The objective was to analyze the clinical and economic feasibility of using selective methods  of lipopolysaccharide (LPS) sorption  for sepsis treatment.

Materials and methods.  A clinical and economic model was used to assess the feasibility of using some technologies of selective lipopolysaccharide sorption. The model was developed in accordance with the current industry standard «Clinical and Economic Research» used in Russia. The target  population was patients of 18 years old and older with sepsis. The methodology involved the evaluation of available randomized clinical trials, as well as studies involving data from network meta-analyses and systematic  reviews of the use of the studied  technologies. The calculation of direct  medical and indirect non-medical  costs was made with an analysis of the impact on the budget  during  the first year and on the time horizon for five years.

Results. The value of direct  and indirect costs was determined when using sorption  devices based on Efferon LPS, Toraymyxin,  Alteco LPS Adsorber,  Toxipak  columns. It was shown that  among the therapeutic alternatives, the use of the Efferon LPS column had the least burden on the budget.

Conclusion. The  use of selective  lipopolysaccharide sorption  technologies in the  intensive  care program  for sepsis patients, although accompanied  by an increase  in direct  and indirect financial costs, leads to budget  savings in the medium  term. Improving  the mechanism  for compensating the costs of using this technology is a promising way to improve the outcomes of sepsis treatment.

The objective was to summarize the Center's experience in the treatment of sudden cardiac death and to assess the prospects of using venoarterial extracorporeal membrane oxygenation (VA ECMO) in the complex of extended cardiopulmonary resuscitation (CPR).

Materials and methods.  109 patients aged 52.6±1.5 years, delivered  to the hospital  by emergency  medical teams with a background of ongoing cardiopulmonary resuscitation.

Results. In the majority of cases (78), extended resuscitation measures were ineffective, ECMO was not used due to inadequate technology connection criteria. In 15 cases, primary stabilization without ECMO was achieved, and these patients were transferred for further treatment to intensive care unit (ICU), 8 of them died later. Extracorporeal cardiopulmonary resuscitation (ECPR) was used in 16 cases, in 6 cases, patients were decannulated after cardiac recovery; also, ECMO was used postmortem 15 times to preserve donor organs. The overall survival rate among the delivered to the Center was 7.5%. We found out the correlation between the duration of the prehospital period and survival rate (time to hospital admission in survivors was 42.7±9.6 min versus 64.31±3.13 min in the deceased). The association between pH (AUC ROC 0.728) on admission and favorable outcome was found to be more reliable than EtCO2 (0.266) and blood lactate  (0.387).

Conclusion. The creation of centers for the treatment of patients with refractory circulatory arrest seems reasonable on the basis of level 3 hospitals with the possibility  of using X-ray surgical methods  of treatment. The widespread  introduction of ECPR should be accompanied  by the change of CPR  algorithms  in the prehospital period. The effectiveness of ECPR is determined by mandatory strict  adherence  to the connection criteria, which can be revised as experience accumulates.

The objective was to evaluate  the effectiveness of the erector  spinae plane block (ESP-block) as a component of perioperative analgesia in endovideosurgical  hernioplasty of inguinal hernias.

Materials and methods. The study included 70 patients who underwent endovideosurgical plastic surgery of inguinal hernias. All patients randomly divided into the main (n=32) and control  (n=38) groups, were given general combined anesthesia. In the main group, it was supplemented with the ESP-block, which was performed with ropivacaine at the L1 level. Intraoperatively, fentanyl was used for analgesia. The indication for its introduction was an increase in the Surgical Pleth Index (SPI) of more than 50. In the early postoperative period, ketoprofen and tramadol were used for analgesia, which were administered with the development of moderate  and high intensity of the pain. The effectiveness of the ESP-block was evaluated by comparing the total doses of analgesic drugs that were required for analgesia during surgery and in the early postoperative period in patients of both groups.

Results. In the main group, the total doses of fentanyl and ketoprofen were statistically significantly lower compared to the control group (p<0.01). After surgery, tramadol was used only in patients of the control  group. In some patients of the main group who required analgesia in the early postoperative  period (n=15), the pain syndrome  developed  only 12 hours after the end of the surgery. Their intraoperative need for fentanyl  did not differ from other patients of the main group (p>0.05).

Conclusion. In endovideosurgical hernioplasty of inguinal hernias, the use of the ESP-block as part of multimodal analgesia contributes to achieving a good level of analgesia both intra- and in the early postoperative period.

The objective was to compare the efficacy and safety of morphine in neuraxial blocks during knee arthroplasty.

Materials and methods. A retrospective analysis of 60 medical histories of patients who underwent total knee arthroplasty for the period from 2017 to 2019 was performed. All patients were operated under  general anesthesia  with mechanical  ventilation in combination with epidural  or spinal analgesia with opiates. Patients of the 1^st  group (n=20) after catheterization of the epidural space at the level of L_1–2 were injected with a morphine solution 1% – 0.3 ml epidurally. Patients of the 2^nd  group (n=20) were injected with a morphine solution 1% – 0.01 ml intrathecally at the level of L_3–4. Patients of the 3^rd group (n=20) underwent standard combined anesthesia:  general anesthesia  with mechanical  ventilation and epidural  analgesia at the level of L_1–2  with a solution of 0.2% ropivacaine  in the form of an infusion of 6 ml/hour. All patients received infusion of 0.2% solution of ropivacaine  epidurally  6 ml/hour at the level of L_1–2  in the postoperative period.

The incidence of nausea, vomiting, pruritus, headache and the level of postoperative pain syndrome were assessed on a numerical rating scale 6 hours after the end of the surgery.

Results. The level of pain syndrome in patients who received intrathecal and epidural analgesia with morphine was equally low, while in patients who received epidural  analgesia with ropivacaine,  the level of pain syndrome was statistically significantly  higher, which required  the additional prescription of non-steroidal anti-inflammatory drugs and/or narcotic  analgesics parenterally. The frequency  of nausea, vomiting,  pruritus and headaches was maximum in the 2^nd  group, significantly lower in the 1^st, while in the 3^rd, pruritus did not occur.

Conclusion. The use of morphine in neuraxial block in knee arthroplasty has a positive effect on the quality of anesthesia and postoperative pain relief.

Background.  Postoperative laparoscopic  cholecystectomy period is often associated  with nausea and vomiting, which is stopped  by an antiemetics injected  intravenously. Meanwhile,  it is known  that  the  oral pregabalin  before surgery  to potentiate the  effect of opioids and nonsteroidal anti-inflammatory medications during anesthesia  also has an antiemetic effect.

The objective was to evaluate  the effect of oral pregabalin to reduce the frequency of postoperative nausea and vomiting in laparoscopic cholecystectomy  cases.

Methods and Materials. Randomized double blind study. One hundred patients of the American Society of Anesthesiology (ASA) class1 were tested and divided  into two groups. The first group did not receive any antiemetics preoperatively. The second group received 75 mg of oral pregabalin 30 minutes  before anesthesia.  We followed up patients postoperatively in the recovery room and general surgical ward for 24 hours, recorded  the incidence of nausea and vomiting, prescription of any antiemetics and developing their side effects. We assessed the risk of developing the incidence of postoperative nausea and vomiting by the use of the Koivuranta score.

Results. Statistical analysis using SPSS showed a significant  reduction of postoperative nausea and vomiting  in the second group (pregabalin) compared with the first group.

Conclusion. Preoperative 75 mg of oral pregabalin  has antiemetic effect on postoperative time. No significant  postoperative side effects were noted.

Prediction of dysphagia after posterior fossa surgery (PFS) is a cornerstone on the well-timed extubation. Premature extubation is associated with the risk of aspiration, prolonged extubation leads to post-intubation dysphagia. PFSs are complicated by neurogenic dysphagia in 29–66% of cases. The use of classical methods for diagnosing dysphagia in the early postoperative period is difficult. Screening tests are characterized by low specificity.

The objective was to develop an objective and accurate  clinical and electrophysiological model capable of predicting dysphagia.

Materials and methods.  The study included  123 patients over 16 years old with extracerebral posterior fossa tumors. Somatosensory evoked potentials (SSEPs) were recorded  before the intervention and in the early postoperative period in a state of residual sedation  in intubated patients. Patients were divided into two groups by clinical assessment: without swallowing disorders and with dysphagia.

Results. The model allows to identify 19 out of 20 patients with dysphagia and 77 out of 103 patients without dysphagia.

Conclusion. The research showed the possibility of objective prediction of neurogenic dysphagia based on an accurate  digital method.

Legal pressure on the medical worker is currently a factor in reducing  the prestige of the medical profession. An unfair assessment of the quality of medical care leads to a simplification of approaches to the implementation of legally «risk» treatment technologies and the degradation of healthcare. Significant problems are the insufficient formation of competencies among specialists involved in expert work, and gaps in the enforcement of clinical recommendations. Professional medical non-profit organizations have leverage to improve the situation. The elimination of these shortcomings will contribute to an objective and fair legal interpretation of the actions of a medical worker in medical care.

Severe poisoning with cardiotropic drugs in children,  accompanied  by pronounced rhythm disorders  and low cardiac output syndrome,  is quite rare, but sometimes they can end fatally.

The objective was to demonstrate the successful use of electrocardiostimulation in acute propafenone  poisoning in a child of three years old.

Materials and Methods. A retrospective analysis of the features of the course of severe propafenone poisoning in a three-year-old child who required pacing was carried out. Special attention was paid to the analysis of rhythm disorders  that  led to cardiac arrest  by the type of electrical  activity without a pulse, high efficiency of timely electrocardiostimulation in order to relieve bradyarrhythmia. Against the background of the therapy,  a stable recovery of the correct  sinus rhythm was achieved six hours after the connection of a temporary electrocardiostimulator.

Conclusion. The presence  of persistent bradyarrhythmia-type rhythm disorders  in acute  poisoning with antiarrhythmic drugs in children  is an indication for the emergency use of electrocardiostimulation.

A clinical case of treatment of a 64-year-old  patient with cardiac arrest is presented. In the complex of resuscitation measures, an automatic chest compression machine was used, and upon admission to the hospital, venoarterial extracorporeal membrane oxygenation was connected as the main method of maintaining effective blood circulation as soon as possible. The interaction of a multidisciplinary team was demonstrated, the features of decision-making when choosing a hemodynamic support  method, the complications that  arose and possible difficulties were described.

The article  presents  an analysis of literature data  on modern  protective regimens  for invasive respiratory support  in premature newborns  with respiratory distress  syndrome. We have considered positive and negative  aspects of the used methods  of invasive ventilation of the lungs, which are currently widely used as a method  of respiratory therapy  in obstetric hospitals  at any level, even in the category  of children  with extremely and very low birth weight. Modern  protective mechanical ventilation provides for 2 main directions for reducing ventilator-induced lung damage: a decrease in tidal volume (Vt) and the principle  of tolerable  (permissive) hypercapnia. The use of the technique of permissive hypercapnia and regimens with a target volume can reduce the likelihood of ventilator-induced lung injury in newborns. Despite the limited indications for mechanical ventilation in modern neonatology and the widespread use of non-invasive ventilation, for patients who really need mechanical ventilation, the use of volume-targeted regimens offers the best chance of reducing  ventilation complications.

We summarize the possible benefits and risks of using various anticoagulants during hemoperfusion. Clotting in the extracorporeal circuit can lead to a decrease in the effectiveness of therapy,  additional workload,  risk to the patient and economic losses. At the same time, relatively excessive anticoagulation against the background of existing hemostasis  disorders  can lead to severe hemorrhagic complications, which in turn  worsen the prognosis of patients. The article describes the causes of heparin resistance, the main techniques for overcoming it, and provides practical guidelines for anticoagulant therapy during hemoperfusion. It is well known that routine methods of monitoring hemostasis (such as platelet count, activated partial thromboplastin time) are unable to assess the balance of pro/anticoagulants. The authors have proposed a reasonable personalized approach to anticoagulant therapy  of extracorporeal blood purification depending  on the pathology  in patient and thromboelastography (TEG) data, and antithrombin III levels.

The analysis of the literature in the main search scientific systems was carried out to identify the current means of cerebroprotection. The assessment is given both to the familiar methods that  have become «traditional» for cardiac surgery (hypothermia, etc.) and pharmacological approaches that are less common in clinical practice: the use of melatonin,  ketamine.  The characteristics of some drugs that  are promising for solving this problem are also given.