Lactate and glucose of the venous blood were continuously monitored using the Eirus system for intravascular microdialysis with 20 patients operated for complex non-heritable valvular heart disease and ischemic heart disease. The lactate and glucose concentrations, measured by microdialysis techniques, were correlated to the values of arterial blood (rho = 0.917, p < 0.0001 for lactate and rho = 0.693, p < 0.0001 for glucose, respectively). According to the Bland-Altman test results the mean difference between the values measured with Eirus system and that in arterial blood gases made 0.09 ± 1.1 mmol/L for lactate and -0.1 ± 4.65 mmol/L (M ± 1.96 SD) for glucose, correspondingly. Thus, the technique of intravascular microdialysis allows with acceptable accuracy continuous monitoring of lactate and glucose concentrations in median vein under combined high-risk cardiac surgery and timely diagnostics of the values variation in the perioperative period.

Anesthetic management in extirpation of the esophagus with simultaneous plastic reconstruction has a direct control over the response to the treatment. Anesthesiologists are to be involved into all stages of treatment, starting from out-patient care. A team approach to treatment and development and introduction of the perioperative management protocol are required to achieve the best outcome. Multidisciplinary approach reduces the frequency of complications and time required for the follow-up post-surgical care.

Hysterectomy is an extensive surgical intervention, which is accompanied by heavy post surgical pain syndrome. Despite mainstreaming of the combined anaesthesis concept, which implies the simultaneous prescription of several analgesics with different mechanisms of action, frequently the quality of postoperative anesthesia continues to be unacceptable. Another option of the problem solution is to introduce the additional regional anesthesia practices, in particular the nerve block anesthesia in the transversus abdominis plane. This study allowed concluding that the block anesthesia of transversus abdominis plane block before hysterectomy does not result in significant reduction of postsurgical pain syndrome and morphine consumption during the first day after surgery, while significantly increases time of the first demand for morphine and helps reducing the dermic hyperalgesia area postoperatively.

Analysis of  four pharmacoeconomic replacement models for  midazolam, propofol and  phentanyl with dexmedetomidine for sedation in resuscitation and intensive care unit (RICU) shows increase of the annual costs (at current prices) by 14-28 million rubles (at prices of the reference country – by 9-23 million rubles). The calculation of the RICU stay cost in the rates of the health care providers rather than in that of the Compulsory Health Insurance (CHI) effects a saving of up to 1 billion rubles at current prices and up to 3.5 billion rubles at prices of the reference country.

Cardiovascular disease continues to be the major mortality cause worldwide. In recent years there increasingly frequently published the controversial reports on adverse effects of hyperglycemia on the course and outcome of various acute conditions. However, many researchers consider developing hyperglycemia metabolic disorders as an additional risk factor for unfavorable course of acute myocardial infarction, which increases the frequency of complications, duration of the patients’ hospital stay and mortality. Currently the emergency medicine turned on the wide use of the special enteral nutritional cocktails like “Diabetes” to manage different types of hyperglycemia under various acute disorders. Under the conditions of resuscitation and intensive care unit (RICU) there looked into the possibility and efficacy of early monitoring of the hyperglycemia target values using the special enteral nutritional cocktails with the MI patients. The study included 60 patients, while 30 (the treatment group) thereof were on the enteral nutritional cocktails like “Diabetes” as the only nutrient source in the acute period of the disease. The duration of stay in resuscitation and intensive care unit and duration of the general hospital stay, the demand for insulin therapy as well as mortality due to MI complications turned out to be lower with the patients of the treatment group compared to the reference group of patients.

The basic pathophysiologic characteristics, technical difficulties and handling methods thereof, including among others the difficult respiratory passages, the characteristics of ventilation and oxygenation, circulatory dynamics, dependence on the patient’s position on the operation table are described by the example of 60 gynecological cancer patients with concurrent obesity. It is shown that as of today the multimodal combined anesthesia based on the tricomponent epidural analgesia in combination with sevoflurane and apparently desflurane appears to be the best choice of anesthetic protection during traumatizing surgical treatment for the cancer patients with the associated obesity. The focus is made on advisability of hemodynamic monitoring of these patients.

There covered the characteristics of anesthetic management in trauma suffered by civilians during military conflicts (348 anaesthesis). Special attention is paid to organizational activities. A special focus is made on organizational aspects. It is demonstrated that the work optimization requires expediently the equipment of the shocking surgery of the medical admission unit and the operating rooms not only with the analgesia apparatus, but also with artificial pulmonary ventilation units, given that the essential method of anesthesia is the total intravenous anesthesia without anesthetic gas. The oxygen concentrators are advisable for the operating and intensive care units. It is necessary to know the presumable number of patients who can be attended simultaneously and to provide for the demanded quantity of medication and consumables. It is reasonable to have the kit assumed for one patient in the medical admission unit, where in most cases anesthesia as part of the complex intensive therapy is started.

Patients with sepsis are an extremely heterogeneous group in terms of characteristics of autogenous response to infectious matter. The analysis is carried out for the employment feasibility of the teragnostics fundamentals in management of patients with sepsis. Consideration of the positive examples of patients with sepsis management from the standpoint of the “medical test → therapy” strategy requires the introduction into clinical practice of the teragnostics individual elements and determines the direction of future research. Using of the specific molecular and instrumental medical tests makes it possible to select the targeted therapy for individual populations of patients, to monitor the response to the provided treatment, to increase the efficiency and drug use safety, as well as to save the material resources. The teragnostics logic should be one of the most promising components of the critical care medicine development as a whole and not only that of sepsis.

Currently the neonatal sepsis is a major cause of mortality in the neonatal resuscitation and intensive care units. Systemic inflammatory response (SIR) is considered as the main pathogenetic component of sepsis. The inflammatory mediators take the lead in the SIR development. There exist over 300 inflammatory mediators, however only dozens of them are used in the clinical practice as markers, the others are to be reasoned from the standpoint of their reliability, sensitivity and specificity. None of the markers can be regarded as universal, wherefore the problems emerge in identification of key points of CIR pathogenesis. The most severe SIR complication is the evolving multiple organ failure (MOF). The mortality rate due to MOF still remains extremely high, while making up 80% of the total mortality in resuscitation units. Early diagnosis of neonatal sepsis is critical to reduce the mortality rate in these patients. Clinical symptoms with infants are marginal and non-specific, and therefore the introduction in practice of accurate methods of early laboratory diagnostics of neonatal sepsis is one of the vital tasks of neonatology.

The literature review covers the historical background and current concepts of the artificial pulmonary ventilation possibilities in treatment of the severe chest injury. Various regimens of artificial ventilation are described, and their application in terms of thoracic trauma pathogenesis is justified. Different views are given on the choice of the respiratory support method subject to the type of trauma, and the important role of internal pneumatic stabilization is shown. At the same time it is noted that the prospects for improvement of the treatment outcomes with the severe chest injury patients is not so much develop any single method of ventilation or any surgery technique as towards the combined use of various methods of the chest stabilization and treatment of the pulmonary tissue injury. It is stated that the objectification of success rate of the artificial pulmonary ventilation and the analysis of recovery of spontaneous respiratory predictors will contribute to optimization of the treatment policy for the patients with chest injury.

The review presents some data that reflect the incidence frequency, pathogenesis and approaches to the prevention of infectious complications after coloproctological surgery. They show no uniform recommendations for prevention thereof using the techniques and technologies available with the emergency care specialists. The effectiveness of various pro- and prebiotics, fecal microbiota transplantation are most extensively studied. Also the role of changes in intestinal canal biocenosis and endoluminal translocation in the pathogenesis of systemic infection and other infectious complications is demonstrated.