The article is devoted to the life, professional career, and scientific legacy of Viktor Ivanovich Strashnov (1931–2026), a Soviet and Russian physician, scientist, and one of the founders of anesthesiology and intensive care medicine in the USSR and Russia. The paper outlines the main stages of his biography, his professional development, his work at the First Leningrad Medical Institute named after Academician I. P. Pavlov, and his leading role in the establishment of anesthesiology and intensive care services at the institute’s clinics. The article highlights his researches on gas exchange, hemodynamics, protection against surgical stress, and the improvement of regional anesthesia techniques, including high prolonged epidural anesthesia and combined spinal-epidural anesthesia. His contribution to medical education, scientific mentorship, and authorship of major academic works that influenced the development of the specialty is also emphasized. It is shown that V. I. Strashnov’s work played an important role in shaping modern approaches to anesthetic management and intensive care in Russia.
The objective was to elucidate the modern concept of protective lung ventilation, particularly during laparoscopic operations involving carbondioxide pneumoperitoneum and Trendelenburg position based on the literature analysis.Results. We indicate that protective mechanical lung ventilation is a critically important component of anesthetic management for laparoscopic robot-assisted operations in gynecology. Targeted use of low tidal volumes, optimal positive end-expiratory pressure, recruitment maneuvers, and PaCO₂ control contributes to preserving lung function, adequate oxygenation, and stabilization of cerebral blood flow.Conclusion. The use of protective artificial ventilation reduces the severity of lung damage, reduces the risk of postoperative cognitive impairment, and improves clinical outcomes.
Introduction. Multi-stage spinal surgery in child is a significant source of recurring psychoemotional stress for the patient and his parents, which increases the risk of postoperative complications, including agitation and delirium. In this regard, the search for safe non-pharmacological methods of correcting the perioperative condition is relevant. Aromatherapy is considered as one of these methods, but its use in the context of multi-stage spinal surgery in children with simultaneous effects on the parent-child dyad has not been sufficiently studied.The objective was to evaluate the effect of preoperative aromatherapy on the level of anxiety and depression in parents, as well as on the frequency of postoperative agitation in children undergoing multi-stage spinal surgery.Materials and methods. A prospective randomized open-label controlled trial was conducted. Children aged 5-15 years (n = 50) who were scheduled for surgery using the envelope method were divided into the main group (n = 25; aromatherapy sessions using a mixture of essential oils) and the control group (n = 25; without aromatherapy). The parents’ anxiety and depression levels were assessed on the HADS scale before and on the 3rd day after surgery. Postoperative agitation in children was assessed on the RASS scale during the first 3 hours of awakening. The occurrence of delirium was assessed on the Pediatric Anesthesia Emergence Delirium scale PAED scale on the first day after surgical treatment.Results. In the preoperative period, all parents demonstrated a high level of anxiety on the HADS scale, with no significant differences between the groups (control group: Me [Q1; Q3] = 7.0 [5.0; 9.0]; main group: 8.5 [6.0; 11.0]). In the postoperative period, the main group recorded a significant decrease in the anxiety index to 4.7 [2.0; 7.0] points, while in the control group it increased slightly to 8.5 [6.0; 11.0] (p < 0.005). No episodes of post-operative agitation were recorded in the child in the main group, 5 cases of agitation (20%) were recorded in the control group. There were no cases of delirium in the groups, as well as the relationship between the level of preoperative anxiety in the parent and the development of agitation in the child.Conclusions. The results obtained suggest that preoperative aromatherapy can be an effective auxiliary method for reducing psychoemotional stress in parents and preventing postoperative agitation in children during multi-stage spinal surgeries.
The fibrinolysis system is one of the most important regulators of homeostasis and participates in maintaining stable blood flow. The key element of this system is the balance of plasminogen activators and inhibitors, which can be considered as markers of normal physiological and pathological reactions. The use of laboratory determination of the level of the tissue plasminogen activator/tissue plasminogen activator inhibitor-1 (t-PA/PAI-1) complex in clinical practice is promising in diagnostic and prognostic terms as a biomarker of increased thrombotic risk in the early stages of the development of complications of the disease. This review will provide up-to-date information on practical applications, and diagnostic capabilities, and using such a marker of thrombotic risk as the t-PA/PAI-1 complex in neurological and cardiovascular diseases, obstetric pathology, in patients with COVID-19, as well as in metabolic disorders and in general conditions associated with damage to endothelial cells and an imbalance of the fibrinolytic system.
The issue of postoperative pain relief in outpatient surgery, particularly in dentistry, remains relevant both in Russia and abroad. This work analyzes the literature on the topic of modern approaches to choosing a method of pain relief after outpatient dental interventions, and reviews the most common painkillers and their combinations. The influence of different groups of drugs on the mechanisms of pain formation is considered: transduction, transmission, modulation and perception. The article also reflects the mechanisms and features of pain formation in the orofacial region in dental pathology. The conducted analysis of the literature showed that, today in outpatient practice, there is no single standard for pain relief for patients during and after dental operations. This is greatly influenced by the national characteristics of different countries, such as the presence or ban on a number of drugs, as well as the availability of potent and narcotic drugs for prescription in outpatient settings. At present, the evidence collected in the world specialized literature confirms the effectiveness of using the principles of preventive and multimodal analgesia in dental outpatient practice. Meanwhile, high-quality comparative clinical studies that allow choosing the most effective and safe method of postoperative pain relief are limited.
The objective was to evaluate the expression of the interleukin-6 (IL‑6) gene as a predictor of severe urosepsis and to justify its inclusion in the diagnostic algorithm.Materials and methods. A prospective clinical study was conducted. The study included 90 patients: 30 patients with complicated inflammatory kidney diseases complicated by urosepsis and/or septic shock (group 1), 30 patients with uncomplicated postoperative course after surgical treatment of nephrolithiasis without signs of sepsis (group 2), and 30 practically healthy volunteers (control group). At 4 stages of observation (hospitalization/before surgery, 1st, 3rd, and 7th days), clinical and laboratory parameters, severity of organ dysfunction according to the SOFA scale (Sequential Organ Failure Assessment), traditional markers of inflammation (leukocytosis, leukocyte intoxication index – LII, C-reactive protein – CRP, procalcitonin – PCT), and expression of the IL-6 gene (IL-6) were evaluated. Statistical analysis included nonparametric criteria, correlation and ROC analysis.Results. In patients with urosepsis, the expression of the IL 6 gene at the time of admission was significantly higher than in the control group and in patients with uncomplicated postoperative inflammation (2.06 [1.58; 2.89] vs. 0.049 [0.03; 0.09] and 0.43 [0.25; 0.55] relative units; p < 0.001). The peak of IL 6 expression occurred at the time of hospitalization and preceded the maximum increase in leukocytes, LII, CRP, and PCT, which reached their highest values on the first day of intensive care. At this stage, IL 6 expression was statistically significantly correlated with the severity of organ dysfunction according to the SOFA score (R = 0.394; p = 0.031) and the integrated inflammation index. ROC analysis showed the greatest prognostic value of IL 6 expression for detecting severe urosepsis (AUC 0.767; 95% CI 0.569–0.965; p = 0.028), while the AUC for PCT was 0.741 (95% CI 0.553–0.930; p = 0.046), for LII – 0.682, for SOFA – 0.651; total leukocytosis and CRP had low independent predictive ability (AUC 0.560 and 0.511, respectively).Conclusion. The expression of the IL 6 gene is an early and highly sensitive molecular genetic marker of the systemic inflammatory response in patients with inflammatory kidney diseases complicated by urosepsis and/or septic shock, which is more dynamic than traditional laboratory indicators. The inclusion of the determination of IL 6 expression in the diagnostic algorithm will improve the accuracy of early risk stratification of severe urosepsis and optimize intensive care management.
The objective was to assess the effect of a fixed-dose combination of Diclofenac and Orphenadrine (Neodolpasse®) on the effectiveness of pain relief and rehabilitation in the early postoperative period in patients undergoing knee arthroplasty.Materials and methods. The comparative prospective randomized study included 40 patients undergoing total knee replacement under combined anesthesia (spinal + saphenous block + iPACK block (the space between the popliteal artery and the capsule of the posterior part of the knee joint)). In the main group (n = 20), Neodolpasse® (a combination of 75 mg diclofenac and 30 mg orphenadrine in 250 ml of solution) was administered intravenously at the end of anesthesia, as well as in the postoperative period 2 times a day for 2 days. In the comparison group (n = 20), ketoprofen 100 mg was used instead of Neodolpasse® in the same way. The severity of pain was assessed using a visual analogue scale (VAS) before surgery and 6, 12, 24, and 48 hours after surgery. The need for additional narcotic analgesics was recorded. The assessment of patient’s recovery of weight-bearing function in the operated leg and their ability to actively move the knee joint was carried out by a rehab physician 24 hours after surgery.Results. The median VAS value in the main group after 6 hours was 5 [3; 6.75] points and was higher than in the comparison group (3 [1.75; 4), p = 0.004]. After 12 hours, the analgesic effect in the main group was better (3 [2; 5.75] versus 5.5 [4; 7], p = 0.03). No significant differences in the VAS values after 24 hours and 48 hours were found. Positive dynamics of recovery of active joint function after 24 hours was noted in 85% of patients in the main group and in 70% of the comparison group (p = 0.451). The need for additional administration of narcotic analgesics was recorded in 20% of patients in the main group (after 6 hours) and in 15% in the comparison group (but after 12 hours). No side effects or reactions were recorded.Conclusion. The analgesic effect of the diclofenac (75 mg) + orphenadrine (30 mg) combination after knee arthroplasty is comparable to that of ketoprofen (100 mg). Moreover, the use of this drug may facilitate the functional recovery in the operated leg in the early postoperative period.
Introduction. In 2025, an updated version of the organ dysfunction assessment scale (SOFA-2) was published; however, the question of whether it should replace the previous version remains open.The objective was to evaluate whether the modified SOFA-2 scale has advantages over the traditional SOFA-1 scale in assessing the severity of patients with sepsis and predicting outcomes.Materials and methods. A retrospective analysis of 255 medical records of patients with sepsis (Sepsis-3 criteria) was performed. SOFA-1 and SOFA-2 scores were calculated upon admission to the intensive care unit and on days 1-3. Statistical analysis included the Wilcoxon signed-rank test, Mann-Whitney U test, Bowker’s test of symmetry, McNemar’s test, and ROC analysis.Results. Median total scores obtained using both scales did not differ significantly at any time point (p > 0.05). Significant redistribution of scores was observed in the cardiovascular and central nervous system components (p < 0.001), while the renal component showed identical results (p > 0.05). The prognostic ability of both scales for in-hospital mortality (32.5%) was comparable: AUROC for SOFA-2 was 0.703 (95% CI 0.666-0.741), and for SOFA-1 was 0.701 (95% CI 0.663-0.740).Conclusion. SOFA-2 reflects contemporary approaches to intensive care; however, its prognostic value for mortality is practically identical to SOFA-1. The greatest differences are observed in the assessment of cardiovascular and central nervous system components of multiple organ dysfunction. The feasibility of widespread implementation of SOFA-2 for routine use at this stage without additional research is questionable.
Introduction. Hemidiaphragmatic paresis (HDP) after brachial plexus block results from inadvertent involvement of the C3-C5 phrenic nerve roots. While brachial plexus block performed by supraclavicular approach (SC) is commonly associated with HDP, the incidence of this complica tion in brachial plexus block performed by costoclavicular approach (CC) remains unclear.The objective was to compare the incidence of ipsilateral HDP between supraclavicular (SC) and costoclavicular (CC) blocks using ultrasound-assessed diaphragmatic excursion and peak expiratory flow rate (PEFR).Materials and methods. In this prospective, observer-blinded, randomized study, 48 patients undergoing elective below-elbow surgery were allo cated to receive either SC-BPB (n = 24) or CC-BPB (n = 22). Patients received 30 ml of a 1:1 mixture of 0.5% bupivacaine and 2% lignocaine with adrenaline. Diaphragmatic excursion was measured via M-mode ultrasonography during normal inspiration, deep inspiration, and sniff manoeuvre, and PEFR was recorded pre-block and 30 minutes postoperatively. HDP was defined as a reduction in diaphragmatic excursion: > 50% as complete, 25-50% as partial, and < 25% as no palsy. Secondary outcomes included block onset time, total anesthesia-related time, and incidence of adverse events.Results. HDP incidence was significantly higher in Group SC compared with Group CC across all respiratory manoeuvres. Post-block diaphrag matic excursion and PEFR declined more in Group SC (p < 0.05). Block onset and time to complete sensory and motor block were longer in Group CC, while no patient experienced clinical respiratory compromise or adverse events.Conclusion. Ultrasound-guided costoclavicular brachial plexus block is associated with a lower incidence of ipsilateral HDP and better preserva tion of pulmonary function compared with the supraclavicular approach, despite a slightly slower onset of block.
Introduction. Perioperative disturbances of energy metabolism in cardiac surgery patients significantly affect postoperative course and outcomes. Under conditions of surgical stress and cardiopulmonary bypass (CPB), conventional approaches to metabolic assessment have limited diagnostic value.The objective was to evaluate perioperative changes in cardiorespiratory function and energy metabolism in cardiac surgery patients with uncomplicated operations performed under general anesthesia using CPB.Materials and methods. Thirty patients were included in the study. Metabolic and hemodynamic parameters were assessed at four stages: after anesthesia induction, during sternotomy, before CPB initiation, and in the early post-perfusion period. Indirect calorimetry (IC) was used to measure oxygen consumption (VO2), carbon dioxide production (VCO2), resting energy expenditure (REE), and respiratory quotient (RQ). Central hemodynamics were evaluated using transesophageal echocardiography. Blood gas parameters, lactate, and glucose levels were also analyzed.Results. The lowest VO2 index values were recorded after anesthesia induction (106.55 ± 30.69 ml∙min–1⋅m–2), reflecting a state of pharmacologically induced metabolic suppression. From the sternotomy stage onward, a persistently increased level of energy expenditure was observed until the end of surgery. In the early post-perfusion period, VO2I index increased to 166.59 ± 44.69 ml⋅min–1⋅m–2, exceeding values calculated by the reverse Fick method by 76%. Predictive equations (Harris–Benedict) underestimated actual energy requirements by an average of 29%. Reduced RQ values (0.54–0.59) indicated predominant lipid substrate utilization. After CPB discontinuation, blood lactate levels increased 2.5-fold and blood glucose levels by 36%. A significant correlation between VO2 and cardiac output was observed (r = 0.63; p = 0.001).Conclusion. Perioperative changes in energy metabolism are stage-dependent and predominantly adaptive in nature. Indirect calorimetry enables objective assessment of metabolic and perfusion status at different stages of cardiac surgery.
Introduction. In Part I of this review, we collate and analyze established approaches to cancer pain management, encompassing routine, emerging, and promising methods. Emphasis is placed on transparent search procedures, comparability of evidence, and the practical applicability of conclusions for both bedside clinicians and the development of methodological guidance and recommendations.The objective was to critically synthesize the evidence on the effectiveness and safety of pharmacological analgesia in adult oncology patients and to delineate key areas of uncertainty to guide further research and implementation.Materials and methods. We conducted a narrative review with elements of a structured search (October 2025; updated on 23 Oct 2025). Sources included PubMed/MEDLINE, Embase, the Cochrane Library, Scopus, Web of Science, and eLIBRARY.ru; clinical trial registries (ClinicalTrials. gov and WHO ICTRP); and documents from relevant professional societies. The primary time window was 2000–2025 (with no strict limits for foundational studies). 63 sources were included in the final analysis for Part I.Sections. The review addresses pharmacological strategies for cancer-related pain. The lowest therapeutic responsiveness, despite the need for rapid symptom control, is typically observed in nociplastic pain (central sensitization). High resistance is also characteristic of mixed pain syndromes in which neuropathic pain coexists with a predominant nociceptive component. Refractory central neuropathic pain frequently necessitates the use of ketamine and cannabinoids; however, the evidence base is constrained by small randomized controlled trials and a considerable burden of adverse effects.Conclusions. Standard analgesic approaches provide acceptable effectiveness with well-characterized adverse reactions and contraindications. Nevertheless, a substantial cohort of patients continues to require more contemporary, safer, and pathophysiology-informed strategies for cancer pain control.
Combined trauma remains a relevant and complex area of modern critical care. Rapidly developing pathophysiological disturbances in severe trauma require immediate correction. The Damage Control Resuscitation (DCR) strategy is considered as a modern approach to the treatment of patients with severe trauma and hemorrhagic shock, aimed at early correction of coagulopathy, acidosis, and hypothermia. This review analyzes the key pathophysiological foundations of DCR, clinical trial data, and the results of implementing this strategy in hospitals of various levels. Particular attention is paid to the challenges of practical implementation of DCR, including the limited availability of blood components, laboratory support, and transfusion therapy infrastructure. The adaptation of some DCR components to conditions of limited resources and variability in clinical practice is considered. Unresolved issues related to the criteria for activating massive transfusion, optimal ratios of blood components, and evaluating the effectiveness of DCR implementation are separately discussed. The review highlights the need for further research and the development of tailored algorithms to improve clinical outcomes in patients with multiple trauma.
Introduction. Fluid therapy is an integral component of anesthetic and resuscitation management in the early perioperative period following abdominal oncological surgery. Optimizing fluid therapy remains particularly challenging in hepatopancreatobiliary surgery, particularly during pancreaticoduodenectomy (PD). Currently, there is no consensus in the scientific community regarding the optimal regimen and strategy for fluid therapy during PD.The objective was to analyze the clinical efficacy of different infusion therapy strategies in PD.Materials and methods. A review of studies, systematic reviews, meta-analyses, and clinical guidelines on fluid therapy during pancreaticoduodenectomy was conducted. The search was conducted using PubMed, the Cochrane Controlled Clinical Trials Register, Google Scholar, and e-Library (for Russian authors). Studies from the past ten years were primarily reviewed. Inclusion criteria for the review were text publications comparing restrictive, targeted, and liberal perioperative fluid therapy in patients undergoing PD. Exclusion criteria were duplicates, abstracts, abstracts without a full-text version, and publications not related to the study objective.Results. Perioperative fluid therapy is a critical factor significantly affecting PD outcomes. Both excessive (liberal) and overly restrictive fluid regimens are associated with an increased risk of postoperative complications, including those specific to PD. An optimal fluid therapy strategy for PD should be balanced, avoiding both hyperand hypovolemia, and take into account individual patient risk factors (pancreatic duct diameter, pancreatic consistency, albumin level).Conclusion. A modern approach to the strategy of infusion therapy in PD should be personalized, physiologically justified and dynamically controlled and based on a constant assessment of the balance between ensuring adequate organ perfusion and preventing iatrogenic hyperhydration.
The objective was to evaluate the effectiveness of nitric oxide inhalation in correcting gas exchange disorders and clinical outcomes in patients with severe combined trauma complicated by ARDS.Materials and methods. An open prospective study included 47 patients with ARDS against the background of severe combined trauma. Patients were divided into two groups: the 1st group (n = 24) patients who received standard therapy, the 2nd group (n = 23) patients who received, in addition to standard therapy, inhalation therapy with nitrogen monoxide at a dose of 20-28 ppm. In both groups, the parameters of artificial lung ventilation, oxygen fraction in the inhaled mixture, positive end-expiratory pressure, saturation, oxygenation index, and compliance were evaluated on days 1, 3, and 5 after the injury.Results. In the group of patients who received inhalation therapy with nitrogen monoxide, compared to the control group, there was a decrease in ventilation parameters (PEEP and FiO2) and an improvement in oxygenation parameters (SpO2 and PaO2/FiO2) on the first day (p < 0.05). It was found that the use of inhalation therapy with nitrogen monoxide leads to a stable increase in gas exchange parameters such as the oxygenation index and arterial blood oxygen saturation on the third day after the start of therapy. The achieved improvement in gas exchange parameters was maintained on day 5 after the start of therapy. Despite a significant improvement in respiratory function, no statistically significant differences in overall mortality were observed between the groupsConclusions. Nitric oxide inhalation therapy is an effective addition to the standard treatment of ARDS, allowing to optimize ventilation parameters and improve oxygenation in the shortest terms, thereby reducing the risk of ventilator-associated lung damage. Further research should focus on optimizing patient selection criteria and therapeutic protocols.
Introduction. Nosocomial meningitis (NM) is a rare but difficult-to-diagnose and treat complication of neurosurgical procedures.Materials and methods. A literature search and analysis was performed in the medical information systems PubMed and eLibrary, using the following keywords: nosocomial meningitis, postneurosurgical meningitis, surgical site infection (SSI), device-associated infection.Results. The main strategy for counteracting NM in neurosurgery represents an integrated approach to its prevention at all stages of the perioperative period. This approach includes strict adherence to aseptic rules, optimization of work with tissues and compliance with an adequate regimen of antibiotic prophylaxis; its implementation can reduce the risk of developing NM. Prolonged administration of antibacterial drugs in the postoperative period and their local administration into the surgical wound remain a subject of debate.Conclusion. An emphasis on perioperative preventive measures can reduce the incidence of NM and improve outcomes following neurosurgery.
This review article examines multiple organ dysfunction syndrome (MODS) in pediatric practice, including its epidemiology, terminology, and prognostic principles. MODS is a complex clinical syndrome associated with a high risk of complications and mortality in critically ill children. Its epidemiology remains poorly understood, and its prevalence ranges from 10% to 35% among intensive care unit (ICU) patients. The main triggers for MODS include sepsis, severe trauma, burns, cardiac surgery, and hematologic malignancies.Current organ dysfunction assessment scales (pSOFA, PELOD-2, MODS, Phoenix, etc.) are discussed, along with their limitations and the need to strengthen these tools in terms of phenotypes and biomarkers. Particular attention is given to the potential of using artificial intelligence and machine learning to predict MODS, as well as the role of innovative molecular biomarkers (including non-coding RNA, mitochondrial DNA, neutrophil trap markers, etc.) in early diagnosis and risk stratification. Methodological challenges in implementing these technologies in clinical practice are highlighted, including the need for external validation, the creation of standardized databases, and overcoming regulatory barriers.
The objective was to analyze the literature on neuroendocrine dysfunctions in patients with chronic disorders of consciousness (DoC), who are in intensive care units due to their chronic critical condition.Materials and methods. We conducted a systematic review of Englishand Russian-language sources (PubMed, Scopus, Web of Science, etc.) from 2006 to 2024. Fifty publications (systematic reviews) were included that provided data on hormonal status in patients with DoC and chronic critical illness (CCI).Results. In most cases, the authors indicated hypothalamic-pituitary-adrenal axis (HPA-axis) dysregulation (blunted diurnal cortisol variation, ACTH-cortisol dissociation, secondary adrenal insufficiency). The HPT-axis dysregulation frequently shows non-thyroidal illness syndrome («low T3»), associated with severity and mortality. The HPG-axis dysregulation is frequently accompanied by the development of hypogonadotropic hypogonadism. Many endocrine dysfunctions are associated, among other things, with circadian rhythm disorders. Paroxysmal sympathetic hyperactivity (PSH) is a major modifier of both endocrine profiles and clinical expression. Suggested practices include screening for adrenal insufficiency, hormone replacement therapy.Conclusions. In patients with chronic disorders of consciousness, various endocrine dysfunctions commonly occur and may have a significant impact on disease course and prognosis. Early identification and multidisciplinary management of hormonal dysfunctions potentially improve functional outcomes. Prospective, multicenter studies are warranted to standardize diagnostics for central adrenal insufficiency and to assess the effectiveness of hormone-directed interventions.
Introduction. Respiratory distress (RD) is the most common reason for neonatal hospitalization in the neonatal intensive care unit (NICU).The objective was to identify associations between the inflammatory phenotype associated with neonatal RD in preterm infants and survival and the need for invasive mechanical ventilation. Materials and methods. A prospective, observational, multicenter study conducted from June 1 to September 6, 2025, in the NICUs of four perinatal centers in the Russian Federation (Ufa (n = 124), Stavropol (n = 123), Astrakhan (n = 70), and Khabarovsk (n = 47), total 364). Inclusion criteria: preterm infants admitted to the NICU with signs of respiratory distress, gestation age 34 weeks or less. The severity of the neonatal condition was assessed using the nSOFA scale, and the invasiveness of hemodynamic support was assessed using the VIS index [7]. The primary endpoint was 28-day mortality. The secondary endpoint was the need for invasive mechanical ventilation. Inflammatory phenotypes were identified during the first 24 hours of admission to the intensive care unit (stage one) and after three days of treatment (stage two) using a logistic regression model. A calculator was used that included six laboratory parameters: leukocytes, platelets, procalcitonin, C-reactive protein, D-dimer, and fibrinogen, followed by ranking in points and weighting coefficients. Based on the total value of the weighting coefficients, three subphenotypes of the RD course were identified: hypoinflammatory, intermediate, and hyperinflammatory (less than 0.8, 0.8-1.2, and more than 1.2, respectively). The obtained data were analyzed using SPSS statistical software (version 26.0).Results. At the first stage, the hypoinflammatory subphenotype of RD was detected in 194 (53.3%) newborns, and a mixed phenotype in 170 (46.7%) newborns. On the third day of treatment in the NICU (stage II), the hypoinflammatory phenotype was verified in 205 (76.5%), the intermediate phenotype in 61 (22.8%), and the hyperinflammatory phenotype in 2 (0.7%) newborns. At both the first and the second stages of the study, the hypoinflammatory phenotype of RD was significantly more common (x2 = 37.4, p < 0.001). We did not find a statistically significant association between the inflammatory phenotype and mortality (x2 = 1.55, p = 0.214). It was found that patients with an intermediate inflammatory phenotype in RD were significantly more likely to require invasive mechanical ventilation (x2 = 9.786, p = 0.002, AUG ROC 0.678).Conclusion. The severity of the condition and mortality in RD in preterm infants are not associated with inflammatory phenotypes. The presented calculator for assessing the severity of systemic inflammation has moderate discriminatory ability in predicting the need for invasive mechanical ventilation in preterm infants with RD.
Introduction . Training of admission department registrars in psychological first aid for relatives of patients with life-threatening conditions is a pressing issue in the modern healthcare system. The objective was to establish the effectiveness of the educational and methodological complex of the residency «Anesthesiology and Resuscitation» on psychological first aid for relatives of intensive care patients in developing universal competence in interacting with relatives of patients during the training of admission department registrars. Materials and methods . Two sessions were held with 8 registrars in a simulation center, and the 3 rd simulation session was held at the registrars’ workplace. Simulated relatives of patients played apathy, fear, hysteria, crying, anxiety, and aggression. The scores of the checklists according to the psychological first aid algorithm were compared at all sessions for each psychological reaction and for each session for all reactions. Results . No differences in scores were found for apathy and crying. For hysteria, aggression, and anxiety, there were more scores at the 3rd session. In case of fear, the points at the 3 rd session were higher than at the 2 nd and 1 st , at the 2nd session, they were higher than at the 1 st . There was no differences between psychological reactions at the 2 nd and 3 rd sessions. At the 1 st session, the points for apathy were higher than for other reactions, except for crying, the points for crying exceeded the points for anxiety and fear. Conclusion . The educational and methodological complex of the residency «Anesthesiology and Resuscitation» of psychological first aid for relatives of intensive care patients improves the results of simulation training in the formation of universal competence in interacting with relatives of patients. The methodology of «in situ simulation» sessions is applicable in the formation of such competence.
Introduction . The emergence of new composite (incorporated, combined, aggregated) indices that allow simultaneously evaluating inflammation, nutrition, and immunity is being actively studied as a risk factor for severe cardiovascular, oncological, and infectious diseases. The objective was to evaluate to evaluate the diagnostic capabilities of new composite inflammatory indices in the intensive care of severe acute pancreatitis and purulent-inflammatory diseases. Materials and methods . The retrospective cohort study included 62 patients (male – 32, female – 30, median age – 49.5 years, Q1–Q3 – 35.5–64) in the intensive care unit with a diagnosis of severe acute pancreatitis, purulent-inflammatory. The significance of the following indicators reflecting the state of systemic inflammation, immunity, and nutrition were studied in surviving and deceased patients: NLR index (neutrophil/lymphocyte ratio); MLR index (monocyte/lymphocyte ratio); PLR index (platelet/lymphocyte ratio); LMR index (lymphocyte-monocyte ratio); NLPR index (neutrophil / lymphocyte x platelet ratio); AISI (aggregate index of systemic inflammation ); SIRI (systemic inflammatory response index); SII index (systemic immune-inflammation index); LCR index (lymphocyte/C-Reactive Protein ratio); CLR index (C-Reactive Protein/Lymphocyte Ratio); CALLY index (C reactive protein-albumin-lymphocyte index); TIH (total index hematology); CAR index (C-Reactive Protein/Albumin ratio); PNI (prognostic nutritional index); MII-1 ((multi inflammatory index) (Sysmex XT-2000i analyzers (Japan) and DxC 700 AU Beckman Coulter, USA)). Results . Values of NLR > 3.8; PLR < 149; SIRI > 3.06; NLPR > 1.83; LCR < 120; CLR > 77.7; CAR > 2.51; CALLY index < 47; TIG < 12.8; PNI < 37; MII-1 > 334 are associated with the manifestation of systemic inflammation and the development of a critical condition in purulent-septic diseases. Conclusion . The obtained cut-off points make it possible to use composite indexes for objectification and automatic calculation of the results and dynamics of intensive therapy for purulent-inflammatory diseases.
