The objective was to assess the impact of postoperative respiratory complications (RC) on the development of multiple organ dysfunction syndrome (MODS) and in-hospital mortality after cardiac surgery, and to identify independent predictors of these complications.

Materials and methods. We performed a single-center retrospective cohort study included 1514 consecutive patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The diagnosis of acute respiratory distress syndrome (ARDS) was established according to the Berlin criteria. Organ dysfunction was assessed using the Sequential Organ Failure Assessment (SOFA) score. The association between RC and the incidence of MODS, dynamics of SOFA score, duration of mechanical ventilation, ICU length of stay, and mortality was evaluated. Multivariate logistic regression was used to identify independent risk factors.

Results. The overall incidence of RC was 14.4% (n = 219). ARDS was diagnosed in 1.7% (n = 26) of patients. The development of RC significantly increased the risk of MODS: 46.2% in the RC group versus 3.8% in the group without RC (p < 0.001). The mean maximum SOFA score was significantly higher in the RC group [9 (7; 11)]; p < 0.001). All patients with ARDS developed MODS. Mortality in the MODS group reached 53.9% and correlated with the maximum SOFA score (r = 0.84) and its change (r = 0.79). Independent predictors of RC were age > 65 years, emergency surgery, CPB duration > 120 minutes, and obesity. ARDS was the strongest independent predictor of MODS (OR 15.4).

Conclusion. Postoperative respiratory complications, particularly ARDS, are critical triggers of multiple organ dysfunction and are responsible for high mortality rates. The SOFA score is a valuable tool for assessing the severity of the condition and the prognosis. Proactive prevention of RC by controlling modifiable risk factors is a key strategy to reduce the incidence of MODS and improve survival.

Introduction. Demographic changes in the age structure of the population lead to an increase in the number of surgical intervention in elderly patients.

The objective was to study the effects of thermal helium-oxygen mixture on the development of postoperative cognitive dysfunction in elderly patients.

Materials and methods. The study included 53 patients. They underwent elective osteosynthesis of the proximal femur for a fracture. They were divided into 2 groups: group 1 – control (n = 24), group 2 – patients who received helium-oxygen inhalations (n = 29). Anesthesia and perioperative monitoring in patients were standardized. To assess postoperative cognitive impairment, the MoCA test was used, control points: before surgery, 3 days after surgery. To compare the incidence of cognitive impairment in the postoperative period, Z-criteria were calculated for each patient. Δ composite score was calculated to identify the presence or absence of cognitive impairment.

Results. In the group with the use of helium-oxygen inhalation, statistically significant changes were noted: the score by MoCA test after inhalation was higher than in the control group. In group 2, it was noted that the score by MoCA test for subtests after inhalation was higher than in group 1. In group 2, a smaller number of cognitive impairments in the postoperative period were also noted.

Conclusions. The use of helium-oxygen mixture reduces the incidence of cognitive impairment in elderly patients with elective osteosynthesis of the proximal femur for a fracture.

Introduction. The emergence of new composite (incorporated, combined, aggregated) indices that allow simultaneously evaluating inflammation, nutrition, and immunity is being actively studied as a risk factor for severe cardiovascular, oncological, and infectious diseases.

The objective was to evaluate to evaluate the diagnostic capabilities of new composite inflammatory indices in the intensive care of severe acute pancreatitis and purulent-inflammatory diseases.

Materials and methods. The retrospective cohort study included 62 patients (male – 32, female – 30, median age – 49.5 years, Q1–Q3 – 35.5–64) in the intensive care unit with a diagnosis of severe acute pancreatitis, purulent-inflammatory. The significance of the following indicators reflecting the state of systemic inflammation, immunity, and nutrition were studied in surviving and deceased patients: NLR index (neutrophil/lymphocyte ratio); MLR index (monocyte/lymphocyte ratio); PLR index (platelet/lymphocyte ratio); LMR index (lymphocyte-monocyte ratio); NLPR index (neutrophil / lymphocyte x platelet ratio); AISI (aggregate index of systemic inflammation ); SIRI (systemic inflammatory response index); SII index (systemic immune-inflammation index); LCR index (lymphocyte/C-Reactive Protein ratio); CLR index (C-Reactive Protein/Lymphocyte Ratio); CALLY index (C reactive protein-albumin-lymphocyte index); TIH (total index hematology); CAR index (C-Reactive Protein/Albumin ratio); PNI (prognostic nutritional index); MII-1 ((multi inflammatory index) (Sysmex XT-2000i analyzers (Japan) and DxC 700 AU Beckman Coulter, USA)).

Results. Values of NLR > 3.8; PLR < 149; SIRI > 3.06; NLPR > 1.83; LCR < 120; CLR > 77.7; CAR > 2.51; CALLY index < 47; TIG < 12.8; PNI < 37; MII-1 > 334 are associated with the manifestation of systemic inflammation and the development of a critical condition in purulent-septic diseases.

Conclusion. The obtained cut-off points make it possible to use composite indexes for objectification and automatic calculation of the results and dynamics of intensive therapy for purulent-inflammatory diseases.

The objective was to compare the diagnostic and prognostic efficacy of using oxygen extraction coefficient, central venous oxygen tension and oxygen recovery rate from arterial blood for assessing tissue oxygenation in critically ill pediatric patients.

Materials and methods. The study involved 28 critically ill pediatric patients, who were admitted in intensive care unit. In addition to traditional acid-base balance and blood gas measurements, all patients were assessed in venous blood from the superior vena cava (PcvO₂), oxygen extraction coefficient (OER), and oxygen recovery rate from arterial blood (PO₂(X)). Arterial blood samples were collected at the end of the first day after admission and on the third, fifth, and seventh days of their ICU stay. Patients were divided into two groups: survived and died patients. In order to achieve the goal of our study, multiple correlation regression analysis was used to identify factors explaining changes in the dependent variable, arterial lactate concentration and then to construct a multiple regression model.

Results. A pattern of increasing arterial lactate concentration with decreasing oxygen recovery rate from arterial blood was identified, indicating decreased tissue oxygenation and an increase in the albumin-corrected anion gap. The calculated parameter of the arterial blood oxygen extraction rate PO₂(X) showed high diagnostic and prognostic efficiency, confirmed by the results of multiple correlation-regression analysis, variance analysis and ROC analysis.

Conclusion. The constructed multivariate regression model for predicting arterial blood lactate levels, which includes arterial blood oxygen recovery rate as a factor, may be useful for practitioners both in identifying the leading factor in developing lactic acidosis and in monitoring the dynamics of changes in arterial blood lactate levels.

Introduction. There is still an urgent need for clinically based risk assessment systems for patient deterioration.

The objective was to assess the discriminatory ability of the pediatric early warning scores PEWS and рqSOFA in predicting the duration of treatment in intensive care units

Materials and methods. Design: a prospective, observational, multicenter study. Inclusion criteria: children admitted to the ICU aged 1 month to 17 years. Exclusion criteria: children on mechanical ventilation and patients with shock. A total of 470 children were included in the study. The severity of the condition of all children admitted to the ICU was assessed within the first hour of treatment in the department using the PEWS and qSOFA scores. The end point was the duration of treatment in the intensive care unit (less than and more than 72 hours) depending on the body temperature on admission (below and above 38 оC). Demographic and clinical data are presented as median values with interquartile ranges of means and standard deviations. Continuous variables were compared using the Mann–Whitney U test. The discriminatory ability of the scores was determined by calculating the area under the ROC curve.

Results. The predictive ability of the PEWS score regarding the risk of longer treatment in the ICU is statistically significantly (p < 0.0001) higher compared to the pqSOFA assessment system. At the same time, its prognostic significance is low (AUG ROC less than 0.7). In the presence of fever, the discriminatory ability of the PEWS and pqSOFA scores is not statistically significant.

Conclusions. The PEWS score is a weak but informative predictor of the risk of organ dysfunction in a hospitalized child. Scores on the PEWS and pqSOFA scores of two or more points serve as the basis for hospitalization of the patient in the ICU.

Introduction. Sepsis is a severe life-threatening disease associated with high mortality and long-term decrease in the quality of life of surviving patients.

The objective was to identify risk factors associated with the development of chronic critical illness (CCI) in children with sepsis.

Materials and methods. A retrospective analysis of children with sepsis admitted to the intensive care unit (ICU) of the Republican Children’s Clinical Hospital from January 2020 to June 2025 was performed. Patients were divided into two groups based on clinical outcomes: the CCI group, defined by an ICU stay of ≥14 days with persistent organ dysfunction, and the non-CCI group, including patients with rapid recovery or early death. Data on baseline demographics, clinical characteristics, and diagnostic and therapeutic differences were collected and analyzed.

Results. Of 326 children with sepsis, 44 were classified as CCI (13.5%) and 282 as non-CCI (86.5%), including 31 deaths and 251 rapid recovery. No significant differences were observed between the groups by gender or age. Respiratory diseases were the predominant sources of infection in both groups. Compared with the group without CCI, children with CCI had a longer duration of mechanical ventilation, a higher frequency of infections caused by carbapenem-resistant pathogens, higher baseline pSOFA scores, and comorbidity. ROC analysis identified prolonged mechanical ventilation, carbapenem resistance, and pSOFA score as independent risk factors for the development of CCI in children with sepsis.

Conclusion. Risk factors for the development of CCI in pediatric sepsis include prolonged mechanical ventilation, multidrug resistance of infectious agents, and elevated pSOFA scores.

Introduction. Early recognition of variants of clinical manifestations of sepsis is essential for the correct choice of strategy and tactics of its treatment.

The objective was to analyze the causes and manifestations of various variants of the course of sepsis and to assess the dependence of its outcomes on these factors.

Materials and methods. A retrospective analysis of 189 medical records of patients with sepsis was conducted. Clinical recovery within 14 days occurred in 63 of them (group 1), and death – in 46 (group 2). 80 patients developed a chronic critical illness (CCI, group 3), which resulted in recovery in 23 cases and death in 57 cases. Demographic and anthropometric parameters, reasons for hospitalization, severity and type of comorbidities, manifestations of organ dysfunction (SOFA), source of infection, microbiological test results, and laboratory data were assessed. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), NLPR index (NLR x platelets), aggregate index of systemic inflammation (AISI: neutrophils x monocytes x platelets/lymphocytes), and multi-inflammatory index (MII-1: NLR x CRP, g/L) were calculated at admission and over time. ROC analysis and multivariate logistic regression analysis were used to assess the relationship between sepsis outcomes and the initial values of these factors and the rate of their change during observation and treatment.

Results. No significant differences were found between the groups in initial clinical and laboratory parameters. Differences in the dynamics of sepsis progression became apparent within the first few days after the start of treatment. Despite the predictable changes in both laboratory data and composite indices corresponding to the severity of sepsis manifestations, no significant association was established between changes in most of them and the trajectory of the septic process. It was only established that ΔCRP values can predict early recovery, and the NLPR index on day 4 can predict mortality. Simultaneous use of several indices demonstrated their association with outcome more clearly (CRP + NLPR + Δ lactate for rapid recovery; CRP + NLR + AISI for early death; NLR + ΔTLR for CCI).

Conclusion. Recognizing sepsis progression variants at the onset of the disease is impossible due to the lack of a significant correlation between simple clinical and laboratory parameters and outcomes. Differences in sepsis dynamics become clearly evident by the fourth day of treatment. Lymphocyte and platelet levels, CRP, procalcitonin, as well as the NLR, TLR, NLPR, MII-1, and AISI indices and their rate of change over time, are not suitable for predicting all sepsis progression variants due to their low specificity and sensitivity; the significance of each can change dramatically depending on the specific clinical scenario.

Introduction. Spinal anesthesia is commonly employed in pediatric practice due to its effectiveness and safety profile. However, even when administered appropriately, there is a risk of rare but serious neurological complications, including spinal hemorrhages. The current literature contains few reports of intradural hematomas in children, particularly in cases without predisposing factors such as coagulopathies or anticoagulant therapy. The publication of this clinical case is significant because it highlights a rare instance of an intradural hematoma occurring in a clinically healthy adolescent following spinal anesthesia. This case emphasizes the need for increased awareness and enhanced diagnostic strategies within pediatric anesthesiology.

Case presentation. A 15-year-old adolescent male underwent an elective surgical procedure to remove metallic implants from the femoral bones using spinal anesthesia. The surgery and the early postoperative period were uneventful, and the patient was discharged on the third postoperative day. However, on the fourth day post-surgery, the patient developed severe lower back pain, headache, vomiting, and neck stiffness. Upon hospital admission, meningeal signs were present, along with leukocytosis (15.4∙109/L) and elevated C-reactive protein (8.9 mg/L). Spinal MRI revealed two intradural hematomas at the levels of L2 and L4 vertebrae. Cerebrospinal fluid analysis demonstrated pronounced erythrocytosis, with a cell count up to 5072/3 and a protein concentration of 3.31 g/L. Conservative management was initiated, which included therapeutic lumbar punctures, antibiotic therapy, fluid replacement, and symptomatic treatment. Over the course of treatment, the meningeal symptoms regressed, cerebrospinal fluid returned to normal levels, and laboratory parameters improved to baseline. The patient was ultimately discharged in satisfactory condition with no neurological deficits.

Conclusion. This case illustrates that intradural hematoma can occur after spinal anesthesia even in patients without coagulopathies or other risk factors. The lack of early pathognomonic signs can complicate the diagnosis, underscoring the importance of closely monitoring patients with persistent pain and meningeal symptoms during the late postoperative period. Timely MRI evaluation and appropriate management are crucial in preventing severe neurological complications.

Introduction. Training of admission department registrars in psychological first aid for relatives of patients with life-threatening conditions is a pressing issue in the modern healthcare system.

The objective was to establish the effectiveness of the educational and methodological complex of the residency «Anesthesiology and Resuscitation» on psychological first aid for relatives of intensive care patients in developing universal competence in interacting with relatives of patients during the training of admission department registrars.

Materials and methods. Two sessions were held with 8 registrars in a simulation center, and the 3^rd simulation session was held at the registrars’ workplace. Simulated relatives of patients played apathy, fear, hysteria, crying, anxiety, and aggression. The scores of the checklists according to the psychological first aid algorithm were compared at all sessions for each psychological reaction and for each session for all reactions.

Results. No differences in scores were found for apathy and crying. For hysteria, aggression, and anxiety, there were more scores at the 3rd session. In case of fear, the points at the 3^rd session were higher than at the 2^nd and 1^st, at the 2nd session, they were higher than at the 1^st. There was no differences between psychological reactions at the 2^nd and 3^rd sessions. At the 1^st session, the points for apathy were higher than for other reactions, except for crying, the points for crying exceeded the points for anxiety and fear.

Conclusion. The educational and methodological complex of the residency «Anesthesiology and Resuscitation» of psychological first aid for relatives of intensive care patients improves the results of simulation training in the formation of universal competence in interacting with relatives of patients. The methodology of «in situ simulation» sessions is applicable in the formation of such competence.

Due to advanced modern technologies, some progress in recent years has been made in treatment of malignant brain tumors (MBT). However, the prognosis for many patients with malignant brain tumors remains poor. Patients with an expectedly poor prognosis require special attention and care as aggressive therapeutic approaches do not lead to full or partial restoration of function and current therapy is unable to prolong life. In this context, admission to an intensive care unit (ICU) is often inappropriate as the disease is in progress. This situation requires a palliative care specialist consultation along with a medical consilium to discuss the opportunities and goals of medical care and patients’ management in the ICU. The prognosis and realistic treatment goals understanding by relatives is crucial for decision-making, and hospice/palliative care unit/ care or home nursing may be a reasonable alternative to ICU admission. Although the benefits of this approach in terms of reducing ICU burden are obvious, the potential role of palliative care in neuro-oncology is underestimated. Early integration of palliative care into the healthcare system for patients with malignant brain tumors will not only ensure an ongoing clinical monitoring and improve the quality of life but also reduce the number of futile visits of an ambulance and unjustified ICU admissions.

Introduction. Human albumin (HA) solution is commonly used in cardiac surgery for hypovolemia correction, hemodynamic stabilization, and as a component of perfusion media. Despite its widespread use, the efficacy and safety of HA in cardiac surgery patients remain debated. Existing evidence is conflicting: some studies suggest potential benefits for hemodynamic control and renal function, while others show no significant advantage over crystalloids or synthetic colloids regarding key outcomes such as mortality and complication rates. The lack of unified clinical guidelines or algorithms for HA administration in the perioperative period, coupled with its high cost, underscores the need for a systematic review of current evidence to define clear and justified indications for its use in this specific patient population.

The objective was to review the literature on the effectiveness and safety of using HA solutions in adult cardiac surgery patients

Materials and methods. Based on the analysis of literature in the PubMed, Cochrane Library, eLibrary, Google Scholar databases, publications were selected with search restrictions on the following parameters: «people», «adults», «efficacy», «safety», «replenishment of CBV», «hypoalbuminemia », «intensive care», «surgical intervention», «cardiac surgery», «mortality», «survival».

Results. According to the literature analysis, the use of HA solutions in cardiac surgery patients in the situation of hypovolemia correction and hemodynamic stabilization is justified. Preference should be given to isooncotic HA solution (4–5%). The administration of HA solution does not affect the frequency of postoperative complications, mortality, length of stay in the intensive care unit and hospital.

Conclusions. The use of HA solutions in cardiac surgery patients requires an individual approach, assessment of the clinical condition and potential benefits of its physiological effects in certain clinical scenarios, however, additional randomized clinical studies comparing albumin 5% and albumin 20% in this population are needed for final conclusions.

The fibrinolysis system is one of the most important regulators of homeostasis and participates in maintaining stable blood flow. The key element of this system is the balance of plasminogen activators and inhibitors, which can be considered as markers of normal physiological and pathological reactions. The use of laboratory determination of the level of the tissue plasminogen activator/tissue plasminogen activator inhibitor-1 (t-PA/PAI-1) complex in clinical practice is promising in diagnostic and prognostic terms as a biomarker of increased thrombotic risk in the early stages of the development of complications of the disease. This review will provide up-to-date information on practical applications, and diagnostic capabilities, and using such a marker of thrombotic risk as the t-PA/PAI-1 complex in neurological and cardiovascular diseases, obstetric pathology, in patients with COVID-19, as well as in metabolic disorders and in general conditions associated with damage to endothelial cells and an imbalance of the fibrinolytic system.

Hypophosphatemia is a common metabolic disorder in intensive care unit (ICU) patients. A deficiency in serum phosphate can develop primarily due to three reasons: reduced intestinal phosphate absorption, redistribution of phosphate from the extracellular to the intracellular compartment (transcellular shift), increased renal phosphate excretion, or any combination of these factors. Complications of acute hypophosphatemia are caused by impaired energy metabolism due to decreased adenosine triphosphate synthesis and compromised tissue oxygenation resulting from depletion of 2,3-diphosphoglycerate, leading to cellular dysfunction in multiple organ systems. Symptomatic hypophosphatemia (at a phosphate level < 0.32 mmol/L) is characterized by the development of respiratory failure, the need for mechanical ventilation, reduced myocardial contractility, rhabdomyolysis, and central nervous system disturbances. Hypophosphatemia is one of the electrolyte disturbances observed in sepsis, refeeding syndrome, insulin therapy for diabetic ketoacidosis, and other conditions associated with high mortality rates. Studies investigating the impact of hypophosphatemia on ICU patients, as well as approaches to its correction, have yielded conflicting results for many years. Currently, the Russian Federation lacks approved pharmaceutical preparations of phosphates for both enteral and parenteral administration. This unavailability precludes the appropriate correction of acute hypophosphatemia in intensive care units, ultimately compromising the quality of medical care and potentially adversely affecting patient outcomes. This review is dedicated to the problem of hypophosphatemia in ICU patients, its influence on outcomes, and the management strategies for this condition.

This literature review systematizes current knowledge about the epidemiology and clinical features of newborns from multiple pregnancies with monochorionic placentation. The specific complications characteristic of this group are highlighted, namely twin-twin transfusion syndrome, anemia-polycythemia syndrome and selective fetal growth retardation syndrome. Modern approaches to the diagnosis and prognosis of multiple organ failure syndrome in this category of patients, such as the nSOFA and NEOMOD scales, are considered. However, these systems do not have sufficient flexibility to assess the health status of this group of patients, which underscores the need for further research on predictors of the development of multiple organ failure syndrome. In particular, it is relevant to study the acid-base state and gas homeostasis of blood in the neonatal period in newborns from monochorionic twins, which is an urgent task for optimizing perinatal care.