Objective. To assess the efficacy of preventive high-flow oxygenation and non-invasive ventilation in early post-extubation period compared to standard oxygen therapy in patients with ARDS. Material and methods. A prospective randomized single-center study enrolled 61 adults who received invasive mechanical ventilation for at least 24 hours and met the Berlin definition of acute respiratory distress syndrome. After successful 120-minute spontaneous breathing trial test, patients were randomized into three groups of post-extubation respiratory support: standard oxygen therapy through a face mask, high-flow oxygenation through nasal cannula or non-invasive pressure support ventilation. The active follow-up period was 48 hours with assessment of blood gases, hemodynamics, and respiratory status. The need for reintubation and its causes were recorded for 7 days. Results. All groups did not differ in age, gender, severity of organ dysfunction and ventilation time. The overall rate of reintubation within 7 days was 23% (14/61) (15% in the high-flow oxygenation and non-invasive ventilation groups, 38% in the standard oxygen therapy group). When all causes of reintubation were analyzed, we found no between-group differences (p=0.094). When non-respiratory causes were excluded, we found significantly less incidence of reintubation after high-flow oxygenation or non-invasive ventilation in early post-extubation period (p=0.033). Length of ICU- and hospital-stay, as well as mortality rate did not differ between groups. Conclusion. In patients with acute respiratory distress syndrome, preventive high-flow oxygenation or non-invasive ventilation in early post-extubation period is associated with less incidence of reintubation for respiratory causes compared to standard oxygen therapy.
Background. Induction of anesthesia and mechanical ventilation frequently lead to arterial hypotension whose nature can be elucidated through analysis of volumetric and pressure-derived hemodynamic parameters. These include measured or calculated, including indexed, indicators of the left and right cardiac chambers (left ventricular stroke work index, right ventricular stroke work index), peripheral (indexed total peripheral vascular resistance — iTPVR) and pulmonary (indexed pulmonary vascular resistance — iPVR) vascular resistance. Informative value of these indicators remains a subject of debate. Objective. To evaluate utility of pulmonary artery catheter derived hemodynamic parameters at induction of anesthesia and initiation of mechanical ventilation in patients with various heart failure phenotypes scheduled for CABG. Material and methods. We studied 100 patients with coronary artery disease at induction of anesthesia and initiation of mechanical ventilation immediately before myocardial revascularization. Group 1 (n=50) consisted of patients with preserved left ventricular ejection fraction (LVEF ≥50%); group 2 (n=50) — reduced LVEF (41–49%). Hemodynamic assessment included pressure-derived parameters (pulmonary artery catheter) and volumetric measurements (transesophageal echocardiography, TEE). Measurements were performed at four stages: (1) before induction of anesthesia (“baseline”); (2) after induction of anesthesia, prior to administration of muscle relaxants (“spontaneous breathing phase”); (3) 10 min after initiation of mechanical ventilation (“post-MV”); and (4) 3 min after Trendelenburg positioning (30° head-down tilt). Results. Anesthesia induction resulted in arterial hypotension in both groups without impairment of myocardial contractility. This indicated vasoplegia as predominant mechanism. Initiation of mechanical ventilation and subsequent Trendelenburg positioning increased central venous pressure (CVP) and pulmonary artery pressures (mean PAP) by 20% and 60%, respectively (p<0.05). According to TEE data, these changes were not attributable to preload augmentation, but rather reflected the influence of elevated intrathoracic pressure. Under MV, interpretation of pulmonary artery catheter derived parameters was hindered by unpredictable effects of increased intrathoracic pressure. This questioned clinical significance of calculated indices of cardiac performance and vascular resistance. Dynamics of iPVR and iTPVR depended on balance between myocardial performance and pressure gradients (mean PAP — pulmonary capillary wedge pressure and mean arterial pressure — CVP, respectively). This dynamics did not provide additional insights into ventricular preload or afterload. TEE is essential to understand hemodynamic profile of a particular patient. Conclusion. PAC derived hemodynamic parameters such as LVSWI, RVSWI, iPVR and iTPVR do not provide additional clinically meaningful information about hemodynamic profile of patients.
Background. Nutritional deficiency is a risk factor for complications and adverse outcomes in critically ill patients. Enteral nutrition is considered the method of choice for correcting the nutritional status of patients in intensive care units. However, the implementation of enteral nutrition is associated with a number of objective and subjective problems: late initiation, non-compliance with clinical recommendations, and low gastrointestinal tolerance. Objective. Based on an analysis of scientific literature, we aim to identify risk factors for decreased enteral nutrition tolerance and propose methods for correcting these disorders. Results. The therapeutic potential of innovative enteral formulas based on the P4 protein complex (a combination of dairy and non-coagulating plant proteins) successfully overcomes gastrointestinal intolerance to nutritional support in critically ill patients. This 4-component formula effectively counteracts the limitations of standard casein-predominant polymeric feeds. The use of innovative P4-based formulas accelerates gastric emptying and minimizes gastric residual volume, thereby reducing the risk of aspiration, while also decreasing the likelihood of malabsorption and bacterial translocation. Conclusion. Upon the onset of signs of low enteral nutrition tolerance in critically ill patients, it is advisable to employ a comprehensive approach. This strategy includes the administration of prokinetics alongside enteral tube feeding formulas containing a combination of dairy and non-coagulating plant proteins (P4).
Plasma exchange is one of the extracorporeal treatment methods for sepsis. Despite extensive research of plasma exchange, changes in definitions of sepsis, heterogeneous patient populations and differences in study design make it difficult to define the target population for this method. The purpose of this review was to analyze publications devoted to plasma exchange for the treatment of sepsis. Searching was conducted in PubMed database using appropriate keywords. Final searching session was conducted on February 5, 2026. Primary selection yielded 8.107 references. After analysis of titles and abstracts, we excluded 8.099 studies without necessary data. The final group included 8 studies.
The authors present successful management of malignant hyperthermia crisis with CGS score 53. Molecular genetic analysis revealed a previously unreported variant c.12146A>C (p.Glu4049Ala) in the RYR1 gene that was initially classified as a variant of uncertain significance. This variant is absent in major databases (ClinVar, gnomAD, European Malignant Hyperthermia Group). Classic malignant hyperthermia crisis in carrier provides key clinical evidence for its pathogenicity and prompts re-evaluation of its baseline classification. These findings will contribute to international databases on pathogenic human variants. They are also crucial for improving the safety of anesthetic management in individuals with this genetic predisposition.
