The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection parameters in patients treated with dexmedetomidine infusion in perioperative period of vascular surgery.

Materials and methods. The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received perioperative infusion of dexmedetomidine at a dose 0.40 [0.34–0.47] mg/kg/h during 7.0 [6.0–8.0]) hours. Group II was a control group. In the perioperative period, the occurrence of CVC, the blood level of the N-terminal fragment of the prohormone B-type natriuretic peptide (NT-proBNP) and cardiospecific troponin I (cTnI) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.

Results. Perioperative CVC without taking into account arterial hypotension were recorded in 3 (2.9%) patients in group I and in 14 (13.7%) patients in group II (p = 0.009). Arterial hypotension was recorded in 14 (13.7%) patients in group I and in 5 (4.9%) patients in group II (p = 0.051). Perioperative dexmedetomidine infusion reduced the risk of CVC, except for arterial hypotension (OR 0.1905, 95% CI 0.0530–0.6848, p = 0.011) and increased the risk of arterial hypotension (OR 3.5787, 95% CI 1.1254–11.3796, p = 0.031). The cTnI level in patients of groups I and II was 0.017 [0.011–0.024] and 0.019 [0.011–0.028] ng/ml (p = 0.196) before surgery, 0.02 [0.011–0.029] and 0.02 [0.015–0.039] ng/ml (p = 0.050) after surgery, 0.018 [0.014–0.024] and 0.028 [0.018–0.033] ng/ml (p = 0.0002) before discharge from the hospital. At the same stages, the level of NT-proBNP was 221.5 [193.3–306.5] and 237.8 [171.3–310.1] pg/ml (p = 0.572), 237.0 [205–303.5] and 289.0 [217.5–409.5] pg/ml (p = 0.007), 250.5 [198.8–302.0] and 259.6 [171.0–421.6] pg/ml (p = 0.933).

Conclusion. In patients at high cardiac risk undergoing vascular surgery, perioperative dexmedetomidine infusion reduces the risk of a composite outcome including cardiac mortality, nonfatal myocardial infarction, myocardial ischemia, pulmonary embolism, stroke, hypertension, and arrhythmias, while the risk of arterial hypotension increases significantly. The perioperative dynamics of cTnI and NT-proBNP require further research. The start of dexmedetomidine infusion in 2.7% of cases is accompanied by severe bradycardia, requiring discontinuation of the infusion.

The objective was to study the safety and efficacy of a personalized opioid-sparing pain relief protocol in the context of enhanced rehabilitation after advanced robot-assisted pelvic surgery.

Materials and methods. The prospective study included 19 patients who underwent surgery under combined thoracic epidural anesthesia/analgesia: general anesthesia was administered with propofol or sevoflurane/desflurane with ketamine + 6–8 ml/hour of 0.25% ropivacaine, in the postoperative period 0.125% bupivacaine was administered at a rate of 8–15 ml/hour. In the comparison group (n = 21), opioids were used as a component of general anesthesia and multimodal analgesia. Intra- and postoperative opioid consumption, pain severity, opioid-related side effects, and timing of postoperative rehabilitation were evaluated.

Results. In the study group, the median milligram equivalents of morphine were significantly lower than in the control group (103 versus 148 and 91 versus 404, respectively; p = 0.001 for both comparisons). The values of the numerical pain scale did not differ significantly between the groups. Side effects were significantly lower in the treatment group (26% vs. 62%; p = 0.026). There were significant differences in the timing of intestinal function recovery, initiation of regular diet and transfer from the recovery room in favor of opioid-sparing pain relief (p = 0.037; p = 0.046; and p = 0.023; respectively).

Conclusions. The use of a personalized opioid-sparing pain relief protocol in the context of enhanced rehabilitation of patients underwent the advanced robot-assisted pelvic surgery helped to reduce opioid consumption, side effects, and postoperative rehabilitation without affecting the severity of pain. 

The objective was to determine the prognostic value of predictors of early postoperative cognitive disorders in traumatological patients to assess the development of the main clinical outcomes (postoperative delirium and delayed neurocognitive recovery).

Materials and methods. A two-center prospective cohort observational study of patients aged 45–74 years after planned traumatological operations (endoprosthetics of large joints of the lower extremities, spinal fusion surgery, transpedicular fixation of vertebrae) under general anesthesia with tracheal intubation was conducted in the period from March 2021 to June 2022. Before the operation, demographic indicators, concomitant diseases, background therapy, laboratory tests and testing (ASA, MoCA, AUDIT, CFS, HADS-A, RASS). At the end of the operation after extubation and in the postoperative period, patients were analyzed according to the scales RUS, CAM- ICU and CAM-ICU-7, NRS and BPS. Statistical analysis was carried out using the software SPSS Statistics 27.0.1.0.

Results. The study included 200 patients. Early postoperative cognitive disorders (ePCD) (agitation and emergence delirium (ED)) 61 (30.5%) patients were diagnosed, 139 (69.5%) patients had adequate awakening in the operating room. Independent predictors of the development of ePCD were the age of patients (≥ 60), glucose level ≥ 5.6 and a high score on the Clinical Frailty Scale (≥ 4). The prevalence of postoperative delirium (POD) was 11% (22 patients). The independent risk factors for POD were the duration of hypotension and the presence of hyperactive ED. Delayed neurocognitive recovery after surgery and anesthesia was observed in 115 patients (57.8%). At the same time, a statistically significant predictor of this condition was the duration of hypotension for more than 15 minutes (sensitivity 59.18%, specificity 65.85%).

Conclusion. When comparing the influence of the study group (patients with ePCD) with the control group, it was determined that ePCD is an independent risk factor for the development of POD (p < 0.001).

Introduction. To date, reliable information about the “ideal” infusion therapy regimen for critically ill preterm infants in the early neonatal period is not known.

The objective was to determine the indications for the transition to restrictive tactics of infusion therapy in critically ill preterm infants

Materials and methods. The design was a prospective, observational study. The development included 110 newborns < 32 weeks of gestation (birth weight less than 1500 grams). 11 of them died.

Results. In deceased newborns, right ventricular mean pressure (RVMP) was higher in the first 3 days of intensive care and the left ventricular ejection fraction (LVEF) was higher by the third day of treatment they had a higher vasoactive inotropic index. The critical threshold value of RVMP was 29.0 mmHg. The “separation point” regarding the risk of death depending on the volume of infusion therapy was 100 ml/kg/day. The threshold value of the nSOFA score regarding the need to limit the volume of infusion therapy based on ROC analysis was 5.0 points.

Conclusion. Preterm infants with a high risk of death (nSOFA score > 5 points) require restrictive infusion therapy. The critical threshold value for the volume of fluid administered may be 100 ml/kg/day.

The objective was to evaluate the clinical effectiveness and safety of biapenem (Bianem–AF drug) in the treatment of severe forms of infection in ICU patients.

Materials and methods. The prospective observational study. At the first stage, microbiological testing of strains (n = 51) isolated from patients in ICU of the Scientific and Clinical Center of Anesthesiology and Intensive Care of the Pavlov University was performed to determine sensitivity to meropenem and biapenem by serial dilution method with the determination of MIC (Minimal Inhibitory Concentration). The genes of serine and metallocarbapenemases were detected by PCR method. At the second stage, patients over 18 years old with the site of infection that required surgical treatment and with clinical and laboratory signs of sepsis were included (n = 19: 11 females, 8 males, mean age 63.4 years). These patients received therapy with biapenem 600 mg every 12 hours as extended infusions over 1 hours (after bolus injection for the first 24 hours). Daily assessment of the severity of the inflammatory reaction and organ dysfunction was conducted to all patients included in the study. Microbiological analysis of biological material obtained from the site of infection has been obtained. Clinical effectiveness was evaluated as recovery/improvement or lack of effect. Adverse effects were recorded.

Results. Among 51 isolates of microorganisms: 27 (52.9%) Klebsiella pneumonia, 16 (31%) strains of other representatives of the order Enterobacteriales, 8 (15,6%) non-fermenting gram-negative microorganisms. 48% of Klebsiella pneumoniae isolates were resistant to meropenem and biapenem. All of them had serine (class A and D) and metallo-carbapenemase (class B) genes, as well as their combination. Of the 16 strains of other representatives of the order Enterobacteriales, only 2 (12.5%) were resistant to meropenem and biapenem. Resistance to carbapenems in the non-fermenting gram-negative microorganisms reached 87.5%. The proportion of ESBL producers among carbapenem-sensitive Enterobacteriales reached 93%. The response to biapenem therapy was received in 100% of patients. A day after the start of biapenem administration, a decrease in the level of procalcitonin was noted from 4.65 ng/ml (1.26; 18.8) to 2.2 (1.3; 16.2), after 72 hours – to 1.9 (0.8; 5.0) ng/ ml, by the 7th day – to 0.6 (0.3; 2.5) ng/ml. The median SOFA score decreased from 3.0 (1.5; 4.0) after 24 hours to 2.0 (0,5; 3,5). The average duration of antibacterial therapy was 6 days, the duration of stay in the ICU was two days, and the duration of hospitalization was 9.5 days. There were no adverse effects when using biapenem.

Conclusion. Given the high prevalence of ESBL producers and Pseudomonas aeruginosa strains in hospitals, the more favorable safety profile of biapenem compared to other carbapenems, Biapenem appears to be a justified choice for initial empirical therapy MDR sepsis.

Introduction. The endotracheal intubation procedure is integral to modern medicine and essential to emergency care, surgical practice and intensive care procedures.

The objective was to evaluate the effect of the 25° backup position on glottic view and difficulty of intubation compared to the sniffing position in adult patients receiving general anaesthesia with endotracheal intubation

Materials and methods. The comparative clinical study was conducted in Al-Hussain Military Hospital, Baghdad, Iraq during the period from 1^st of January 2022 to 1^st of January 2023. A convenient sample of 150 patients who aged 18–60 years, were classified according to the American Society of Anesthesiologists as I or II, and underwent elective surgery under general anaesthesia was included in this study. These patients were allocated into two groups. Group A consisted of 75 patients who were anaesthetized in the sniffing position. Group B consisted of 75 patients who were anaesthetized in 25° backup position.

Results. There was no significant difference between the sniffing position and 25° backup position regarding the number of patients who needed ancillary manoeuvres and ancillary equipment (P-values were 0.583 and 0.151, respectively). The glottic view was significantly better in the 25° backup position than the sniffing position according to the Cormack–Lehane (p = 0.001) with a significantly lower difficulty in intubation according to the intubation difficulty scale (p = 0.008).

Conclusion. The 25° backup position is better than the sniffing position in glottic visualization, the difficulty of intubation and the time of intubation. Age, gender, and body mass index have no significant effects on the visualization of the glottis between the 25° backup position and the sniffing position. There was no significant difference between two regarding the number of patients who needed ancillary manoeuvres and ancillary equipment. The glottic view is significantly better in the 25° backup position than sniffing position according to the Cormack–Lehane. The mean of the time of intubation is lower in the 25° backup position compared to the sniffing position.

The objective was to develop a predictive model for assessing the risk of hospital mortality in patients with COVID-19-associated acute respiratory distress syndrome (ARDS) treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO).

Materials and methods. We carried out the analysis of case histories of 123 patients treated in the ICU № 7 of the Moscow City Clinical Hospital 52 during the COVID-19 pandemic period. All patients were treated with the VV-ECMO for COVID-19-associated ARDS according to current indications. We analyzed the characteristics potentially associated with mortality, after which we performed statistical analysis, on the basis of which we created the predictive model.

Results. The overall-mortality rate was 87% (107/123). Independent predictors of death in patients with COVID-19 treated with the VV-ECMO were the maximum VV-ECMO blood flow rate, the period from the onset of the disease to mechanical ventilation, P/F prior to the VV-ECMO initiation and the fact of septic shock development during VV-ECMO. The quality of the prognostic model: AUC = 0.952 [0.909‒0.995], p < 0.001.

Conclusions. The nomogram to assess the risk of death in patients with COVID-19 treated with the VV ECMO has been developed. It includes the assessment of the maximum VV-ECMO blood flow rate, the period from the onset of the disease to mechanical ventilation, P/F prior to the VV-ECMO initiation and the fact of septic shock development during VV-ECMO.

The objective was to substantiate components, criteria and levels of the patient safety system of the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital as the methodological basis for their subsequent practical assessment in the Russian Federation.

Materials and methods. Content analysis of scientific literature (monographs and articles) on the problem of ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital. Determination of the initial list of criteria (indicators, factors) for ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospitals, expert assessment of their significance with identification of the main one, including leading (main) criteria. Justification of the content characteristics of the leading criteria, as well as the levels of ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital. Expert assessment method. Statistical analysis of data distribution, ranking assessment of their significance.

Results. It was established that 17 criteria (factors, indicators) are the main ones for ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital, of which five are leading (main) and the most informative. They comprehensively reflect one of the five levels of ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital.

Conclusion. The system for ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital is multidimensional and dynamic (controllable), its state is characterized by 5 main (leading) components, which are the methodological basis for the practical assessment of one of five levels of the system and determining the directions for its change (control, correction).

Neurosurgical operations to remove giant brain tumors, thanks to the development of high-tech operating techniques, are rarely accompanied by massive intraoperative blood loss (especially when removing tumors of glial origin). However, when removing meningiomas characterized by greater variability in location and blood supply, massive intraoperative blood loss may develop. Since May 2023, the State Healthcare Institution «Regional Clinical Hospital» in Saratov, within the framework of interdisciplinary cooperation of services – neuro- and x-ray surgery, anesthesiology-resuscitation and transfusiology, has begun the integrated use of blood-saving technologies in patients during operations to remove giant-brain tumors. The authors present the case of successful use of blood-saving technologies in the coordinated work of the above services to provide surgical treatment of the patient with a giant meningioma of the wings of the sphenoid bone on the left.

Introduction. Methemoglobinemia is a rare condition characterized by an elevated level of methemoglobin in the blood, leading to chemical hypoxia. The most common symptom is central cyanosis refractory to oxygen therapy. Diagnosis of methemoglobinemia is difficult due to the nonspecific clinical presentation and lack of awareness. Accurate diagnosis requires a thorough medical history, differential diagnosis, and confirmation through laboratory investigations.

The objective was to demonstrate the successful use of ascorbic acid in the management of acute secondary methemoglobinemia in an 11-year-old boy on prolonged metoclopramide therapy.

Materials and methods. The retrospective analysis was conducted on the clinical course of acute secondary methemoglobinemia in the 11-year-old boy on prolonged metoclopramide therapy, necessitating oxygen therapy and parenteral administration of ascorbic acid solution. Special attention was given to the clinical presentation, characteristic changes in laboratory parameters, and the effectiveness of timely ascorbic acid therapy. Clinical and laboratory improvement was achieved within 24 hours of treatment initiation.

Conclusion. Caution should be exercised when prescribing medications that can induce methemoglobinemia, taking into account dosage, duration, and frequency of use. Furthermore, careful attention should be given to the combination of metoclopramide with other drugs that may affect iron heme oxidation reactions.

In pediatric intensive care practice, a hypertensive crisis (HC) is an acute and urgent condition with a high risk of damage to target organs and organ failure, requiring emergency treatment aimed at decreasing arterial blood pressure (BP) and minimizing the risk of complications. HC is subdivided into uncomplicated (acute), in which no signs of organ damage are present, and complicated (urgent), with acute organ damage (neurological, renal or cardiac dysfunction). The main triggers of HC are concomitant endocrine disorders, renal impairment, and use of certain medications. The clinical signs of HC are diverse and non-specific, and depend on the age of the child and on the type of HC. Intensive care to children with HC is provided in intensive care units and is aimed primarily at gradually decreasing the patient’s BP (by 25% during the first 6–8 hours). In complicated HC, antihypertensive drugs are administered parenterally, whereas patients with uncomplicated HC may receive the drugs in enteral or sublingual form. The main drugs for intensive therapy of HC in children and adolescents are calcium channel blockers, vasodilators, α- and β-blockers, ACE inhibitors, centrally acting agents etc. Each group of antihypertensive drugs has its own peculiarities of pharmacokinetics, pharmacodynamics and dose selection, and its own range of adverse effects and contraindications. Timely recognition and competent intensive treatment of children and adolescents with HC will reduce the risk of complications and improve the therapeutic prognosis of this urgent condition.

Introduction. Professional burnout syndrome (PBS) in specialists in emergency medicine is one of the global problems of modern health systems, since its presence has a significant impact both on the health of individual employees and the quality of care in general.

The objective was to analyze risk factors, peculiarities of the course of professional burnout syndrome and its prevention among physicians of intensive care units based on the data of world literature in order to eliminate them in domestic clinical practice.

Materials and methods. The analysis includes 122 publications from abstract databases PubMed and e-library for the period from 2017 to 2023. The search was carried out using keywords: provider burnout syndrome, stress, personality, anesthesiologist, intensive care physician, intensive care unit. After the initial study of abstracts, 72 articles were excluded from the review, where there was no access to the full text or they were devoted to organizational preventive measures.

Results. The frequency of professional burnout syndrome among specialists of intensive care units was about 40%, which was significantly higher compared to other medical specialists. It was revealed that PBS is a crisis period in middle-aged specialists due to functional changes in higher nervous activity. The main risk group with the highest probability of developing PBS is the intensive care unit nursing staff. A significant workload combined with a low level of motivation, dissatisfaction with professional activities and the lack of recognition of personal achievements by colleagues and management are key risk factors for the development of emotional burnout syndrome.

Conclusion. A high level of professionalism in combination with the spiritual and moral component of the personal life of a specialist and the elimination of reversible negative factors of the medicine of critical conditions will allow with a high probability to prevent the development of professional burnout syndrome.

The search for domestic publications on this publication was conducted in the database on the RSCI website, and foreign ones in the PubMed and Google Scholar databases in the period 2022-2023. Their analysis showed that actively studied approaches to the immunocorrection of sepsis are aimed at changing the content or activity of cytokines, growth factors, the use of immune checkpoint inhibitors, as well as myeloid suppressor cells. When modulating the action of cytokines, a variety of approaches are used, such as changing the affinity of cytokines to their receptors, extending the half-life of cytokines and «fine-tuning» the action of cytokines. For the safe and effective use of bioregulators for immunocorrection in sepsis, additional multicenter studies of their clinical effectiveness are needed, including taking into account the stratification of patients into individual endotypes and the mechanisms of action of bioregulators.

Introduction. Respiratory distress of newborns is one of the most common causes of complications, irreversible damage to the central nervous system and deaths in the neonatal period.

The objective was to analyze the current features of epidemiology, risk factors and outcomes of respiratory distress (RD) in newborns according to the literature.

Materials and methods. The analysis includes 112 publications included in the abstract PubMed database for the period from 2017 to 2023. The search was carried out using keywords: respiratory distress, respiratory distress syndrome, newborns, favorable outcome, unfavorable outcome, risk factor, epidemiology. After the initial study of abstracts, 62 articles were excluded from the review on predicting disease outcomes and the effect of therapeutic measures on the course of respiratory failure in the neonatal period.

Results. Studies on the epidemiology of respiratory distress in newborns are very numerous, but the information available in them is extremely heterogeneous and cannot be extrapolated to patients with neonatal ICUs all over the world. Low weight and short gestation at the time of birth are the main risk factors for an unfavorable neonatal period outcome, especially in developing countries. A special risk group is prematurity with extremely low body weight, especially if they have severe infections and sepsis. Severe hypoxemic respiratory failure in the neonatal period in full-term newborns, in most cases, is noted in persistent pulmonary hypertension, which requires significant costs of all health care resources. Therapeutic strategies that have significantly reduced mortality in newborns with RD are surfactant replacement therapy and various options for non-invasive respiratory support.

Conclusion. The most frequent cause of hypoxemic respiratory failure in the neonatal period is respiratory distress syndrome and transient tachypnea of newborns, which is due to nursing full-term newborns and increasing indications for surgical delivery.

The problem of cerebral protection in cardiac surgery is relevant, despite all the techniques used. Due to its properties, ketamine can occupy its niche in solving this problem. The article analyzes current literature sources and describes the use of ketamine for analgesia, sedation and cerebral protection, and analyzes its properties for reducing the systemic inflammatory response. The mechanisms of its action and recommended doses are given, and schemes for its use both during anesthesia and the postoperative period are presented.