sedation with local anesthesia is an effective and fairly safe method of anesthesiological support for implantation of the occluder of the left atrial auricle. It can be used in patients with a high risk of GA, with predictable difculties of tracheal intubation, as well as if the patient wishes accordingly. The limitations of the use of intravenous sedation in combination with local anesthesia are anatomical variants of SFM that are difcult for occluder implantation, as well as the patient's low tolerance to ECG in consciousness.

Objective: to study the effect of selective plasmadsorption (SPS) on the level of pro-inflammatory and anti-inflammatory plasma cytokines, markers of liver failure in patients with obstructive jaundice.

Material and Methods. The study was conducted in 23 patients with prolonged obstructive jaundice. The baseline level of total bilirubin ranged from 285 μmol/L to 589 μmol/L. All patients were exposed to selective plasmadsorption before biliodigistic surgery and twice in the early postoperative period. Selective plasmosorption was carried using OctoNova by Asahi Kasei Medical (Japan) with the use of the sorbent based on the Plasorba BR-350 anion exchange resin. In one procedure, about two volumes of circulating plasma were treated.

Results. Initial increase in the level of pro-inflammatory TNF-α, IL-1β, IL-6 cytokines as well as anti-inflammatory IL-10 cytokine was established.

Following SPS, TNF-α level signifcantly decreased by 42.4% (p < 0.05). The decrease in IL-1β and IL-6 was 38.9% and 34.0%, respectively. The level of IL-10 signifcantly decreased by 30.7% (p < 0.05). A signifcant decrease in the levels of total bilirubin by 39.8 ± 3.8%, conjugated bilirubin (by 38.2%), unconjugated bilirubin (by 32.5%), ALT (by 23.5%), AST (by 37%), and bile acids (by 31.4%) was revealed by the end of the procedure. There were no hemorrhagic complications associated with SPS.

Conclusions. Selective plasmosorption in complex treatment of patients with mechanical jaundice with hepatic insufciency in perioperative period reduces endotoxicosis level not only due to correction of biochemical markers of liver failure but also due to reduction of proinflammatory and anti-inflammatory cytokines.

Introduction. Nosocomial meningitis (NM) is one of the leading complications in neurosurgery due to high mortality and disability rates.

Objective. The study was aimed to determine the reference values of laboratory parameters to diagnose NM in neurosurgical patients in the intensive care unit (ICU).

Results. The incidence of NM in neurosurgical patients in ICU was 8.4 (95% CI 6.8–10. 0) per 100 patients. The dominant microbial agents of NM were coagulase-negative staphylococci, A. baumannii, and K. pneumoniae. We revealed the increase in leukocytosis, C-reactive protein, and blood procalcitonin in patients with infectious complications of other systems, regardless of NM presence. Episodes of hyponatremia and an increase in body temperature ≥ 38.0 occurred signifcantly more often in patients with NM. Changes in cerebrospinal fluid (CSF) cytosis, glucose, lactate, and the CSF/blood glucose ratio can serve as reliable criteria in the NM diagnosis.

Conclusions. The diagnosis of NM is most likely when the increase in CSF cytosis > 65 cells/μL, CSF lactate > 4.2 mmol/L is observed, the decrease in the CSF glucose < 2.6 mmol, and CSF/blood glucose ratio < 0.45 is found.

Oxygen therapy is a common method of respiratory support, but its use involves the risk of carbon dioxide recycling and the development of hypercapnia in the patient.
The aim of the study. Assess the carbon dioxide tension in the oxygen tent depending on the patient's body position in the experimental newborn Model.
Materials and Methods. The study was performed on the phantom of the newborn. Influence of 3 patient positions at fresh mixture feed rate 2.5, 5, 7 and 10 l/min is evaluated. Monitoring of the carbon dioxide tension was carried out using Testo 480, measurements were carried out for 60 minutes.
Results of the study. A clear relationship was established between the position of the newborn's body and the tension of carbon dioxide in the oxygen tent. The minimum tension of carbon dioxide is noted in the patient's position ≪on the back≪ at a fresh mixture feed rate of 7.5 l/minute and is 527 ± 64 ppm, and the maximum ‒ in the child's position ≪on the stomach≪ at the same oxygen-air mixture feed rate: 1180 ± 63 ppm.
Conclusion. The position of the newborn baby's body is the main factor affecting the carbon dioxide stress in the oxygen tent.

Hyperglycemia in premature newborns is an independent risk factor for death, so blood glucose testing is widely used in the practice of neonatal intensive care units.

Objective: to evaluate the associations of the frequency of carriage of allelic variants of polymorphic loci of genes predisposing to type 2 diabetes mellitus in newborns with extremely low body weight and hyperglycemia.

Methods. The study design is prospective, controlled, single – center, non-randomized. Genomic DNA samples were studied in newborn infants with extremely low body weight (ELBW) (n = 105). Previously, we compared the distribution of allele frequencies of the studied genes between a group of newborns with ELBW and a population sample of adults (control). Then, the distribution of allele frequencies of the genes was compared depending on the presence of hyperglycemia in newborns with ELBW. For the analysis, loci with already known association with the development of type 2 diabetes mellitus were selected ‒ ADRB2 (rs1042713) and (rs1042714), ADRB3 (rs4994), GNB3 (rs5443), PPARA (rs4253778), PPARD (rs2016520), TCF7L2_IVS3 (rs7903146) and TCF7L2_IVS4 (rs12255372), PPARGC1A (rs8192678), MTHFR (rs1801131), PPARG (rs1801282), MTNR1B (rs10830963), SIRT1 (rs7069102).

Results. In newborns with ELBW, we found a more frequent occurrence of the mutant allele A of the polymorphic locus rs8192678 in the PPARGC1A gene and the allele C of the polymorphic locus rs4253778 in the PPARA gene, in contrast to the adult population sample. But in newborns with ELBW, hyperglycemia is most likely associated with the carrier of the allele C rs1801282 of the PPARG gene (χ2 = 18.972, p < 0.001) and the allele T rs7903146 in the TCF7L2 gene (χ2 = 11.496, p < 0.001).

Conclusions. The carriage of the allele С rs1801282 of the PPARG gene is characterized by the presence of a strong conjugation with hyperglycemia in newborns with extremely low body weight. It is desirable to monitor the level of glycemia in the conditions of neonatal intensive care units, taking into account the carriage of genes predisposing to hyperglycemia.

Medical vocabulary is a part of the Russian language used by the professional community. Most of the terms are borrowed from other languages and poorly understood by most native speakers. The development of medicine, in particular, anesthesiology and resuscitation, leads to the emergence of many new conditions, symptoms, syndromes and their defnitions. The latter often cause controversy among doctors. The article is devoted to some aspects of the appearance of controversial terms in anesthesiology and resuscitation to discuss them.

The article is devoted to the consideration of a clinical case of providing artifcial one-lung ventilation for performing thoracoscopic plastic of the right dome of the diaphragm in a patient with grade 3 posttracheostomy cicatricial tracheal stenosis. The patient is presented after a new coronavirus infection COVID-19 from 2020, prolonged mechanical ventilation through a tracheostomy tube (74 days), the development of medium thoracic cicatricial tracheal stenosis of grade 3 (the lumen of the narrowest part of the trachea is 4 mm) after decannulation and the development of relaxation of the right dome of the diaphragm (according to CT data, the dome is located at the level of the IV intercostal space). The frst stage under conditions of combined general anesthesia and high-frequency ventilation of the lungs was performed to restore the lumen of the trachea by bougienage of the stenosis area with tubes of a rigid endoscope under the control of a fberoptic bronchoscope with further nasotracheal intubation with a thermoplastic single-lumen endotracheal tube with a diameter of 8.0 with a cuff. At the second stage, during thoracoscopic plastic of the right dome of the diaphragm, to provide artifcial one-lung ventilation, a bronchial blocker was used, introduced through the same endotracheal tube into the right main bronchus under the control of a fberoptic bronchoscope.

Fetal surgery is a rapidly growing feld of medicine. Anesthetic provision of fetal operations is developing together with progressing surgical techniques. The fundamentals of the physiology of a pregnant woman and a fetus are considered. The features of transplacental drug transfer are described. The mechanisms of uteroplacental and fetoplacental interactions have been analyzed. The contemporary data are presented that allow judging about the method of choice and approach to anesthesia in open fetal surgery. Reviewed scientifc information, including reviews of recent years and randomized trials The perspective of an anesthesiologist is shown, involved in open fetal surgery, including perioperative and intraoperative management of two high-risk patients, i.e. a pregnant woman and fetus undergoing surgical intervention at the same time. Postoperative management of patient data. The impossibility of carrying out such operations without the well-coordinated work of a large multidisciplinary team of specialists is noted.

Sepsis is a life-threatening condition, which is manifested by the development of organ dysfunction due to generalized inflammation caused by the infection of various nature. Timely lesion debridement combined with adequate antibiotic therapy are important components of the successful treatment of sepsis. At the moment, there is no consensus about the volume and time of intervention in the development of surgical sepsis. The article discusses modern approaches to solving the problem of adequate sanitation of the source of infection. The results of few randomized trials in this area are presented.

Source control is absolutely essential for the successful treatment of sepsis. However, it is difcult to create a unifed algorithm for surgical control for all cases due to different approaches depending on the infection location. Properly designed clinical trials are necessary to determine the optimal timing of surgery for sepsis and septic shock as least.