The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection parameters in patients treated with an infusion of a succinate-containing drug during the intraoperative period of vascular surgery.

Materials and methods. The study involved 120 patients with high cardiac risk (revised cardiac risk index  > 2, risk of perioperative myocardial infarction or cardiac arrest  > 1 %) who underwent elective vascular surgery. Patients were randomly divided into two groups. Patients of group 1 received intraoperative infusion of succinate-containing drug at a dose of succinate 0.35 [0.26–0.40] mg/kg/min^– 1. Group II was a control group. In the perioperative period, the occurrence of perioperative CVC, the blood level of the N-terminal segment of natriuretic B-type prohormone (NT-proBNP) and cardiospecific troponin I (cTnI) were analyzed.

Results.  Perioperative CVC was registered in 11 (18.3 %) patients of group I and in 11 (18.3 %) patients of group II (p   =  1.0). The level of NT-proBNP in patients of group I and group II was 207  [160–300] pg/ml and 229  [150.6–298.9] pg/ml (p   =   0.817) before surgery, 234.2 [155.9–356] and 277 [177.7–404] pg/ml ( p   =  0.207) after surgery and 240.5[149.3–306] and 235.5 [133–495.1] pg/ml ( p   =  0.979) before discharge from the hospital. An increased level of cTnI after surgery was recorded in 4 (6.7 %) patients of group I and in 1 (1.7 %) patient ( p   =  0.364) of group II.

Conclusion. Intraoperative infusion of succinate-containing drug does not affect the occurrence of CVC in patients with high cardiac risk during vascular surgery. The succinate-containing drug does not affect the preoperative level of NT-proBNP and cTnI.

Introduction. Valproic acid is one of the commonly prescribed basic anticonvulsants for the treatment of epileptic seizures in children with cerebral palsy. Its active metabolites can cause hematological and coagulation disorders, cause valproate-induced steatohepatitis.The objective was to assess the level of hematological, biochemical and coagulation blood parameters in the perioperative period in children with severe forms of cerebral palsy during the treatment of concomitant epilepsy with valproic acid.

Materials and methods.  A prospective cohort study included 72 patients with cerebral palsy, spastic hip dislocations, who underwent reconstructive interventions on hip joints. Depending on the presence of concomitant epilepsy, the patients were divided into two groups. Perioperative laboratory blood parameters, complication incidence, the duration of stay in the intensive care unit and hospitalization were assessed.

Results.  In patients with epilepsy, the number of platelets in the blood was lower compared to the control group. The level of alkaline phosphatase before and after surgery in 34 % of children who took anticonvulsants exceeded the maximum value of the norm. Groups differed in terms of peri -operative coagulogram and thromboelastography. The frequency of complications in patients with epilepsy ranged from 0.08 % to 16.2 %.

Conclusions.  Basic therapy with valproic acid in children with severe forms of cerebral palsy and concomitant epilepsy is associated with a tendency to hypocoagulation, but was not accompanied by clinically significant thrombocytopenia or coagulopathy during hip surgery. Taking valproic acid drugs in patients with cerebral palsy and epilepsy was not accompanied by an increase in serum liver enzymes at all stages of  observation, which minimized the likelihood of valproate-induced hepatotoxicity. Anticonvulsant therapy with valproate in children with severe forms of cerebral palsy and concomitant epilepsy did not increase the potential risk of complications in the perioperative period, did not affect the duration of stay of patients in the intensive care unit and hospitalization.

The objective was to study the risk factors, outcomes of infections caused by colistin-resistant K. pneumonia (CRKP) and to evaluate the  sensitivity of these microorganisms to antibacterial agents to determine the most adequate antibiotic therapy options.

Materials and methods. Klebsiella pneumoniae strains isolated in the ICU of an acute care hospital between October 2020 and August 2022 were included in the study. Microorganisms were identified using an automatic analyzer PHOENIX. The determination of antibiotic sensitivity was studied by the method of serial micro-dilutions in agar with the determination of MIC EUCAST criteria were used to interpret sensitivity. Detection of carbapenemases was carried out by PCR. Clinical efficacy of starter therapy was evaluated as recovery/improvement and no effect.

Results. The infection was characterized by a severe course in 58.9 % of patients, with SOFA scores ranging from 1 to 16 points (mean 5.8 points). 88.2  % of patients had received prior antibiotics, most commonly carbapenems. CRKP infections occurred more frequently in older men with comorbidity. The clinical efficacy of initial antibiotic therapy was 41.2 %. In 47.1 % of cases, there was no effect, which required adjustment of therapy. Excluding patients in whom it was impossible to evaluate the effect, eradication was achieved in 33.3 % of patients. 64.6 % of patients were discharged or transferred to another hospital; 6 patients died between 5 and 41 days after diagnosis of CRKP infection. Fatal outcome was more frequent in women ( p=0.042), patients with higher comorbidity index (p=0.027), in case of sepsis and/or septic shock ( p=0.011), and in earlier detection of CRKP after hospitalization ( p<0.001).

Conclusion. The efficacy of initial antibiotic therapy after detection of CRKP infection has been shown to be associated with patient  survival and reduced risk of mortality with an odds ratio of 3.5. We also identified risk factors for mortality in CRKP infection: comorbidity, sepsis, duration of hospitalization and female gender.

Introduction . The choice of the method and time of initiation of extracorporeal detoxification (ECD) in septic shock (SSh) complicated by acute kidney injury (AKI) is a debatable problem.

The objective was to evaluate the influence of various ECD tactics on the dynamics of markers of systemic endotoxicosis and acid-base status (ABS) in patients with SSh complicated by AKI.

Materials and methods. Study included 57 patients. Group 1 – 36 patients used continuous veno-venous hemodiafiltration (CVVHDF) for urgent indications. Group 2 – 21 patients used early combined ECD (LPS-sorption and CVVHDF). A comparative analysis of the main laboratory parameters between the groups was performed.

Results. Early combined ECD made it possible to reduce the concentration of leukocytes by the 3rd day of therapy from 20.6 to 12.5 ·10⁹/l (39.3 %) from the initial level in group 2, and from 22.2 to 19.15·10⁹/l (13.7 %) in group 1 ( p=0.04); C-reactive protein by the 5th day of therapy from 284 to 145 mg/l (48.9 %) in group 2, and from 299.3 to 199.8 mg/l (33.2 %) in group 1 ( p=0.02); procalcitonin by the 5th day of therapy from 7.2 to 1.6 ng/ml (77.8 %) in group 2, and from 7.8 to 4.45 ng/ml (42.9 %) in group 1 ( p= 0.02); pH by the 3rd day of therapy from 7.17 to 7.37 in group 2, and from 7.19 to 7.27 in group 1 (p =0.04); IL-6 level by the 5th day of therapy from 764.9 to 361.7 pg/ml (52.7 %) in group 2, and from 700.1 to 542.5 pg/ml (22.5 %) in group 1 (p=0.007).

Conclusions. Early combined ECD more quickly reduces markers of systemic endotoxicosis and eliminates impairment of ABS, than CVVHDF.

The objective was to evaluate the effect of renal replacement therapy on the concentration of tigecycline in the blood in the treatment of patients with sepsis and acute kidney injury.

Materials and methods. The serum level of tigecycline was analyzed in three patients with sepsis-associated acute kidney injury against the back -ground of renal replacement therapy (RRT) in the hemodiafiltration mode. The quantitative content of tigecycline was determined by high-performance liquid chromatography.

Results. Significant variability of serum tigecycline levels was revealed in patients with sepsis-associated acute kidney injury (AKI) under the conditions of the use of RRT. The use of standard dosage regimens of tigecycline in this situation may be accompanied by both a significant increase in the concentration of the drug in the blood relative to the target values, and its low level, which does not reach the values of the minimum inhibitory concentration (MIC) for pathogenic strains.

Conclusion. Significant variability of serum concentrations of tigecycline in patients with sepsis-associated AKI against the background of RRT causes the emergence of potential risks associated with both insufficient safety of treatment due to possible accumulation and  significant excess of the target concentration value against the background of inhibition of the functions of the physiological excretory systems  of the body, so with the low effectiveness of antibacterial therapy in conditions of increasing the rate of elimination of the drug from the  systemic bloodstream due to extracorporeal clearance and reducing the concentration of the antibiotic to subtherapeutic.

The objective was to evaluate the clinical effectiveness of various surgical techniques for early stabilization of the rib cage in comparison with conservative treatment tactics. The authors attached great importance to the search for predictors of an unfavorable outcome in patients with severe combined trauma.

Materials and methods. This multicenter, non-randomized, open, retro- and prospective cohort study included 65 patients with chest trauma. Pa tients were categorized into three groups depending on the technique of restoration of the disturbed thoracic skeleton. Group 1 included 19 patients with the age of 39.9 ± 2.4 years and severity of MODS-II scale 4.0 ± 0.6, ISS 24.1 ± 1.8 points. In this group, submersible constructs were used to restore sternal reconstruction. Group 2 included 24 patients aged 30.9 ± 2.4 years with MODS-II severity score of 4.3 ± 0.5, ISS 27.1 ± 1.0 points. The stabilization of the frame was carried out using the technique of fixation of the bones of the ribs and sternum with an external fixation device (AVF). Frame stabilization was performed according to the technique of fixation of rib and sternum bones with external fixation apparatus (EFA). Group 3 contained 22 patients aged 48.6 ± 2.9 years with severity of MODS-II scale 3.9 ± 0.3, ISS 24.3 ± 1.3 points and conservative treatment tactics.

Results. The respiratory biomechanics parameters in groups 1 and 2 had no statistically significant differences after 24 hours of the surgical interven tion and stabilized the rib cage. The exception concerned increased CO2 accumulation and a distinct tendency to decrease lung tissue extensibility (Slang) in the group 1, which could indicate restriction of chest excursion. The analysis of correlation between clinical and laboratory parameters and lethal outcome indicated that unfavorable outcome was most closely related to prolonged prehospital time, initial severity of the condition according to SOFA and APACHE II integral scales, as well as to the development of acute kidney injury and uncompensated tissue hypoxia.

Conclusion. The comparison of the three treatment methods showed that each of them has its own advantages: the technique of surgical treatment using submersible structures is characterized by the greatest aggressiveness for the victim, limits the excursion of the chest in accordance with the biomechanics of respiration, which contributes to the aggravation of tissue hypoxia, but reduces the duration of treatment and financial costs. The least expensive, but comparable in aggressiveness, is the method of hardware fixation. The most sparing for the patient, although lengthening the time of treatment and, accordingly, its cost, is the conservative method of management. Thus, the choice of surgical tactics is left to the attending physician and the patient.

The objective was to predict the fatal outcome of the disease in newborns on artificial lung ventilation by means of an intelligent analysis of the immunological database.

Materials and methods. The retrospective clinical study included 108 mature newborns. Upon admission to the intensive care unit, on the 3rdday and at the end of the disease, the plasma concentrations of IL-1β, IL-6, IL-8, TNF-α, G-CSF, s-Fas, FGF, NO were determined by ELISA; the relative content of CD3⁺CD19^–, CD3^–CD19⁺, CD3⁺CD4⁺, CD3⁺CD8⁺, CD69⁺, CD71⁺, CD95⁺, HLA-DR⁺, CD34⁺; CD14⁺, CD3–CD56⁺ by immunophenotyping; relative content of lymphocytes with expression of AnnexinV-FITC⁺PI^–, AnnexinV-FITC⁺PI⁺. By the method of decision trees, the rule of predicting death was formulated.

Results. The patient is predicted fatal outcome if, upon admission to intensive care, he has the relative content of lymphocytes with expression of AnnexinV-FITC⁺PI⁺ ≥ 0.95 % and plasma concentration of G-CSF ≤ 1.46 pg\ml or G-CSF ≥ 1.46 pg\ml and AnnexinV-FITC⁺PI⁺ ≥ 4.75 %(specificity 98.68 %; sensitivity 96.97 %; accuracy 98.68 %).

Conclusion. In newborns with respiratory pathology and perinatal involvement of the central nervous system on artificial ventilation, death is determined by the high activity of T-lymphocyte apoptosis mediated by the low plasma concentration of granulocyte colony stimulating factor.

Intensive care allows maintaining the vital functions of patients with irreversible brain damage for a long time. Under appropriate criteria, human death is determined by brain death, but most patients die after an undetermined period from the inevitable complications. Our legislation does not allow stopping futile treatment and letting a hopeless patient die naturally. In Russia, patient’s right to autonomy and self-determination is fulfilled through the informed consent or refusal to medical intervention. An adult comatose patient with a brain damage isn’t able to make this decision and sign the consent or refusal form, doesn’t have a Health Care Agent, and the medical council makes decision. In this situation, proper treatment is performed regardless of the prognosis. Even if the patient would prefer to die with dignity and comfort, his right to decide cannot be realized.

In many countries of the world, there has long been a practice of the advance care planning in case the patient is unable to decide. A person signs advance directives, appoints a Health Care Agent for the medical decision-making. Based on the documented preferences of the patient and communication with his surrogate, doctors can limit the life-sustaining treatment for a hopeless patient and allow him to die. The presented analysis of international data provides basic information for the discussion of the possibility of advance care planning in our country.

Nutritional support, which is a process of substrate provision with all the nutrients necessary for life for various  categories of patients who do not have the opportunity for proper natural nutrition, is a mandatory basic component of their intensive treatment. The practical implementation of nutritional support has two aspects: clinical and organizational. Currently, all components of the clinical aspect are well developed and tested and there are no reasons not to use them in everyday clinical practice. The least resolved and worked out in the majority of our medical institutions remains the organizational aspect, which often does not allow for the proper realization of this type of medical treatment.  The article contains the main organizational options for decision the existing problem and many years of practical experience in implementing nutritional support in a multidisciplinary emergency hospital.

Introduction .  Methemoglobinemia is a rather rare cause of hypoxemia and hypoxia, however, with a severe course of the disease and an increase in the concentration of methemoglobin in the blood of more than 20 %, this can cause the development of multi-organ dysfunction and death.

The objective was to descript the case of methemoglobinemia in a child with congenital epidermolysis bullosa with the use of a combined drug containing benzocaine.

Materials and methods.  Newborn premature baby boy, from the first pregnancy, gestation period 36 weeks, suffering from congenital epidermolysis. Birth weight 2850 g, height 47 cm. Apgar score in the first minute – seven, on the fifth – eight points. As a local treatment, an aerosol for external use «Olazol» was prescribed. At the age of 56 hours from the moment of birth, a sharp deterioration in the child’s condition  was noted in the form of a decrease in SpO₂ to 72–76 %, pronounced tachycardia, an increase in methemoglobin concentration in the blood (53.7 %).

Results.  A distinctive feature of this case was the presence of severe methemoglobinemia, which led to severe metabolic acidosis, venous hypoxemia and tissue hypoxia. Timely diagnosis and adequate therapy in the early stages of the pathological process contributed to the  complete stabilization of the child’s condition and the normalization of the blood gas composition fifteen hours after the start of therapy.

Conclusion.  The use of drugs containing benzocaine in the early neonatal period is a risk factor for the development of methemoglobinemia, which requires a dynamic assessment of the level of methemoglobin in the blood in order to prevent tissue hypoxia.

Introduction. Massive perioperative blood loss that accompanies major surgical interventions is a specific critical condition, the  pathogenesis of which is dominated by severe hypovolemia, anemia, and threatening coagulopathy in combination with powerful shockogenic sympathoadrenal stress. Both massive blood loss itself and massive transfusion are associated with a significant risk of serious complications, including death. It is worth noting that information on the survival of patients after replacement of several circulating blood volume (CBV) is limited, and most of the articles are devoted to adult patients with highly traumatic surgical interventions.

The objective was to present the experience in managing the patient with blood loss of more than 5.5 CBV according to the MT protocol adopted at the Research Institute of Pediatric Oncology and Hematology. The 3-year-old patient underwent surgical intervention in the following volume: median laparotomy, nephradrenalectomy on the right (lesion 10–15–20 cm in size), paracaval and aortocaval lymph node dissection (conglomerate 7–8 cm in size), resection of S5-S6-S7 liver segments, resection of the right domes of the diaphragm. During the surgical  intervention of 440 minutes (7.3 hours), the total blood loss was 5.5 CBV (5.500 ml).

Results. After surgery, he was transferred to prolonged assisted ventilation of the lungs, the duration of which was 2 days. On the 3^rd day after the operation, adjuvant polychemotherapy was started. 17 days after the operation, the patient was transferred to the specialized department for further treatment. The patient was alive for a year after surgery.

Conclusion. Maintenance of homeostasis, normothermia, normocoagulation through basic infusion therapy with balanced crystalloid solutions, targeted transfusion therapy with the introduction of fresh frozen plasma, transfusion of donor platelets and donor  erythrocytes/autoerythrocytes during anesthesia in the child with extremely massive blood loss, contributed to early post-anesthetic rehabilitation,  provided the opportunity to continue special treatment in the intensive care unit.

Introduction. Adequacy of perioperative analgesia is one of the main issues of surgical care. Anatomo-physiological and psychological characteristics of childhood necessitate more thorough approach to this problem in pediatric anesthesiology, since ensuring optimal analgesia provides prevention of somatic perioperative complications and influences further physiological neuropsychiatric development of a child.

The objective was to compare regional techniques of perioperative analgesia during abdominal interventions in children and to discuss the conditionsof their application and effectiveness.

Materials and Methods. A literature search was conducted using PubMed, Medline, Embase, and Google Scholar databases. Both English – and Russian-language publications indexed in Scopus and RSCI were included in the search.

Results. Among methods of regional anesthesia, neuroaxial blockade options, which have both high proven efficacy and several disadvantages and complications, remain the most popular techniques. Currently, the alternative methods are available, presented as interfascial blockades with anefficacy comparable to neuroaxial techniques and a wide safety profile. Among these techniques, we can distinguish rectus sheath block, transversus abdominis plane block, erector spinae plane block and other methods.

Conclusion. Despite advances in pain management, inadequate postoperative analgesia in pediatric practice remains a serious problem. Therefore, it is important to optimize the treatment of postoperative pain in children by applying multimodal analgesia using modern regional blockades.

Diabetic ketoacidosis (DKA) is an acute and severe complication of type 1 diabetes mellitus that is associated with a high risk of cerebral edema (CE)and may result in death. DKA is characterized by acute hyperglycemia, ketonemia and metabolic acidosis in the setting of decreased levels of insulin and excessive levels of the counter regulatory hormones. Algorithms of intensive treatment of DKA include such steps as fluid replacement therapy, correction of electrolyte imbalances, and intravenous infusion of insulin, performed in order to resolve metabolic acidosis and hyperglycemia as well as to prevent the development of complications (CE and hypokalemia). The analysis of literature has shown that during fluid replacement the most preferred options are balanced crystalloid solutions (Hartman’s solution and Plasma-Lyte). Infusion therapy is divided into bolus (administration of crystalloid solutions at the rate of 10 ml / kg for 30-60 minutes) and maintenance (administration of solutions for 24-48 hours). Intravenous glucosesolutions (5–10 %) are infused when the patient’s blood glucose falls below 14–16 mmol/L. Electrolyte disturbances (hypokalemia and hyponatremia) are resolved by prompt intravenous infusion of potassium and sodium solutions. Intravenous infusion of insulin is started at the rate of 0.05–0.1 U/kg/h, not earlier than 1 hour after the initiation of fluid resuscitation. Successful treatment of DKA in pediatric practice relies on clear understanding of the pathophysiological mechanisms of this complication and knowledge of the doses of the pharmaceutical drugs and volumes of infusion solutions to be used.

The objective was to determine the attitude of anesthesiologists and intensivists to the possibility of a complete transition to the use of domestic equipment for mechanical ventilation instead of imported ones.

Materials and methods. An anonymous survey of members of the Association of anesthesiologists-intensivists, doctors with experience working on ventilators (code 232870 and 232890), using the Google Forms software service. The survey involved 227 specialists from different regions of the country working in hospitals with both more and less than 1000 beds.

Results. At the workplaces of respondents, imported equipment predominates (91.6 %). The majority of experts (92.6 %) believe that the capabilities of domestic equipment relative to imported ones are lower, 0.4 % – higher, 7 % do not see any differences. The main complaints about modern domestic equipment: less reliability (84.1 %), fewer capabilities (71.4 %), worse interface work (60.4 %), worse service (25.6 %). 92.1 % do not consider it advisable to refuse to import devices, although 63.9 % of respondents do not work with domestically produced ventilators at all.

Conclusion. Domestic anesthesiologists and intensivists are not ready to use exclusively domestically produced devices in their practical work. It is necessary to improve the interaction of the professional community with manufacturers of domestic respiratory equipment in order to disseminate the positive information about it.