The objective: to evaluate the prognostic value of Nomogram M for major adverse cardiac events (MACE) and major adverse cardiac and cerebral events (MACCE) after elective cardiac surgery with cardiopulmonary bypass.
Subjects and Methods. This is a retrospective cohort study of the Nomogram M prognostic value for MACE and MACCE after elective cardiac surgery with cardiopulmonary bypass. 158 patients were enrolled in the study. The prognostic value was estimated using ROC-analysis.
Results. The frequency of MACE and MACCE during hospitalization made 5.7% (9 of 158 patients) and 6.3% (10 of 158 patients), respectively. AUC Nomogram M for MACE was 0.888 [0.825; 0.950] (p < 0.001). Cut-off value made 12.5 points (sensitivity – 88.89%, specificity – 83.89%). Odd ratio was 41.67 [95% CI 4.98; 348.61] (p < 0.001).
AUC Nomogram M for MACCE was 0.893 [0.834; 0.951] (p < 0.001). Cut-off value made 12.5 points (sensitivity – 90.00%, specificity – 84.46%). Odd ratio was 48.91 [95% CI 5.91; 404.78] (p < 0.001)
Conclusion. Nomogram M has a good prognostic value for the occurrence of MACE and MACCE after elective cardiac surgery with cardiopulmonary bypass. For MACE sensitivity made 88.89%, and specificity – 83.89%. For MACCE sensitivity was 90.00%, specificity – 84.46%.

The objective: to study the prognostic significance of the ratio of the absolute number of neutrophils to lymphocytes (NLR) and platelets to lymphocytes (PLR) in assessing the risk of cardiovascular complications in non-cardiac surgical interventions.
Subjects and Methods. 85 patients aged 66 [61‒70] years who underwent elective vascular surgery were examined.
Results. Concomitant circulatory diseases were diagnosed in 98.8%. PLR < 91.2 with the sensitivity of 60% and the specificity of 67.8% was associated with diabetes mellitus (AUC – 0.686; 95% CI 0.576‒0.783, p = 0.0022). Cardiovascular complications were registered in 9.3% of patients. NLR was an independent predictor of cardiovascular complications: OR – 5.216; 95% CI 1.246‒21.826, p = 0.005. NLR > 2.1 discriminated cardiovascular complications with the sensitivity of 75% and specificity of 75% (AUC – 0.827; 95% CI 0.690–0.921; p = 0.004). PLR was also a predictor of cardiovascular complications: OR – 1.0111; 95% CI 1.0001–1.0223; p = 0.027. PLR > 105.5 allowed identifying patients with NT-proBNP > 650 pg/ml with the sensitivity of 75.0% and the specificity of 61.8% (AUC – 0.740; 95% CI 0.630‒0.832; p = 0.0308).
Conclusion. NLR and PLR can be used to identify patients with increased cardiac risk when undergoing vascular surgery. Further research in this field is advisable.

The objective: evaluation of the effect of budesonide and low-volume mechanical ventilation (LVMV) on pulmonary volemia, oxygen transport and respiratory biomechanics in patients with concurrent ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) during coronary artery bypass grafting (CABG) with artificial circulation (AC).
Subjects and Methods. 50 patients with concurrent IHD and COPD were enrolled in the study. During AC, patients of Group I (20 people) received mechanical ventilation with the peak inspiratory pressure of 15 mbar, tidal volume of 3‒4 ml/kg, positive end-expiratory pressure of 5 mbar in combination with inhalation of nebulized budesonide. In Group II (30 people), the similar isolated respiratory support was provided. Pulmonary blood volume, indices of extravascular lung water (EVLW), pulmonary vascular permeability (PVPI), oxygen delivery (DO2I) and consumption (VO2I), oxygen extraction ratio (O2ER), pulmonary shunt fraction (Qs/Qt), oxygenation index were determined. The study consisted of 3 stages: before AC, after its completion and one day after CABG.
Results. Before CABG, the EVLW index in all patients exceeded the standard level by 67‒72%. After weaning from AC, it decreased by 23% in Group I and by 8% in Group II. In patients receiving budesonide, PVPI significantly decreased after artificial circulation, while in patients from Group II, it remained unchanged. DO2I and O2ER in all patients were within the reference range, and VO2I was below it with a minimum value in Group II after weaning from AC. In this cohort, the Qs/Qt level was significantly higher, while OI was lower versus patients from Group I. Among patients who received budesonide immediately after AC and 2 hours after it, pulmonary resistance decreased while lung compliance increased. In Group II, those parameters changed oppositely. In Group I, one case of hydrothorax was recorded, and in Group II, 2 patients were diagnosed with polysegmental pneumonia and 2 patients – with pneumothorax. The median duration of mechanical ventilation in the postoperative period made 220 minutes in Group I, and 290 minutes in Group II (p = 0.018).
Conclusion. In patients with concurrent IHD and COPD, use of the combination of low-volume mechanical ventilation and inhalation of nebulized budesonide during AC stabilizes the volemic status of the lungs, improves the oxygenating function and respiratory biomechanics in the postperfusion and early postoperative periods of CABG.

The objective: to conduct a comparative assessment of the severity of intraoperative bleeding with different methods of airway management (using a laryngeal mask and endotracheal tube) during endoscopic rhinosinussurgical procedures.
Subjects and Methods. A prospective randomized cohort single-center study of 160 cases of endoscopic rhinosinussurgical procedures under general anesthesia was conducted.
Tracheal intubation (TI) was used in 79 cases (Group 1), a laryngeal mask (LM) – in 81 (Group 2). The evaluation criteria in the groups included the bleeding intensity (BI) by 6-point scale of average categories (Fromme-Boezaart Score), indicators characterizing the state of blood circulation during surgery: HR, BPsys., BPdiast., MAP, and perfusion index.
Results. Significantly lower BI values were observed in Group 2 at all time points of the study (at the 10th, 30th and 60th minute of surgery). This was due both to using a laryngeal mask, and to lower HR, BPsys., BPdiast, and MAP.
Conclusion. The use of a laryngeal mask for airway management during general anesthesia in endoscopic rhinosinussurgical procedures helps to reduce the intensity of surgical field bleeding.

The objective. Analysis of the course of the postoperative period and number of complications in patients with ovarian cancer during cytoreductive operations with hyperthermic intraoperative intra-abdominal chemotherapy.
Subjects and Methods. We assessed the number of bed-days, the volume of infusion-transfusion therapy, diuresis, the volume of enteral feeding, the level of leukocytes, urea, creatinine, and lipocalin associated with gel in 45 patients with ovarian cancer after cytoreductive surgery with hyperthermic intraoperative intra-abdominal chemotherapy.
Results. All patients developed polyuria while reference parameters of urea and creatinine were stable. Due to these changes, additional markers of acute renal damage were searched for. 15.9% of cases developed leukopenia on days 7–10. The number of complications and deaths does not exceed the world level.
Conclusion. A multicomponent and versatile approach to the postoperative management of patients allows minimizing the level of complications and deaths. A search for a more sensitive marker of acute kidney injury is needed.

The objective: development of a method for determining the individual risk of post-ERCP pancreatitis (PEP) before endoscopic intervention.
Subjects and Methods. A prospective observational study of the results of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) was performed in 1,210 patients. The primary end point was the development of PEP. Multiple regression logistic analysis was used to determine the risk of developing PEP.
Results. A model of independent variables was determined, which significantly (p = 0.0001) affected the risk of developing PEP. Based on the results of the logistic analysis, regression coefficients were calculated for all significant patient-dependent factors (gender, age, preoperative level of amylasemia and bilirubinemia, and nature of the underlying disease). The risk of PEP decreased in men (by 47.5%), with an increase in the age of patients (for 1 year by 2.3%) and bilirubin (with an increase of 1 μmol/l by 0.3%) but increased with an increase in amylase activity blood serum (by 0.7% for each 1 U/l). A formula has been developed to assess the individual risk of PEP at the stage of preparing a patient for therapeutic ERCP.
Conclusion. Analysis of patient-dependent factors makes it possible to reliably determine the risk of developing PEP. It was determined that a female gender, young age (under 40 years old), sphincter of Oddi dysfunction increased the risk of PEP, while a male sex, stenting of the main pancreatic duct, and jaundice reduced this risk. The use of the proposed formula will help predict a significant (p = 0.0001) degree of risk of PEP before performing primary therapeutic ERCP in a particular patient.

Clarification of etiology and identification of infectious agents in critically ill newborns is a very urgent problem of neonatal resuscitation.
The objective. To study the characteristics of microbiota in critically ill newborns at admission to the intensive care unit (ICU) of a specialized hospital.
Subjects and Methods. 165 critically ill newborns were examined, and bacteriological tests of blood, feces, and saliva were performed.
Results. Positive culture results were obtained in 40 (24%) patients. The most frequent causative agent was S. epidermidis (47.5%). The detection rate of E. faecalis amounted to 15%, S. haemolyticus ‒ 15%, C. albicans – 12.5%, and K. pneumoniae ‒ 10%. Microorganisms were isolated from feces in 70% of cases, from the oral cavity in 62.5%, and from blood in 12.5%. E. faecalis was equally frequent at all three sites (5%).
Conclusion. In 76% of patients, no neonatal infectious agent was isolated at admission to ICU of a specialized hospital that is most likely associated with the early administration of antibacterial drugs in the first hours of life of the newborn.

The epidural anesthesia has found widespread application in abdominal surgical interventions. But the relevance of its use is the subject to some doubt and discussion in connection with developing surgical technologies and reduction of the degree of surgical aggression, and introduction of new approaches to the management of patients in the perioperative period. Often the risks of epidural anesthesia exceed expected benefits. This is a limiting factor for its use. Today, there is no uniform approach to the way epidural analgesia is administered in the intraoperative period. However, there is a correlation between the frequency of adverse events related to epidural block and the route of administration (speed of administration, volume, and concentration).
Therefore, selecting the optimal method of epidural analgesia within the framework of combined anesthesia can minimize the risks and maximize its positive effects in abdominal surgery.

The problem of persistent critical illness (PCI) in newborns is poorly understood. The epidemiology of this pathological condition in newborns has not been precisely established, however, it is known that PCI is considered a predictor of an unfavorable outcome in any pathology and proceeds more severely then in adults and children. Long-term outcomes of PCI in surviving newborns are associated with subsequent asthenia, cognitive impairment, chronic fatigue syndrome, a high incidence of disability, complex physiological abnormalities, and chronic organ dysfunction from which they rarely recover.
Nutritional, respiratory and hemodynamic supports are key components of neonatal PCI therapy. The physiology of a newborn is different from that of an adult patient; therefore, inotropic therapy in this category of patients requires special approaches. In the past few years, in addition to dopamine, dobutamine and adrenaline, newborns have been prescribed milrinone, norepinephrine, vasopressin, and levosimendan as hemodynamic support. The clinical potential of these drugs in neonates is still under evaluation but there is some evidence for their benefits for use in PCI.

Strains of microorganisms characterized by resistance to antimicrobial drugs used in medical organizations continue to spread In most regions of the world including Russia. It is clear that it affects both the effectiveness of antimicrobial therapy and tactics and strategy of its use not only in adults patients but also in children. The pandemic of coronavirus infection, in addition, highlighted the growing problems in treatment of invasive mycoses, the dose adjustment of antibiotics during sorption and dialysis therapy methods. These circumstances made it necessary to make adjustments to Guidelines on Diagnostics and Antimicrobial Therapy of Infections Caused by Multiresistant Strains of Microorganisms, which were prepared by a group of leading Russian experts in 2020 [1]. The submitted version of the recommendations was approved on 25.03.2022 at a joint meeting of the working group with representatives of public organizations: Association of Anesthesiologists-Intensivists, the Interregional Non-Governmental Organization Alliance of Clinical Chemotherapists and Microbiologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), and NGO Russian Sepsis Forum. These recommendations reflect an interdisciplinary consensus opinion on approaches to the diagnosis and antimicrobial therapy of infections caused by multiresistant microorganisms. They are based on data from publications obtained from randomized trials as well as based on international clinical guidelines with a high degree of evidence.
It is rational to use the Guidelines for determining the tactics of empirical and etiotropic therapy of the most severe infections.