Introduction. Sepsis remains one of the leading causes of mortality in intensive care units (ICU). Assessing the risk of fatal outcomes is crucial for clinical decision-making and improving treatment outcomes.

The objective was to determine the prognostic significance of clinical scales assessed in dynamics for predicting mortality in septic ICU patients who are predominantly in prolonged and chronic critical illness.

Materials and methods. A single-center retrospective study was conducted using data from the RICD v2.0 database. The prognostic significance of the APACHE II, NUTRIC, SOFA scales, SIRS criteria, and PNI index was assessed dynamically, with focus on time to the fatal outcome. Sepsis was diagnosed using Sepsis-3 criteria. The primary endpoint was the area under the ROC curve (AUROC).

Results. The study included 52 sepsis patients (33 men, median age was 60 years old, median ICU stay was 57 days, mortality rate was 11.5%). The highest prognostic effectiveness was found for the APACHE II and NUTRIC scales when assessed 1–14 days before the fatal outcome (AUROC 0.91 and 0.90, respectively). For assessments conducted ≥ 15 days before the fatal outcome, prognostic significance was maintained only for the NUTRIC scale (≥ 6 points, AUROC 0.82). Both APACHE II and NUTRIC scales demonstrated high negative predictive value, allowing effective identification of patients with low mortality risk.

Conclusions. Dynamic assessment of the APACHE II and NUTRIC scales is important for predicting mortality in sepsis patients with prolonged ICU stays. The NUTRIC scale retains its prognostic value when assessed ≥ 15 days before the fatal outcome, confirming its role in long-term monitoring of septic patients.

Introduction. The use of extracorporeal blood purification (EBP) in septic shock (SS) complicated by acute kidney injury (AKI) remains a con troversial topic.

The objective was to evaluate the effectiveness of EBP methods in patients with abdominal SS complicated by AKI.

Materials and methods. Group 1 included 34 patients who received continuous veno-venous hemodiafiltration (CVVHDF) as emergency therapy. Group 2 consisted of 35 patients who underwent early isolated CVVHDF. Group 3 comprised 32 patients who received early combined EBP (selec tive plasma filtration + CVVHDF).

Results. Combined EBP from day 1 to day 5 of therapy demonstrated a reduction in C-reactive protein from 223.5 to 140.9 mg/L (p = 0.001; −37.1%) compared to group 2 (219.7 to 179.2 mg/L; p = 0.004; −18.4%) and group 1 (214.5 to 189.3 mg/L; p = 0.772; −11.7%), as well as a decrease in interleukin-6 from 242.8 to 70.3 pg/mL (p = 0.001; −71.1%) vs. group 2 (233.7 to 123.4 pg/mL; p = 0.003; −47.2%) and group 1 (247.4 to 184.3 pg/mL; p = 0.512; −25.5%). Tumor necrosis factor levels decreased from 20.1 to 4.6 pg/mL (p = 0.001; −77.1%) in group 3, while group 2 showed a reduction from 19.4 to 11.9 pg/mL (p = 0.001; −38.7%) and group 1 exhibited minimal change (21.4 to 20.5 pg/mL; p = 0.525; −4.2%). Cystatin-C levels in group 3 decreased from 1.45 to 0.85 µg/mL (p = 0.048; −41.4%), whereas group 2 showed a slight reduction (1.6 to 1.5 µg/mL; p = 0.997; −6.3%) and group 1 demonstrated an increase (1.5 to 1.9 µg/mL; p = 0.027; +22.7%).

Conclusions. Combined EBP significantly reduces inflammatory markers and improves kidney function compared to isolated renal replacement therapy, both in the early and delayed periods.

Introduction. Multiple studies were shown significant role of cell-free DNA (cfDNA) as a marker and mediator of the septic process. Excessive formation of cfDNA is associated with adverse clinical events, which allows to consider this structure as a potential target for therapy.

The objective was to study the level of cell-free DNA in patients with septic shock, to evaluate the correlation of the cfDNA level with clinical and laboratory data of patients, and the incidence of acute kidney injury and mortality.

Materials and methods. The prospective single-center observational pilot study included 52 patients over 18 years old with septic shock (Sepsis-3 criteria) admitted to the intensive care unit of the Moscow City Clinical Hospital named after S. S. Yudin of the Health Department of Moscow from August 2023 to May 2024.

Results. The final number of patients included in the study was n = 52 (64% of men and 36% of women) aged 52.1 ± 17.3 years, with a severity score according to SOFA 10 ± 4 and Apache II 22 ± 7 points, respectively. The concentration of cfDNA was 3041 (876–7815.0) ng/ml. Correlation analysis revealed associations of various directions with clinical and laboratory data, the most significant was a moderately positive correlation with the level of lactate (r_xy = 0.49, p < 0.0001) and creatinine (r_xy = 0.42, p < 0.002). ROC curve analysis showed an association between the level of cfDNA and 28-day mortality (area under the curve 0.69, AUC 95% confidence interval (CI) (0.54–0.84), p = 0.031; cut off level – 1893 ng/ml; sensitivity – 72.2% and specificity – 62.5%).

Conclusion. The study found that cfDNA had diagnostic value in septic shock, and the level of cfDNA correlated with clinical diagnostic data and significant clinical events in patients with septic shock.

Introduction. Infectious complications in spine surgery occur in 0.6–17.6% of cases and are associated with high treatment costs. Perioperative antibiotic prophylaxis is considered to be an effective preventive measure. However, there are no clear recommendations for its use in children, including the optimal duration of antibiotic administration. This study presents a retrospective analysis of the impact of different perioperative antibiotic prophylaxis regimens on infection rates and the length of hospitalization.

The objective was to evaluate the effectiveness of different perioperative antibiotic prophylaxis regimens in pediatric patients undergoing spinal surgery.

Materials and methods. A retrospective study was conducted involving 319 children (aged 1–18 years) who underwent elective spine surgeries at the H.Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery. The patients were divided into two groups: the main group (perioperative prophylaxis ≥ 72 hours, n = 205) and the control group (perioperative prophylaxis ≤ 48 hours, n = 114). Antibiotics were administered intravenously 30–60 minutes before skin incision in all cases. The effectiveness of perioperative antibiotic prophylaxis was assessed based on clinical and laboratory data and local signs of infection at the surgical site.

Results. The average length of hospitalization was shorter in the short-protocol perioperative antibiotic prophylaxis group (21.29 days vs. 25.22 days, p = 0.00005). Local inflammatory changes were not observed in the short-protocol group, whereas 13 cases were recorded in the prolonged-protocol group (p = 0.0053). The results suggest the effectiveness of the short protocol of perioperative antibiotic prophylaxis.

Conclusion. Surgical site infection is a common and serious complication after spinal surgery in children. Adequate perioperative antibiotic prophylaxis plays a crucial role in reducing the risks of infectious complications. However, clear guidelines accounting for the anatomical and physiological characteristics of pediatric patients are lacking. Therefore, further studies are needed to develop a unified concept, which will significantly reduce the incidence of surgical site infections.

The objective was to assess the level of knowledge about the problem of sepsis, as well as attitude and practice regarding antibiotic use among medical university students.

Materials and methods. A questionnaire based on the “Knowledge, Attitudes, and Practices” (KAP) model was developed, with a Cronbach’s alpha coefficient of 0.741 (indicating acceptable internal consistency). A cross-sectional anonymous survey was conducted among medical university students across different academic years. The data was collected using an online form.

Results. The study included 170 respondents, of whom 52 (69.4%) were males and 118 (30.6%) – females, with a median age of 20 [19; 22] years. Among the participants, 22 (13.0%) had secondary medical education. The most common sources of information on sepsis and antibiotic resistance among the respondents were university academic courses and online resources. The mean scores on the scale of assessment of respondents’ knowledge about sepsis and antibiotic resistance was 0.71 ± 0.46, on the scale of assessment of the level of attitude to the problem – 0.73 ± 0.45, on the scale of assessment of the level of practice – 0.70 ± 0.46. Correlation analysis revealed a weak positive association between knowledge and practice (r = 0.21). When comparing senior and junior students, significantly higher scores were observed only in the “Knowledge” domain.

Conclusion. Despite self-reported adherence to rational antibiotic use, the study identified systemic gaps in students’ knowledge about sepsis and antimicrobial therapy. A discrepancy was observed between high self-assessed competence and objectively low knowledge levels. Contradictions in the assessment of antibiotic prescribing practices and the level of knowledge on the problem underscore the need to plan educational events aligned with current clinical guidelines.

The objective was to determine the diagnostic relevance of a number of markers of endothelial dysfunction as early predictors of acute severe pancreatitis.

Materials and methods. 55 patients with acute pancreatitis were examined, which, depending on the severity of the disease, were divided into 2 groups: 1 group – 37 patients with a severe course of acute pancreatitis, 2 group – 18 patients with a less severe course of the disease. Endothelial dysfunction markers (vascular endothelial growth factor, syndecan-1 and intercellular adhesion molecules) and their dynamics within 14 days were analyzed.

Results. Critically ill patients with severe acute pancreatitis at all stages of the study, starting from the moment of hospitalization, are distinguished by high levels of vascular endothelial growth factor and their further growth (from 464.55 (291.78; 867.21) to 927.91 (243.36; 4958.56) pg/ml), as well as persistently high levels of syndecan-1 (5.13 (1.16; 9.82) – 5.71 (2.90; 23.94) ng/ml). During 5 days of hospitalization, the high level of intercellular adhesion molecules remained (62.19 (51.39; 87.96) – 71.54 (48.42; 91.86) ng/ml) with a further decrease by 10 days to 56.75 (46.44; 74.11) ng/ml. The mortality rate in patients with acute severe pancreatitis was 43.0%.

Conclusion. High levels of vascular endothelial growth factor, intercellular adhesion molecules and syndecan-1 at the time of hospitalization are early predictors of a severe course of acute pancreatitis and an unfavorable outcome of the disease. The severe course of the disease is accompanied by a further increase in the level of vascular endothelial growth factor, a consistently high level of syndecan-1 and a decrease in the level of inter cellular adhesion molecules.

Introduction. A comprehensive airway assessment requires an understanding of the anatomical features of the neck and upper airway. Accurately predicting a potentially difficult airway is a multifactorial challenge, dependent on patient-related factors, clinical context, and the anesthesiologist’s proficiency. Failure to anticipate a difficult airway remains a common cause of anesthesia-related complications.

The objective was to evaluate the relationship between the neck circumference to thyromental distance ratio (NC/TMD) and the incidence of difficult intubation in adult patients scheduled for elective surgeries under general anesthesia.

Materials and method. This study included 100 patients undergoing elective surgeries under general anesthesia with endotracheal intubation of ASA grades I and II. Patients were examined preoperatively and intraoperatively. Data collection using the patient proforma which includes the demographic data, body mass index (BMI), NC/TMD ratio, thyromental distance (TMD), and Modified Mallampati Test (MMT). Statistical software (SPSS 20.0) was used for statistical analyses of the data.

Results. In cases of difficult intubation, TMD was significantly lower (mean = 6.07 cm, SD = 0.892) than in its absence (7.31 cm, SD = 0.877, P = 0.02994). The values of the ratio between neck circumference and TMD in individuals without difficult intubation were lower: 4.78 (SD = 0.466) versus 5.71; SD = 0.183 (P < 0.001).

Conclusion. The NC/TMD ratio is a simple, effective, and non-invasive predictor of difficult intubation. It demonstrates superior sensitivity and specificity compared to NC and MMT. Routine incorporation of this measurement in preoperative airway assessment could improve the safety of anesthesia.

Introduction. The leading positions in terms of pain intensity in the postoperative period are occupied by operations in the scope of hysterectomy and myomectomy. The psychological component plays an important role in the formation of postoperative pain.

The objective was to conduct a comparative analysis of the effectiveness of methods of perioperative anesthesia during operations on the uterus with laparotomy access, taking into account the psychoemotional status of patients.

Materials and methods. The study included 50 patients who underwent scheduled hysterectomy from laparotomy access. Depending on the method of perioperative anesthesia, the patients were divided into two groups: group 1 (n = 25) – combined spinal–epidural anesthesia; group 2 (n = 25) – spinal anesthesia with prolonged local anesthesia of the postoperative wound. On the eve of the operation, the level of anxiety and depression, pain catastrophization, and the level of alexithymia were assessed. In the postoperative period, the pain level was assessed according to a digital rating scale: at the time of the first activation, 24 and 48 hours after surgery, and at discharge. The activation time, the need for additional anesthesia, and satisfaction with the received anesthesia were analyzed.

Results. Pain syndrome was significantly higher in the 2nd group – 3 [2; 4] points at rest (p = 0.019) and 4 [3; 5] points during movement (p = 0.04), on the 1st day after surgery. In the 2nd group, more intense pain at the time of the first activation was 5 [3; 5] points (p = 0.001). Patients with identified anxiety/ depression have an increased need for local anesthetics. The preoperative pain catastrophization level of more than 19 points was accompanied by a more pronounced pain syndrome, regardless of the method of anesthesia. Patients who scored ≥ 55 points on the oronto Alexithymia Scale had a higher need for narcotic analgesics.

Conclusion. Combined spinal-epidural anesthesia is more effective in patients with signs of anxiety/depression and alexithymia. Clinically pronounced anxiety and depression according to HADS ≥ 8 points, a score according to PCS ≥ 19 points, as well as a score according to TAS-26 ≥ 55 points make it possible to identify a group at increased risk for the development of uncontrolled pain syndrome and low satisfaction with postoperative anesthesia.

Introduction. The increase in citizens’ complaints about the provision of medical care of inadequate quality, associated with the delayed transfer of patients from/to the ICU, necessitates monitoring of actual legal practice.

The objective was to analyze materials of judicial practice – decisions of the courts of first instance, verdicts, appellate and cassation rulings, etc., in the text of which there was an indication of the delayed transfer of patients from/to the ICU.

Materials and methods. Of 2103 materials of judicial practice from June 2013 to January 2025, the study included 43 court decisions, in the text of which there was an indication of the delayed transfer of patients from/to the ICU. Statistical processing was performed in Microsoft Excel and Jamovi (version 2.3.28).

Results. The study included 35 court decisions that had been adopted based on the results of civil cases; the texts of 5 court decisions issued based on the results of civil cases substantiated information on the initiation of criminal cases on the same factual circumstances; 3 judicial act were made based on the results of criminal cases. The number of court orders containing information about delayed transfer of patients from/to the ICU increased by two every three years. The defendants were 44 medical organizations in 33 subjects of the Russian Federation. In civil cases, city and district hospitals were more likely to be defendants and co-defendants than university clinics and regional hospitals. A more common cause of deficiencies/defects in the provision of inadequate quality medical care in criminal cases was insufficient qualifications of employees compared to civil cases. In criminal cases, the defendants were mainly anesthesiologists and pediatricians, and the victim of the crime was a child under 18 years of age. Nine doctors were convicted, six of whom were serving sentences, three of them anesthesiologists. The actions of anesthesiologists were qualified under Articles 109, 293 and 238 of the Criminal Code of the Russian Federation.

Conclusion. An increase in the number of court orders related to the delayed transfer of patients from/to the ICU was revealed. City and district hospitals were mainly involved as defendants and co-defendants in civil cases, while the subjects of criminal liability were anesthesiologists and pediatricians.

The objective was to demonstrate the potential of indirect calorimetry in the comprehensive assessment of cardiopulmonary oxygen transport dynamics during peripheral venoarterial extracorporeal membrane oxygenation (VAECMO) in a patient with severe heart failure following emergency cardiac surgery.

Conclusion. The comprehensive evaluation of cardiopulmonary oxygen transport using indirect calorimetry provides valuable information, broadening the diagnostic capabilities for metabolic disturbances in low cardiac output syndrome. This approach allows for effective management of pharmacological therapy and mechanical support of the compromised heart.

Introduction. Amniotic fluid embolism (AFE) is a rare but life-threatening complication of childbirth, characterized by the sudden development of arterial hypotension, hypoxia, shock and coagulopathic disorders. AFE is one of the most formidable and unpredictable complications of childbirth, accompanied by high mortality. Despite its rarity (1:8,000–1:80,000 births), AFE remains the leading cause of maternal mortality. Pathogenesis is associated with the entry of amniotic fluid into the maternal bloodstream, which leads to cardiopulmonary shock, DIC syndrome and multiple organ failure. Diagnosis of AFE is difficult due to its lightning-fast development and the lack of specific markers. Treatment requires immediate multidisciplinary intervention, including resuscitation, surgical hemostasis and correction of coagulopathy.

This article presents a case of a 34-year-old patient with risk factors (polyhydramnios, uterine scar, previous operative deliveries), who developed a clinical picture of EAF with multiple circulatory arrests, massive blood loss and multiple organ failure after an emergency cesarean section. The measures taken included cardiopulmonary resuscitation (CPR), surgery (ligation of uterine vessels, extirpation of the uterus, relaparotomy) and supportive therapy (plasmapheresis in the plasma exchange mode, ultrahemodiafiltration). Thanks to a timely multidisciplinary approach, a favorable outcome without neurological deficit was achieved.

Conclusion. This case demonstrates that with early diagnosis, surgical and complex treatment with dynamic laboratory monitoring, it is possible to achieve a favorable outcome even in severe EAF.

Aesthetic plastic surgery is an actively developing branch of medicine, in which operations are accompanied by a pain syndrome that requires, in accordance with modern concepts, a multimodal approach to anesthesia. An important role in the multimodal approach is played by regional, ULTRASOUND-associated anesthesia methods, which contribute not only to reducing intraoperative opioid load, but also to reducing pain in the postoperative period. This article describes a clinical case of the use of a TAP block and an extended ESP block in a patient with remission of opioid dependence who underwent simultaneous surgical intervention in the form of abdominoplasty, breast tightening and enlargement. Narcotic analgesics were not used during anesthesia, as well as throughout the entire postoperative period. The use of the ESP block helps to reduce pain in the intraoperative and postoperative period.

Introduction. New aggregated hemacytometric indices of the ratio of neutrophils, lymphocytes, platelets, monocytes, Creactive protein, albumin can be promising markers of the objective state and dynamics of critical conditions in cardiology, oncology, infectious pathology and intensive care.

The objective was to compare methods for calculating new composite hemacytometric indices and discussion of the conditions of their use and effectiveness in intensive care.

Materials and methods. A literature search was conducted using PubMed, Medline, and Google Scholar databases in the period 2020–2024. The search includes publications indexed in Scopus.

Results. Combined indicators characterizing the status of inflammation, immunity, nutrition during intensive care are more accurate in comparison with traditional single hematological and biochemical parameters. However, the diagnostic value of these indicators is still variable, and little has been studied in intensive care.

Conclusion. It is obvious that the use of hemacytometric, combined (composite) indices in various fields of clinical medicine is an objectively new step in the interpretation of laboratory parameters.

Introduction. Brain injuries of various etiologies are characterized by a high incidence of disability and mortality. For many years the medical community has been searching for evidence based neuroprotective agents. Drugs from a wide range of pharmacological groups with different mechanisms of action and applications are claimed. Neuroprotective drugs are actively studied in both preclinical and clinical trials.

Materials and methods. The search for publications over the last 5 years (2020–2024) was conducted in databases elibrary.ru, PubMed, Google Scholar. Keywords: neuroprotection, inert gases, argon, krypton, xenon, melatonin, metformin, dexmedetomidine, succinates, succinic acid. A total of 50 publications, of which 25 were preclinical studies (animals, cell cultures), 15 were clinical studies, 10 were reviews.

Conclusion. According to research conducted by scientists from different countries, the results of the effectiveness of many preclinical studies have been demonstrated, some of which could not be brought «from bench to bedside». For all methods, it is recommended to perform clinical trials and large randomized controlled trials to confirm their place in evidence-based medicine.

Introduction. Monitoring of external respiration after general anesthesia is of interest for predicting complications associated specifically with delayed recovery of components of external respiration due to the residual effect of drugs. The problem of choosing optimal monitoring methods to reduce risks in the postoperative period has not yet been solved.

The objective was to analyze the literature on the topic of methods for studying the state of components of external respiration during tracheal extubation.

Materials and methods. New sources of literature on the PubMed (MEDLINE), eLibrary, Google Scholar database in the period from 1971 to 2024.

Results. An analysis of the literature has shown that today, there are many methods for monitoring the state of respiratory components after general anesthesia, but not in all cases their prognostic assessment of the risk of complications is high. Instrumental methods have proven to be more objective than clinical ones. Measurement of the occlusive pressure of the respiratory tract, ultrasound examinations of the muscle tone of the diaphragm, accelerometric methods for assessing the restoration of neuromuscular tone give specialists an idea of the state of the links of external respiration and have high specificity and sensitivity.

Conclusion. The combination of different methods that evaluate the work of several components of the respiratory system makes it possible to exclude the residual effect of drugs acting in isolation on different components of the respiratory system, thereby preventing the risk of complications after tracheal extubation.