Thoracoscopic radiofrequency epicardial ablation of the left atrium is performed under conditions exclusive for this intervention. Anesthetic management for this surgery is not standardized. Objective. To determine the optimal anesthetic technique for thoracoscopic radiofrequency epicardial ablation of the left atrium. Material and methods. The study included 187 patients who underwent thoracoscopic radiofrequency ablation. Of these, 126 ones were in prospective part. Patients were divided into two groups according to anesthesia: total intravenous anesthesia with mechanical ventilation and combined endotracheal anesthesia. Central hemodynamics, mechanical ventilation, and acid-base status were recorded intraoperatively at three stages of intervention. We analyzed characteristics of early postoperative period and postoperative morbidity. Results. Intraoperative stage is characterized by supine position, alternate single-lung ventilation and communication between pleural cavities. The median of BIS in the combined endotracheal anesthesia group changed between stages: 67 (beginning of surgery) — 40 (main stage) — 57 (end of surgery). In the total intravenous anesthesia group, BIS was stable. At the main stage, FiO2 set to maintain optimal PaO2 and SatO2 was 80 [60; 80] in the CEA group and 50 [45;70] in the intravenous anesthesia group. No dependency between anesthetic technique and intra-/postoperative complications was found. Cardiac index at the beginning of surgery was higher in the total intravenous anesthesia group. Sympathomimetic support increased cardiac index to normal values. Conclusion. Total intravenous anesthesia is safe for thoracoscopic radiofrequency epicardial ablation of the left atrium regarding stable anesthesia and optimal gas exchange indicators. Total intravenous anesthesia combined with inotropic support allowed for higher cardiac index and smaller hemodynamic changes.
Background. Early identification of sepsis in patients with prolonged ICU stay requires predictive approaches considering dynamic clinical changes. Objective. To identify the risk factors and compare two data alignment strategies (left-aligned and right-aligned) for developing sepsis prediction models in critically ill patients, predominantly those in prolonged or chronic critical illness. Material and methods. A single-center retrospective study was conducted using data from the Russian Intensive Care Dataset (RICD v2.0) between December 2017 and September 2024. Two data alignment approaches were applied for model development: left-aligned (based on ICU admission) and right-aligned (based on time of sepsis onset). Predictive models were constructed using logistic regression and the XGBoost machine learning algorithm. Sepsis was identified according to Sepsis-3 criteria. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC). Results. The study included 575 patients (336 ones with sepsis; median age 64 years; median ICU stay 42 days; in-hospital mortality 11.3%). In case of left-aligned approach, significant risk factors included age ≥67 y.o., community-acquired pneumonia, elevated lactate and creatinine, ischemic stroke and chronic comorbidities. Predictive efficacy of logistic regression model was trivial (AUROC 0.661). The right-aligned approach allowed detection of significant changes in vital signs up to 6 hours before sepsis onset. The highest predictive performance was achieved using the XGBoost algorithm (AUROC 0.734). Conclusion. This study first identified specific risk factors for sepsis in patients with prolonged ICU stay. The right-aligned approach combined with XGBoost demonstrated superior predictive accuracy. These findings warrant further assessment in studies with internal and external validation.
Background. Arterial hypotension following anesthesia induction and initiation of mechanical ventilation is a common phenomenon with potentially harmful consequences. Effective hemodynamic management requires identification of predominant underlying mechanism. Objective. To examine hemodynamic alterations underlying arterial hypotension following anesthesia induction in patients with preserved or impaired myocardial contractility undergoing coronary artery bypass grafting. Material and methods. A prospective clinical study enrolled 100 patients with chronic heart failure scheduled for CABG: group 1 (n=50) — patients with preserved left ventricular ejection fraction (LVEF ≥50%), group 2 (n=50) — patients with reduced LVEF (41—49%). Hemodynamic assessment included pressure-derived parameters (pulmonary artery catheter) and volumetric measurements (transesophageal echocardiography) at four time points: (1) prior to anesthesia induction; (2) after induction but before neuromuscular blockade (“spontaneous breathing phase”); (3) 10 min after initiation of MV; (4) 3 min after Trendelenburg positioning. Results. Induction of anesthesia resulted significant reduction of mean arterial pressure (MAP) and perfusion pressure in both groups. Pressure further declined after MV initiation (p<0.05). In group 2, this was accompanied by decrease in indexed stroke volume by 16.5% and cardiac index by 16.7% (p<0.05). Central venous pressure significantly increased after MV initiation only in patients with reduced LVEF. Despite Trendelenburg position augmenting venous return, no increase in left ventricular end-diastolic volume or cardiac output was recorded in both groups. Conclusion. Arterial hypotension following anesthesia induction is primarily driven by pharmacologic vasodilation and impaired cardiac performance under positive pressure ventilation. Pressure-derived parameters are often artifacts of increased intrathoracic pressure that limits their clinical value.
Introduction. A personalized medicine involving timely assessment of individual characteristics of patients is important in modern world. This assessment takes into account not only variable phenotypic traits but also various markers, including genetic markers. An important aspect of treatment after open-heart surgery is early rehabilitation that cannot be achieved without adequate and timely analgesia. Objective. To study the association of polymorphic markers of the COMT, OPRM1, CYP2D6, CYP2B6, and CYP2C9 genes with effectiveness of postoperative pain relief in open-heart surgery. Material and methods. A pilot observational study involved 90 patients who underwent cardiac surgery through median sternotomy. Postoperative multimodal anesthesia implied fentanyl, tramadol, paracetamol, and ketoprofen. Pain severity was daily assessed using digital rating scale at rest and coughing. Postoperative nausea, vomiting, itching, urinary retention, sedation and sensations around postoperative wound were also evaluated. Consumption of analgesics was measured postoperatively. A single molecular genetic analysis was performed to determine the alleles and genotypes of the following single nucleotide variants: rs1065852 of the CYP2D6 gene, rs1799971 of the OPRM1 gene, rs4680 of the COMT gene, rs2279343 of the CYP2B6 gene, rs1799853 of the CYP2C9 gene. Results. Current analgesia scheme for open heart surgery does not provide adequate pain relief within three postoperative days. Female gender was a predictor of duration and intensity of pain syndrome, as well as sedation depth. Among genetic markers, homozygous genotype AA rs4680 of the COMT gene identified in 54.5% of patients is of the greatest interest. However, it cannot be used as a predictor of pain intensity and analgesic consumption. In six months after surgery, 24.5% of patients with median sternotomy still experienced chest pain, and 13.2% reported QoL impairment. Conclusion. In the study group, 54.5% of patients were carriers of homozygous genotype AA rs4680 of the COMT gene. Clinical significance of this genetic polymorphism for evaluating the effectiveness of pain management in cardiac surgery is still a matter of debate and depends on specific analgesia regimen.
Background. A few reports on prevention and correction of inadvertent hypothermia in parturient and postpartum women, the need to clarify definitions of this condition and heterogeneous evidence on effectiveness of methods for its correction inspired this review. Objective. To expand data on prevention and correction of inadvertent hypothermia in obstetrics. Material and methods. The review was conducted in accordance with the PRISMA-ScR guidelines. Five databases (from January 1990 to May 2025) were searched for publications on active and passive warming methods for parturient and postpartum women. Eligibility criteria (PCC): (P) — population: women in labor and postpartum women regardless of urgency and method of delivery, (C) — concept: inadvertent hypothermia, warming methods, (C) — context: correction of hypothermia in context of blood loss, postpartum hemorrhage, coagulopathy. Types of sources: primary studies, meta-analyses, ScR, guidelines. Source management: Mendeley Desktop, review management: Rayyan. An iterative EXCEL form was developed for data extraction. ScR protocol registered: INPLASY202580010. Results. The ScR included 40 publications from 19 countries. The term “inadvertent perioperative hypothermia” was the most common (unintentional, unintended, or accidental hypothermia). Most studies included healthy women who had undergone cesarean section under regional anesthesia. The most common methods for active warming were warming of infusion solutions (75%), convective blankets (37%), and combinations of these methods (45%). Preoperative active warming is indicated in 58% of sources. The incidence of postpartum hemorrhage was recorded in four studies, but none assessed the incidence of coagulopathic bleeding. Conclusion. Multimodal strategy of active warming initiated before delivery and continued in intraoperative and postoperative period is optimal. The effect of hypothermia on blood loss in context of postpartum hemorrhage remains virtually unexplored. Further research may allow hypothermia to be considered as a factor aggravating obstetric blood loss.
Water-electrolyte imbalance disorders are one of the main manifestations of severe burn injury largely determining the course and prognosis of burn disease. Water balance and microcirculation disorders are followed by dyselectrolytemia. Understanding of these disorders and their timely correction are essential for successful treatment of severely burned patients. Objective. To assess severity of water-electrolyte imbalance in acute period of burn disease and to develop an optimal algorithm for correction. Material and methods. We retrospectively analyzed 44 victims with severe burns, whose daily fluid balance was determined. Standard laboratory tests were performed, including analysis of electrolyte composition and acid-base balance. Victims were divided into 2 groups depending on onset of intensive care. Correction of changes included infusion therapy. Infusion volume on the first day was determined by the Parkland formula, on the 2nd and 3rd days according to clinical situation. Composition depended on disturbances in electrolyte balance and acid-base balance. Conclusion. All severely burned patients develop hypovolemia, dyselectrolytemia and metabolic lactic acidosis in acute period of burn injury. Early initiation of infusion therapy with corrective and balanced solutions leads to restoration of water balance, electrolyte and acid-base disturbances on the 3rd day of burn disease. Delayed therapy was accompanied by more severe hypovolemia, electrolyte imbalance, and metabolic lactic acidosis. Recovery of fluid, electrolyte, and acid-base balance was observed on days 5—6 of burn injury. Conclusion. All severely burned patients develop hypovolemia, electrolyte imbalance, and metabolic lactic acidosis in acute phase of burn injury. Early fluid therapy with corrective and balanced solutions leads to restoration of fluid balance, electrolyte, and acid-base imbalances on day 3 of burn injury. This allows for early surgical treatment.
Background. Simulation-based education (SBE) has become an integral standard for training anesthesiologists and critical care physicians worldwide. This approach ensures safe acquisition of practical and non-technical skills. The period from 2020 to 2025 is characterized by development of material base. However, effectiveness of SBE requires ongoing assessment taking into account teaching staff, equipment, and methodological support. Objective. To analyze SBE in training of clinical residents in anesthesiology and intensive care in the Russian Federation between 2020 and 2025. Material and methods. In 2025—2026, an anonymous online survey of 75 faculty members from various regions of the Russian Federation was conducted using a specially developed questionnaire involving 43 questions. Survey methodology, covering organizational, personnel, and methodological aspects of SBE, was identical to the 2020 study. This allowed for a comparative analysis. Results. Progress was noted in certain areas over a 5-year period. Indeed, 100% of centers are equipped with basic intubation phantoms (compared to 96% in 2020). The share of training in video laryngoscopy (from 0 to 64%) and ultrasound-guided central venous catheterization (from 38% to 56%) increased. However, systemic challenges were identified: only 24% of faculty members have a specialized certification in SBE. There is a shortage of highly realistic robotic simulators, and there is no a unified system for training faculty members. The use of structured debriefing and objective assessment checklists remains inconsistent (72% and 52%, respectively). Conclusion. Despite positive progress in equipping and expanding the range of skills, systematic implementation of simulation technologies in anesthesiology and critical care residency in the Russian Federation faces persistent barriers. Key barriers include insufficient professional training of faculty members, fragmented methodological support and shortage of equipment for highly realistic simulation. To fully realize potentials of simulation training, we need for unified educational standards, mandatory professional development programs for faculty members, administrative support from university administrators, and centralized methodological guidance from professional communities.
Background. Patients with acute heart failure (AHF) and cardiogenic shock requiring cardiac surgery represent the cohort of the highest risk with extremely poor perioperative outcomes. Standard risk stratification tools (EuroSCORE II, STS scores) consistently underestimate mortality in this population, necessitating integration of additional prognostic modalities including biomarkers and dynamic hemodynamic assessment. Objective. To analyze current evidence on optimizing perioperative management of patients with AHF and cardiogenic shock. Material and methods. A systematic review was performed across PubMed, Embase, Cochrane Library, and Google Scholar databases (2000—2025). Systematic reviews, meta-analyses, randomized controlled trials, and large cohort studies addressing perioperative management of adults with AHF or cardiogenic shock undergoing cardiac surgery were included. Among 410 initially identified records, 35 studies met inclusion criteria after screening and full-text assessment. Results. In addition to EuroSCORE II, modern approach includes assessment of biomarkers (ST2 protein, galectin-3, NT-proBNP), perfusion parameters (lactate, central venous saturation (ScvO2), and cardiogenic shock-specific assessment (SCAI). The choice of anesthesia is driven by the need for hemodynamic stability, not by a debate about support methods. Hybrid and minimally invasive procedures instead of open surgery are justified. Perfusion modification (MECC, pulsatile mode) reduces inflammatory response and improves organ perfusion. Intensive care strategy should be preemptive with early planning of mechanical circulatory support (extracorporeal membrane oxygenation) and multiple organ support. Conclusion. Perioperative management of cardiac surgery patients with acute heart failure should be based on a multidisciplinary approach including advanced risk assessment, individual choice of surgical tactics and anesthesia, modified perfusion and preventive intensive care.
Objective. To develop and externally validate the models for predicting in-hospital mortality and septic complications in patients with COVID-19. Material and methods. This study was conducted in accordance with the TRIPOD guidelines. A retrospective derivation cohort included patients hospitalized between April 2020 and December 2021. External validation was performed in a cohort of patients hospitalized during the period of Omicron variant predominance (January—February 2022). Results. The final model included age, SpO2, respiratory rate, and Glasgow Coma Scale score. The derivation cohort included 488 patients, while the validation cohort comprised 382 patients. During external validation, AUROC for in-hospital mortality was 0.798 (95% CI 0.752—0.845), while AUROC for sepsis and septic shock were 0.680 and 0.704, respectively. Calibration was good for mortality and less pronounced for other outcomes. Conclusion. Original model demonstrates stable discriminative performance and acceptable calibration for predicting in-hospital mortality in patients with COVID-19.
Objective. To identify predictors of acute mesenteric ischemia (AMI) in patients undergoing on-pump cardiac surgery. Material and methods. A case-control study was conducted between 2020 and 2025 and included 100 ICU patients after on-pump cardiac surgery. Key perioperative parameters were compared between patients with AMI after surgery (group 1, n=50) and eligible patients without AMI (group 2, n=50). Results. According to ROC analysis, P-POSSUM score, VIS (vascular inotropic index), chronic heart failure NYHA class III—IV, ALT, CPB and aortic cross-clamping time showed satisfactory predictive ability, whereas EuroScore II, leukocyte/platelet ratio (WPR), surgery time and blood loss demonstrated good predictive ability. Original model for predicting postoperative AMI includes four predictors: EuroScore II, WPR, surgery time and blood loss. When assessing the effectiveness of the model, AUC was 0.85±0.04 (95% CI 0.77—0.92) (p<0.001). Sensitivity was 80%, specificity — 76%. Conclusion. Perioperative predictors of AMI in early postoperative period after on-pump cardiac surgery include EuroScore II >7, CHF NYHA class III—IV, surgery time >225 min, CPB time >105 min, blood loss >275 ml, WPR >0.036.
Objective. To evaluate nephroprotective effect of balanced amino acid infusion in patients with intact kidney function undergoing cardiac surgery with cardiopulmonary bypass (CPB). Material and methods. The study included 128 patients divided into two groups: the intervention group (n=64) and the control group (n=64). In the intervention group, a balanced amino acid solution (Aminoven 10%, Fresenius Kabi, Austria) was administered at a dose of 2 g/kg/day immediately after anesthesia induction and for the first 24 hours postoperatively. The control group received placebo infusion (a balanced crystalloid solution — Sterofundin, 20 ml/kg/day, B. Braun, Germany) under identical conditions. Statistical analysis of data was performed in Python 3.12 environment. Results. There were significant differences in estimated glomerular filtration rates (eGFR) (92 [84.1; 100.3] vs. 82.6 [72.4; 92.1], p=0.0011) and creatinine clearance (106.1 [94.8; 118.3] vs. 94.1 [82.9; 105.6], p=0.001). There was less incidence of acute kidney injury (AKI) in the intervention group (12.5% vs. 23.4%) (although this difference was not significance (p=0.166)), as well as shorter duration of injury (3 [3; 3] vs. 5 [4; 5.75] days, p=0.002). Additionally, AKI was less severe in the intervention group and required lower doses of loop diuretics. Analysis of blood urea levels confirmed safety of amino acid infusion. Conclusion. Infusion of a balanced amino acid mixture has a positive impact on kidney function parameters, incidence and duration of AKI in patients with intact kidney function. This intervention is safe and does not affect nitrogen balance.
Elimination of factors preventing early extubation (EE) is essential to reduce ventilation time and realize preventive and therapeutic measures. Objective. To study intra- and postoperative risk factors affecting EE. Material and methods. A retrospective cohort study included 2254 patients over 18 years old who underwent open cardiac surgery in 2019 year. To establish independent risk factors associated with ventilation time, we analyzed 96 perioperative parameters in 900 patients. In this article, we present analysis of 33 intraoperative parameters and 25 postoperative parameters. Results. We created 2 models to characterize intra- and postoperative periods using univariate and multivariate logistic regression analysis. Each model was characterized by high predictive accuracy, sensitivity and specificity. As a result, independent risk factors associated with ventilation time and providing EE were identified. Regression coefficient was calculated for each factor to predict EE. Conclusion. Research of risk factors influencing ventilation time allowed a personalized approach to each patient regarding individual risk and possibility of EE.
Pneumonia caused by multidrug-resistant (MDR) hospital-acquired pathogens remains one of the most serious complications in intensive care for polytrauma. High mortality and limited options for antibiotic therapy necessitate searching for adjuvant treatment approaches. We report a combined therapy with xenon inhalations and chlorin photosensitizer «Radachlorin» in a 22-year-old male with severe blast trauma complicated by bilateral MDR pneumonia. At admission, the patient demonstrated severe systemic inflammation (CRP 90.9 mg/L, PCT 12.9 ng/mL) and multiple organ dysfunction with necessary mechanical ventilation. Bronchoscopy and chest CT revealed bilateral pneumonia, while bronchoalveolar lavage revealed massive growth of Acinetobacter baumannii (107 CFU/mL, carbapenem-resistant). A course of combined therapy was performed: daily short xenon-oxygen inhalations and nebulized Radachlorin inhalations with photoactivation. Treatment resulted in significant improvement: CRP decreased to 30.2 mg/L, PCT to 0.26 ng/mL, bacterial load in airways decreased, and oxygen saturation improved to 92%. After 9-day ventilation, the patient was extubated; septic process was controlled. This case demonstrates potential of xenon inhalation with nebulized Radachlorin inhalations with photoactivation as an adjuvant modality in management of severe infectious complications in patients with polytrauma.
Training of anesthesiologists and intensive care specialists is an important element of healthcare system, as these specialists are essential for safe management of critically ill patients. Objective. To analyze regulations for training of anesthesiologists and intensive care specialists in the Russian Federation. Material and methods. We analyzed changes in regulatory framework governing the training of anesthesiologists and intensive care specialists in the Russian Federation over the past 3 years. Results. Regulations governing the training of anesthesiologists and intensive care specialists in the Russian Federation were analyzed. In 2022, the Government of the Russian Federation amended many aspects of regulatory activities, including those related to medicine due to anti-Russian sanctions imposed by several foreign countries. This was necessary to reduce personnel shortage in anesthesiology and intensive care. Conclusion. There is still the need for changes in regulatory framework.
In fast-paced world and associated stress, it is especially important to consider the impact of various factors on mental state. Primarily, these factors include exposure to stress in the workplace. Anesthesiology and intensive care are among the specialties where factors of psychoemotional stress are particularly pronounced. Psychological characteristics of a person may influence predisposition to burnout in specialists working in anesthesiology and intensive care. Objective. To assess the influence of psychological characteristics on burnout syndrome in specialists working in anesthesiology and intensive care. Material and methods. A total of 387 employees (anesthesiologists, intensive care specialists and nurses) of ICUs were surveyed. Participants were asked to provide the following information: gender, age, length of service, position, academic degree, marital status, and number of children. The following psychological assessment methods were used: the Individual Typological Questionnaire (authored by L.N. Sobchik) and the MBI Professional Burnout Questionnaire adapted by N.E. Vodopyanova. After excluding questionnaires unsuitable for analysis, data from 241 respondents were used for statistical analysis. Results. Among anesthesiologists and intensive care specialists, anxiety predicted such professional burnout signs as emotional exhaustion and depersonalization. Introversion positively correlated with inverted indicator of reduced professional achievement. Spontaneity prevents emotional exhaustion, extroversion prevents depersonalization, and emotional lability and extroversion prevent reduced professional achievement. Rigidity positively correlated with emotional exhaustion scores in female physicians and with depersonalization in representatives of all groups. Among department heads, elevated anxiety and introversion had opposite effects and reduced signs of professional burnout, as did sensitivity. Among nurses, introversion and anxiety increased emotional exhaustion and depersonalization, extroversion reduced signs of emotional burnout, and spontaneity and aggressiveness prevented decline in professional achievement. Conclusion. We obtained data on increased risk of professional burnout among ICU employees with high levels of anxiety, rigidity, introversion and low extroversion.
Background. Despite more than 10-year experience of simulation training In Russia, availability of human resources and equipment, potential of simulation-based educational technologies in training for anesthesiology and critical care residency programs is still unsystematic and insufficiently effective. Objective. To develop a unified practical training program for anesthesiology and critical care residency programs using simulation technologies. Material and methods. A group of experts in simulation training for anesthesiology and critical care conducted a literature review using the Kern methodology to identify problem skills and competencies and evaluate modern simulation training programs. A Delphi consensus assessment was used to identify educational needs. The program sections, topics, and types of lessons, as well as learning outcome assessment system, were developed taking into account existing national and international experience. Results. Analysis of Russian and international lawsuit databases and studies on simulation training in anesthesiology and intensive care allowed us to identify skills and competencies whose poor quality impacts patient safety. Using the Delphi method, we identified practical skills and competencies that should be taught using simulation technologies. These results formed the basis for developing educational needs and formulating learning objectives. The program sections were designed to acquire practical and non-technical skills. For the first time In Russian medical education, the program included introductory simulation course and critical situation training. A system of assessment tools was developed for use in ongoing and final assessment of learning outcomes. This system focuses on skills and competencies. A plan for the pilot implementation of the program for 2026—2028 was developed. Conclusion. For the first time In Russian medical education, a training program involving simulation technologies for residency was developed. Implementation of this program will improve professional training of future anesthesiologists and critical care physicians. Evaluating the implementation of the program is planned in 2027—2028.
Introduction. Anesthetic safety in children remains one of the key challenges of modern clinical practice. Despite advances in monitoring and procedural standardization, the risk of intraoperative critical incidents (CI) in children remains significantly higher than in adults. Simple non-invasive tools for preoperative risk assessment based on key physiological parameters require validation. Objective. To analyze breath-holding test (BHT) after deep inspiration as a predictor of intraoperative CI in children undergoing mechanical ventilation (MV). Material and methods. A prospective study enrolled 135 children aged 5—10 years scheduled for elective abdominal surgery under general anesthesia with MV. Preoperative triple BHT was administered, and mean value used for analysis. Recording intraoperative CIs was the primary objective of intraoperative monitoring. Predictive value of BHT for CIs was assessed using ROC curves. Results. Intraoperative CIs were identified in 20.7% of patients. Shorter BHT after deep inspiration was significantly associated with higher incidence of intraoperative CI. AUC was 0.847 for overall critical incidents, 0.903 for hemodynamic, and 0.853 for respiratory events (p<0.001). Optimal cutoff values for BHT were ≤28 seconds for overall and hemodynamic incidents and ≤27 seconds for respiratory incidents. Conclusion. BHT after deep inspiration is a simple, noninvasive, and informative method for preoperative risk stratification and demonstrates high predictive value for intraoperative CI in mechanically ventilated pediatric patients.
The SOFA score was proposed 30 years ago. This scale is now requiring corrections due to changes in diagnostic methods and therapy of organ dysfunction. This review presents the background of the SOFA-2 score, summarizes the main stages and principles of development. The algorithm for the SOFA-2 score and its differences from original SOFA score are also discussed. The authors analyze advantages and limitations of the updated score.
Predicting the outcomes of intensive care for congenital malformations (CM) in newborns is one of the most serious problems in neonatology. Objective. To identify predictors of intensive care outcomes in CM children requiring surgery in early neonatal period according to endocrine status. Material and methods. There were 34 newborns with CM and gestation period 39.23 (38—40) weeks. Diaphragmatic hernia (25%), esophageal atresia with tracheoesophageal fistula (20%), Ledd syndrome (10%) and omphalocele (15%) were the most common. Mean age of children was 2.5 (1—4) days. Results. A new prediction model for ventilation time includes serum cortisone and cholecalciferol after surgery, concentration of dehydroepiandrosterone a day after surgery and SpO2 immediately after surgery. Sensitivity was 0.832, specificity — 0.956, AUC — 0.958. To assess the probability of long-term ICU-stay (> 5 days) in patients with favorable outcomes, appropriate model involves concentration of 17-OH pregnenolone immediately after surgery, gradients of 17-OH pregnenolone and progesterone, as well as the ratio of 17-OH pregnenolone and aldosterone immediately after surgery and one day later (sensitivity — 0.842; specificity — 0.9; AUC — 0.942). The only independent predictor of adverse outcomes in CM newborns is lactate concentration. Its concentration was significantly higher in deceased children immediately after surgery (5.6 vs 2.2 mmol/L; p< 0.05) and a day later (6.1 vs 1.8 mmol/L; p< 0.05). The probability of unfavorable outcome is significantly higher in case of the ratio of 17-hydroxypregnenolone/corticosterone and 17-hydroxypregnenolone/cortisone equal to zero on the first day after surgery. Conclusion. Depletion of hormone precursors immediately after surgery and on the first day after surgery is a risk factor for unfavorable outcomes.
There are no algorithms for treating burn patients based on burn injury outcome prediction indices. Objective. To improve prognosis of burn injury outcomes in patients with a Revised Frank Index (RFI) score 71—180 by taking into account white blood cell (WBC) and platelet counts. Material and methods. The study included 104 ICU patients with skin burns. WBC and platelet counts were measured on the first day after injury. We compared WBC and platelet counts in patients with different outcomes. Their predictive ability was assessed using binary logistic regression analysis and classification tree analysis. Results. WBC and platelet counts on the first day were significantly lower in survivors. Binary logistic regression analysis suggested that WBC and platelet counts were associated with injury outcome. We developed the outcome prediction algorithm and determined prognostic WBC and platelet counts. The algorithm is as follows: leukocyte count is first assessed, and WBC count >25.1·109/L is unfavorable. In case of WBC count ≤25.1·109/L, platelet count is assessed. This value ≤396·109/L is favorable, while platelet count >396·109/L is unfavorable. Conclusion. Original burn injury outcome prediction algorithm takes into account leukocyte and platelet count and enables predicting favorable outcomes in patients with RFI score 71—180 with 93% accuracy.
