The objective was to study the dynamics of NT-proBNP blood level during the perioperative period of vascular surgery and to study the association of this biomarker level at the stages of treatment with developed cardiovascular complications (CVC).

Materials and Methods. The study involved 129 patients aged 66 [61–70] years who underwent elective vascular surgery. NT-proBNP blood level was determined at stages: I – before surgery, II – 24 hours after surgery, III – before discharge from the hospital. Correlation analysis, logistic regression and ROC-analysis were used for data processing.

Results. Median NT-proBNP (pg/ml) at stage I was 54[42–215], stage II – 149[63–298] (p1–2 = 0.0001) and stage III – 78[48–288] (p1–3 = 0.037). NT-proBNP blood level at stage I correlated with the biomarker level at stages II (rho = 0.558, p < 0.0001) and III (rho = 0.689, p < 0.0001). The biomarker was associated with CVC at all stages: I – OR 1.0048, 95% CI 1.0021–1.0074, p < 0.0001, AUC 0.825; II – OR 1.0040, 95% CI 1.0020–1.0060, p < 0.0001, AUC 0.820; III – OR 1.0026, 95% CI 1.006–1.0046, p = 0.015, AUC 0.687. At stage I, NT-proBNP > 218 pg/ml was a CVC predictor (sensitivity 82%, specificity 85%), this biomarker level was registered in 30 (23.2%) patients; at stage II, NT-proBNP > 281 pg/ml was associated with CVR (sensitivity 81%, specificity 80%), at stage III NT-proBNP > 158 pg/ml was associated with CCC (sensitivity 79%, specificity 65%).

Conclusions. After vascular surgery, the median NT-proBNP value increases significantly, remaining within the reference limits, and does not de[1]crease until the patients discharge from the hospital. The perioperative NT-proBNP dynamics may differ in patients with different initial biomarker levels. In 23.2% of vascular surgical patients, the preoperative NT-proBNP blood level increased to a level of more than 218 pg/ml, indicating CVC risk (very good quality predictor model). After surgery, the level of NT-proBNP associated with CVC (very good quality model) exceeds 281 pg/ml. Prior to discharge of patients from the hospital, the association of NT-proBNP with CVC is characterized by a moderate quality model (AUC 0.687). The prognostic significance of the biomarker at this stage of surgical treatment needs further research.

The objective was to validate cardiac index (CI) and stroke volume variation (SVV) measured by pulse wave transit time (PWTT) technology  using estimated continuous cardiac output (esCCO) technique, with pulse contour analysis (PCA) after off-pump coronary artery bypass grafting  (OPCAB)

Materials and methods. The study involved 21 patients after elective OPCAB. In all patients, CI and SVV were measured with both esCCO technique  (CI_esCCO and _esSVV) and PCA (CI_PCA and SVV_PCA). The agreement between methods was analyzed using correlation analysis and Bland-Altman  analysis. In addition, the trending ability of _esCCO technique to control changes in CI during dynamic tests was investigated.

  Results. During the study, 178 pairs for CI and 174 pairs for SVV were collected. The mean bias between CI_esCCO and CI_PCA was 0.06 L·min^–1 m^–2 with limits of agreement of ± 0.92 L·min^–1 m^–2 and a percentage error of 35.3%. The concordance rate of CI_esCCO was 70%. The mean bias between  _esSVV and SVV_PCA achieved – 6.1% with limits of agreement of ± 15.5% and percentage error of 137%.

Conclusions. The coherence of CI_esCCO and _esSVV based on PWTT in comparison with PCA is not appropriate. Further development of this  monitoring algorithm may be required for more correct measurement of cardiac output and fluid responsiveness 

 The objective was to evaluate the renal vascular resistive index as a predictor of acute kidney injury in children of the first year of life in congenital  heart surgery with cardiopulmonary bypass.

 Materials and methods. A single-center retrospective study included 150 patients with congenital heart disease (CHD), whose renal vascular  resistive index (RVRI) was assessed at the stages of surgical interventions (before surgery, 6 hours after the end of cardiopulmonary bypass (CPB)  and the 1st day after surgery).  Acute kidney injury (AKI) was diagnosed according to the KDIGO criteria. To achieve comparability of the obtained groups, pseudo-randomization was  performed. After compensating for the uneven distribution of cofounders, groups of patients comparable in number were obtained (n= 52 in both groups).

 Results. The renal vascular resistive index at the stages of surgical intervention did not differ among patients with and without acute kidney injury.  The baseline of creatinine was higher in the group without AKI, however, starting from the 1st postoperative day, it prevailed in the group with  AKI. The chances of developing AKI in male patients were 74% lower.

 Conclusion. The absence of a predictive ability of the renal vascular resistive index in acute kidney injury in children aged 1 month to 1 year with  congenital heart disease operated with cardiopulmonary bypass was demonstrated.

 The objectives was to evaluate the effectiveness of diagnosing predictors of difficult airways with ultrasound.

Materials and methods. 70 patients were examined. Before the surgery, we assessed the risk of difficult intubation by the LEMON scale and ultrasound methods using the following criteria: tongue thickness, vertical distance from the highest point of the hyoid bone to the mandible, neck  soft tissue thickness, and epiglottis thickness. The diagnostic ability of the LEMON scale and ultrasound diagnosis of difficult laryngoscopy was  assessed by determining the sensitivity, specificity and cut-off point using the ROC-AUC analysis.

 Results. The analysis of the obtained data showed a higher sensitivity of ultrasound criteria for difficult airways compared with the LEMON scale.

  Conclusion. Ultrasound diagnostic methods are effective for assessing difficult laryngoscopy. Ultrasound diagnostic criteria for difficult laryngoscopy  are more sensitive compared to the LEMON scale. Diagnostic criteria for difficult laryngoscopy are: tongue thickness > 61 mm, vertical distance  from the highest point of the hyoid bone to the mandible > 12.85 mm, neck soft tissue thickness > 5.15 mm, and epiglottis thickness > 2.85 mm.

 The objective was to compare the optic nerve sheath diameter measured by CT (ODSN-CT) with the level of compression of the mesencephalic  cisterns and the midline shift in the diagnosis and prediction of intracranial hypertension (ICH) during the first 3 days after brain injury.

 Materials and methods. We examined 90 patients with TBI, the average age was 34.2 ± 13 years, GCS < 9. All patients had invasive ICP monitoring.  At the time of implantation of the ICP sensor, intracranial hypertension (ICH) was in 11 (12%) patients; later, during the first 3 days, the development of ICH was in 58 (64%) patients. All patients underwent computed tomography of the head at the time of hospitalization: mesencephalic  cisternae was compressed in 57 (63%) and midline shift was observed in 34 (38%) patients, mean value of ONSD-CT was 7.26 ± 0.9 mm, maximum  value of ONSD-CT was 7.34 ± 0.9. We used correlation analysis, logistic regression and ROC-analysis.

Results. The level of mesencephalic cisternae compression, mean and maximum value of ONSD-CT correlated with the ICP value measured at the  time of ICP sensor implantation and during the first 72 hours after brain injury (p < 0.05). Midline shift did not correlate with ICP value measured  at the time of sensor implantation and during the first 72 hours after brain injury (p > 0.05). In the diagnosis of ICP > 20 mm Hg at the time of  implantation of the sensor – the average ONSD-CT, AUC 0.902 ± 0.046 (0.812; 0.991), cut-off 7.8 mm with sensitivity and specificity of 82 and  80%, respectively. When predicting ICP > 20 mm Hg in the first 72 hours - the maximum ONSD-CT, AUC 0.815 ± 0.047 (0.724; 0.907), cut-off  7.1 mm with sensitivity and specificity of 85 and 66%, respectively.

Conclusions. The ONSD-CT parameter is an independent diagnostic and prognostic criterion of ICH in the first 3 days in patients with severe  TBI. The mean ONSD-CT can be used to diagnose ICH along with such signs of ICP as level of mesencephalic cisterna compression and midline  shift and to make a decision on invasive ICP monitoring. The maximum value of ONSD-CT can be used to assess the probability of ICH in the  first three days after TBI

 The objective was to assess the effectiveness and safety of the use of a fixed combination of Diclofenac and Orphenadrine (Neodolpasse) for analgesia  in patients who underwent knee replacement.

Materials and methods. 40 patients who underwent knee replacement in conditions of combined spinal-conduction analgesia (femoral nerve  block) were included into the study. In the main group(n = 20), Neodolpasse (a combination of Diclofenac 75mg and of Orphenadrine 30 mg in  250 ml of solution) was administered intravenously 30 minutes before surgery, and then in the postoperative period 2 times a day for 2 days. In the  comparison group (n = 20), Ketoprofen (intravenously,100 mg) was used instead of Neodolpasse 30 minutes before surgery, in the postoperative  period, it was continued 2 times a day for 2 days (intravenously, 100 mg). The severity of the pain was assessed with a visual analog scale (VAS) 6,  12, 24 and 48 hours after surgery. The assessment of the restoration of the supporting function of the operated leg and the ability of the patient to  perform active movements in the knee joint was carried out after 24 and 48 hours. The possible side effects was assessed throughout the entire period.

Results. The median value of VAS after 24 hours in the main group was 2.5 (2;3) points, which was significantly lower in compassion to VAS of the  control group 4(3;5) p = 0.006. A more pronounced analgesic effect while using Diclofenac and Orphenadrine persisted for 48 hours, the median  value of VAS in the main group after surgery was 2 (2;3), in the control group – 3 (2.8;4) p = 0.021. There were no significant differences in the  recovery time of restoration of the supporting ability of the operated leg and knee joint function, in the frequency of Tramadol use in the compared  groups. Side effects and complications were not identified.  

Conclusion. The use of the fixed dose of Neodolpasse as part of multimodal perioperative analgesia in patients, who underwent knee replacement,  contributed to a decrease in the severity of pain syndrome in the postoperative period.

A clinical case of simultaneous surgery in the volume of transplantation of the left lateral sector of the liver and kidney retransplantation from one  living related donor to a 10-year-old girl with cirrhosis of the liver and after transplantectomy of the donor kidney is presented. The child born in  2013 was transferred to program hemodialysis in 2015 as a result of the development of end-stage chronic kidney disease (CKD) in the outcome of  congenital kidney dysplasia. In October 2022, renal replacement therapy was started as a result of a relapse of end-stage CKD. In January 2023, she  suffered purulent cystitis. 02.24.2023 – transplantectomy. 05.05.2023, simultaneous transplantation of the left lateral sector of the liver and kidney  allotransplantation from a living related donor were performed. Anesthesiologists faced a serious problem in the form of the selection of adequate  infusion therapy, taking into account the combination of two surgical interventions that radically differ in the tactics of anesthesiological support,  as well as the correction of water – electrolyte disorders in the complete absence of diuresis throughout the fifteen-hour surgical intervention

The objective wasto evaluate the efficiency of the highly realistic simulator “Test Chest” in training residents in the specialty “Anesthesiology and Resus-citation” in the alveolar recruitment maneuver and the de-escalation option for setting positive end-expiratory pressure in ARDS during a practical session.

Materials and methods. The study included 28 residents of the first year of study in the specialty «Anesthesiology and Resuscitation», who  were divided into two groups. The 1st group – residents who were given theoretical classes before the study: lectures and a seminar on the topic:  «Respiratory support in ARDS» and the 2nd group (simulation) – in addition to the lectures, the trainees had preliminary practical classes in the  simulation center with a demonstration of the method of selecting ALV parameters in ARDS and independent performance of the alveolar recruit[1]ment maneuver, setting the positive pressure at the end of exhalation. In the simulation center, students were offered a situational task, the solution  of which involved determining the clinical picture and selecting the necessary ALV parameters. The evaluation was carried out by two teachers  independently using a checklist modified for objective student evaluation.

Results. In the 1st group, 4 (28%) trainees coped with the task, in the 2nd group, in 13 cases (95%), the task was successfully completed. In the course  of the study, the trainees of both groups revealed difficulties in selecting ALV parameters in ARDS, which required a more detailed consideration  of these issues, both in theoretical and practical classes.

 Conclusion. The use of the highly realistic simulator “Test Chest” in the selection of ALV parameters in ARDS during a practical session makes it  possible to increase the effectiveness of training in the alveolar recruitment maneuver and the de-escalation option for setting positive end-expiratory  pressure in ARDS for residents in the specialty “Anesthesiology and resuscitation”.

 It is becoming increasingly important to prevent complications of surgical treatment, including perioperative acute kidney injury due to prolongation of life expectancy and age-related multicomorbidity.

 The objective was to review the recommendations of the expert groups and the studу results on risk factors, criteria and biomarkers of perioperative acute kidney injury.

Materials and methods. Reports on search results for the last 15 years as of May 15, 2023 in the eLibrary, PubMed databases for the keywords «acute  kidney injury», «biomarker», «perioperative period». The inclusion of reports in the review and their evaluation are based on the authors consensus.  

Results. In the perioperative period, acute kidney injury without a decrease in diuresis and/or an increase in serum creatinine levels up to a certain time  may occur. This condition, which varies in causes and mechanisms of development, is potentially reversible with timely detection and treatment. The  study of both biomarkers that surpass creatinine and diuresis in the timing and accuracy of detecting kidney damage/dysfunction, as well as tools for  a comprehensive assessment and risk stratification of perioperative acute kidney injury, have not yet been completed with evidence-based conclusions.  

Conclusion. The strategy of using laboratory biomarkers in combination with the clinical context and risk factors for the prevention, diagnosis and  treatment of subclinical acute kidney injury of various origins, supported by the Acute Disease Quality Initiative (2020), could be implemented  based on additional evidence from future clinical studies.

Neuromuscular disorders are extremely common in critically ill patients; they significantly affect the recovery time and limit the quality of subsequent  life. Until now, it is difficult to assess the presence of such disorders in intensive care units. The presented literature analysis of the current state of  the issues of epidemiology, pathogenesis and pathophysiology of critical illness polyneuromyopathy (CIPNM) determines the current directions  in the diagnosis and treatment of this pathology

Relevance. The severe brain damage in most cases leads the patient to a long-term chronic critical condition (CCS). Regardless of the underlying  disease that led to CCS, patients will have a certain imbalance of neurohumoral regulation and characteristic cognitive, muscle-reflex disorders.  This cohort of patients is characterized not only by a cascade of typical pathological processes in the brain, but also by the consistent involvement of  the cardiovascular system, respiratory organs, digestive organs, water metabolism, hormonal regulation, immunity, the addition of infectious-septic  complications closes the circle of pathological processes, which often leads to death.

 Materials and methods. The search for domestic publications was carried out in the database on the RSCI website, foreign – in the PubMed, Google  Scholar databases in the period 2000–2023. When analyzing the PubMed database, the query «sepsis neuroinflammation» found 5272 links. We  also studied works on the following keywords: «neurotransmitters and sepsis». Publications describing the clinical picture, diagnosis, and sepsis  were analyzed. A total of 40 articles were analyzed

 Such systems as immune, nervous and endocrine are interconnected due to regulatory peptides. Stable functioning of the central nervous system  (CNS), or rather adequate secretion of neuropeptides are necessary for a normal immune response. Neuronal anti-inflammatory regulation of tissue  macrophages is characterized by a local, rapid response to the pathogen through neuromediators.

Confirmation of the neuropeptide theory of immunity regulation is the verification of neuropeptide receptors on peripheral blood lymphocytes and  monocytes. These results indicate a possible mechanism of a «vicious» circle that occurs in infectious-septic complications and leads to damage to  vital organs.

To date, there are no widely available means for accurate monitoring of brain function at the patient’s bedside. There is no evidence or recommendations  to support monitoring of cerebral perfusion or function in sepsis patients. At the same time, modern research on the phenotyping of patients taking  into account brain dysfunction (sepsis associated encephalopathy) is based on the basic postulates of the pathophysiology and biochemistry of  sepsis, but does not offer any methods of instrumental diagnosis of this condition, except for the use of validated delirium, coma scales (Glasgow  coma scale, FOUR, CAM-ICU, etc.).

 Despite the described pathogenesis, there is currently no single definition of cardiac cardiomyopathy. However, most authors describe the fundamental  features of this pathology: acute reversible one- or two-ventricular systolic or diastolic dysfunction with reduced contractility, not due to coronary  heart disease. Primary cellular myocardial dysfunction in sepsis can manifest in several ways, including impaired function of the left and/or right  ventricles during systole or diastole, as well as with insufficient cardiac output (CO) and oxygen delivery. To explain the changes in myocardial  contractility associated with sepsis, several mechanisms have been proposed taking into account the host response. Since most of the parameters  of the echo signal depend on the conditions of the volemic status, the evaluation of the echo signal should be repeated at several time points and  supplemented with the definition of cardiac biomarkers.

 Conclusion. Analyzing the literature data on sepsis-associated encephalopathy and septic cardiomyopathy, it is possible to judge the interconnectedness  of these events indirectly through damage to neurons during infectious-septic complications. Especially neuro-humoral mechanisms of regulation of  the response to an infectious agent should be evaluated in patients with CCS, not only relying on laboratory diagnostics, but also using instrumental  methods of visualization of brain, heart, and kidney damage. Such methods include magnetic resonance imaging (MRI), electroencephalogram  (EEG), cerebral oximetry (CMRO2), echocardiography, ultrasound examination of the kidneys, etc