The objective was to perform a comparative analysis of the information content of potential predictors of cardiovascular complications of various types in patients operated on for vascular diseases.
   Materials and Methods. We examined 129 patients aged 66 [61–70] years who underwent elective vascular surgery. We analyzed comorbidity, general clinical indicators, special cardiac risk indices and biomarkers: N-terminal segment of B-type natriuretic peptide prohormone (NT-proBNP) and cardiospecific troponin I. We used logistic regression and ROC analysis.
   Results. 21 (16.3 %) perioperative cardiovascular complications were registered in 17 (13.2 %) patients. In one-factor regression, the predictors of cardiovascular complications were coronary heart disease (OR 4.5904; 95 % CI 1.3119–5.9340; p = 0.0171), combination of coronary heart disease and chronic heart failure (OR 2.9419; 95 % CI 1.0140–8.5350; p = 0.047), ASA class > 3 (OR 2.9402; 95 % CI 1.0304–8.3899; p = 0.0438), high cardiac risk surgery (OR 3.4741; 95 % CI 1.1162-10.8126; p = 0.0316), Lee cardiac risk index (OR 2.2353; 95 % CI 1.2842–3.8911; p = 0.0045), the American College of Surgeons cardiac risk index for assessing the risk of perioperative myocardial infarction or cardiac arrest (OR 1.5312; 95 % CI 1.0927–2.1456; p = 0.0133) and the preoperative level of the N-terminal prohormone B-type natriuretic peptide (NT-proBNP) (OR 1.0048; 95 % CI 1.0021–1.0074; p = 0.0004). In multivariate regression, the predictors of cardiovascular complications were high-risk cardiac surgery (OR 5.7439; 95 % CI 1.1027–29.9181; p = 0.0379) and NT-proBNP (OR 1.0044; 95 % CI 1.0015–1.0073; p = 0.0033). The biomarker level > 218 pg/ml discriminated against cardiovascular complications with sensitivity of 82.4 % and specificity of 85.3 % (AUC 0.825; 95 % CI 0.747–0.887; p < 0.0001).
   Conclusion. In vascular interventions, the most significant predictors of cardiovascular complications are high-risk cardiac surgery and the preoperative level of NT-proBNP > 218 pg/ml with a sensitivity and specificity level exceeding 80 %.

   The objective of the study was to evaluate the effectiveness of prolonged ESP-block in comparison with prolonged thoracic epidural anesthesia in MIDCAB surgery.
   Materials and methods. We conducted a prospective randomised two centre study with 45 patients who underwent MIDCAB surgery. In addition to general anesthesia, prolonged ESP-block was performed in group 1 (n = 22), and prolonged epidural anesthesia was performed in group 2 (n = 23).
   Results. The decrease in blood pressure caused by the development of the regional block at all stages of anesthesia was more pronounced when using epidural anesthesia. In group 2, the dosage of norepinephrine was higher: 0.06 (0.05; 0.0725) mcg/kg–1/min–1 in group 1 and 0.16 (0.16; 0.16) mcg/kg/min in group 2, p < 0.001. The duration of prolonged mechanical ventilation in group 1 was lower and amounted to 102.5 (90; 110) minutes versus 110 (110; 115) minutes in group 2. The duration of surgery did not differ between the groups, the fentanyl consumption for anesthesia was higher in group 1: 0.7 (0.6; 0.8) mg versus 0.6 (0.5; 0.1) mg in group 2 (p < 0.001). Postoperatively, pain was rated as mild to moderate in both groups, with less pain in the group with epidural analgesia at stages 4 to 32 hours at rest and on coughing. After 48 hours, there were no statistical differences between the groups. The score of pain during coughing in both groups did not exceed 3 points, and patients did not need emergency analgesia.
   Conclusion. In MIDCAB operations, the prolonged ESP-block is an effective method of regional anesthesia. While providing a sufficiently high level of analgesia, the use of the ESP-block during surgery only slightly increases the fentanyl usage. In the postoperative period, when using the ESP-block, extubation occurs earlier, and analgesia is almost as good as epidural blockade.

   The objective was to assess the predictive value of the risk scale for difficult intubation in obese patients.
   Materials and methods. The object of the study was 110 patients (90 women and 20 men) operated on as planned in 2022. The mean age of the patients was 42 ± 11 years. The median body mass index (BMI) was 43.7 kg/m 2 (Q1–Q3: 37.9–49.1). All patients underwent a standard preoperative examination with the identification of the risk of difficult airways according to the intubation difficulty scale (IDS): mouth opening, neck mobility, mandibular protrusion, Mallampati class, sternomental and thyromental distances, and history of previous intubations were assessed.
   Results. Difficult intubation (3–4 degrees according to Cormack–Lehane) were detected in 19 patients (17.3 %). ROC-analysis revealed the dependence of the probability of difficult intubation on the total points on the intubation difficulty scale. The area under the ROC curve was 0.809 ± 0.063 with 95 % CI: 0.685 – 0.932. The model was statistically significant (p < 0.001). The cut-off point value for the total points on the intubation difficulty scale, which corresponded to the highest value of the Youden index, was 4. The sensitivity and specificity of the model were 100.0 % and 47.3 %, respectively. Significant differences (p < 0.001) were found in the analysis of the risk of difficult intubation depending on the total points on the intubation difficulty scale. The most significant differences (p < 0.001) were demonstrated by the mouth opening width and neck mobility. There were no differences (p = 0.547) when analyzing the history of difficult airways and nighttime snoring.
   Conclusion. Overall, the intubation difficulty scale showed predictive value in terms of assessing the risk of difficult airways (p = 0.002, χ² = 13.230). The most reliable indicators for predicting the risks of difficult intubation were mouth opening less than 4 cm (p < 0.001, χ² = 11.185) and head and neck flexion in the atlanto-occipital joint less than 90^о (p < 0.001, χ² = 10.858). Assessment of thyromental and sternomental distances, mandibular protrusion ability, and Mallampati class also showed statistical significance. Prior history of difficult intubation and nighttime snoring showed no statistically significant risk in predicting difficult airways (p = 0.547, χ² = 0.363).

   The objective was to study the effect of continuous renal replacement therapy (CRRT) in the acute period of traumatic brain injury (TBI) on intracranial pressure (ICP).
   Materials and methods. An analysis of the dynamics of ICP during CRRT in patients with severe TBI was performed. The division of procedures into three groups, depending on the variant of ICP change, allowed to perform a comparative analysis of a number of factors that were potential predictors of aggravation of intracranial hypertension.

   Results. During CRRT, ICP decreased in 39 % of cases (Group 1) and increased in 29 % of cases (Group 2). In 32 % of cases (Group 3), ICP did not change significantly during the procedure. The initial sodium level and the degree of sodium decrease during the first 6 hours of the procedure
differed between the groups, which turned out to be significantly higher in the group 2. An inverse correlation was found between the change in sodium level during the first 6 hours of the procedure and the change in ICP.
   Conclusions. CRRT in the acute period of severe TBI can be associated with both a decrease and increase of ICP. The main risk factor for worsening intracranial hypertension during CRRT is hypernatremia.

   Background. Assessing the probability of an adverse outcome of severe infections and sepsis in children in order to timely correct treatment is one of the most acute problems of resuscitation and intensive care.

   The ojective was to identify predictors of the adverse outcome of severe infections and sepsis in children upon admission to ICU.
   Materials and methods. Design – a retrospective cohort multicenter uncontrolled study. 180 children with a severe course of infectious diseases and sepsis were examined. The mean age of the patients was 1.3 (0.5–4.1) years, boys were 94 (52.2 %) patients and girls were 86 (47.7 %) patients. Signs of shock at admission were detected in 100 (55.6 %) children. The PEMOD score on the first day of treatment in ICU was 5.0 (40–8.0) points. The duration of treatment in ICU was 8.6 (1–83) days. Depending on the outcome of the disease, all patients were divided into two groups: group
I – «recovery», group II – «death».
   Results. Significant differences depending on the outcome of the disease were characteristic of clinical and laboratory signs such as mean blood
pressure, base deficiency, PEMOD score, concentration of total protein, albumin and lactate in the blood. Mean blood pressure below 60 mmHg., base deficiency > [–8.4] mmol/L, plasma lactate greater than 3.3 mmol/L, serum albumin less than 30 g/L and PEMOD > 7 on ICU admission indicate a high probability of death. The magnitude of the base deficiency has the maximum sensitivity (87.5 %) and specificity (61.3 %) to predict outcome on ICU admission.
   Conclusion. The severity of the condition of children with a severe course of infectious diseases and sepsis upon admission to ICU is due to the phenomena of systemic hypoperfusion, hypoxia and metabolic disorders against the background of hypoalbuminemia.

   The objective – to evaluate the dynamics and prognostic value of inflammatory markers and other laboratory parameters in the blood of patients
with COVID-19 and to assess the severity of the course and mortality in this disease.
   Materials and Methods. The clinical and laboratory data of 819 patients with COVID-19 treated in a hospital were retrospectively analyzed. In 700 (85.5 %) patients, the disease occurred in a moderate form, these patients were recovered. Patients with severe course (n = 119) were treated in the intensive care unit, of which 47 (39.5 %) patients had a favorable outcome and 72 (60.5 %) patients died. All patients underwent clinical, biochemical (including IL-6) and coagulological studies at admission and in dynamics. The concentration of IL-1ß, IL-8, IL-10, tumor necrosis factor TNF-α were additionally measured in patients with severe COVID-19.
   Results. Initially, patients with severe disease, compared with moderate, had higher levels of C-reactive protein (p < 0.001), LDH (p = 0,007), D-dimers (p = 0.028), fibrinogen (p = 0.014), the number of white blood cells (p = 0.018), as well as lower levels of albumin (p < 0.001). In the group of patients with fatal outcome, higher levels of LDH (p = 0.008), creatinine (p = 0.009), urea (p < 0.001), troponin (p = 0.024), D-dimers (p = 0.002), fibrinogen (p = 0.009), the relative content of immature leukocytes (p = 0.004), neutrophil to lymphocyte ratio (p = 0.022) were found than in survivors. On the 7th day of hospitalization, an acute increase in ferritin, urea, D-dimers, LDH, interleukins was noted in the group of deceased patients. Using the observer’s operating curves method, predictors of an unfavorable outcome in COVID-19 were determined: IL-10 above 9.46 pg/ml (area under the ROC curve AUC = 0.902), urea above 6.6 mmol/L (AUC = 0.815), TNF-α above 12.6 pg/ml (AUC = 0.799), C-reactive protein above 59.6 mg/L (AUC = 0.714), LDH above 348 U/L (AUC = 0.702), neutrophil to lymphocyte ratio above 4.94 (AUC = 0.700), IL-6 above 62.2 pg/ml (AUC = 0.686), ferritin above 772 μg/L (AUC = 0.654).
   Conclusions. Baseline levels of LDH, D-dimers, and fibrinogen have a discriminatory ability to determine both the severity and the outcome of COVID-19. The severity of the inflammatory response upon admission correlates with the severity of the disease, but has no prognostic value. At the time of admission, patients with an unfavorable outcome already have initial manifestations of organ dysfunction (assessed by creatinine, urea, and troponin levels). On the 7th day of hospitalization, the relationship of values and the outcome appears in ferritin and interleukin 6. The presence of a strong correlation between the levels of interleukins IL-6, IL-8, IL-10, TNF-α makes it possible to measure any of them.

   Background. Since the beginning of COVID-19 pandemic, the importance of clinical criteria for tracheal intubation in critically ill patients with respiratory failure became more noteworthy, especially in resource limitations. The objective was to evaluate the importance of hemoglobin oxygen saturation as a criterion for tracheal intubation in patients with COVID-19.
   Materials and methods. This is a multi-center, prospective, observational cohort study. We included 117 patients with COVID-19 who needed respiratory support between March to June 2021. Patients were intubated by the protocol of each institution participating in the study and the anesthesiologist’s clinical judgement. Signs of respiratory failure, methods of respiratory support and patient outcome were recorded.
   Results. Among 117 studied cases, 100 patients had hemoglobin oxygen saturation of 60–90 % in whom 58 were intubated. During hospitalization, 56 intubated patients and 14 non-intubated patients died (96.6 % Vs. 33.3 %).
   Conclusion. Arterial blood hemoglobin oxygen saturation of 60–90 could not be the correct key to unlock the problem of intubation decision in patients with COVID-19. Therefore, hemoglobin oxygen saturation should not be solely regarded as an indication for intubation in COVID-19. 

   The objective was aimed to measure plasma midkine (MK)* levels in patients with COVID-19 and assess its clinical significance.
   Materials and Methods. 88 patients observed in our hospital with a diagnosis of COVID-19 were included in the study. The patients’ demographic characteristics, clinical, and laboratory data were studied, and the relationship between MK levels, prognosis, and other parameters was investigated.
   Results. Of the 88 patients included in the study, 43 (48.9 %) were female and 45 (51.1%) were male. 24 (27%) patients died. The mean age of non-survivors was 70 ± 12.3 years and the survivors were 61.9 ± 18.2 years. Mortality predictors such as D-dimer, ferritin, troponin, LDH, CRP, and procalcitonin were significantly higher in non-survivors than in survivors (p < 0.05). The median MK level (IR) was 152.5 ± 125 pg/ml in all patients, 143 ± 149 pg/ml in survivors, and 165.5 ± 76 pg/ml in non-survivors (p = 0.546). The difference between these two groups was not statistically significant. The area under the ROC curve was found to be 0.542 (95% CI 0.423–0.661, p = 0.546).

   Conclusion. MK is not a biomarker that can replace or reinforce known predictors of mortality in COVID-19 patients.

   The objective – to summarize the current literature data on the etiology, pathogenesis, diagnosis and treatment of malignant hyperthermia.

   The search and analysis of literature data on malignant hyperthermia in the medical information systems PubMed, Сochrane librarу, Cyberleninka for the last 10 years was performed with using the keywords: «malignant hyperthermia», «dantrolene», «general anesthesia», «succinylcholine», «inhalation anesthetics». The search criteria were met by 96 publications. In addition, references to selected articles were manually checked for applicable articles including recent reports of malignant hyperthermia, in addition to works of historical significance. It was shown that malignant hyperthermia develops in susceptible individuals during or after general anesthesia with the use of trigger agents – inhaled halogen-containing anesthetics and succinylcholine. Until recently, the problem of treatment in Russia remained unresolved, since specific therapy for this syndrome was not available. In connection with the official registration of Dantrolene in the Russian Federation, this problem no longer has a life-threatening potential. Doctors should recognize the symptoms of this disease as early as possible in order to quickly begin the pathogenetic treatment of malignant hyperthermia in order to prevent fatal complications. The material is intended for a wide audience of anesthesiologists, resuscitators and surgeons who may encounter this pathology in clinical practice.

   The literature review is devoted to the peculiarities of artificial lung ventilation (ALV) in patients with morbid obesity during laparoscopic oncosurgical interventions in the Trendelenburg position. At present, there are no consensus recommendations on the choice of the optimal ALV mode during anesthesia in this area of oncosurgery. When analyzing data obtained from other types of operations, there was no impression that there were significant advantages of any ALV modes, both with volume and pressure control. However, high values of positive end-expiratory pressure (PEEP) have the most evidence of benefit in this category of patients, and the inversion of the duration of the respiratory cycle phases without creating a high PEEP can help reduce the risk of lung damage when all other ALV techniques do not allow for adequate oxygenation.

evaluate the frequency of mistakes made without it and with its use.
   Materials and methods. The study included 32 residents of the first year of study in the specialty «Anesthesiology and Resuscitation», who had previously held theoretical lectures on the topic: «Organization of the workplace of an anesthesiologist». In the simulation center, the subjects were asked to prepare the anesthesiologist’s workplace. The trainees were divided into two groups. The1^st group – performing the task without prior acquaintance with the checklist and the 2nd group – acquaintance with the checklist. The assessment was carried out by two teachers independently of each other using a checklist modified for objective assessment of the subjects.
   Results. In the 1^st group, 8 (50 %) students coped with the task, in the 2^nd group, in 15 cases (94 %), the task was successfully completed. Checking the availability of funds for tracheal intubation was successfully completed by trainees in both groups. At the same time, points were identified: a leak test and checking the correct functioning of the anesthetic-respiratory apparatus, which the subjects could not cope with, which required more detailed consideration, both in theoretical and practical classes of these issues.
   Conclusion. The use of the checklist: «Organization of the workplace of an anesthesiologist» allows to increase the effectiveness of training of residents and reduce the number of mistakes made.

   Cardinal changes in approaches to the choice of antimicrobial therapy for severe infections have occurred in recent years. They are associated with the growth of antibiotic resistance of nosocomial pathogens and the lack of sufficiently effective «universal» schemes of empirical antibiotic therapy. Recent international and domestic recommendations focus on a «pathogen-specific» approach aimed at the treatment of infections caused by specific problematic resistant pathogens. The application of such «pathogen-specific» recommendations is not possible without the availability of appropriate quality microbiological data. The further evolution of diagnostic methods is directed creating test systems that allow detecting the main pathogens of infection and the most important antibiotic resistance genes, allowing to reduce the time from the moment of taking clinical material for microbiological examination to obtaining the result that affects the choice of antibiotic therapy regimen. The review contains practical recommendations on the choice of drugs for targeted antimicrobial therapy based on the clinical interpretation of the results obtained using the «hyperplex» panel BioFire BCID2 (Blood Culture Identification 2BCID2), taking into account the statements set out in the guidelines «Diagnosis and antimicrobial therapy for infections caused by polyresistant strains of microorganisms».