Authors group raises the issue of legal regulation of cardiopulmonary resuscitation in the Russian Federation. Domestic legislation lacks clarity in matters concerning the effectiveness criteria and time frames of the extended resuscitation measures. The current protocols for declaration of death are not applicable in ECMO (extracorporeal membrane oxygenation) conditions. Thus, there is a need to improve the legal regulation of issues of establishing a person’s death, including the development of a united protocol, containing precise criteria for TOR (Termination of Resuscitation) measures, regardless of the technologies used. All this effort would reduce the number of hopeless, prospectless evacuations to hospitals, as well as ensure legal protection for medical personnel.

The concept of brain death was introduced in the late 1960s and continues to develop. The article presents a brief history of the evolution of the idea of death by neurologic criteria. The concept is accepted worldwide, but there is still considerable variability in brain death determination protocols. New treatments for critical patients change the preconditions for brain death testing. The refinement of diagnostic techniques improves the capabilities of confirmatory tests. Controversial cases of determination of brain death cause public resonance and justified criticism of opponents of the concept. All these factors lead to review of some concept statements, terminology and update diagnostic protocols. In 2020, an international expert working group presented the minimum clinical standards for determination of brain death/death by neurologic criteria with guidance for various clinical circumstances. Some countries have already started to implement international recommendations and revise national diagnostic protocols. The extensive debate accompanying this process is an important contribution to the improvement of the concept of brain death.

Introduction. The marked increase in the resistance of infectious disease pathogens to antimicrobial drugs (AMDs), especially in intensive care units (ICUs), poses a threat to healthcare systems worldwide. This leads to adverse consequences: medical, social and economic. The objective was to evaluate the practice of AMDs using in the ICUs of Russian multidisciplinary hospitals based on its compliance with quality indicators.

Materials and Methods. Single-point survey of AMDs using was conducted in 37 ICUs of various types in 12 multidisciplinary hospitals in different cities of the Russian Federation (Krasnoyarsk, Moscow (4 centres), Omsk, Saratov, Smolensk (2 centres), Tomsk, Yakutsk and Yaroslavl). The study was conducted in accordance with the protocol of international Global-PPS project from September to December 2022. The object of the study was the medical records of patients who received systemic AMDs for preventive or curative purposes. The practice of AMDs using was studies as well as the assessment of the prescription compliance with the quality indicators.

Results. The survey included 501 patients of whom 314 (62.7%) received systemic AMDs. The frequency of AMDs prescription ranged from 24% in cardiac ICUs to 86.9% in surgical ICUs and reached 100% in paediatric departments. The vast majority of drugs were used for therapeutic purposes (74.3%–89.3%) and were prescribed for the treatment of nosocomial infections (71.6% on the average). Carbapenems (20.6%), third-generation cephalosporins (13.1%) and fluoroquinolones (11.6%) prevailed in the structure of prescriptions.

Conclusion. The following accuracies in AMDs using were identified during our study: low frequency of etiotropic therapy, inappropriate duration of perioperative antibiotic prophylaxis and relatively low frequency of planning the duration of therapy. These accuracies provide an opportunity to optimize the practice of using drugs of this group in ICUs of hospitals participating in the study.

The objective was to assess the significance of classical cardiopulmonary exercise testing (CPET) indicators to stratify the risks of cardiopulmonary complications after radical surgery for lung cancer.

Materials and methods. The study involved 185 patients with lung cancer aged (66 ± 9) years who have undergone surgery at the clinic of the Pavlov University in 2018–2023. The following indicators of the CPET included in the recommendations for predicting mortality and postoperative complications were determined and analyzed: metabolic equivalent of task (MET), oxygen consumption (V’O₂/kg, ml/min/kg, % of expected),

ventilatory equivalent for CO₂ (V’E/V’CO₂). Statistical analysis of the data was carried out: intergroup differences were assessed using the Student t-test, prognostic significance – the Mann–Whitney U-test, and the separating value – the Youden index.

Results. No dependence was found between the development of complications and the achieved MET values (p = 0.513), as well as V’O₂/kg (peak) (p = 0.688), V’O₂/kg (AT) (p = 0.707), V’O₂/kg (peak)% of expected (p = 0.617). Significant differences in V’E/V’CO₂ were found at the anaerobic threshold (AT) stage: the probability of complications in patients with V’E/V’CO₂(AT)≥ 32.649 was 3.221 times higher (95% CI: 1.304 – 4.571).

The sensitivity and specificity of the model for V’E/V’CO₂ were 69.8% and 60%, respectively. V’E/V’CO₂ is also informative at the free pedaling (FP) stage. The odds of cardiopulmonary complications were 3.286 times higher with V’E/V’CO₂ (FP) ≥ 37.874 (p > 0.001). V’E/V’CO₂ retains its significance after unloading at all stages of recovery (R1, R2, R3). In the risk group patients with V’E/V’CO₂ (B1) ≥ 34.274, complications developed in 37.3% (p > 0.001), with V’E/V’CO₂ (B2) ≥ 37.533 in 38.8% (p > 0.001), with V’E/V’CO₂ (B3) ≥ 38.508 in 32.6% of cases (p = 0.007).

Conclusions. Contrary to accepted recommendations for predicting mortality and cardiopulmonary complications after surgical interventions, the values of MET, as well as V’O₂/kg (peak) and V’O₂/kg (AT) were not informative for risk stratification in thoracic surgery. V’E/V’CO₂ in relation to cardiopulmonary complications is informative not only on AT, but also during free pedaling and recovery, which makes it available for assessing the functional reserves of comorbid patients with low exercise tolerance. 

Introduction. Body composition in cancer patients is changed by the developing of tumor, concomitant pathology and surgical intervention. Bioimpedance analysis (BIA) is a key method of analyzing the body composition. The study of the dynamics of the main indicators of bioimpedance and nutritional status can provide important information about the effectiveness of preoperative preparation, as well as contribute to a more personalized choice of nutritional support in the perioperative period.

The objective was to identify the main patterns of changes in body composition and nutritional status during preoperative nutritional support in patients with high surgical and anesthetic risk in abdominal oncosurgery.

Materials and Methods. An open, randomized, prospective, controlled study was conducted. 89 patients were included, divided into control and main groups, who were scheduled for surgery for malignant neoplasms of the upper gastrointestinal tract. The randomization was carried out using the resource www.randomizer.org and a randomization table for 120 people. In the control group, the preparation for surgery was carried out by «traditional» methods. In the main group, preoperative nutritional support included methods of enteral oral (sip feeding), enteral tube or parenteral nutrition. The dynamics of body weight, BIA parameters, serum total protein, albumin, transferrin, amount of peripheral blood lymphocytes were evaluated in all patients before and after surgery.

Results. Preoperative nutritional support led to a statistically significant increase in body mass index, as well as such BIA indicators as lean body mass, lean body mass index (p < 0.001), skeletal muscle mass, skeletal muscle mass index (p = 0.002), active cell mass, active cell mass index (p < 0.001) ), phase angle (p = 0.002). Both total and extracellular fluid increased (p = 0.001). Intergroup comparative analysis revealed a statistically significant higher level of total protein in the main group compared to the control on the 3rd and 5th day after surgery (p < 0.01). Serum albumin preoperatively, on the 3rd and 5th day of the postoperative period was statistically significant higher in the group of patients with preoperative nutritional preparation (p < 0,001). In the main group, a statistically significant decrease in the incidence of pneumonia in the postoperative period was obtained (p = 0.011).

Conclusion. Preoperative nutritional support in patients with high surgical and anesthesia risk in abdominal oncosurgery positively affects the main body composition indicators characterizing somatic protein pool and muscle tissue reserves. The obtained data fully correlate with the positive dynamics of the main laboratory markers of nutritional status, and are accompanied by a decrease in the incidence of postoperative complications.

Introduction. To date, we have an unsolved question about choosing the optimal drug for maintaining anesthesia during surgical interventions in children, suffering from severe forms of cerebral palsy, with the aim of preventively reducing the risks of developing perioperative adverse events.

The objective was to compare the incidence of perioperative adverse events in children with severe cerebral palsy using propofol or sevoflurane as a means of maintaining general anesthesia during orthopedic interventions on the hip joint.

Materials and methods. A prospective randomized comparative study included 170 patients with cerebral palsy, spastic hip dislocations, for which orthopedic interventions were performed. Depending on the drug used to maintain general anesthesia, the children were divided into two groups. In the first group, patients received propofol (CP-P), in the second – sevoflurane (CP-S). Hemodynamic parameters, time to tracheal extubation after the end of the operation, and the frequency of adverse events were assessed in the perioperative period.

Results. At the time of surgery, intergroup differences in hemodynamic parameters were recorded, while the time to tracheal extubation did not differ. Intraoperatively unstable hemodynamics was recorded in patients with CP-P in 8% (95% CI from 3.4% to 16.2%) of cases, in CP-C in 17% (95% CI from 12.1% to 30.1%) of cases (p = 0.07). Acute neurological and respiratory disorders were not detected (0%, 95% CI from 0% to 3.4%). Biochemical blood tests of patients in the groups differed in the level of aspartate aminotransferase, gamma-glutamyl transferase, and total bilirubin.

Conclusions. Propofol and sevoflurane as agents for maintenance of general anesthesia in children with severe cerebral palsy cause adverse perioperative events with equal frequency during orthopedic hip interventions and have the same safety profile.

Introduction. The problem of endothelioprotection is currently highly relevant for critical care medicine. The effect of diabetic ketoacidosis on the state of endothelial glycocalyx has not been sufficiently studied. The effectiveness of infusion therapy in the treatment of diabetic ketoacidosis is determined by the functional state of the endothelium.

The objective was to evaluate the effectiveness of meglumine sodium succinate used in the infusion therapy of diabetic ketoacidosis for correction of endothelial glycocalyx dysfunction Materials and methods. The prospective study included 50 patients with diabetic ketoacidosis, divided into 2 groups – the first, where 0.9% sodium chloride was used as an infusion solution, the second, where meglumine sodium succinate (Reamberin) was added to the infusion program at a daily dose of 10 ml /kg. Two control groups were also examined: 20 healthy volunteers and 20 people with diabetes mellitus without a history of critical complications. Their randomization was carried out using the blind envelope method. We studied the levels of syndecan-1 in blood plasma and the albumin-creatinine ratio of urine (hereinafter referred to as ACR) at baseline in all groups, as well as in the study groups (№ 1 and № 2) during intensive care.

Results. Syndecan-1 and ACR levels were lowest in the group of healthy volunteers. In the group of people with diabetes mellitus without critical complications, the level of these markers was statistically significant higher than in healthy volunteers. The highest values of syndecan-1 and ACR markers were in the groups of patients with diabetic ketoacidosis, and at the initial time point, they were representative of each other in both groups. During the study, it was revealed that in the group with the inclusion of Reamberin (group No. 2), the levels of syndecan-1 and ACR were lower in dynamics than in the group using 0.9% sodium chloride exclusively (group No. 1). The maximum difference was reached by 48 hours of intensive care and was 19.3% for syndecan-1 and 17.5% for ACR.

Conclusion. The use of polyionic crystalloid solution Reamberin as part of infusion therapy has a positive effect on the state of glycocalyx during intensive care, which reduces the severity of capillary leakage syndrome.

Introduction. Systemic immune-inflammatory diseases can affect many systems and organs and have an extremely severe course with complications, causing multiple organ failure and death. Often, children with such diseases require hospitalization in the intensive care unit (ICU). For example, approximately 50% of patients with multisystem inflammatory syndrome, associated with COVID-19 in children (MIS-C) and systemic lupus erythematosus require hospitalization in the ICU.

The objective was to determine risk factors for lethal outcome in children with immune-inflammatory diseases hospitalized in the ICU.

Materials and methods. The retrospective cohort study included 51 patients (23 boys, 28 girls) with immune-inflammatory diseases such as MIS-C (n = 18), systemic rheumatic diseases (n = 24), and sepsis (n = 9) aged 7 months to 17 years, hospitalized in the ICU of the Clinical Hospital of St. Petersburg State Pediatric Medical University in the period from 2007 to 2023.

Results. 13 patients (25.5%) died 39 (17; 62) days after admission to the ICU. Patients with a lethal outcome were significantly older and were admitted to the ICU later than surviving patients (30 vs. 7 days, p = 0.013), and also spent a longer time in the ICU (30 vs. 6 days, p = 0.003). Lethal outcome was more common in older children (> 162 months) who were admitted to the ICU later (> 26 days from the disease onset/diagnosis), who received previous immunosuppressive therapy, developed invasive mycosis during their stay in the ICU and were in the ICU for a long time (> 15 days). Multiple regression analysis revealed three significant predictors of lethal outcome: age > 162 months, time of admission to the ICU > 26 days from diagnosis, and ICU stay > 15 days (r2 = 0.458, p < 0.00001).

Conclusion. Early identification of patients at high risk of adverse outcome is a primary goal for optimization of therapy. Careful monitoring of immunosuppressive therapy and prevention of invasive mycosis can improve the outcome in children with systemic immune-mediated diseases.

Introduction. One of the complications after Cesarean Section is nausea and vomiting, especially during spinal anesthesia. The main causes of nausea and vomiting are complex, and may be related to surgical intervention, decrease in blood pressure, vagal excitation, and oxytocin administration.

The objective was to compare and estimate the efficacy of intravenous injections of ondansetron, pyridoxine and metoclopramide in inhibiting emesis prophylactically in patients undergoing cesarean section under spinal anesthesia.

Materials and methods. This study included 100 pregnant females in the last term without significant concomitant pathology of ASA grades I and II. Patients were randomly allocated into three drug groups and a control group. Each group consisted of 25 patients: the ondansetron group (4 mg intravenously), the metoclopramide group (10 mg intravenously), the pyridoxine group (100 mg intravenously), and the placebo group or the control group (normal saline - 2 ml intravenously). During the study, nausea and vomiting occurred during and after surgery, in addition to any additional adverse effects. Statistical software (SPSS 20.0) was used for statistical data analysis.

Results. The incidence of intra- and postoperative nausea and vomiting was higher in the placebo group (40% and 32%) compared with the ondansetron group (4% and 8%), the metoclopramide group (8% and 16%), and the pyridoxine group (20% and 24%). Signs of gastrointestinal disorders were more pronounced in the pyridoxine group compared with the metoclopramide and ondansetron groups. The incidence of nausea and vomiting after surgery was high in the placebo group and statistically significant compared with the ondansetron group (p = 0.0232), there was no statistically significant difference with the metoclopramide and ondansetron groups.

Conclusion. According to the results of the study, ondansetron and metoclopramide were more effective in reducing nausea and vomiting than pyridoxine and placebo. Ondansetron was significantly more effective for prevention of both intra- and postoperative nausea and vomiting.

The objective was to evaluate the utero-placental blood flow using the method of tissue oximetry, the effectiveness of pain syndrome relief and the influence on the condition of the woman in labor through the natural childbirth when using epidural anesthesia (EA), combined spinal-epidural anesthesia (CSEA) and dural puncture epidural anesthesia (DPEA).

Materials and methods. A prospective study involving 240 patients during emergency deliveries was conducted at the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology of the Ministry of Health of Russia. Anesthesia of childbirth was carried out by epidural method (N = 60), combined spinal-epidural (CSEA, N = 60) and DPE technique (N = 60), the control group consisted of female patients with no pain relief (N = 60). On 1, 3, 5, 7, 10, 15, 25, 30, 60, 90 and 120th minutes, data from near-infrared spectroscopy (NIRS), pain on VAS, BP, RR, and blood oxygen saturation were assessed.

Results. We have not seen NIRS decrease below 89% for either EA or CSEA. All three methods (EA, CSEA, DPE) provided effective, fast-onset and long-term anesthesia to the childbirth, manifested by statistically significant reduction of the severity of pain syndrome on VAS from 8 points to 1–3 points. The fastest analgesic effect was observed in the CSEA group (1–3 min), then in the DPE group (3–10 min) and in the EA group (7–15 min). Reduction of pain severity was more significant in DPE (up to 1–2 points on VAS) compared to EA. The reduction of pain syndrome in CSEA was more stable and lasting than in EA. The used anesthesia methods have a high favorable safety profile, as BP, HR and RR, as well as oximetry and blood oxygen saturation during the entire observation period were within normal values.

Conclusions. DPE and CSEA, along with traditional EA, provide a favorable risk-benefit ratio due to the minimal effect on uterine placental blood flow, rapid onset of anesthesia, early bilateral sacral analgesia with low maternal side effects.

Introduction. Endogenous heparin-like syndrome (HLS) in obstetrics is a rare complication characterized by the manifestation of the effect of heparin in the absence of its exogenous administration due to an increase in the concentration of glycosaminoglycans (GAG). Obstetric patients with HLS are at risk for the development of hemorrhagic complications in the perioperative period. The heterogeneity of the structure and anticoagulant activity of GAG complicates the laboratory diagnosis and therapy of HLS.

The objective was to conduct a retrospective analysis of clinical observations of endogenous heparin-like syndrome in patients from an obstetric hospital and literature data on the diagnosis and therapy of hemorrhagic syndrome associated with HLS.

Materials and methods. The retrospective analysis included 6 obstetric female patients treated on the basis of the Academician V. I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, with laboratory signs of endogenous heparin-like syndrome (HLS).

Results. Laboratory signs of HLS were detected in women after uterotomy, 5 had additional risk factors (thrombotic microangiopathy (TMA), placental abruption, preeclampsia, surgical correction of fetal spina bifida. The use of thromboelastometry, namely HEPTEM, made it possible to identify HLS. The bleeding was stopped after the administration of antifibrinolytic in observations № 2–5, however, the bleeding recurred in the woman in observation № 6 because non-specific therapy did not fully normalize thrombin generation, which was reduced under the influence of GAG.

Conclusion. A clinically significant increase of endogenous GAG in the blood is a complex process. Female patients have high risk of bleeding associated with HLS need to laboratory monitoring of the hemostasis system in the perioperative period. Different laboratory methods, especially, tests with heparinase should be used to increase the probability of detecting HLS. TEM parameters allow for reasonable hemostatic therapy.

Introduction. Regional anesthesia is an important component of adequate analgesia in colorectal surgery. Currently, epidural analgesia (EA) is considered the «gold standard» of regional anesthesia in colorectal surgery. EA has a number of contraindications and complications that limit its use in anesthesiological practice. The article presents possible alternatives to EA that could be used as part of multimodal analgesia in colorectal surgery. The key role is assigned to fascial-sheath blocks: TAP block and QL block.

The objective was to analyze the literature on the use of epidural anesthesia, TAP block, and QL block in colorectal surgery.

Materials and methods. The literature was searched using PubMed, MEDLINE, Google Scholar, and eLibrary databases for the period 2008–2024. The keywords for the search were: Regional anesthesia, colorectal surgery, epidural anesthesia, TAP-block, QL-block, regional anesthesia, colorectal surgery, epidural anesthesia, TAP block, QL block.

Results. 44 articles published from 2008 to 2024 were analyzed. The predominant number of articles (39) are presented by foreign sources, which indicates a low degree of study of the problem among domestic researchers.

Conclusions. EA is traditionally considered the «gold standard» of regional anesthesia in colorectal surgery. It is impractical to recommend the TAP block and the QL block as an equivalent replacement for EA. It is necessary to conduct new, larger-scale studies reflecting the effectiveness of fascial-sheath blocks in colorectal surgery.

Introduction. Methods for correcting perioperative blood loss and hemostasis disorders in children during liver transplantation are still controversial and are largely conducted empirically by specialists. Additional difficulties are imposed by the features of a continuously growing and developing organism, as well as the following hemostasis system.

The objective was to analyze modern approaches to the correction of hemostasis disorders in children in the perioperative period of liver transplantation.

Materials and methods. The analysis of literary sources indexed for the period from 2000 to 2024 in the databases PubMed, Google Scholar, Cochrane MEDLINE and E-Library (for Russian authors).

Results. The analysis of the literature has shown that at present, in liver transplantation in children, a personalized approach prevails in choosing the tactics of infusion – transfusion therapy and correction of developing changes in the hemostasis system. Modern approaches are aimed at the fastest possible identification of specific perioperative disorders of pro- and anticoagulant factors directly «at the patient’s bedside» and targeted correction of each specific element.

Conclusion. Despite the active development and improvement of approaches to correcting perioperative hemostasis disorders during liver transplantation, improving pharmacotherapy protocols, minimizing the time to obtain laboratory data and reducing the influence of the human factor on the interpretation of results and treatment choice, the study of the hemostasis system and correction of its disorders is still very far from the final stage.

Introduction. Occupational stress is one of the most common causes of cardiovascular catastrophe among emergency response personnel.

The objective was to analyze the literature sources on assessing the level of stress and its impact on health indicators in medical staff of anesthesiology and intensive care units.

Materials and methods. The analysis included 70 publications from the PubMed and e-library abstract databases for the period from 2017 to 2023. The search was carried out using keywords: professional burnout syndrome, stress, personality, anesthesiologist-resuscitator, intensive care unit, heart rate variability, provider burnout syndrome, stress, personality, anesthesiologist, intensive care physician, intensive care unit, heart rhythm variability. After a primary examination of abstracts, 20 articles were excluded from the review as there was a lack of access to the full text or they were devoted to organizational prevention activities

Results. It has been demonstrated that a long working day for more than 10 years is associated with an increase in the likelihood of developing coronary heart disease (CHD), especially among men. A linear increase in the risk of recurrent CHD attacks was established in a working time of more than 40 hours a week for four years after a myocardial infarction. It was revealed that severe occupational stress was associated with a decrease in HRV due to parasympathetic influences. In resident anesthesiologists, the maximum inhibition of heart rhythm variability was noted at the stage of induction of anesthesia and on the eve of night watch.

Conclusion. A long-term increase in sympathetic activity of the autonomic nervous system and suppression of parasympathetic impulses indicate a high probability of developing cardiovascular diseases associated with the level of occupational stress.

Strains of microorganisms characterized by resistance to antimicrobial drugs used in medical organizations continue to spread in most regions of the world, including Russia. This naturally affects both the effectiveness of antimicrobial therapy and the tactics of its use not only in adults but also in children. The coronavirus pandemic has highlighted the growing problems with the treatment of invasive mycoses, the selection of dosage of antibacterial agents when using sorption and dialysis therapy methods. In combination with the registration of new antibacterial drugs ABSTRACT in Russia, this necessitated the need to make adjustments to the Methodological recommendations “Diagnostics and Antimicrobial Therapy of Infections Caused by Polyresistant Strains of Microorganisms” (2nd edition), prepared by a group of leading Russian experts in 2022 [1]. The presented version was approved in December 2024 at a joint meeting of representatives of public organizations: the Russian Association of Anesthesiologists-Intensivists, the Interregional public organization “Alliance of Clinical Chemotherapists and Microbiologists”, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), the public organization “Russian Sepsis Forum”. These recommendations reflect the interdisciplinary consensus opinion on approaches to the diagnosis and antimicrobial therapy of infections caused by polyresistant microorganisms.