The objective was to study the incidence of the late cardiovascular complications depending on the use of perioperative cardioprotection in patients with high cardiac risk.

Materials and methods. We analyzed data of medical cards and telephone interviews of 307 patients aged 47 to 85 (67 [63–71]) years who underwent surgical procedures a year before the interview. Perioperative pharmacological cardioprotection (dexmedetmidine or phosphocreatin) was used in 168 (54.7 %) patients. The endpoints of the study were composite outcome (one or more cardiac events), MACCE (cardiac mortality, myocardial infarction, stroke or a combination of these) and 1-year cardiac mortality. To process the data, we used logistic regression with the calculation of the odds ratio (OR) and 95% confidence interval (95% CI) and ROC analysis.

Results. During 12 months after vascular surgery, various cardiac events (composite outcome) developed in 29.3 % of patients, including MACCE in 11.4 % of cases and cardiac mortality in 3.3 %. Patients who received and did not receive cardioprotection had a different risk of composite outcome (OR 0.5392, 95 % CI 0.3287–0.8846, р=0.014) and risk of MACCE (OR 0.4835, 95 % CI 0.2372–0.9852, p = 0.041). Perioperative cardioprotection had no effect on the risk of 1-year cardiac mortality (OR 0.3994, 95 % CI 0.1177–1.3556, р = 0.125).

Conclusion. Within one year after vascular surgery, more than 29 % of patients with high cardiac risk develop one or more cardiac events (composite outcome), including cardiac mortality in 3.3 % of cases. Perioperative cardioprotection with dexmedetomidine or phosphocreatine reduces the risk of composite outcome and the risk of MACCE, without reducing one year cardiac mortality.

Introduction. Perioperative cognitive disorders (POCD) represents a risk for elderly patients. Currently, there is no uniform and standardized methodology for the identification of POCD in the existing literature. Additionally, there is an ongoing debate regarding the optimal anesthetic option for geriatric patients.

The objective was to compare the incidence of delayed cognitive recovery depending on the main component of anesthesia in patients operated for colorectal cancer using composite Z-scores.

Materials and Methods. The study cohort comprised 31 patients who underwent surgical treatment for colorectal cancer under inhalation or intravenous anesthesia. The inclusion criteria were as follows: age over 60 years, planned surgical intervention of more than 180 minutes, absence of neurodegenerative, psychiatric diseases, cerebrovascular accident (CVA), diabetes mellitus in the anamnesis, and compliance with ASA class II or III. Neuropsychological testing was conducted preoperatively and on the fourth or fifth postoperative day. Delayed cognitive recovery was defined as a decrease in the composite Z-score of more than one standard deviation (SD) in comparison to the preoperative assessment.

Results. Delayed cognitive recovery in the group where sevoflurane was the main component exhibited in two patients (12.5%). In contrast, this complication was not observed in the group where propofol was the main component (p = 0.484). When using propofol, the delta of the composite Z-score was statistically significantly better – 0.306 [0.078; 0.484] than when using sevoflurane – –0.121 [-0.556; 0.022] (p = 0.001), which indicated a faster recovery of cognitive functions in the postoperative period.

Conclusion. The results of neuropsychological tests on patients who underwent surgical interventions with propofol as the main component were more similar to the results of preoperative assessments. This suggests a faster recovery of cognitive function in the postoperative period.

Introduction. Surgical treatment of patients with urgent abdominal surgical pathology is associated with a high risk of developing various somatic complications. The most common of them is acute kidney injury (AKI), which is an independent factor in increasing the duration of hospitalization and mortality.

The objective was to develop a prognostic model of individual risk of AKI after surgical treatment of patients with urgent abdominal surgical pathology.

Materials and methods. A cohort comparative study of the treatment outcomes of 271 patients with urgent abdominal surgical pathology was conducted. The primary endpoint was the development of AKI. The main group included patients (N = 134) whose early postoperative period was complicated by AKI, and the control group (N = 137) included patients without this complication. Binary logistic regression analysis was used to build a model for predicting the probability of AKI development, which included statistically significant predictors. ROC analysis was performed to determine the sensitivity and specificity of the resulting individual risk model for AKI.

Results. It was proven that type 2 diabetes mellitus (p = 0.003), early stages of chronic kidney disease (p = 0.026), and mechanical jaundice (p < 0.001) were significantly more often verified in patients of the main group. In the AKI group, the levels of creatinine (p < 0.001), urea (p < 0.001) and proinflammatory cytokines – tumor necrosis factor alpha (p < 0.001) and C-reactive protein (p < 0.001) were significantly higher. Based on the obtained results, a model for predicting the individual risk of AKI was developed using binary logistic regression analysis, the sensitivity and specificity of which were 82.8% and 88.3%, respectively. High validity of the proposed model was proven.

Conclusion. The proposed model allows predicting a reliable individual risk of acute kidney injury after surgical treatment of patients with urgent abdominal surgical pathology.

Introduction. The recently introduced cardiovascular-kidney-metabolic syndrome (CVKMS) is defined as a health disorder associated with obesity, diabetes mellitus, chronic kidney disease, and cardiovascular disease. Patients with CVKMS are at risk for postoperative complications. Postoperative hyperlactatemia is independently associated with an increased risk of death after major surgery.

The objective was to conduct a comparative analysis of the dynamic parameters of blood lactate level with postoperative complications and duration of treatment of patients with metabolic syndrome (MetS) and CVKMS in non-cardiac surgical interventions.

Materials and methods. 48 patients were divided into the CVKMS group (n = 16) and MetS group (n = 32). Both the peak concentration and clearance of blood serum lactate in the first 0, 6, 12, 18, 24 and 48 hours after surgery were calculated. Lactate concentration greater than 2.0 mmol/L was defined as hyperlactatemia. Endpoints were the severity of complications according to the Clavien–Dindo classification and the duration of postoperative treatment.

Results. Peak lactate concentrations were statistically significantly higher and lactate clearance was significantly lower in the CVKMS group in comparison with MetS group. 54% of patients developed hyperlactatemia. Lactate clearance after surgery was significantly lower in patients with hyperlactatemia. In patients with CVKMS, the degree of severity of postoperative complications and the length of stay were significantly bigger.

Conclusions. Elderly patients with CVKMS as compared to patients with MetS have a significantly higher blood lactate concentrations, more postoperative complications that require longer treatment. The identification of patients with CVKMS makes it possible to stratify the risks of postoperative complications.

Introduction. The increasing prevalence of healthcare-associated infections (HAIs) caused by critical, high and medium priority pathogens among patients with severe community-acquired pneumonia (SCAP) and the high mortality rate necessitate monitoring of pathogens and consideration of predictors.

The objective was to identify predictors, determine the etiology and evaluate the dynamics of pathogens of HAIs over a 10-year period in patients with SCAP.

Materials and methods. An analysis of medical records of 756 patients treated in the intensive care unit was of the I.I. Mechnikov NWSMU was conducted in the period from 2013 to 2023. Incidents of HAIs (catheter-associated urinary tract infection – CAUTI, catheter-associated bloodstream infection – CLABSI) and ventilator-associated pneumonia – VAP) were determined in accordance with the NASCI criteria from 2023.

Results. The study included 663 patients with SCAP. The density of HAIs in patients with SCAP was 6.2/1000 days of device use (DDU) and shows an increase in the period 2021–2023. The frequency of CLABSI caused by multiple drug resistance (MDR) pathogens was 69.2%, CAUTI 24.4%, VAP 42.9%. 72 cases of HAI were registered in 67 patients, of which 24 (35,8%) patients with SCAP had 50 critical and high priority pathogens, of which 16 (23.8%) had bacterial-fungal associations. The priority pathogens in the registration of DAIs for the entire analyzed period were carbapenem-resistant strains of A. baumannii and K. pneumoniae as well as K. pneumoniae isolates resistant to third-generation cephalosporins. A trend towards expanding the spectrum of pathogens and increasing the proportion of Candida non-albicans in the etiological structure of fungal HAIs was identified in the period 2021–2023. Independent predictors of DAIs were identified in patients with SCAP, which were > 7 DDU for CLABSI, and > 72 hours of mechanical ventilation for VAP, and an increase in procalcitonin > 0.5 ng/ml for VAP and CAUTI. When registering CAUTI, the severity of comorbidities (CCI score ≥ 5: 3.829; 1.867–7.852, p < 0.001) in patients with SCAP and the severity of organ dysfunction (SOFA score > 4.0 (9.976; 1.277–77.958, p = 0.028) in patients with SCAP COVID-19 were independent predictors of HAIs.

Conclusion. In the period 2021–2023, an increase in HAIs was observed in the group of patients with SCAP. The main pathogens of which were critical, high and medium priority pathogens K. pneumoniae, A. baumannii, as well as Candida spp. (C. tropicalis, С. parapsilosis, P. kudriavzevii). Independent predictors of HAIs in patients with SCAP were identified, which were the duration of use of devices and the increase in the level of procalcitonin above 0.5 ng/ml. When registering CAUTI, risk factors such as the severity of comorbidities for patients with SCAP and the severity of organ dysfunction in patients with SCAP COVID-19 were identified.

The objective was to investigate the nitrogen balance (AB) in patients with acute pancreatitis who have predictors of severe course with early nasogastric and nasojejunal feeding and to assess it as a predictor of the severe form of the disease.

Materials and methods. A prospective cohort single-center study was carried out in the Intensive Care Unit (ICU) of the Occupational Health Facility “Neftyanik”, Tyumen. The participants in the study (n = 64) presenting predictors of severe acute pancreatitis (APACHE II > 8, CRP > 150 mg/L, SOFA > 2) received early enteral feeding (during the first 24 hrs.) via a nasogastric (NG) or nasojejunal (NJ) probe. The feeding formula (the standard polymer formula enriched with dietary fibers) was administered during the first 5 days taking into consideration its tolerability. Urinary nitrogen excretion was determined based on urinary urea and thereafter NB was calculated. Raw data were statistically processed using SPSS – 26 software suite.

Results. During early NJ feeding, patients received statistically significantly more nitrogen compared to the NG feeding. In severe AP patients, starting from day 3, negative NB was statistically significantly greater than in moderately severe AP patients. The NB-based severe acute pancreatitis prognosis models are statistically significant – day 3: AUC 0.785 (95 % CI: 0.670–0.900; p <0.001), sensitivity (Se) – 0.613, specificity (Sp) 0.909, cut-off value – 14.45 g/day; day 4: AUC – 0.768 (95 % CI 0.653–0.884; p = <0.001), cut-off value – 16.8 g/day, Se – 0.774 and Sp – 0.696; day 5: AUC – 0.903 (95 % CI 0.828–0.979; p = <0.001), cut-off value – 10.07 g/day, Se – 0.839, and Sp – 0.848. Inclusion of the additional index – the method of delivering enteral feeding: NG or NJ – into each of the formed one-factor models has not changed the results.

Conclusion. Starting from day 3 of the disease onset, daily nitrogen balance can be used as a predictor of a severe form of acute pancreatitis. The method of feeding (NG or NJ) rendered no influence on the prognosis model.

Introduction. The knowledge and experience of anesthesiologists about predictors of unplanned ICU (intensive care unit) readmission are implemented into practical models for their prevention. However, differences in the time before patient’s ICU readmission make significant adjustments to the possibility of their implementation.

The objective was to analyze intensivist opinions about predictors of early and late unplanned ICU readmissions. Materials and methods. The survey of intensivists was conducted in 9 hospitals in Saint Petersburg and the Leningrad Region from July 2023 to July 2024. Statistical information processing was carried out using the Jamovi software package.

Results. The study included 381 questionnaires. Long ICU stay ( > 14 days) (AOR: 0.373; 95% CI: 0.183–0.758, p = 0.006; 0.492; 0.246–0.985, p = 0.045), emergency surgeries and procedural complications (1.283; 1.071–1.537, p = 0.007; 1.387; 1.136–1.694, p = 0.001), as well as lack of data on oxygen therapy and respiratory support in the transfer epicrisis (0.315; 0.172–0.576, p < 0.001; 0.505; 0.278–0.919, p = 0.025) increase the chances of 24- and 48-hour unplanned ICU readmission. Transfer of patients from the ICU to «off-hours» (1.244; 1.020–1.517, p = 0.031; 1.518; 1.243–1.853, p < 0.001) was a risk factor for the 48- and 72-hour periods. Registration of adverse acute cardiovascular events (2.876; 1.368–6.047, p = 0.005; 2.578; 1.390–4.780, p = 0.003) increased unplanned ICU readmission in the 48-hour and 7-day periods. Sepsis in a patient in the ICU was considered by respondents to be an independent predictor of ICU readmissions for all periods except the 24-hour period. Characteristic predictors of unplanned ICU readmissions also were: for 24-hour – the impossibility of conducting «round-the-clock» laboratory and instrumental diagnostics (0.764; 0.639–0.914, p = 0.003), patient readmission due to the need to free up a ICU bed (1.345; 1.138–1.589, p = 0.001), failure to hold council (0.507; 0.270–0.954, p = 0.035); for 72-hour – physician experience (0.968; 0.939–0.997, p = 0.033); for 14 days – Mechanical Ventilation > 7 days (1.674; 1.025–2.734, p = 0.040).

Conclusion. The analysis of the opinions of intensivists made it possible to identify independent and determine modifiable predictors of early and late unplanned readmission of the patient to the ICU.

Clinical guidelines «Sepsis (in adults)» are an interdisciplinary document developed by 8 professional non-profit public organizations and approved by the Scientific and Practical Council of the Ministry of Health of Russia. They are intended to help doctors of various specialties (anesthesiologist and intensivist, surgeon, emergency physician, neurosurgeon, cardiovascular surgeon, thoracic surgeon, transfusiologist, orthopedic traumatologist, nephrologist, urologist, maxillofacial surgeon, infectious disease physician, clinical pharmacologist, medical microbiologist) in determining the treatment strategy and tactics for patients with sepsis or at risk of its development. The material presented to the reader’s attention reflects the main provisions of the document that are important for practical work. Its full content can be found on the websites of the Ministry of Health (https://cr.minzdrav.gov. ru/) and the public organizations (in particular, https://association-ar.ru/; https://общество-хирургов.рф/; https://sepsisforum.ru/; https://www. antibiotic.ru/) that developed them. In terms of their main provisions, the recommendations correspond to the latest international guidelines (Surviving sepsis campaign from 2021), but take into account the specifics of the work of medical organizations in the Russian Federation. These recommendations apply to the following codes of the International statistical classification of diseases and problems related to adult health: A40 – streptococcal sepsis (A40.0/A40.1/A40.2/A40.3/A40.8/A40.9); A41 – other sepsis (A41.0/A41.1/A41.2/A41.3/A41.4/A41.5/A41.8/41.9) and B37.7 – candidal septicemia.

Introduction. Acute gastrointestinal injury is a polymorphic syndrome with many causes.

The objective was to consider modern aspects of diagnosis and assessment of severity of acute gastrointestinal injury.

Materials and methods. The literature search and analysis was performed in the medical information systems PubMed and eLibrary, using following keywords: acute gastrointestinal injury, intestinal fatty acid-binding protein (iFABP), D-lactate.

Results. In this review, we present the scores for assessment of the severity of acute gastrointestinal tract injury, clinical symptoms, as well as new laboratory and instrumental diagnostic approaches.

Conclusion. Early detection of this category of patients is vital to provide a personalized intensive therapy aimed at restoration of adequate function of the gastrointestinal tract.

Introduction. Acute respiratory distress syndrome is one of the most formidable complications of critical conditions in children, leading to severe systemic hypoxia and associated with a high probability of death.

The objective was to demonstrate respiratory support characteristics in acute respiratory distress syndrome complicated by bronchopulmonary fistula in a child with sepsis.

A clinical case was used to illustrate the main principles of invasive invasive artificial lung ventilation in severe hypoxemic respiratory failure due to pneumonia caused by Streptococcus pyogenes. The basic data of the history, clinical and laboratory examination were reflected, special attention was paid to the intensive care measures and the choice of the optimal mode of invasive invasive artificial lung ventilation, which allowed to achieve the target indicators of the gas composition and the acid-basic state of the blood.

Conclusion. In severe acute respiratory distress syndrome in children, it is advisable to perform invasive artificial lung ventilation with inspiration control by pressure and guaranteed respiratory volume at a positive end expiratory pressure of at least 6 sm H2O. The use of inspiration/expiration ratio reversal can only be justified in extremely rare cases as a life-saving measure in the absence of persistent hypercapnia.

Introduction. The passive leg raising (PLR test) test is a widely used diagnostic test for assessing fluid responsiveness. However, there is no generally accepted methodology describing the details of its implementation.

The objective was to establish criteria for conducting the PLR test based on the diagnostic accuracy of various variations.

Materials and methods. A systematic review and meta-analysis included prospective cohort studies that evaluated the diagnostic accuracy of different PLR test variations. The primary endpoint was the area under the ROC curve (AUROC). The search was conducted up to March 2024 and included «snowball» method. The covariate influence was assessed via univariate meta-regression. The risk of bias was evaluated using QUADAS-2, and evidence certainty was assessed with GRADE.

Results. The meta-analysis included 33 prospective cohort studies, 1,607 critically ill patients The AUROC for the PLR test was 0.882 [0.849; 0.916] (moderate certainty of evidence). Transthoracic and transesophageal echocardiography, transpulmonary thermodilution, and pulse contour analysis showed comparable results for assessing cardiac hemodynamics during PLR test, p = 0.253 (moderate certainty of evidence). Evaluating hemodynamic changes within the first two minutes of the PLR test increased diagnostic accuracy (high certainty of evidence). The starting body position (low Fowler’s position or supine) during the PLR test did not impact diagnostic accuracy (low certainty of evidence). Baseline covariates (age and gender) had no effect on diagnostic accuracy of the PLR test in critically ill patients (high certainty of evidence).

Conclusion. For assessing fluid responsiveness in critically ill patients, the PLR test should include intracardiac hemodynamic assessment within two minutes using any common method. Low Fowler’s position is preferable starting position of the body for PLR test.

The use of cardiopulmonary bypass (CPB) technologies is often associated with ischemic and re-perfusion injury to the myocardium. The contact of patient’s blood with the surface of the extracorporeal circuit leads to platelets activation and often triggers a systemic inflammatory reaction. Nitric oxide (NO) is a signal molecule produced by the endothelium of blood vessels. Under normal circumstances, it prevents excessive activation and aggregation of platelets, thus providing an organ-protective effect. Currently, there is a considerable amount of data available about positive effects of use of inhaled NO. Nitric oxide delivery into oxygenators of artificial and assisted blood circulation. However, there is a limited amount of publications on effects of NO delivery into gas circuit of oxygenators of artificial and assisted blood circulation. The objective of this article was to summarize currently available information about effects of NO delivery into extracorporeal circuits oxygenators through extensive literature review.