Background. In recent years, there has been a growing number of cardiac surgeries performed using minimally invasive techniques. However, there is still debate about the optimal ventilation support for these operations, which are performed through a mini-thoracotomy.

The objective was to study the possibility of using high-frequency jet ventilation during minimally invasive mitral valve surgery performed from right-sided mini-thoracotomy, to evaluate its effectiveness and safety.

Materials and methods. 80 patients were divided into two groups: one group received high-frequency jet ventilation (HFJV), and the other received low-volume ventilation (LVV). Before surgery, during surgery, and in the intensive care unit, invasive hemodynamic parameters, arterial blood gas composition, and metabolic markers were assessed. The nature and incidence of postoperative complications were also analyzed.

Results. In the HFJV group, compared to the LVV group, the level of oxygen tension in arterial blood (PaO₂) was significantly higher at 30 minutes after thoracotomy – 307 (220–352) mmHg versus 106 (90–127.5) mmHg, p < 0.001, and at 30 minutes after the end of cardiopulmonary bypass (CPB) – 264 (188–323) mmHg versus 147 (109.5–183.5) mmHg, p < 0.001. PaO₂/FiO₂ was also higher in the HFJV group compared to the LVV group at these stages – 623 (450–714) versus 214 (171.3–263.3), p < 0.001 and 534 (367–654) versus 260 (200.5 – 358), p < 0.001. The number of patients with a PaO2/FiO2 of 200 or lower in the HFJV group was significantly lower than in the LVV group – 2.5 % compared to 32 %, p < 0,001 before CPB and 5 % compared to 25 %, р = 0,013 after CPB.

There was no statistically significant difference between the groups in the number of postoperative pulmonary complications, as well as the duration of artificial lung ventilation (ALV) and stay in the intensive care unit (ICU).

Conclusions. The use of high-frequency jet ventilation during minimally invasive mitral valve surgery performed through right-sided mini-thoracotomy provides adequate oxygenation and prevents the development of hypoxemia. This technique does not increase the number of postoperative complications.

The objective was to determine the pressure in the non-ventilated lung using different flows of high flow oxygen insufflation (HFOI) during one-lung ventilation.

 Materials and methods. The study included 20 patients who underwent videothoracoscopic lobectomy for malignant tumors of the peripheral bronchus. After induction of anesthesia, direct sequential laryngoscopy and tracheal intubation were performed: 1) installation of a double-lumen tube (DLT); 2) verification of the correctness of the installation using a video bronchoscope. All patients were given HFOI to the non-ventilated lung via the DLT circuit. The study was divided into seven stages, at each of which HFOI was performed for 10 minutes and the pressure in the non-ventilated lung was recorded: stage I – 80 l/min, stage II – 70 l/min, stage III – 60 l/min, stage IV – 50 l/min, stage V – 40 l/min, stage VI – 30 l/min, stage VII – 20 l/min.

 Results. At stage I of the study with HFOI of 80 l/min, the pressure in the non-ventilated lung was 2 ± 0 cm Н₂О, at stages II – VI (HFOI in the range from 70 to 30 l/min) – 1.0 ± 0 centimeter of water column and at stage VII (HFOI 20 l/min) – 0 ± 0 cm Н₂О.

 Conclusion. The pressure in the non-ventilated lung when using high-flow oxygen insufflation under one-lung ventilation at a flow rate of 80 l/min is 2 cm Н₂О, from 30 to 70 l/min – 1 cm Н₂О, 20 l/min – 0 cm Н₂О.

The objective was to evaluate the impact of patient’s nutritional status on the development of postoperative complications in laparoscopic gastric resection.

 Materials and methods. We conducted a retrospective study of patients who underwent laparoscopic distal gastric resection under combined general anesthesia at the Moscow Clinical Scientific Center named after A. S. Loginov from 2017 to 2021. We assessed the presence/absence of postoperative complications, albumin levels and total lymphocyte counts in all patients to determine malnutrition in the postoperative period. The statistical analysis of the data obtained and the determination of the correlation of parameters with postoperative complications were carried out.

 Results. 200 patients (52% women, 48% men) were included in the study. The average patient’s age was 68 (61–75) years, and the average body mass index (BMI) was 26 (23.75–29.0) kg/m². Early postoperative complications were 24.5%: motor disorders (gastrostasis – 13.5%, intestinal paresis – 7.0%), fluid collections – 8.5%, postoperative pancreatitis and abdominal bleeding – 3.5% each, anastomosis leakage and pneumonia – 3%/; while 11% of patients had a combination of several types of complications. There were 64.5% patients with absolute lymphopenia and 38.5% with hypoalbuminemia in postoperative period. A correlation was revealed between the malnutrition and total postoperative complications (Kendall’s tau-b 0.194, p-value < 0.01) and anastomosis leakage (Kendall’s tau-b 0.240, p-value < 0.01).

 Conclusion. Absolute lymphopenia and hypoalbuminemia may be risk factors for postoperative complications.

The article discusses the current problems of digitalization of the anesthesiology and intensive care services, including the lack of unified approaches to assessing the level of digital maturity. The key barriers to the introduction of digital technologies into clinical practice were analyzed. The study proposes a new method for assessing the level of digital maturity of the anesthesiology and intensive care services of a medical institution, based on the developed formula that takes into account key indicators of digitalization: the level of automation of processes, integration of information systems, access to real-time data, the use of artificial intelligence and other technologies. The proposed method can be used to diagnose the current state of digital maturity of the service, plan further steps and improve the efficiency and quality of medical care.

Introduction. Cesarean section is associated with a significant level of emotional stress. Given the inability to use most anxiolytic drugs in obstetrics, alternative methods for stabilizing the psycho-emotional state of patients are required. One possible option is virtual reality technology. The objective was to evaluate the impact of virtual reality technology on perinatal anxiety and pain intensity during elective cesarean section.

Materials and Methods. A prospective randomized controlled trial was conducted with 62 patients. The patients were divided into two groups: the control group (n = 30) and the main group (n = 32). In the control group, standard preoperative preparation was performed, while in the main group, virtual reality technology was additionally used. Anxiety levels were assessed using the PASS-R scale, and pain intensity was evaluated using the visual analog scale (VAS). Additionally, blood pressure and heart rate indicators were analyzed.

 Results. Compared to the control group, the use of virtual reality technology resulted in a significant reduction in anxiety levels 6 hours after surgery (11.2 ± 4.9 vs. 17.4 ± 5.8 points, p < 0.05) and a decrease in pain intensity during fetal extraction (2.5 ± 1.3 vs. 4.0 ± 1.3 points, p = 0.0089). The main group also showed lower blood pressure and heart rate indicators compared to the control group at all stages of the surgical intervention (p < 0.05).

Conclusion. The use of virtual reality technology before and during elective cesarean section under spinal anesthesia may be an effective method for reducing anxiety, stress, and pain during surgery and in the postoperative period, as well as for improving the psychological state of patients.

Introduction. RUSH protocol (Rapid ultrasound in shock and hypotension) is a unique ultrasound examination algorithm that allows to establish the cause of systemic hypoperfusion and arterial hypotension in a critically ill patient in a minimum time, simultaneously with therapeutic interventions.

The objective was to evaluate the effectiveness and clinical significance of the RUSH protocol in the practical activities of pediatric anesthesiology and intensive care units with an infectious profile for the purpose of early diagnosis of the shock type.

Materials and methods. Twenty-five children who needed treatment in the intensive care unit were examined, the median age was 6.1 (1 month – 17 years) years. All were diagnosed with shock of various etiologies upon admission, 10 (40%) children required infusion of sympathomimetics. The average duration of mechanical ventilation was 7.45 (0–32 days) days, the duration of treatment in the intensive care unit was 11.5 (0–32 days) days. Death occurred in 9 (36%) children. All patients underwent ultrasound examinations using the RUSH protocol. Comparison of diagnoses was carried out between the initial physical examination data, the RUSH protocol results and the final diagnosis. Comparability in determining the type of shock by one observer was assessed using the kappa coefficient.

Results. Excellent sensitivity, good specificity and maximum comparability with the final diagnoses were in hypovolemic shock (100% sensitivity and specificity). Good sensitivity and specificity were characteristic of cardiogenic shock. A sufficient level of compliance, excellent specificity, but low sensitivity were noted in distributive shock. In three patients, the RUSH protocol diagnosed a combined type of shock (sensitivity 100%), while the physical examination did not establish a diagnosis of shock depending on the leading link of pathogenesis.

Conclusion. The RUSH protocol is an indispensable tool for screening ultrasound examination for diagnosing the type of shock in children with acute infectious diseases in critical condition.

Introduction. The combination of multiple organ dysfunction syndrome and low cardiac output syndrome (MODS + LCOS) is an unfavorable phenotype of a critical condition with a high risk of death, in which standard cardiotonic therapy is not always effective.

The objective was to evaluate the effectiveness of levosimendan in the treatment of small cardiac output syndrome in newborns with multiple organ dysfunction syndrome.

Materials and methods. 68 newborns with MODS+ LCOS were studied using the continuous method. All the studied children were on artificial lung ventilation, received inotropic therapy, were rated on the NEOMOD scale of 2 points or more, and had a reduced cardiac output fraction rate (< 60%) in Echocardiography. All patients were randomly assigned to two groups: group A (n = 34) received levosimendan for standard inotropic therapy (adrenaline, norepinephrine, dopamine in any combination). Levosimendan was added at the start of inotropic therapy at a dosage of 0.05–0.1 micrograms/kg–1/min–1 and was used until hemodynamic stabilization. Group B received standard inotropic therapy without levosimendan.

 Results. Primary treatment outcomes: mortality was 2.9% in group A and 5.8% in group B, respectively, p = 0.5. Secondary treatment outcomes: neurological complications were detected in 5.8% in group A and 29.4% in group B, respectively, p = 0.01; persistent multiple organ failure developed in 2.9% and 17.6%, respectively, p = 0.046; the duration of hospitalization was 24 (20;29) days and 46 (40;48) days, respectively, p = 0.001; duration of hospitalization in Intensive Care Unit was 10 (8;13) days and 20 (18;26) days, respectively, p = 0.001; duration of MODS was 7 (6;8) days and 8 (7;9) days, respectively, p = 0.272; duration of mechanical ventilation of the lungs was 8 (6;8) days and 9 (7;10) days, respectively, p = 0.346; duration of cardiotonic support was 8 (6;8) days and 7 (7;8) days, respectively, p = 0.212.

Conclusion. Addition of levosimendan to inotropic therapy in newborns with MODS+ LCOS reduces the risk of neurological complications, the incidence of persistent multiple organ failure, and reduces the duration of hospitalization in general and directly in the emergency department.

Introduction. Ensuring vascular access in children when developing critical condition is an urgent problem. Circulatory insufficiency, hypovolemia, dehydration, and peripheral venous reserve deficiency significantly complicate access to the vascular bed, even with modern technical support. Intraosseous access is an alternative method that provides the possibility of rapid administration of medications and infusion media, including when resuscitation is necessary. Literature data indicate extremely limited experience of using intraosseous access in children in Russia with the development of critical conditions, especially those associated with the development of acute hypovolemia and dehydration.

The objective was to present the experience of providing and using intraosseous access in infants in critical condition with severe dehydration.

 Materials and methods. The study describes a group of 10 infants who were admitted to the anesthesiology and intensive care unit of a children’s infectious diseases hospital with acute infectious diseases of the gastrointestinal tract and severe dehydration (dehydration on the CDS is more than 2 points).

Results. The average time for setting up an intraosseous access took no more than 30 seconds, which was significantly less than the time for providing access to the main or peripheral venous vessels. The procedure of intraosseous access in none of the patients was associated with technical difficulties. Assessment of the degree of dehydration on the СDS 2 and 4 hours after the start of intensive therapy showed a decrease in the degree of dehydration.

Conclusions. Intraosseous access is an effective and safe way to provide emergency vascular access in children with severe degrees of dehydration.

Background. Diabetic ketoacidosis (DKA) is a common acute complication of type 1 diabetes (T1D) in children and adolescents that requires urgent hospitalization in an intensive care unit. DKA can lead to endothelial dysfunction (ED), but the diagnostic criteria for this condition have not been well studied in this urgent condition.

 The objective was to evaluate the severity of ED in children with T1D based on the degree of DKA by analyzing markers of endothelial glycocalyx (EGL) destruction in blood serum.

Materials and methods. 60 children and adolescents aged 9–14 years were studied, of which 30 patients had T1D decompensation (DKA) and were included in Group I, conditionally healthy children were included in Group II. Patients with DKA were further divided into three subgroups based on the severity of clinical manifestations: 1^st (severe, n = 5), 2^nd (moderate, n = 16), 3^rd (mild, n = 9). The concentrations of syndecan-1 (CD₁ ), syndecan-4 (CD₄ ), endocan-1 (EC₁ ), heparin sulfate (HS), hyaluronic acid (HA), and angiopoietin-1 (AP₁ ) were measured in blood serum using enzyme immunoassays.

Results. An increase in four of the six studied markers of EGL degradation (CD₁ , HS, HA, and AP₁ ) was observed in patients at the stage of T1D decompensation compared to the control group. In the subsequent division of the study group, the highest concentrations of CD₁ , CD₄ , HS, HA, and AP₁ were found in patients with severe DKA, with a decrease in average values for less severe clinical manifestations.

Conclusion. High levels of the markers of EGL destruction (CD₁ , HS, GC, and AP₁ ) indicate the presence of ED in children with T1D at the stage of disease decompensation. The severity of ED is related to the clinical severity of DKA.

The objective was to compare the efficacy and safety of the use of aprotinin and tranexamic acid in cardiac surgery with cardiopulmonary bypass (CPB) in adult patients.

Materials and methods. A randomized prospective comparative study was conducted. A total of 62 patients were included who underwent cardiac surgery with CPB. In order to prevent bleeding, fibrinolysis inhibitors were used intraoperatively in all patients, depending on the drug used, two groups were formed: «tranexamic acid» (n = 32) and «aprotinin» (n = 30). The time of the operation, the time of CPB and anoxia were recorded, postoperative blood loss according to 12-hour intervals and the need for transfusion during and after surgery were assessed. In the postoperative period, the need for inotropic support at the time of transfer to the intensive care unit (inotropic index), time of ALV, kidney (GFR, creatinine) and liver (ALT, direct bilirubin) function, as well as markers of the inflammatory response (white blood cell count, C-RP) were taken into account.

Results. The volume of postoperative blood loss for 12 hours, as well as the need for transfusion in the intraoperative period, did not differ in the studied groups. At the same time, a decrease in the need for erythrocyte suspension was detected in the «aprotinin» group in the early postoperative period (p = 0.02). In the «aprotinin» group, the white blood cell count was higher than in the «tranexamic acid» group (p = 0.02), while the C-RP level was significantly lower in the “aprotinin” group (p = 0.002). The values of the PaO₂ /FiO₂ ratio in the studied groups did not differ, and the time of ALV was significantly lower in the «aprotinin» group (p = 0.016).

Conclusion. The results of the study showed that the use of aprotinin during cardiac surgery with CPB reduces the need for transfusion of hemocomponents in the early postoperative period; no side effects were detected when using the drug.

Introduction. The prevalence of HELLP syndrome ranges from 0.5% to 0.9%. The mortality rate during its development reaches 24%. One of the reasons for the unfavorable outcome of this complication is acute cerebrovascular accident, but the true frequency of this complication in HELLP syndrome is currently not specified. An even rarer complication is ischemic brainstem stroke. Progressive endothelial dysfunction leading to generalized microthrombosis and coagulopathy may be the cause of neurological complications in both HELLP syndrome and other types of thrombotic microangiopathy. Despite the fact that ischemic stroke is not an indication for therapeutic apheresis procedures, probably, their early onset with the development of stroke against the background of any of the options for obstetric thrombotic microangiopathy allows to gain time for a differential diagnosis and in a short time to improve the neurological status, laboratory parameters and general condition of the patient.

The objective was to present a clinical case of the development of brainstem stroke in a patient with an atypical course of HELLP syndrome without clinical and laboratory signs of liver failure, to summarize existing data on the frequency of strokes during pregnancy, risk factors, etiology, as well as diagnostic and treatment strategies.

Conclusion. Obstetric thrombotic microangiopathy can be the cause of ischemic stroke; it requires an urgent differential diagnosis with hemorrhagic stroke, thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome and catastrophic antiphospholipid syndrome, an interdisciplinary approach to diagnosis and treatment, as well as early inclusion in the complex therapy of therapeutic apheresis.

The development of pseudohyperchloremia in bromine poisoning has been described in several clinical cases, as well as in the veterinary literature. Among the side effects of bromides, the likelihood of developing such condition has not been described. We report a case of pseudohyperchloremia in patients taking a bromine-containing multicomponent drug. Severe hyperchloremia was detected – 209 mmol/l and 233 mmol/l – in the absence of metabolic acidosis and negative anion gap. This case is the first Russian-language description of the phenomenon.

The objective was to analyze modern approaches to the use of electrical and pharmacological cardioversion in patients with persistent atrial fibrillation (AF).

Materials and methods. A non-systematic literature review was conducted. Russian publications were searched in the eLibrary database, and international publications were sourced from PubMed and Google Scholar.

Results. Cardioversion in patients with persistent AF employs either electrical cardioversion (ECV) or pharmacological cardioversion with cavutilide. ECV demonstrates high efficacy and a low rate of adverse events. However, its effectiveness depends on patients’ constitutional characteristics. Additionally, ECV requires total intravenous anesthesia, which may lead to sedation-related adverse events. Pharmacological cardioversion with cavutilide shows comparable efficacy to ECV. Studies indicate a favorable safety profile for cavutilide; however, due to the risk of proarrhythmic events, strict adherence to administration protocols and extended post-procedural monitoring in intensive care unit are obligatory.

Conclusion. The choice of the optimal method for restoring sinus rhythm in patients with persistent AF should be individualized.

The objective was to summarize data from the literature on methods of diagnosis and prevention of nosocomial meningitis.

Nosocomial meningitis (NM) and ventriculitis are severe, often life-threatening complications in neurosurgery. Currently, postoperative meningitis, shunt infections, and drainage-associated ventriculitis are distinguished. For each of the above groups of diseases, there are specific diagnostic approaches, etiotropic agents, and treatments that differ significantly from community-acquired infections of the central nervous system. Pathogens are represented by a wide range of opportunistic and pathogenic microorganisms, which differ significantly from community-acquired ones. The diagnosis of NM is based mainly on clinical assessment and laboratory examination of cerebrospinal fluid. In most recommendations, there are no precise laboratory criteria for the diagnosis of NM, which is explained by the variability of shifts depending on the microorganism that caused the infection and on the individual characteristics of the patient, as well as the variety of clinical situations. NM prevention is based on minimizing risk factors, includes measures against endogenous and exogenous infection, and can be divided into three stages: preoperative, intraoperative and postoperative. The development of criteria for NM and ventriculitis, the identification of risk factors remains an important problem that has not been definitively solved to date.

The objective was to summarize the available data on the use of V-V ECMO (veno–venous extracorporeal membrane oxygenation) in severe respiratory failure and to update ideas about the tactics of intensive therapy.

 Materials and methods. In this review, we searched Web of Science, Scopus, Medline, PubMed, and E-library database. 48 articles were included, containing modern approaches to V-V ECMO, as well as current data of clinical and scientific studies.

 Results. In this review, we presented the physiologic aspects of V-V ECMO, indications for its use and data on its effectiveness in the treatment of severe respiratory failure of various etiologies. Current clinical data on management tactics and aspects of intensive care are presented.

 Conclusions. Ensuring “Lung rest” with the creation of conditions for the restoration of lung gas exchange function is the main point of application of V-V ECMO in intensive care for severe respiratory failure. Individualized approach to the assessment of indications and timely initiation of the method in multidisciplinary institutions with extensive experience are key factors that improve the treatment outcomes of patients in this group.

The objective was to evaluate the effectiveness of antisecretory therapy in patients in critical surgical condition with complicated erosive and ulcerative lesions of the gastric mucosa and/or duodenum of mixed origin complicated by bleeding.

 Materials and methods. The observational study included 30 patients who were hospitalized between March and December 2024. The patients were divided into two groups. The control group included 15 patients receiving Omeprazole gastroprotective therapy, and the comparison group included 15 patients receiving Lanson-AF therapy. The results of the study were recorded at the following stages: I – before prescribing the drug, II – after 4 days of therapy with Omeprazole and Lansone-AF. All patients at stages 1 and 2 were assessed according to clinical, laboratory and fibrogastroduodenoscopy data. Statistical data processing was performed using the IBM SPSS Statistics 20 program.

 Results. According to FGDS data, at the 1st stage of the study, defects of the gastroduodenal mucosa of varying severity were detected in all patients included in the study. After Omeprazole therapy, with repeated FGDS on day 4, 8 patients (53%) showed a decrease in the diameter of erosions (ulcers) and swelling of the mucous membrane. After Lanson-AF therapy on day 4, 12 patients (80%) with repeated FGDS had an overgrowth of scar tissue on the walls and edges of the defect, the absence of edema and a visible defect in the mucous membrane. There were no significant changes in the biochemical state of the blood during drug therapy.

 Conclusion. The use of Lanson-AF for antisecretory therapy in critically ill patients with complicated erosive and ulcerative lesions of the gastroduodenal mucosa of mixed origin was accompanied by a more pronounced clinical effect than with omeprazole therapy.