The article presents reflections on the place of digitalization in the development of domestic anesthesiology and intensive care. The important role of this technology in ensuring high-quality treatment is shown. The practical component of implementing tasks within the framework of digitalization should include reducing the workload on personnel not related to direct work with the patient, but also changing the management of treatment system to improve its efficiency and the safety of medical activities.

Nitric oxide (NO) is a cellular signaling molecule that causes smooth muscle relaxation in the vascular wall. Inhaled NO (iNO) has been used in intensive care for more than three decades. In Russia, this method was tested in the late 1990s. iNO acts as a selective pulmonary vasodilator, it effectively reduces pulmonary artery pressure and intra-pulmonary blood shunting. In patients with acute respiratory distress syndrome, iNO is used to improve oxygenation, but its role remains controversial. In cardiac surgery, numerous studies have reported the positive effect of iNO on pulmonary hypertension and the elimination of dysfunction and/or insufficiency of the right ventricle. Yet, various studies have failed to demonstrate significant differences in long-term clinical outcomes. Many clinical applications have been proposed at using iNO as a preventive measure for ischemic-reperfusion injury of various organs associated with cardio-pulmonary bypass. iNO has been used with evidence-based efficacy in neonatology in infants with persistent pulmonary hypertension. Yet, various studies have failed to demonstrate significant differences in long-term clinical outcomes for different use cases and applications in critical care medicine. Further studies of iNO are needed, possibly based on the phenotyping of patients’ sensitivity to iNO.

The objective to perform the objective assessment of the intensity of pain syndrome after cemented total knee replacement with epidural analgesia with 0.2% ropivacaine solution and epidural analgesia with a combination of 0.2% ropivacaine solution with morphine was performed.

Materials and methods. The study included 60 patients who underwent cemented total knee replacement for gonarthrosis under combined spinal-epidural anesthesia. In patients of the control group (n = 30), postoperative anesthesia was performed with 0.2% ropivacaine solution epidural through a catheter at the L2–3–L1–2 level in the form of a bolus followed by constant infusion. In patients of the main group (n = 30), analgesia was performed according to the same technique, but using a morphine solution of 1% – 0.3 ml (3mg) as part of a bolus of 0.2% ropivacaine solution epidural. The hemodynamics of the patients, the volume of intraoperative blood loss, and infusion therapy were homogeneous due to the carefully developed surgical procedure, had no significant differences and were not taken into account when publishing the data. The level of glycemia and cortisol in venous blood on the day of surgery (1 hour before surgery and 4 hours after surgery), age, and pain intensity on a numerical rating scale (NRS) were studied. Statistical processing was performed by MedCalc Software Ltd.

Results. In the postoperative period, the level of venous blood cortisol in patients of the main group was 486.2 [470.6; 494.5] nmol/l, and in patients of the control group – 876.8 [803.7; 918.7] nmol/l (p < 0.001 according to the Mann–Whitney U-criterion); pain intensity on the numerical rating scale in the main group was 1 [1; 1.5] score, in the control group was 4 [3; 5] scores (p < 0.001, U–Mann–Whitney criterion). There was also a correlation between the value of glycemia and the pain intensity by NRS in the postoperative period (Spearman’s coefficient r = 0.669, 95% CI = 0.499–0.789, p < 0.0001).

Conclusions. As a result of the study, it was found that epidural analgesia with morphine leads to a lower increase in glucose and cortisol levels in the postoperative period, lower pain intensity when subjectively assessed using the numerical rating scale, which indicates a high quality of anesthesia.

Introduction. The use of various regional blockades as a component of general anesthesia reduces the risk of postoperative complications such as intense pain syndrome, postoperative nausea and vomiting, and postoperative cognitive dysfunction. The study is devoted to the development and description of the technique of regional anesthesia of the anterior surface of the neck during operations on the thyroid and parathyroid glands under ultrasound navigation.

The objective was to develop a safe and effective technique of regional anesthesia for operations on the thyroid and parathyroid glands under ultrasound navigation.

Materials and methods. The trial involved 60 patients operated on for thyroid and parathyroid gland diseases. All patients were randomized into two groups: group 1 – combined anesthesia: general anesthesia + three-component blockade of the anterior surface of the neck; group 2 – general anesthesia. In group 1, intermediate cervical plexus blockade, pericapsular thyroid blockade, and Berry’s ligament blockade were performed under the control of ultrasound navigation. The patients’ condition was evaluated preoperatively, intraoperatively and in the postoperative period (after 3 and 12 hours) according to the following parameters: hemodynamic variability, pain intensity according to the numerical rating scale, frequency of postoperative nausea/vomiting and postoperative cognitive dysfunction (MOCA, MMSE), terms of postoperative activation of patients, need for prescription of opioid and non-opioid analgesics after surgery.

Results. The combination of general anesthesia and the technique of three-component regional neck blockade allowed to limit the use of opioid analgesics: opioid consumption in group 1 was 3.12 [2.68; 3.75] μg/kg, in group 2 – 5.93 [4.48; 7.21] μg/kg (p < 0.0001). A higher rate of cognitive recovery was noted in group 1 compared to patients in group 2 (p = 0.0114). Combined anesthesia provided a long pain-free period after surgery: 12 hours after extubation, patients in group 1 had a very low level of pain according to numerical rating scale – 0 [0; 6.0] mm, patients in group 2 had higher values – 14 [10; 18] mm. The use of regional blockade allowed to reduce ketoprofen consumption in the postoperative period (consumption in group 1 amounted to 1.85 [1.30; 2.02] mg/kg, in group 2 – 3.19 [2.58; 5.97] mg/kg (p = 0.0015)).

Conclusion. General anesthesia with three-component regional blockade of the anterior surface of the neck during operations on the thyroid and parathyroid glands under ultrasound navigation is effective and safe technique.

Introduction. Blood pressure optimization during and after reperfusion in patients with acute ischemic stroke can reduce the risk of hemorrhagic complications and improve functional recovery. Several randomized controlled trials of different target blood pressure values have been published with varying results.

The objective was to evaluate the effect of intensive hypotensive therapy in the first day after intravenous thrombolysis on outcomes of acute ischemic stroke and incidence of complications.

Materials and methods. A single-center open label randomized controlled trial was conducted. Patients older than 18 years with acute ischemic stroke who underwent reperfusion were included. Patients were randomized into 2 groups: with a target systolic blood pressure of 161–185 mm Hg on the first day (control group) versus < 160 mm Hg (intensive hypotensive therapy group). The primary end points were mortality and modified Rankin Scale score at day 90 from the onset of stroke.

Results. The final analysis included 69 patients. In the intensive hypotensive therapy group, mortality rate did not differ from the control group: OR 1.1 [95% CI 0.3 to 4.8] (p = 0.896). The median modified Rankin scale score at day 90 in the control group was 2 (1; 3.8) versus 2 (1; 3.5) in the intensive hypotensive therapy group (p = 0.812).

Conclusion. Intensive hypotensive therapy at the first day after intravenous thrombolysis in acute ischemic stroke patients with target values of systolic blood pressure < 160 mm Hg compared to conventional values of 161–185 mm Hg neither improved functional outcome nor decreased mortality and complications rate on day 90 from the onset of stroke.

The objective of the study was to assess the prevalence, etiology, and outcomes of intensive care in patients with septic shock in the ICU of a multidisciplinary hospital.

Materials and methods. A single-center, retrospective, cohort study was conducted involving 398 patients with septic shock who were hospitalized in the ICU over a one-year period. Diagnosis of septic shock, as well as a complex of intensive care, were carried out according to the criteria proposed by the recommendations of the Surviving sepsis campaign (2021). Antibacterial therapy was prescribed based on the Guidelines «Diagnosis and antimicrobial therapy of infections caused by multidrug-resistant strains of microorganisms» (2022)

Results. The proportion of patients with septic shock was 7.4% of the entire population hospitalized in the ICU. The hospital mortality rate was 25%. The dominant loci of infection in patients with septic shock were the abdominal cavity (33%) and lungs (32.4%). The microbial landscape was dominated by gram-negative flora (66%), among which in 35% of cases, Klebsiella pneumoniae was characterized by resistance to the antibacterial drugs used. Combined antibacterial therapy was received by 84% of patients.

Introduction. Sepsis is a serious life-threatening disease, accompanied by high mortality and long-term decline in the quality of life of surviving patients. Recent recommendations from the US Society of Critical Care Medicine presented the Phoenix Sepsis Score as the optimal system for assessing organ dysfunction in children with sepsis.

The objective of study was to compare the discriminatory ability of the Phoenix Sepsis Score, pSOFA and PELOD 2 scores after 24, 72 and 120 hours of intensive care.

Materials and methods. The study design was retrospective, observational, and multicenter. 140 children met the inclusion and exclusion criteria, 29 (20.7%) patients died. The discriminatory power of the study scores was assessed based on ROC analysis.

Results. The area under the ROC curve in the first 24 hours was comparable for the analyzed scores (within 0.600, the significance of the differences between the Phoenix Sepsis Score and pSOFA was 0.57, Phoenix Sepsis Score – PELOD 2 = 0.80, pSOFA – PELOD 2 = 0.74 ). On the third day of intensive therapy, the information value of the scores turned out to be good (Phoenix Sepsis Score– 0.704 ± 0.100, pSOFA – 0.748 ± 0.079, PELOD 2 – 0.810 ± 0.073), but they also did not differ statistically significantly from each other. On the fifth day of treatment, all scores showed excellent and comparable discrimination ability (AUG ROC about 0.900).

Conclusions. The information ability of the Phoenix Sepsis Score, pSOFA and PELOD 2 in children with sepsis is comparable. The Phoenix Sepsis Score can be used to monitor the severity of organ dysfunction during intensive care of pediatric sepsis

The objective was to assess the relationship between the implementation of information technologies in the work of anesthesiology and intensive care services of multidisciplinary hospitals and the severity of the leading components of patient safety at different levels of digitalization.

Materials and methods. Expert assessment of the level of digitalization and the effectiveness of using new medical information technologies in the system of the anesthesiology and intensive care service (department) of 235 multidisciplinary hospitals, including an assessment of the leading components of patient safety at different levels of digitalization. Statistical analysis of data distribution, Student’s t-test for independent samples.

Result. It has been established that the majority (47.7%) of anesthesiology and intensive care units (AICU) of multidisciplinary hospitals in the Russian Federation are at the average (sufficient) level of digitalization. Relatively few (19.2%) AICU of multidisciplinary hospitals are at a high and sufficiently high level in terms of digitalization. At the same time, each of the levels of digitalization of the AICU of multidisciplinary hospitals has a close relationship with the severity of the main components of ensuring the safety of patients in the departments.

Conclusion. Comparison (correlation) of the level of digitalization and components of patient safety of the AICU of multidisciplinary hospitals showed their fairly close and direct relationship. The study confirms that the effectiveness of ensuring patient safety of the AICU of multidisciplinary hospitals is associated, first of all, with a high level of digitalization as an important integral process for ensuring the quality of specialized medical care.

Introduction. Hemostasis screening tests – activated partial thromboplastin time (APTT), prothrombin time (PT) with results expressed as international normalized ratio (INR), thrombin time (TT), fibrinogen concentration (Fg) were initially developed to reveal the causes of bleeding and to assess hemorrhagic risk. Citrate plasma is traditional object followed by blood cells effects on hemocoagulation are lost. A more realistic picture should be provided by hemostasis screening with whole (citrated) blood that allows point-of-care (POC) testing due to exclusion a preanalytical procedures. However, hemostasis POC-screening with whole blood still raises a number of questions.

The objective was to assess a consistency between POC hemostasis testing by whole blood and the same tests by reference methods in the laboratory, and to study how high/low hematocrit and high/low platelet counts influence on the POC hemostasis assays.

Materials and methods. Blood samples were collected as a part of routine check-up for neurological patients (n = 80) at Research Center of Neurology. Patients did not have diseases or complications predisposing to plasma hypocoagulation and did not take anticoagulants as well. Hemostasis tests (n = 100 for each of APTT, PT, TT, Fg) were performed from whole citrate blood using cartridge technology with portable POC hemostasis analyzer OCG-102 (Guangzhou Wondfo Biotech Co., Ltd, China). The results of the tests of the same name obtained from citrate plasma using a standard technique on an automatic coagulometer ACL Elite Pro (Instrumentation Laboratory, USA) was accepted for comparison as a reference mode. The software package «IBM SPSS Statistics», ver. 25 (IBM, USA) was used for statistical analysis. The data is presented as Me [Q1; Q3]. The comparative analysis was performed with nonparametric method using Wilcoxon criterion. Linear regression analysis and nonparametric Spearman correlation were used to assess the influence of platelet count and hematocrit values (categorical variables). Confidential level as p < 0.05 was assumed for each statistics.

Results. About 3–4% of POC assays have failed but that has happened at the initial stage of working with the POC-device. All POC-tests fell within the reference values. Statistically unreliable shift was revealed for repeated POC-assays (after 30 minutes) except INR explaining by cumulated error. Excepting Fg test, results of other whole blood tests have been longer of 7–9% than in plasma (p < 0.05) but their values were not out the reference ranges. Data analysis showed that moderately reduced or moderately elevated values of hematocrit (35–40% and 45–55%, respectively) and platelet count (140–180 thousand/μl and 380–450 thousand/μl, respectively) didn’t affect significantly POC tests.

Conclusion. The results of POC-screening from whole citrate blood do not differ either diagnostically or clinically from the results obtained by the traditional method from citrate plasma. Moderately reduced or moderately elevated values of hematocrit and platelet count, which are the most common in practice, do not significantly affect the results of whole citrate blood POC tests. Thus, the implementation of POC-screening of hemostasis from whole citrate blood is obviously intended for use in intensive care and intensive care units, reception and surgical departments and perinatal centers with prospects for expanding use in anticoagulant therapy rooms, mobile medical diagnostic complexes and small medical and preventive institutions.

Sodium (Na+) imbalance in the body is an urgent problem, especially in the intensive care of children. Hyponatremia (Na+ levels below 135 mmol/l) is a multifactorial condition, but the main cause of this electrolyte imbalance in children is a decrease in renal clearance in combination with high fluid intake. Hyponatremia is subdivided into three pathophysiological types: hypotonic, isotonic and hypertonic. Acute hyponatremia (< 48 hours) has the most pronounced clinical symptoms, which typically include central nervous system (CNS) dysfunction with exacerbation of hyponatremic encephalopathy and cerebral edema (CE). Severe hyponatremia in children and adolescents is treated first by infusion of a 3% solution of NaCl, with the rate and volume strictly controlled to maintain a rate of Na+ increase of no more than 12 mmol/l over a 24-hour period. Hypernatremia (Na+ levels of over 145 mmol/l) in children develops as a result of high-volume or long-term infusion of saline solutions, or as a consequence of gastroenteritis. The pathogenesis of hypernatremia involves the imbalance between consumption and excretion of fluids in the setting of reduced or absent thirst. Clinical manifestations depend on the predominant nature of the hypernatremia (hypo- or hypervolemic) and may include cerebral insufficiency (seizure syndrome, CE). Correction of hypernatremia should be performed at a rate not exceeding 0.5 mmol/l per hour or 10–12 mmol/l per day with infusion of 0.9% NaCl. Timely diagnosis and correction of hypo- and hypernatremia in pediatric intensive care practice will reduce the risk of CNS-related complications and possible death

The objective was to demonstrate the effectiveness of regional anesthesia techniques in the treatment of ischemic lumbosacral plexopathy after vascular surgery.

Introduction. The frequency of ischemic complications after infrarenal aortic surgery is less than 1%. The persistence and severity of neurological symptoms, as well as the low effectiveness of therapy, can negatively affect the result of surgical intervention.

Materials and methods. A 66-year-old patient on the first day after an elective simultaneous aorto-femoral bifurcation prosthetics and cholecystectomy due to an aneurysm of the infrarenal aorta and calculous cholecystitis under inhalation anesthesia had symptoms of left-sided lumbosacral plexopathy, manifesting with left-sided inferior monoplegia, mosaic sensitivity disorders and severe pain syndrome.

Results. During routine pain therapy (acetaminophen, nonsteroidal anti-inflammatory drugs, opioids), on the second day after surgery, a transverse abdominis plane block (TAP-block) on the right side and pericapsular nerve group block (PENG-block) on the left side were performed, that led to a rapid regression of acute postoperative pain and restoration of patient mobility. On the 7th, 11th and 16th days after surgery, neurotrophic therapy and comprehensive rehabilitation were supplemented with interventional pain therapy techniques, which provided not only effective pain relief, but also rapid improvement of neurological symptoms. On the 22nd day of postoperative period, the patient was discharged from the hospital with slight motor deficit in the left leg.

Conclusions. The case describes complicated course of the postoperative period after aorto-femoral bifurcation prosthetics and cholecystectomy and effectiveness of the interventional therapy for lumbosacral plexopathy of ischemic origin. This strategy led to a rapid regression of neurological deficit in parallel with relief of acute postoperative pain and expansion of rehabilitation opportunities.

Introduction. In the development of post-traumatic pancreatitis, an important role is played by microcirculatory disorders, developing against the background of inflammation and decreased capillary blood flow not only in the tissues of the pancreas, but also in other organs, including the intestine, which leads to neuroendocrine dysregulation, dysfunction and/or death of intestinal epithelial cells, disruption of the motor and evacuation functions of the intestine, and, as a consequence, the development of intestinal insufficiency syndrome.

The objective was to demonstrate the effectiveness of enteral therapy in a patient with a closed abdominal injury, liver injury and posttraumatic pancreatitis.

Materials and methods. We analyzed a clinical case of hospitalization of patient K., 38 years old, with the following diagnosis: “Closed abdominal trauma. Liver trauma of the S6 segment. Hemoperitoneum 1000 ml. Complication: right-sided segmental pneumonia. Bilateral hydrothorax. Posttraumatic pancreatitis”. The patient was admitted with complaints of upper abdominal pain and nausea two weeks after blunt abdominal trauma. She was treated as an outpatient. During the last two days she started to notice nausea, increased pain syndrome in the right side and upper parts. She was brought by an ambulance. Hybrid surgical intervention was performed: endovascular celiacography, superselective embolization of the right hepatic artery branch and diagnostic videolaparoscopic sanation and drainage of the abdominal cavity. In the postoperative period, treatment was performed according to the National Clinical Guidelines, supplemented with enteral therapy.

Conclusion. This clinical observation demonstrated the effectiveness of including enteral therapy in a complex of therapeutic measures in the patient with closed abdominal trauma, liver trauma, posttraumatic pancreatitis, which was expressed in a decrease in the level of lactate, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, leukocytes on the 3rd day of dynamic observation. At the same time, an increase in the absolute number of lymphocytes, the concentration of total protein and albumin was noted. The proposed scheme contributed to the regression of signs of intestinal insufficiency syndrome, normalization of intra-abdominal pressure by the 7th postoperative day, prevention of the development of purulent-septic complications and multiple organ failure, a successful outcome of hospitalization.

The unique physicochemical and pharmacological properties of synthetic drugs are responsible for both the morbidity and mortality associated with their overdose. Among the consequences resulting from misuse of these potent opioids, or in the case of mass casualties involving the large-scale use of weaponised synthetic opioids, is the need for higher and repeated doses of the competitive antagonist naloxone, currently the only drug available to reverse opioid overdose. We reviewed the reversal agents available worldwide, discuss the need for stronger, faster and longer-acting opioid antagonists to reverse opioid overdose, and look at possible areas of functionalization of morphinan-based opioid ligands.

A key aspect of the review is the emphasis on the state of capillary blood flow in critical conditions. The review summarizes current information on the role of endothelium in the regulation of microcirculation, the manifestation of acute endothelial dysfunction in critically ill patients and methods for assessing microcirculation. The main methods of treatment used in intensive therapy, which can affect microcirculation, are highlighted, and the feasibility of developing and putting into practice methods for constant monitoring of the state of microcirculation is justified.

Introduction. The need to develop effective methods of renal protection during cardiac surgical interventions is dictated by the progressive increase of acute kidney injury (CS-AKI) in children, which is associated with immaturity of renal function and damaging factors of cardiopulmonary bypass (CPB): activation of systemic inflammation response, hypothermia, hemodilution, hemolysis, transfusion of donor blood components, hypoxia/hyperoxia. CS-AKI in this population results in worsening of both early and long-term patient prognosis. However, there is no universally accepted strategy for nephroprotection in pediatric cardiac surgical patients.

The objective was to analyze existing data on the efficacy of nitric oxide as renal organoprotection in the pediatric cardiac surgery population for 2019–2024.

Materials and Methods. The analysis was performed using domestic and international biomedical databases using the keywords: nitric oxide, nitric oxide inhalation, nephroprotection, artificial circulation, cardiac surgery, children. Results. The review presents current information on intraoperative use of nitric oxide during cardiac surgery under artificial circulation and its effect on further development of acute kidney injury.

Conclusion. Nitric oxide is a promising method of nephroprotection in cardiac surgery of different age groups using artificial circulation, which is confirmed by clinical studies, as well as by the results of serologic and histologic sampling of animal models. The data on the use in pediatric patient group is insufficient and requires further studies.