Perioperative respiratory risk represents a major interdisciplinary challenge, as postoperative pulmonary complications (PPCs) are associated with increased mortality, prolonged hospital stay, and higher healthcare costs. Heterogeneity in the definitions of complications complicates the interpretation of the literature; initiatives such as Standardised Endpoints in Perioperative Medicine (StEP) and the European Society of Anaesthesiology working group on European definitions have proposed harmonised definitions and severity grading systems, thereby improving comparability across studies and clinical applicability of results. This narrative review synthesises data on the epidemiology of PPCs, patient- and procedure-related risk factors, methods of risk stratification and prevention, and presents contemporary prognostic models ranging from clinical risk scores to machine learning algorithms, with particular emphasis on validation requirements and reporting standards. Practical implications include the need to apply StEP definitions with severity grading alongside discrete registry-based outcomes according to the NSQIP (National Surgical Quality Improvement Program) classification, to perform external validation of predictive models, and to implement bundled preventive strategies throughout all phases of perioperative care in high-risk populations. Integration of standardised outcomes, validated risk models, and multistage preventive interventions, including the use of machine learning algorithms, provides a foundation for reducing the incidence of PPCs and improving long-term outcomes.
INTRODUCTION: Patients with acute cerebral insufficiency (ACI) are at high risk of developing the post-intensive care syndrome (PICS), an important role in the formation of which is played by sarcopenia. OBJECTIVE: To study the prognostic significance of sarcopenia in the development and severity of PICS in patients with acute ACI. MATERIALS AND METHODS: A prospective single-center cohort study included 115 patients with ACI due to ischemic (IS) or hemorrhagic stroke (GI). The level of consciousness, severity of neurological deficit, multiple organ dysfunction, PICS on days 3 and 7, duration of mechanical ventilation, and the presence of sarcopenia were assessed. To assess the independent effect of sarcopenia on 28-day mortality, a multifactorial logistic regression analysis was performed. RESULTS: The prevalence of sarcopenia in patients with PICS and ACI was 61.8 %. Patients with sarcopenia were characterized by a more pronounced neurological deficit and the severity of ACI at admission (p < 0.001). Patients with sarcopenia had a more severe course of PICS on day 3 — 3 (2.0; 4.0) points (p = 0.014) and on day 7 — 5 (4; 5.5) points (p < 0.001). Sarcopenia was associated with a high number of complications: pneumonia — 67.6 % (p < 0.001) and sepsis — 31.0 % (p = 0.016), as well as a mortality rate of 42.3 % (p = 0.033) with a mortality rate of more than 28 days. Ventilation in the sarcopenia group was performed in 84.5 % of patients (p = 0.002). CONCLUSIONS: Sarcopenia in patients with ACI and PIСS is associated with a more severe course of PICS, a greater number of complications (pneumonia, sepsis), the need for ventilation, and a higher 28-day mortality rate. With the severity of PICS on day 7 from 3 to 7 points, the probable mortality is significantly higher in patients with sarcopenia.
INTRODUCTION: Preoperative intermittent hypoxia–hyperoxia (IHH) may be considered an organ-protective prehabilitation strategy for high-risk patients; however, the lack of personalized approaches to selecting optimal exposure modes limits its practical use. Near-infrared cerebral tissue oximetry (NIRS) may guide individualization of IHH protocols. OBJECTIVE: To evaluate the safety, tolerability, and biomarker signatures of adaptive response induction during NIRS-personalized IHH sessions. MATERIALS AND METHODS: This prospective single-blind randomized placebo-controlled study included 20 elderly volunteers randomized to the IHH group (n = 10) or the control group (n = 10). Participants underwent three daily 45-minute sessions consisting of five hypoxia-hyperoxia cycles or sham procedures. Personalization was achieved by individually titrating the fraction of inspired oxygen (FiO2) during the hypoxic phase to reduce cerebral tissue oxygen saturation (SctO2) by 20 % from baseline. The composite primary safety endpoint included individual intolerance, adverse events, and complications during sessions. Secondary endpoints assessed between-group differences in the dynamics of vital signs and FiO2. Biomarkers reflecting stress-adaptive responses and antioxidant activity were also evaluated. RESULTS: No cases of intolerance, adverse events, or complications were observed. Vital sign dynamics differed significantly between groups but remained within clinically safe ranges. Between the first and third sessions, a significant reduction in the FiO2 required to achieve a 20 % decrease in SctO2 was noted. The IHH group demonstrated significant increases in hypoxia-inducible factor-1α, nuclear factor erythroid 2-related factor 2, and catalase activity. CONCLUSIONS: Personalized NIRS-guided IHH sessions in elderly volunteers are safe and are associated with a reduction in the FiO2 required to decrease SctO2 to target levels, as well as activation of stress-adaptive and antioxidant pathways. These findings may be applicable to preoperative prehabilitation strategies and warrant confirmation in further clinical studies.
Perioperative malnutrition and protein-energy wasting remain key modifiable risk factors for complications, prolonged hospital stay, and increased costs in surgical patients. The updated 2026 FAR guidelines on perioperative nutritional support systematize evidence from 2021–2025 and present a comprehensive multidisciplinary approach to diagnosing and correcting malnutrition at all stages of surgical care. In contrast to the 2021 version, the new edition introduces a two-step model for nutritional assessment: expanded risk screening (NRS-2002, MUST, MST, and others) complemented by formal malnutrition diagnosis according to GLIM criteria, incorporating phenotypic and etiologic features as well as instrumental assessment of sarcopenia and clinical frailty. This enables a shift from simple risk stratification to outcome prediction and individualized selection of nutritional support strategies. The guidelines emphasize the pivotal role of the preoperative phase, including prehabilitation: correction of nutritional deficits, use of oral nutritional supplements and, when indicated, immunonutrition combined with exercise training and educational interventions. The postoperative section maintains a focus on early enteral nutrition and refines criteria for tolerance, options for direct oral feeding after selected procedures, and indications for supplemental and peripheral parenteral nutrition. For the first time, a distinct post-discharge phase is outlined, with recommendations on continued oral nutritional supplements in high-risk patients. Dedicated sections address the use of specialized formulas (lipid emulsions, omega-3 fatty acids, glutamine, fiber-enriched enteral feeds) and the prevention of refeeding syndrome, including identification of high-risk groups and initial treatment algorithms. The guidelines are fully integrated with ERAS principles, positioning nutritional support as an essential component of the patient pathway rather than an isolated module. The final section provides quality indicators and metrics for the delivery of nutritional and metabolic care, forming a foundation for the development of local protocols, clinical audit, and continuous improvement of practice In Russian surgical wards and intensive care units.
INTRODUCTION: Mechanical power (MP) does not account for aerated lung volume, potentially limiting its accuracy as a marker of ventilator-induced lung injury (VILI). In obese patients undergoing laparoscopic surgery, ventilation power density (VPD) may offer a more reliable predictor of postoperative pulmonary complications (PPCs). OBJECTIVE: To validate the calculation of ventilation power density (mechanical power indexed to the aerated lung volume) and to evaluate its prognostic value for PPCs in obese women undergoing laparoscopic pelvic surgery. MATERIALS AND METHODS: This retrospective cohort study included 64 women (age 35–58 years, ASA II-III, body mass index (BMI) ≥ 30 kg/m²). MP was calculated using the volume-controlled ventilation formula by L. Gattinoni et al. VPD was derived as MP divided by aerated lung volume, the latter computed as: RV + Cstat × PEEP + 0.5 × VT, where RV — residual volume, Cstat — static respiratory system compliance, PEEP — positive end-expiratory pressure, VT — volume tidal). The primary endpoint was PPC occurrence within 48 h postoperatively. ROC curve analysis and logistic regression were performed. RESULTS: PPCs occurred in 18 patients (28.1 %). VPD was significantly higher in the PPC group (11.2 ± 1.6 vs 8.7 ± 2.0 J·L−1·min−1; p < 0.001). The area under the ROC curve (AUC) for VPD was 0.864 (95 % CI 0.762–0.949), significantly outperforming MP (AUC 0.588; DeLong p < 0.001). An optimal VPD threshold of ≥ 9.9 J·L−1·min−1 yielded 88.9 % sensitivity and 76.1 % specificity. Each 1 J·L−1·min−1 increase in VPD was associated with higher PPC risk (odds ratio [OR] 2.256; 95 % CI 1.43–3.57; p = 0.04). CONCLUSIONS: Ventilation power density is a superior predictor of PPCs compared with absolute MP, with a clinically relevant threshold of ≥ 9.9 J·L−1·min−1. These findings may inform future strategies for personalized intraoperative ventilation management, pending prospective validation.
INTRODUCTION: Older age is recognized as an independent risk factor for adverse perioperative outcomes; however, quantitative data on the impact of early old age (65–75 years) on 30-day postoperative complications in a multicenter Russian cohort are lacking. OBJECTIVE: To determine whether older age (65–75 years) is associated with the incidence, pattern, severity, and timing of 30-day postoperative complications and mortality compared with patients aged 18–64 years undergoing elective abdominal surgery. MATERIALS AND METHODS: A multicenter prospective cohort study was conducted (secondary analysis of the STOPRISK database, NCT03945968; STROBE). From 2019 to 2024, 12,000 patients from 38 centers across the Russian Federation were enrolled. After exclusions, the analytical sample comprised 10,915 patients: 18–64 years (n = 8,119) and 65–75 years (n = 2,796). The primary outcome was any 30-day postoperative complication (ESA/ESICM). Secondary outcomes were 30-day mortality, complication severity (Clavien-Dindo), and timing of occurrence. RESULTS: The 30-day complication rate in patients aged 65–75 years was more than twice that in the 18–64-year group (7.15 vs 3.09 %), and 30-day mortality was more than threefold higher (1.18 vs 0.33 %). The greatest relative risk increase was observed for postoperative delirium (RR 7.55), acute myocardial infarction (RR 5.08), arrhythmias (RR 4.26), and acute kidney injury (RR 3.87). The distribution of complication severity according to Clavien-Dindo did not differ between groups, most complications in both groups occurred within the first 5 days. After multivariable adjustment, older age remained an independent predictor of any complications, severe complications, and mortality. CONCLUSIONS: Older age (65–75 years) is an independent predictor of postoperative complications and mortality following elective abdominal surgery, increasing the risk of complications 1.7-fold and the risk of death 2.2-fold after confounder adjustment. The identified profile of high-risk specific complications supports the need for targeted perioperative management protocols in elderly patients.
INTRODUCTION: Acute decompensated heart failure (ADHF) holds a special place in the structure of acute heart failure, accounting for up to 50 % of emergency hospitalizations in cardiology hospitals. Its clinical significance is determined by high readmission rates: over 50 % within six months, nearly 70 % in the first year, and up to 80 % within two years after an ADHF episode. With an in-hospital mortality rate of about 5 %, the risk of a fatal outcome increases significantly in the long term, reaching 30 % or more within the first year after discharge. Given the increasing prevalence of chronic heart failure in the Russian Federation (8.2 %), development of tools for effective outcome prediction in this patient category is an important clinical task. OBJECTIVE: To develop a model for stratifying the risk of mortality in patients with ADHF hospitalized in the intensive care unit. MATERIALS AND METHODS: A pilot prospective single-center cohort study of 140 patients with ADHF was conducted. A comprehensive analysis of clinical, anamnestic, laboratory, and instrumental parameters was performed using multivariate logistic regression and ROC analysis (receiver operating characteristic). RESULTS: The overall mortality in the cohort was 15.7 %. A prognostic model (nomogram) with good discriminatory ability (area under ROC 0.80; 95% CI 0.66–0.94) was created, including three independent predictors: systolic blood pressure < 100 mm Hg (OR 9.96), D-dimer level ≥ 785 ng/ml (OR 4.90), and International normalized ratio ≥ 1.39 (OR 5.88). At an optimal cutoff of 13 points, the model demonstrates sensitivity and specificity of 77 % each. CONCLUSIONS: A model based on three easily determined parameters has been developed, which allows for the stratification of the risk of mortality in patients with ADHF in intensive care unit, potentially contributing to the optimization of treatment strategies and resource allocation.
INTRODUCTION: There is a progress in providing respiratory support (RS) in recent years with increasing safety and decreasing duration. However, there are still many questions that remain unanswered, particularly regarding successful weaning. We consider to use an intellectual ventilation mode to optimize the weaning process. OBJECTIVES: The aim of this study was to evaluate the effectiveness of based on Adaptive Support Ventilation (ASV®) mode for discontinuation of respiratory support in obese patients after cardiac surgery. MATERIALS AND METHODS: We compare the discontinuation processes in our previous trials. It was two trials about using automatic INTELLiVENT®-ASV mode and conventional ventilation modes (Synchronized Intermittent Mandatory Ventilation [SIMV] switching to Pressure Support Ventilation [PSV]). In the first part we assess 80 patients with body mass index (BMI) > 30 kg/m2, 40 of them were ventilated in INTELLiVENT®-ASV, and 40 in conventional modes. In the second part we considered 32 patients with BMI > 35 kg/m2; 16 of them were ventilated in INTELLiVENT®-ASV, and 16 in conventional modes. RESULTS: The duration of spontaneous ventilation (without any mandatory breaths) was longer in the groups that used the automatic mode. The P0.1 level was higher in these groups. The tidal volume (Vt), pressure support (PS) and positive end-expiratory pressure (PEEP) were higher in the groups using conventional modes. The number of manual ventilator settings and the time physicians spent near the ventilator before tracheal extubation were significantly lower in the INTELLiVENT®-ASV groups. CONCLUSIONS: The use of intellectual modes during discontinuation of MV in obese cardiac surgery patients allows ventilation to be delivered with gentler settings; shortens the duration of ventilation with mandatory breaths and the overall duration of respiratory support; reduces Vt, PS, and PEEP without compromising gas-exchange parameters; and saves medical staff time spent working with the ventilator.
INTRODUCTION: Mortality in severe acute pancreatitis (SAP) remains high. Early multiple organ failure (MOF) is the primary factor determining disease severity and outcomes. Treatment is largely symptomatic, and the role of extracorporeal therapies remains controversial. While studies have examined cytokine adsorption and hemodiafiltration in early SAP, the inclusion of lipopolysaccharide (LPS) adsorption remains poorly understood. OBJECTIVE: To assess the impact of multimodal cytokine and LPS hemoperfusion on clinical and laboratory parameters in early-phase acute pancreatitis with MOF. MATERIALS AND METHODS: The study included 30 patients with severe acute pancreatitis. The main prospective intervention group consisted of 15 patients receiving standard therapy in combination with multimodal hemosorption. The prospective control group consisted of 15 parallel-selected patients receiving standard therapy. Clinical, laboratory, and outcome measures were compared between groups. RESULTS: Incorporation of multimodal hemoperfusion into the management of early multiple organ failure in SAP contributed to faster resolution of organ dysfunction in the study group (RMANOVA; p = 0.009). By day 3, it significantly reduced lactate concentration from 2.0 (1.3; 3.0) to 1.5 (1.2; 2.1) mmol/L (p = 0.026) and C-reactive protein from 302 (258; 405) to 220 (163; 281) mg/L (p = 0.026). In the hemoperfusion group, ICU length of stay was shorter — 13,5 (9,6; 16,1) days versus 18,9 (11; 55,8) days in the control group (p = 0.059), and total hospital stay decreased to 19 (17; 36) days compared with 25 (14; 56) days in the control group (p = 0.689). CONCLUSIONS: The use of multimodal hemoperfusion in our SAP patients was linked to faster regression of organ dysfunction and reduced inflammatory markers, yet the study lacks sufficient power to recommend its routine clinical application. To confirm the hypothesis regarding the effectiveness of multimodal hemosorption in the early phase of PTP, a larger prospective study is required.
INTRODUCTION: Delivering of exogenous nitric oxide (NO) into the extracorporeal circuit is a potential strategy for organ protection during cardiopulmonary bypass (CPB). However, its effects are dose-dependent, and optimal concentrations remain unclear. OBJECTIVE: To evaluate the dose-dependent effects of nitric oxide delivery on the structural and functional properties of erythrocyte membranes and platelet aggregation activity in an ex vivo model of CPB. MATERIALS AND METHODS: We performed a single-center, prospective, pilot, experimental ex vivo study using a CPB model. Whole blood samples were obtained from eight healthy volunteers. CPB was simulated for 60 minutes under five conditions: a control (no NO) and NO delivery at 40, 80, 120, and 160 ppm. Erythrocyte membrane microviscosity and polarity were assessed, alongside spontaneous and induced platelet aggregation (adenosine diphosphate, collagen, epinephrine, arachidonic acid). RESULTS: In the control group, 60 minutes of CPB simulation significantly increased erythrocyte membrane microviscosity and decreased membrane polarity. NO delivery in the range of 40–120 ppm prevented the development of these changes. However, an NO concentration of 160 ppm increased the microviscosity of lipid–lipid interactions in erythrocyte membranes. In the control group, collagen-and low-dose of adenosine diphosphate-induced platelet aggregation decreased during CPB simulation. While NO administration at 40–120 ppm stabilized platelet aggregation activity, a concentration of 160 ppm enhanced collagen-induced platelet aggregation. CONCLUSIONS: Exogenous nitric oxide exerts dose-dependent effects on the structural and functional properties of erythrocyte membranes and platelet aggregation activity in an ex vivo CPB model. Nitric oxide concentrations of 40–120 ppm exert membrane-stabilizing effects and prevent platelet hyperactivation, whereas further dose escalation leads to a loss of protective properties.
INTRODUCTION: Nurse anesthetists play a critical role in ensuring patient safety during the perioperative period; however, their clinical competence and role within the team remain insufficiently studied at the national level. OBJECTIVE: To assess the self-reported level of clinical competence among nurse anesthetists, its association with years of professional experience and qualification category, and to identify their predominant team roles. MATERIALS AND METHODS: A multicenter cross-sectional study was conducted among nurse anesthetists. A structured 34-item questionnaire was used, comprising the following sections: socio-professional characteristics, self-assessment of clinical competence, and team roles based on the Belbin Team Roles Inventory. Clinical competence was assessed on a scale from 0 to 100; a predefined threshold was used to classify respondents as competent. Statistical methods includes: χ2 test, Kendall’s tau (τ), and Spearman’s rank correlation coefficient (rs) with 95 % confidence intervals. Statistical significance was set at p < 0.05. RESULTS: A total of 172 respondents were included in the study (median age 42 years, interquartile range 33–49). Only 17.8 % of nurses with limited work experience (< 5 years) reached the competence threshold, compared with 43.6 % in the group with 6–10 years of experience, followed by a decline in more experienced groups, indicating a non-linear relationship between clinical competence and years of experience. No consistent linear correlation was found between work experience and competence scores. Work experience showed a moderate correlation with age and qualification category, but only a weak correlation with competence. CONCLUSIONS: The traditional linear paradigm “experience → qualification category → competence” appears to be ambiguous in the development of professional competence among nurses. The findings support the need to shift from formal consideration of years of experience toward continuous professional development, including regular objective skills assessment, simulation-based training, and consideration of team role profiles in workforce organization.
INTRODUCTION: Severe brain damage may result in prolonged or chronic critical illness (PCCI) representing a special clinical patient`s model. Predicting early the high risk of poor outcome of PCCI should help for in-time use of personalized treatment modalities. Immunological and genetic markers may exhibit potentially high prognostic potential may exhibit. OBJECTIVE: To determine the contribution of the AGTR1 (angiotensin II receptor type 1) rs275651 regulatory 5`-region polymorphism, the content of immune system cells and their neutrophil to lymphocyte ratio (NLR) to the outcome of PCCI in post-hemorrhagic stroke patients. MATERIALS AND METHODS: The study included 192 patients with hemorrhagic stroke in PCCI. 107 patients were admitted to the hospital with nosocomial pneumonia from other hospitals. Age was 59 (49; 67) years, Sequential Organ Failure Assessment score on the day of hospitalization was 3 (1; 4). Women constituted 43 % of the cohort. RESULTS: Neutrophil to lymphocyte ratio (NLR) higher than 4 on the fifth day of hospitalization predicted an unfavourable outcome (p = 0.0001; logrank test; Odds Ratio (OR) 6.7; 95% Confidence Interval (CI) 2.6–17.0; n = 153). Subgrouping the patients showed that the NLR value as determined on the fifth day of hospitalization predicted outcome only for patients admitted without pneumonia. For patients admitted with pneumonia, genetic variants of the angiotensin II receptor gene — AGTR1 were predictive for outcome: minor allele AGTR1 rs275651 A showed poor outcome of PCCI on the first day of hospitalisation (p = 0.037; logrank test; OR 2.6; 95% CI 0.9–7.5; n = 107). For patients admitted without pneumonia no effect of AGTR1 rs275651 genotype revealed (p = 0.76; n = 85). CONCLUSIONS: In post-hemorrhagic stroke patients in PCCI, the increased NLR value (> 4) on the fifth day of hospitalization predicts outcome of PCCI in patients admitted without pneumonia. For patients admitted with pneumonia, the genetic marker, minor allele A of AGTR1 rs275651, associates with an unfavourable outcome.
INTRODUCTION: Damage to the ligamentous apparatus of the knee joint is a common sports injury in orthopedics. Given the possibility of ambulatory treatment for these patients, perioperative analgesia plays a key role in the success of surgery. OBJECTIVE: To evaluate the effect of adding the iPACK block (infiltration in the interspace between popliteal artery and capsule of the knee) on perioperative analgesia as part of combined anesthesia for arthroscopic cruciate ligament reconstruction (ACLR). MATERIALS AND METHODS: A single-center prospective cohort study with a historical control group. 115 patients who underwent ACLR, were divided into 2 groups: Group 0 (control; n = 58: general anesthesia (GA) + adductor canal block (ACB) + local infiltration anesthesia (LIA), Group 1 (intervention group; n = 57: GA + ACB + LIA + iPACK block). Evaluated: pain intensity on a visual-analog scale (VAS), time to the first requirement of an analgesic, need for opioids, time of verticalization, frequency of rebound pain. RESULTS: Significant differences in pain dynamics were revealed both at rest (χ2 = 17.68; p = 0.013) and in movement (χ2 = 22.68; p = 0.0019) according to VAS among the comparison groups, with a lower score in group 1. The average time to the first analgesic requirement was the longest in the iPACK group. The probability of prescribing trimeperidine in the first 24 hours was significantly lower in the iPACK group (RR 0.112; 95% CI 0.023–0.549; p = 0.007). The average time until verticalization did not differ significantly between the groups. The frequency of rebound pain was 13,5 % in the control and 1.6 % in the iPACK group (RR 0.116; 95% CI 0.013–1.064; p = 0.057). CONCLUSIONS: the addition of the iPACK block to method of combined anesthesia of GA + ACB + LIA significantly reduced the intensity of pain, increased the time to the first requirement for an analgesic, and significantly reduced the need for opioid analgesics in patients undergoing ACLR, demonstrating a favorable safety profile.
INTRODUCTION: Postoperative atelectasis is a frequent complication, yet predicting which patients will develop clinically significant hypoxemia remains challenging. Lung ultrasound (LUS) enables quantitative assessment of atelectasis severity, but its prognostic value for desaturation has not been fully established. OBJECTIVE: To determine whether quantitative assessment of postoperative atelectasis severity by lung ultrasound is an independent predictor of clinically significant desaturation, defined as a decrease in peripheral oxygen saturation (SpO2) to ≤ 90 %, in a heterogeneous cohort of surgical patients. MATERIALS AND METHODS: A retrospective observational study was conducted. A simplified 2‑zone LUS protocol was used preoperatively and postoperatively to assess atelectasis severity on a 0–3 scoring scale. The primary predictor was the total postoperative LUS score; the primary outcome was desaturation (SpO2 ≤ 90 %). Prognostic value was assessed using receiver operating characteristic (ROC) analysis and multivariable logistic regression. RESULTS: A total of 450 patients undergoing elective surgery under general anesthesia with mechanical ventilation were included (300 women [66.7 %], 150 men [33.3 %]; median age 51 years, range 18–84). The LUS score demonstrated high prognostic accuracy for desaturation (area under the ROC curve, AUC 0.85); the optimal cutoff was ≥ 3 points (sensitivity 73.8 %, specificity 82.8 %). In multivariable analysis, each 1-point increase in LUS score raised the odds of desaturation 2.95-fold (odds ratio, OR 2.95; p < 0.001), with higher body mass index (BMI) as additional independent predictor. CONCLUSIONS: Quantitative assessment of postoperative atelectasis by lung ultrasound is a strong independent predictor of clinically significant desaturation. LUS monitoring enables objective risk stratification for hypoxemia and helps identify patients who may benefit from targeted respiratory interventions and closer postoperative surveillance.
INTRODUCTION. Accurate prediction of the development and outcomes of cardiogenic shock in patients with myocardial infarction remains a major clinical challenge, highlighting the need to refine existing risk stratification tools. OBJECTIVE. To systematically evaluate the performance of available risk models for predicting in-hospital mortality (IHM) in patients with cardiogenic shock and to explore opportunities for their enhancement using contemporary machine learning (ML) approaches. MATERIAL AND METHODS. A comprehensive literature search was performed in PubMed, Google Scholar, and eLibrary, yielding 639, 4300, and 1762 records, respectively. Only full-text publications reporting patient cohorts, study designs, methods of risk model development, and performance metrics (area under the ROC curve [AUC], sensitivity, specificity) were included. Exclusion criteria were case reports, conference abstracts, dissertations, and author’s abstracts. Risk of bias was assessed using standardized frameworks. RESULTS. Depending on the types of scales and models applied for IHM risk assessment in cardiogenic shock (GRACE, SYNTAX, TIMI, APACHE II, SOFA, SAPS II, CardShock, IABP-SHOCK II, etc.), five groups of studies were identified, within which the predictive accuracy of different approaches was compared. Separate attention was given to studies where IHM risk assessment considered clinical–pathogenetic phenotypes of cardiogenic shock and treatment-related factors. Most risk assessment instruments were developed using logistic regression methods and demonstrated substantial variability in predictive accuracy, with AUC values ranging from 0.65 to 0.85. Several author-derived models showed high predictive performance; however, many lacked external validation and did not meet acceptable standards for risk of bias, limiting the reliability of their predictions. CONCLUSIONS. The improvement of risk assessment tools for predicting IHM in patients with cardiogenic shock may be achieved through the implementation of modern technologies of explainable artificial intelligence and interpretable ML models.
INTRODUCTION: Esophagectomy with immediate esophagoplasty is a high-risk procedure, with the worldwide incidence of postoperative complications reaching up to 65 % and mortality up to 7.8 %, even in high-volume centers. This underscores the need to identify additional predictors of postoperative complications and mortality. OBJECTIVE: Improving outcomes of esophagectomy performed within the Rational Accelerated Perioperative Rehabilitation (RAPOR) program by identifying and minimizing risk factors for complications and mortality. MATERIALS AND METHODS: Between 2012 and 2024, 500 elective esophagectomy with immediate esophagoplasty were performed at the Vishnevsky National Medical Research Center of Surgery. Perioperative management followed the RAPOR program, which includes an interdisciplinary and individualized team approach. Statistical analysis included logistic regression and odds ratio (OR) calculation. RESULTS: Postoperative complications were observed in 29.2 % of patients, pneumonia — in 10 %, anastomotic leakage and graft necrosis — in 6.6 %. Post-esophagectomy mortality was 1.4 %. Risk factors for complications were: age (OR 1.03), comorbidity index (OR 1.17), ASA score (OR 1.46), duration of surgery (OR 1.04), pre-existing pulmonary disease (OR 1.84), history of cardiac arrhythmia (OR 2.16), history of neurological disease (OR 3.03), C-reactive protein level on day 1 (OR 1.01), and lactate level on ICU admission (OR 1.27). Risk factors for postoperative pneumonia were: age (OR 1.03), pre-existing pulmonary disease (OR 2.61) and history of cardiac arrhythmia (OR 2.58), NRS-2002 score (OR 1.52), ASA score (OR 1.78), duration of surgery (OR 1.05), and high intraoperative infusion volume (OR 1.2). Risk factors for anastomotic leakage and graft necrosis included age (OR 1.03). Risk factors for mortality were: high comorbidity index (OR 1.44) and NRS-2002 score (OR 3.15), history of cardiac arrhythmia (OR 6.02), prolonged mechanical ventilation (OR 19.4), and high intraoperative infusion volume (OR 1.7). CONCLUSIONS: Age, comorbidity index, ASA score, duration of surgery, lung diseases, neurological diseases, and cardiac arrhythmias in the medical history are risk factors for postoperative complications. High comorbidity index, NRS-2002 score, cardiac arrhythmias in the medical history, prolonged mechanical ventilation, and large intraoperative fluid infusion volume remain risk factors for mortality.
INTRODUCTION: According to epidemiological studies, preoperative anemia exerts a pronounced negative effect on the immune system by reducing its cellular activity and is considered one of the major independent risk factors for the development of infectious complications. Despite the active investigation of preoperative anemia, to date there are no unified standards or clinical guidelines for the optimal management of such patients undergoing orthopedic surgery. OBJECTIVE: To evaluate the effectiveness of a preventive perioperative hemocorrection strategy in reducing the incidence of infectious complications in patients undergoing orthopedic surgical procedures. MATERIALS AND METHODS: Between January 2023 and February 2025, 116 patients undergoing elective orthopedic surgery participated in this single-center randomized controlled trial, 58 of whom received preventive therapy (preventive group) with iron carboxymaltose, and 58 received standard treatment (standard group). RESULTS: The application of perioperative hemocorrection in the preventive group significantly reduced the incidence of infectious complications: 1 case (1.7 %) vs. 7 cases (12.1 %) in the standard group (p = 0.032). In addition, patients in the preventive group demonstrated a smaller decrease in hemoglobin levels on postoperative day 3 (92.5 vs. 84.1 g/L), which was accompanied by a reduced rate of allogeneic blood transfusions (6 vs. 25 cases; p < 0.001). CONCLUSIONS: These findings confirm that correction of anemia and restriction of allogeneic transfusions may play an important role in the prevention of periprosthetic joint infection following major orthopedic procedures.
INTRODUCTION: Acute massive blood loss is a critical condition associated with the loss of a significant volume of circulating blood, leading to hemorrhagic shock and multiorgan failure. In the setting of prehospital stage and scarce resources carrying out early and adequate intensive care may be impossible or significantly delayed. In these cases reduced oxygen delivery to tissues leads to severe ischemia, and cellular resistance to hypoxic damage becomes one of the key factors determining poor outcomes. Thus, in recent years special attention was given to cytoprotective properties of noble gases. OBJECTIVE: To study the effect of using respiratory mixtures with elevated concentrations of noble gases (argon and krypton) on survival in acute massive blood loss. MATERIALS AND METHODS: A prospective randomized controlled study was conducted on 16 pigs (35–50 kg). Experimental animals were randomized into 2 groups: a control group (n = 8) (30 % oxygen-air mixture) and an experimental group (n = 8) (“Argon-Krypton” mixture: 60 % argon, 30 % oxygen, and 10 % krypton). Acute massive blood loss up to 50 % of the total blood volume was simulated without infusion therapy. Animal survival over 2 hours was assessed, and hemodynamics, acid-base balance, arterial blood gas composition, and hematological parameters were monitored. RESULTS: In the experimental group, 1 animal died, compared to 3 animals in the control group (p < 0.001). Following blood loss simulation the experimental group showed higher rates of mean arterial pressure 57 (53; 66) vs. 39 (20; 51) mm Hg, in the control group (p = 0.041), partial pressure of oxygen 132 (90; 146) vs. 84 (76; 94) mm Hg (p = 0.028) and arterial blood oxygen saturation 99 (97; 99) vs. 96 (94; 97) % (p = 0.015). Acid-base status remained stable in the experimental group, whereas progressive metabolic acidosis was observed in the control group; statistically significant intergroup differences were found within 2 hours of monitoring (p = 0.005). СONCLUSIONS: The use of a gas mixture containing argon and krypton in acute massive blood loss is associated with increased survival in large laboratory animals (pigs), promotes systemic hemodynamics stabilization and reduces the severity of metabolic acidosis.
INTRODUCTION: Sepsis in patients with prolonged and chronic critical illness (PCI/CCI) is frequently characterized by recurrent episodes and a high incidence of severe complications; however, risk factors for adverse sepsis outcomes in this population remain insufficiently studied. OBJECTIVE: To identify independent predictors of sepsis unfavorable outcomes in critically ill patients with a prolonged and chronic critical illness. MATERIALS AND METHODS: The analysis was based on the Russian Intensive Care Dataset (RICD) v2.0 (FRCRR, 2017–2024). Patients with confirmed sepsis according to Sepsis-3 criteria were included. Demographic characteristics, comorbidities, clinical scores, laboratory values, and vital parameters at the onset of the first sepsis episode were assessed. Independent predictors were determined using multivariable Cox regression. RESULTS: A total of 336 patients were analyzed (median age, 64 years; male, 54.8 %). ICU mortality was 14.0 %, and the median intensive care unit (ICU) length of stay was 44 days (30; 62). Septic shock occurred in 55 patients (16.4 %) and was independently associated with the hyperinflammatory sepsis phenotype (hazard ratio [HR] 5.23; 95% confidence interval [CI] 1.61–17.04; p = 0.006) and lower diastolic blood pressure at sepsis onset (HR 0.975; 95% CI 0.954–0.996; p = 0.019). Recurrent sepsis was observed in 96 patients (28.6 %); the only independent predictor was the hypoinflammatory phenotype (HR 5.23; 95% CI 1.29–13.01; p = 0.002). Sepsis-induced coagulopathy occurred in 78 patients (23.2 %) and was independently predicted by a reduced platelet count (HR 0.997; 95% CI 0.994–0.999; p = 0.026). CONCLUSIONS: This study is the first to identify independent risk factors for complicated sepsis in patients with PCI/CCI. The findings may be applied to risk stratification and the development of dedicated prognostic models in this high-risk ICU population.
INTRODUCTION: Rebound pain developing after the resolution of regional blockade is an adverse effect that increases patients’ need for analgesics and reduces their satisfaction with postoperative pain management. First described in 2007, rebound pain remains a poorly studied phenomenon. OBJECTIVE: To summarize and analyze current literature on the incidence, mechanisms, risk factors, and preventive measures of rebound pain in patients undergoing surgery with regional anesthesia. MATERIALS AND METHODS: This review included publications indexed in PubMed, Google Scholar, and eLibrary (for Russian-language sources) that met the study objectives. RESULTS: The literature analysis revealed an average incidence of rebound pain of 40–50 %, identified risk factors such as young age, female sex, pre-existing pain, and certain types of surgical procedures, and determined the main strategies for its prevention. CONCLUSIONS: Rebound pain represents a significant clinical problem adversely affecting the early postoperative course. Prevention remains the cornerstone of management. The most promising approaches include the use of local anesthetic adjuvants, particularly dexamethasone, and systemic analgesics.
