The objective was to evaluate the association between the changes in perioperative cumulative fluid balance and the incidence of severe complications in both emergency and elective high-risk abdominal surgery.

Materials and methods. A retrospective cohort study was conducted in the intensive care unit (ICU) of a tertiary multidisciplinary hospital. Inclusion criteria were age >18 years and ICU admission after laparotomy. Cumulative fluid balance (CFB) and percent fluid overload (PFO) were recorded during the first five postoperative days. The primary endpoint was the incidence of Clavien – Dindo grade IIIB–V complications within 90 days. Multivariate logistic regression analysis was performed.

Results. Totally, 147 patients were included. The overall complication rate was 85 %; the rate of life-threatening complications (Clavien – Dindo grade IIIB–V) was 32 %, and mortality was 22.4 %. Multivariate analysis revealed that increased CFB and PFO at the end of the first postoperative day were independent predictors of life-threatening complications: adjusted odds ratio (OR) for CFB was 1.31 (95% CI 1.07–1.60; p = 0.01) per 1 L; for PFO, it was 1.17 (95% CI 1.05–1.32; p = 0.005) per 1%. The PFO index demonstrated robustness to extreme values, confirmed by bootstrap analysis with bias correction (bias-corrected and accelerated 95% CI 1.02–1.33). Analysis of the predicted probability plot identified threshold values associated with a significantly increased risk: cumulative balance > 6 L (OR 3.8; 95% CI 1.3–10.3; p=0.013) and PFO > 8 % (OR 3.3; CI_95% 1.3–8.4; p = 0.011).

Conclusions. In patients undergoing emergency and elective high-risk abdominal surgery, the development of life-threatening complications is associated with a magnitude of the positive perioperative fluid balance. PFO > 8 % by the end of the first postoperative day may be considered as a clinical trigger for the de-escalation of fluid therapy, transition to complex monitoring of overhydraion, and/or initiation of the deresuscitation.

The objective was to evaluate the association between the volume of intraoperative fluid therapy and the risk of postoperative hyperlactatemia in patients undergoing cardiac surgery with cardiopulmonary bypass.

Materials and methods. This single-center prospective cohort study included 733 adult patients who underwent cardiac surgery with cardiopulmonary bypass between 2024 and 2025. The total intraoperative fluid volume (crystalloids and colloids), normalized to body weight (mL/kg), was used as the exposure variable; the priming volume of the cardiopulmonary bypass circuit was excluded from the analysis. Patients were stratified according to quartiles of fluid volume distribution: the first quartile (Q1) represented the low-volume («restrictive») group, the second and third quartiles (Q2–Q3) represented the moderate-volume group, and the fourth quartile (Q4) represented the high-volume («liberal») group. The quartile boundaries were calculated based on the distribution of infusion volume in the entire study cohort. Hyperlactatemia was defined as a lactate level ≥3 mmol/L within the first 6 hours after admission to the intensive care unit. The type of hyperlactatemia (ischemic or metabolic) was determined using a predefined algorithm incorporating lactate level, ScvO₂, Pv-aCO₂, and lactate clearance at 6 hours. Indicators of tissue hypoperfusion included ScvO₂ < 65%, Pv–aCO₂ > 6 mmHg, and lactate clearance < 10%. Multinomial logistic regression was used to evaluate the independent association between fluid volume and hyperlactatemia type (no hyperlactatemia, ischemic type, metabolic type).

Results. The overall incidence of postoperative hyperlactatemia (lactate ≥3.0 mmol/L within 6 hours after ICU admission) in the general cohort occurred in 30.2% of patients (n = 733). The median intraoperative fluid volume differed significantly between groups (p < 0.001). The incidence of ischemic hyperlactatemia demonstrated a U-shaped relationship with fluid volume: the lowest rate was observed in the moderate-volume group (9.5% per the entire group of patients), whereas in the low-volume («restrictive») group, the frequency increased (13.1%), and the probability of this type of hyperlactatemia also increased according to regression analysis (OR 1.52; 95% CI 1.01–2.29; p = 0.04), peaking in the high-volume («liberal») group (18.0%; OR 1.95; 95% CI 1.28–2.98; p = 0.002). When fluid volume was analyzed as a continuous variable, the lowest predicted risk of ischemic hyperlactatemia corresponded to an infusion range of approximately 35–45 mL/kg. The incidence of metabolic hyperlactatemia differed between groups (p = 0,001), but without a consistent pattern and without a nonlinear association.

Conclusion. In patients undergoing cardiac surgery with cardiopulmonary bypass, a U-shaped association was observed between the volume of intraoperative fluid therapy and the risk of ischemic hyperlactatemia following cardiac surgery with cardiopulmonary bypass. The lowest risk of hypoperfusion-related hyperlactatemia was observed with a moderate fluid volume of approximately 35–45 mL/kg. These findings suggest that a moderate intraoperative fluid strategy may be associated with a more favorable postoperative tissue perfusion profile in cardiac surgical patients.

Introduction. Patients with cardiovascular disease undergoing laparoscopic surgery are at high risk of developing various postoperative complications. A significant portion of these complications are due to splanchnic organ hypoperfusion caused by pneumoperitoneum and associated chronic pathological conditions. Despite the demonstrated organ-protective effect of inhaled nitric oxide (iNO) in cardiac surgery, its use in laparoscopic procedures has not been studied.

The objective was to determine whether intraoperative nitric oxide inhalation at a dose of 40 ppm affects cardiac, endothelial, and hemostatic parameters in patients with cardiovascular disease (CVD) requiring laparoscopic abdominal surgery.

Materials and methods. A pilot randomized study was conducted involving 40 patients with CVD undergoing lengthy laparoscopic procedures. In the main group (n = 20), iNO was delivered using an AIT-NO-01 device (Tianox, Russia) at a concentration of 40 ppm with monitoring of nitrogen dioxide (NO₂) and methemoglobin levels. In the control group (n = 20), no additional anesthetic interventions were provided.

Results. iNO at a dose of 40 ppm was well tolerated, with no adverse events recorded; NO₂ concentrations remained below 2 ppm. iNO had a significant effect on glycoprotein 5 concentrations (–4.80 ± 9.02 vs. +0.36 ± 7.05, p = 0.054) and reduced endothelin-1 levels by approximately 70% (+1.05 ± 3.86 vs. +3.47 ± 4.69 pg/ml, p = 0.082), indicating increased endothelial activity. NT-proBNP variability in the iNO group was 86% lower than in the control group. The decrease in end-diastolic volume was 7.9 times greater in the study group (–12.7 vs. –1.6 mL, p = 0.268). In both groups, a statistically significant increase in potassium levels relative to baseline was noted after 24 hours (control: p = 0.019; iNO: p = 0.002).

Conclusion. The use of iNO at a dose of 40 ppm in laparoscopic abdominal surgery appears safe. Complex effects on coagulation factors, the endothelium, cardiac load, and electrolytes were revealed, which justifies conducting large-scale randomized trials to confirm the organ-protective effects.

The objective was to evaluate the possibility of determining the risk of postoperative complications and death in patients with peripheral lung cancer based on absolute (V’O₂peak) and relative (V’O₂peak % from the proper) values of the oxygen consumption index at the peak of physical activity.

Materials and methods. 128 patients with peripheral lung cancer (68±8 years old) who underwent surgery at the Pavlov University Clinic in 2018–2023 were studied. All patients underwent cardiopulmonary exercise testing (CPET) 3–7 days before surgery. V’O₂peak was recorded at the maximum load level, calculated based on the method of moving averages of 5 out of 7, V’O₂peak% from the proper – based on a linear relationship by age and gender. For the analysis, the patients were divided into groups depending on the presence of postoperative complications and the outcome of hospitalization (discharge or death). For statistical processing of data, the following were used: Student’s t-test, Mann – Whitney U-test, Pearson’s chi-square test, Fisher’s exact test.

Results. When comparing the group of patients with and without complications, it was not possible to identify differences in the V’O₂peak index (p = 0.972). The probability of complications in patients with V’O₂peak > 15 ml/min/kg was 1.065 times lower than in the group with V’O₂peak < 15 ml/min/kg, the differences were not significant (OR = 0.939; 95% CI: 0.410 – 2.152). When comparing V’O₂peak in groups of patients with fatal outcome and discharged patients, no differences were found (p = 0.387). When comparing the group of patients with complications with the group without them, there were no differences in V’O₂ peak % predicted value. There were also no significant differences when comparing the group of patients with fatal outcome with the group of discharged patients (p = 0.735).

Conclusions. The results obtained indicate that the absolute and relative values of oxygen consumption at the peak exercise (V’O₂peak) are not reliable predictors of the risk of postoperative complications or death in operated patients with peripheral lung cancer.

Introduction. Improved survival in the acute phase of critical illness has led to a growing population of patients with chronic critical illness (CCI). The triad of inflammation, catabolism, and immunosuppression (ICS) is considered a key mechanism underlying CCI; however, its temporal dynamics and the interrelationships among its clinical characteristics remain unexplored.

The objective was to evaluate the internal relationships between the temporal parameters of chronic critical illness and the dynamics of the inflammation, catabolism, and immunosuppression triad. Materials and methods. The RICD database data was analyzed (n = 820). Inclusion criteria were age > 18 years, first ICU admission, and at least one documented ICS episode (defined as CRP > 20 mg/L, albumin < 30 g/L, and lymphocyte count < 0.8×10⁹/L). Demographic and laboratory parameters, ICU length of stay prior to CCI onset, CCI duration, number and cumulative duration of ICS episodes, and the proportion of time spent in ICS during CCI were analyzed using Spearman’s correlation analysis.

Results. The median ICU stay prior to CCI onset was 6 days (maximum 277 days) and correlated positively with lymphocyte (r = 0.57) and albumin levels (r = 0.40), and negatively with SOFA score (r = –0.17) and CRP levels (r = –0.29). The median CCI duration was 21 days (maximum 446 days), with a median proportion of time spent in ICS of 28.6% [IQR 11.1–57.1%]. A strong negative correlation was found between CCI duration and the proportion of ICS time (r = –0.67), while no association was observed between the proportion of ICS time and the number of ICS episodes (r = 0.07). The cohort exhibited high complication rates: nosocomial pneumonia in 72.6%, sepsis in 28.7%, and multiple organ failure in 80.5% of patients.

Conclusions. Chronic critical illness is a discrete process characterized by episodic occurrence of the ICS triad, resulting in two distinct clinical trajectories: a short, intensive course with a high proportion of ICS time, or a prolonged course with infrequent episodes of decompensation. The duration of prolonged critical illness reflects the patient’s physiological reserve and may represent a window of opportunity for preventing progression to CCI.

The objective was to evaluate the expression of the interleukin-6 (IL‑6) gene as a predictor of severe urosepsis and to justify its inclusion in the diagnostic algorithm.

Materials and methods. A prospective clinical study was conducted. The study included 90 patients: 30 patients with complicated inflammatory kidney diseases complicated by urosepsis and/or septic shock (group 1), 30 patients with uncomplicated postoperative course after surgical treatment of nephrolithiasis without signs of sepsis (group 2), and 30 practically healthy volunteers (control group). At 4 stages of observation (hospitalization/before surgery, 1st, 3rd, and 7th days), clinical and laboratory parameters, severity of organ dysfunction according to the SOFA scale (Sequential Organ Failure Assessment), traditional markers of inflammation (leukocytosis, leukocyte intoxication index – LII, C-reactive protein – CRP, procalcitonin – PCT), and expression of the IL-6 gene (IL-6) were evaluated. Statistical analysis included nonparametric criteria, correlation and ROC analysis.

Results. In patients with urosepsis, the expression of the IL 6 gene at the time of admission was significantly higher than in the control group and in patients with uncomplicated postoperative inflammation (2.06 [1.58; 2.89] vs. 0.049 [0.03; 0.09] and 0.43 [0.25; 0.55] relative units; p < 0.001). The peak of IL 6 expression occurred at the time of hospitalization and preceded the maximum increase in leukocytes, LII, CRP, and PCT, which reached their highest values on the first day of intensive care. At this stage, IL 6 expression was statistically significantly correlated with the severity of organ dysfunction according to the SOFA score (R = 0.394; p = 0.031) and the integrated inflammation index. ROC analysis showed the greatest prognostic value of IL 6 expression for detecting severe urosepsis (AUC 0.767; 95% CI 0.569–0.965; p = 0.028), while the AUC for PCT was 0.741 (95% CI 0.553–0.930; p = 0.046), for LII – 0.682, for SOFA – 0.651; total leukocytosis and CRP had low independent predictive ability (AUC 0.560 and 0.511, respectively).

Conclusion. The expression of the IL 6 gene is an early and highly sensitive molecular genetic marker of the systemic inflammatory response in patients with inflammatory kidney diseases complicated by urosepsis and/or septic shock, which is more dynamic than traditional laboratory indicators. The inclusion of the determination of IL 6 expression in the diagnostic algorithm will improve the accuracy of early risk stratification of severe urosepsis and optimize intensive care management.

Introduction. In the diagnosis and treatment of sepsis in children, a comparative analysis of various tools for assessing the severity of organ dysfunction is extremely important.

The objective was to compare the discriminatory ability of the Phoenix-4, Phoenix-8 and pSOFA organ dysfunction severity scales in pediatric sepsis.

Materials and methods. The study design is retrospective, observational, single-center. The diagnosis of sepsis and shock was carried out on the basis of Russian recommendations for the diagnosis and treatment of sepsis in children. 97 patients were examined. Septic shock was diagnosed in 26 (26.8%) patients, 19 (19.6%) children died. The endpoint of the study is 28-day mortality. The most common cause of sepsis was pneumonia, which was detected in 82 (84.5%) children. Statistical processing was performed using MedCalc® Statistical Software (www.medcalc.org).

Results. It was found that in children with sepsis, the informational value of the Phoenix-4, Phoenix-8 and pSOFA scales is comparable. In the presence of renal dysfunction in the structure of multiple organ failure, the risk of death increases significantly. Moderate discriminatory ability is inherent in the Phoenix Score Sepsis 8 and pSOFA scales; the information value of the PSS-8 system significantly exceeds the capabilities of the pSOFA scale (AUG ROC 0.676 versus 0.607; p < 0.05). Almost all children (21 of 23) with kidney dysfunction had clinical laboratory signs of shock.

Conclusion. The discriminatory ability of the Phoenix Score Sepsis 4 and Phoenix Score Sepsis 8 scales in pediatric sepsis has no significant differences, however, the Phoenix Score Sepsis 8 rating system has advantages over the Phoenix Score Sepsis 4 scale and pSOFA in assessing clinical outcomes septic shock.

Introduction. Cardiopulmonary resuscitation (CPR) – a standard procedure for cardiac arrest, but in some cases, it is not indicated. The «Do Not Resuscitate» (DNR) order has long been practiced in many countries around the world. The study of withholding CPR in the Russian Federation has received little attention.

The objective. To study how the withholding CPR is implemented in Russia, compare it with international practice, identify problems and prospects for their solution.

Materials and methods. Russian legal documents, clinical recommendations, journal articles and Internet resources related to the withholding CPR have been studied. Out of English-language resources on the DNR order, materials were searched that studied problems of withholding CPR similar to those in Russia

Results. In Russia, according to legal acts, withholding CPR is justified in patients with incurable diseases. There are no clear criteria for incurable diseases, which prevents the outright implementation of withholding CPR. The Clinical Guidelines “Cardiac Arrest in Adult Patients” approved by the Federation of Anesthesiologists and Reanimatologists in 2025 (CG) suggest that the council of physicians should decide to refuse resuscitation based on a list of palliative conditions. In many parts of the world, withholding CPR, based on doctors unilaterally established medical futility, is considered unethical. The DNR orders are based on the advanced shared decision by the patient, relatives and doctors to ensure patient’s autonomy.

Conclusion. The proposals of the CG for withholding CPR do not support patient’s autonomy and do not provide reliable legal protection to physicians. It is necessary to start discussion practice of advance care planning including the DNR order.

Introduction. Mechanical power (MP) has been proposed as an integrative measure of ventilatory load, yet the variety of available calculation methods and their variable accuracy across ventilation modes limit its clinical adoption.

The objective was to review and comparatively analyze mathematical models for calculating mechanical power (MP) of mechanical ventilation, to examine their physical foundations, limitations, and clinical applicability.

Materials and methods. Narrative literature review. A search was conducted in PubMed, Cochrane Library, Google Scholar, eLibrary databases covering the period 1990–2025. Publications addressing the geometric method of MP calculation, Gattinoni’s equation, surrogate formulas for volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV), formula validation, and clinical MP thresholds were analyzed.

Results. Two approaches to MP calculation were identified: the geometric method (reference standard, based on integrating the area under the pressure-volume curve) and surrogate algebraic equations derived from ventilator-displayed parameters. Gattinoni’s equation (2016) is derived from the equation of motion and accounts for elastic and resistive components of respiratory work. Surrogate formulas for VCV and PCV show acceptable accuracy under standard ventilation conditions (bias ~ 1 J/min); however, accuracy decreases with extreme ventilation parameters. According to experimental data, MP values above 12 J/min are associated with ventilator induced lung injury (diffuse edema). In clinical studies, values above 17 J/min were independently associated with increased hospital mortality.

Conclusion. The MP concept may be considered as an integrated measure of the energy load on the respiratory system. Existing surrogate formulas may be used for clinical risk stratification, provided that the limitations of each model are recognized and the approach is individualized according to patient anthropometry and functional lung status.

Introduction. Spontaneous pneumothorax as the onset of metastatic osteosarcoma in children is extremely rare. In the present case, massive involvement of the peripheral lung segments in a patient with osteosarcoma of the right tibia led to the development of bilateral spontaneous pneumothorax. Effective polychemotherapy resulted in a significant reduction in the number of metastases; however, the extensive adhesions that formed against the background of metastatic regression, combined with the multiple pleural drainages performed at the onset of the disease, created obstacles to further surgical treatment.

The objective was to demonstrate the successful use of intraoperative veno-venous extracorporeal membrane oxygenation (VV-ECMO) to prevent critical respiratory complications and ensure the safety of anesthetic management.

Materials and methods. We present the clinical case of a 15-year-old patient with osteosarcoma of the right tibia (stage T2N1M1). Due to the development of bilateral pneumothorax and the formation of massive adhesions in the pleural cavities, which prevented full lung expansion, bilateral thoracic surgery (adhesiolysis) was performed under intraoperative VV-ECMO.

Results. The use of VV-ECMO allowed for the safe performance of complete adhesiolysis, the re-expansion of both lungs, and the creation of conditions for subsequent radical treatment. The duration of ECMO support was 31 hours. Six weeks later, the patient successfully underwent right knee arthroplasty. The patient resumed his chemotherapy regimen.

Conclusion. This clinical case demonstrates that VV-ECMO can be effectively used not only as a method of emergency respiratory support but also as a routine tool for ensuring surgical safety in patients with severe respiratory limitations. The use of ECMO made it possible to overcome the limitations associated with the inability to safely ventilate the lungs, ensuring that adhesiolysis could be performed, followed by a transition to the radical phase of treatment six weeks later.

Introduction. Road traffic accidents (RTA) in the war zone represent a special problem associated with the delay of evacuation and the impossibility of rapid delivery to a trauma center of the appropriate level. In the conditions of pre-hospital care, when time plays a decisive role and bleeding is a direct threat to life, timely transfusion can improve outcomes.

The objective was to demonstrate the possibility of performing blood transfusion in conditions of a forcedly extended pre-hospital stage.

Clinical case. The victim was trapped in a car. First aid was provided at the accident scene. After being removed from the car, the victim was transported to a full-fledged evacuation stage, where the victim received advanced first aid (with elements of qualified care): transfusion of whole blood and blood components, and stabilization of pelvic and long-bone fractures.

Results. Timely replacement of blood loss has a positive impact on the prognosis of patients with acute massive bleeding. Whole blood is the most effective means of stopping bleeding due to its complex hemostatic effect. Therefore, the early use of preserved whole blood of universal group appears to be a promising tool for correcting blood loss.

Conclusion. The use of whole blood of a universal group O(I) Rh(–) as a primary resuscitative agent is justified by its availability and balanced composition. Combined with early surgical damage control, this strategy may improve survival in cases of severe trauma.

The objective was to compare the effectiveness of different opioid-free anesthesia (OFA) regimens, including combinations with regional and fascial blocks, on respiratory outcomes, emergence time, and safety profile in patients with obesity (BMI ≥ 35 kg/m²).

Materials and methods. A literature search was conducted in PubMed/MEDLINE, Cochrane CENTRAL, Embase, Web of Science, and eLibrary/ RSCI (January 2014 – January 2026). RCTs, prospective observational studies, systematic reviews, and meta-analyses evaluating (1) diaphragmatic dysfunction, (2) spirometric parameters and desaturation, (3) awakening and extubation time, (4) bradycardia and hemodynamic stability, (5) and quality of recovery were included. Inclusion criteria: adults with BMI > 35 kg/m², bariatric and/or laparoscopic abdominal surgery, use of OFA ± regional anesthesia. Additionally, two studies, not limited to the obese population, were included to analyze the safety of dexmedetomidine (H. Beloeil et al. 2021) and bolus administration strategies (M. Xiong et al. 2025), with appropriate interpretation reservations.

Results. Eleven RCTs in the target population, 1 prospective observational cohort study (NOS 7/9), and 2 additional RCTs on mixed/general surgical populations (total n = 1385) were analyzed. Quantitative data from 3 systematic reviews/meta-analyses were used for evidence synthesis on bradycardia and comparative effectiveness of regional techniques. ESP block reduced postoperative diaphragmatic dysfunction (PODD) from 73% to 10% (OR 0.04; 95% CI 0.01–0.16; p < 0.001) based on a single RCT. Emergence time increased by 3–7 min with standard dexmedetomidine infusion (≥ 0,5 mkg∙kg^–1∙h^–1), but was not prolonged with bolus-only administration. Dexmedetomidine-induced bradycardia was dose-dependent: RR 2.81 (95% CI 1.34–5.91) at doses ≥ 0.7 μg/kg. The QLB block (blockage of the quadriceps muscle) provides the longest duration of analgesia with minimal effect on hemodynamics.

Conclusion. Based on limited evidence, a potentially promising OFA regimen for obese patients at high respiratory risk may include low-dose dexmedetomidine (bolus 0.5–0.6 mcg / kg without subsequent infusion), esketamine, lidocaine, and ESP or QLB block. This expert recommendation requires prospective validation. Large multicenter RCTs with primary respiratory endpoints are warranted.

Introduction. The second part of this review focuses on clinical scenarios, in which standard analgesic regimens in cancer patients show limited efficacy or unacceptable tolerability, including mixed pain phenotypes, a pronounced neuropathic component, and chemotherapy-induced peripheral neuropathy (CIPN). We address pharmacological approaches that may be feasible for implementation with adequate clinical workflow organization, as well as experimental targets shaping the «next wave» of mechanism-based, targeted analgesia.

The objective was to critically synthesize the available evidence on implementable and theoretically promising pharmacological analgesic strategies in patients with malignant disease.

 Materials and methods. In the second part, a narrative review was performed using the methodology for searching and critically evaluating sources described in detail in the first part of the series; the literature search was additionally updated as of 10.23.2025 with an emphasis on implemented and experimental pharmacological approaches.

Sections. The following approaches are presented as promising methods suitable for routine implementation: xenon–O₂ in subanesthetic regimens as an option for rapid reduction of pain/anxiety with opioid-sparing potential; intrathecal analgesia using ziconotide as an effective strategy for generalized refractory pain with a prominent neuropathic component; and the 8% capsaicin patch as a local treatment for selected subtypes of painful focal CIPN/peripheral neuropathy. Experimental approaches with theoretically justified potential include anti-NGF antibodies, TrkA antagonists, selective NaV1.7 blockers, P2X3 (and P2X2/3) antagonists, as well as σ1 antagonists, KCC2 modulators, CSF1R inhibitors, and tetrahydrobiopterin.

Conclusions. Xenon at subanesthetic concentrations appears to be the most promising approach. Intrathecal therapy remains a powerful option for the control of refractory pain but is associated with technical complexity and potential complications. The 8% capsaicin patch occupies a narrow yet clinically useful niche in focal painful neuropathy/CIPN. Experimental targets support the concept of phenotype-oriented analgesia; however, they are not yet ready for routine clinical use without further accumulation of robust clinical evidence.

Pancreaticoduodenectomy (PD) is associated with high rates of postoperative complications (30–50%) and mortality (2–5%), while traditional risk factors do not adequately reflect a patient’s functional reserve. Frailty assessment is considered a promising approach for perioperative prediction. This review analyzes 35 publications (2014–2025) on frailty scales in patients undergoing PD. The most studied tools were the modified frailty index (mFI-11 and mFI-5), Clinical Frailty Scale (CFS), Edmonton Frail Scale (EFS), Comprehensive Geriatric Assessment (CGA), Risk Analysis Index (RAI), and Fried frailty phenotype. CFS showed the strongest association with mortality (OR 4.89; 95% CI 1.83–13.05), EFS with postoperative complications (OR 2.93; 95% CI 1.52–5.65), and the Fried phenotype with postoperative delirium (OR 3.79). mFI-5 > 2 was associated with increased mortality (OR 2.08) and reduced median overall survival (21.3 vs 42.1 months). mFI-11 > 0.27 was an independent predictor of complications (OR 1.544) and 30-day mortality (OR 1.536). However, the key finding is low sensitivity of all scales: in a comparative study of seven instruments, sensitivity ranged from 21.5% to 38.5% with specificity of 76.7–92.4%. In the largest PD cohort (n = 9986), frailty by mFI ≥0.27 was detected in only 6.4% of patients – 4–6 times lower than the expected prevalence. RAI-C at threshold ≥21 had sensitivity 0.50, RAI-A – 0.25. Thus, existing scales miss 60–80% of frail patients (especially those with prefrailty), raising doubts about their clinical utility as standalone screening tools. The strongest association with mortality was achieved for CFS, with complications – for EFS, with survival – for mFI-5. Given the low sensitivity, the most reasonable strategy is to perform extended geriatric assessment in all patients aged 65–70 years or older without prior screening, who will undergo PD.

Nutrition support is an important part of the complex therapy of critically ill children. A literature review of scientific publications shows that enteral nutrition (EN) is the preferred method of nutritional support for those with a functioning gastrointestinal tract. Despite the development of numerous national and international clinical guidelines and algorithms over the past decades, nutrition remains controversial.

The objective was to substantiate a stepwise approach in the development of a local protocol for nutritional support in the pediatric intensive care unit. This review does not focus on neonates and infants. A total of 50 publications were included.

A stepwise approach to creating a local protocol includes: assessment of nutritional status and timing of enteral feeding initiation; determination of target energy and protein requirements, nutrient delivery methods, and monitoring of nutritional tolerance.

A modern nutrition strategy in the pediatric NICU is active nutritional therapy based on proven algorithms, early use of enteral feeding, and continuous monitoring of gastrointestinal function. Given the nutritional recommendations, further clinical research and the development of standardized nutrition protocols in pediatric practice remain urgent tasks.

This review article examines multiple organ dysfunction syndrome (MODS) in pediatric practice, including its epidemiology, terminology, and prognostic principles. MODS is a complex clinical syndrome associated with a high risk of complications and mortality in critically ill children. Its epidemiology remains poorly understood, and its prevalence ranges from 10% to 35% among intensive care unit (ICU) patients. The main triggers for MODS include sepsis, severe trauma, burns, cardiac surgery, and hematologic malignancies.

Current organ dysfunction assessment scales (pSOFA, PELOD-2, MODS, Phoenix, etc.) are discussed, along with their limitations and the need to strengthen these tools in terms of phenotypes and biomarkers. Particular attention is given to the potential of using artificial intelligence and machine learning to predict MODS, as well as the role of innovative molecular biomarkers (including non-coding RNA, mitochondrial DNA, neutrophil trap markers, etc.) in early diagnosis and risk stratification. Methodological challenges in implementing these technologies in clinical practice are highlighted, including the need for external validation, the creation of standardized databases, and overcoming regulatory barriers.