Introduction. Sepsis is a serious life-threatening disease, accompanied by high mortality and long-term decline in the quality of life of surviving patients. Recent recommendations from the US Society of Critical Care Medicine presented the Phoenix Sepsis Score as the optimal system for assessing organ dysfunction in children with sepsis.The objective of study was to compare the discriminatory ability of the Phoenix Sepsis Score, pSOFA and PELOD 2 scores after 24, 72 and 120 hours of intensive care.Materials and methods. The study design was retrospective, observational, and multicenter. 140 children met the inclusion and exclusion criteria, 29 (20.7%) patients died. The discriminatory power of the study scores was assessed based on ROC analysis.Results. The area under the ROC curve in the first 24 hours was comparable for the analyzed scores (within 0.600, the significance of the differences between the Phoenix Sepsis Score and pSOFA was 0.57, Phoenix Sepsis Score – PELOD 2 = 0.80, pSOFA – PELOD 2 = 0.74 ). On the third day of intensive therapy, the information value of the scores turned out to be good (Phoenix Sepsis Score– 0.704 ± 0.100, pSOFA – 0.748 ± 0.079, PELOD 2 – 0.810 ± 0.073), but they also did not differ statistically significantly from each other. On the fifth day of treatment, all scores showed excellent and comparable discrimination ability (AUG ROC about 0.900).Conclusions. The information ability of the Phoenix Sepsis Score, pSOFA and PELOD 2 in children with sepsis is comparable. The Phoenix Sepsis Score can be used to monitor the severity of organ dysfunction during intensive care of pediatric sepsis

Purpose . This study aims at assessing the association of the development and clinical course of arterial hypotension in premature newborns, depending on the polymorphism of the genes of predisposition to hypertension. Material and methods . The study design is prospective, controlled, single-center, and non-randomized. Genomic DNA samples were studied in premature newborns (n = 199), as well as a population sample of adults (n = 100). Newborns with arterial hypotension (n = 23) formed the study group, patients without it (n = 100) formed the comparison group. Loci with already known association with the development of arterial hypertension and coronary heart disease were selected for analysis: AGT (rs4762), AGTR1 (rs5186), ACE (Ins\Del), ADRB1 (rs1801253), ADD1 (rs4961), CYP11B2 (rs1799998), eNOS (rs1799983), eNOS (rs1549758), eNOS (rs2070744). The distribution of allele frequencies between the studied groups of individuals was compared. Results . Premature babies are significantly more likely to be carriers of the allele with the AGT gene. In newborns with arterial hypotension, we additionally revealed a more frequent occurrence of dominant alleles of the eNOS gene, and children with the SS genotype of the eNOS gene required longer vasopressor therapy. Conclusion. The carriage of risky alleles of genes predisposing to arterial hypertension, not only does not increase the risk of arterial hypotension in premature newborns, but also may, in the case of carriage of mutant alleles of the eNOS rs1549758 gene, contribute to less prolonged vasopressor therapy.

The objective: to evaluate the applicability of the nSOFA scale as a predictor of an unfavorable outcome in premature newborns.Subjects. The study was designed as retrospective and observational. The study enrolled 109 newborns with a gestational age of ≤ 32 weeks of pregnancy (birth weight 1,071 (772‒1,451) g, gestational age 29 (26‒32) weeks, 22 (20,4%) patients died. nSOFA scores were determined based on the first 72 hours after birth, and a peak values were used for analysis. Death was considered an unfavorable outcome.Results. The nSOFA score > 3 was associated with a odds ratio = 2.5 (CI 1.39–4.64, p = 0.002) for an unfavorable outcome. The area under the ROC curve was 0.796 (95% CI = 0.763–0.827).Conclusion. The nSOFA scale is an acceptable tool for measuring the severity of organ dysfunction and predicting mortality in premature newborns, regardless of the etiology of the disease.

Hyperglycemia in premature newborns is an independent risk factor for death, so blood glucose testing is widely used in the practice of neonatal intensive care units.Objective: to evaluate the associations of the frequency of carriage of allelic variants of polymorphic loci of genes predisposing to type 2 diabetes mellitus in newborns with extremely low body weight and hyperglycemia.Methods. The study design is prospective, controlled, single – center, non-randomized. Genomic DNA samples were studied in newborn infants with extremely low body weight (ELBW) (n = 105). Previously, we compared the distribution of allele frequencies of the studied genes between a group of newborns with ELBW and a population sample of adults (control). Then, the distribution of allele frequencies of the genes was compared depending on the presence of hyperglycemia in newborns with ELBW. For the analysis, loci with already known association with the development of type 2 diabetes mellitus were selected ‒ ADRB2 (rs1042713) and (rs1042714), ADRB3 (rs4994), GNB3 (rs5443), PPARA (rs4253778), PPARD (rs2016520), TCF7L2_IVS3 (rs7903146) and TCF7L2_IVS4 (rs12255372), PPARGC1A (rs8192678), MTHFR (rs1801131), PPARG (rs1801282), MTNR1B (rs10830963), SIRT1 (rs7069102).Results. In newborns with ELBW, we found a more frequent occurrence of the mutant allele A of the polymorphic locus rs8192678 in the PPARGC1A gene and the allele C of the polymorphic locus rs4253778 in the PPARA gene, in contrast to the adult population sample. But in newborns with ELBW, hyperglycemia is most likely associated with the carrier of the allele C rs1801282 of the PPARG gene (χ2 = 18.972, p < 0.001) and the allele T rs7903146 in the TCF7L2 gene (χ2 = 11.496, p < 0.001).Conclusions. The carriage of the allele С rs1801282 of the PPARG gene is characterized by the presence of a strong conjugation with hyperglycemia in newborns with extremely low body weight. It is desirable to monitor the level of glycemia in the conditions of neonatal intensive care units, taking into account the carriage of genes predisposing to hyperglycemia.

The objective of the study is to evaluate the discriminative ability of nSOFA in newborns with sepsis.Subjects: The study was designed as retrospective, observational, and one-center. End points included assessment of the severity as per nSOFA and pSOFA; 28-day survival. 121 patients were enrolled in the study. Microsoft Excel (Graphpad Software, San Diego, California, USA) and MedCalc (v 7.1.0.0; MedCalc Software, Belgium) were used for the analysis.Results. A study of the discriminative power of the scores showed that both assessment systems had a good model quality. However, nSOFA had a statistically more significant (p < 0.05) area under the ROC curve (0.981± 0.014).Conclusion. The high value of the discriminative ability of the nSOFA scale indicates the feasibility of its use in patients with sepsis in neonatal intensive care units

Transpulmonary thermodilution is widely used method for hemodynamic assessment in critically ill adults and children. However, the use of this method without strict indications and incorrect interpretation of data may lead to incorrect clinical decisions. This review is devoted to history of transpulmonary thermodilution, clinical problems and limitations in hemodynamic measure-

Введение. Распространенность нозокомиальных инфекций в стационарах Москвы составляет 7,61 %. В условиях практически тотальной поли- и панрезистентности возбудителей нозокомиальной пневмонии (НП) в отделениях реанимации поиск альтернативных методов антибиотикотерапии является актуальным. Одна из таких альтернатив — ингаляционные антибиотики (ИА). В данной публикации приведены результаты исследования «Ингаляционные антибиотики в реаниматологии» на основе анкетного опроса врачей — анестезиологов-реаниматологов. Цель исследования. Анализ частоты применения ингаляционных форм антибиотиков при НП у реаниматологических пациентов в стационарах Российской Федерации. Материалы и методы. Данный опрос был рецензирован двумя ведущими профильными специалистами, утвержден 25.11.2017 комитетом по рекомендациям и организации исследований Федерации анестезиологов и реаниматологов (ФАР) России (http://www.far.org.ru/research/362-ingabx). Опрос проводился 10.01.2018–30.10.2018. Результаты. По результатам исследования были получены данные о распространенности использования ИА для лечения НП (64 % опрошенных); показаниях (все опрошенные используют отечественные рекомендации; 80 % назначает ИА при неэффективности текущего режима антибиотикотерапии); используемых лекарственных препаратах (колистиметат натрия применяется в 52 % случаев (11 респондентов), тобрамицин — 9 % (2 респондента), амикацин — 24 % (5 респондентов), другое (ацетилцистеин-антибиотик, гентамицин, цефалоспорины различных поколений, бактериофаги) — 15 % (3 респондента)) и оборудовании (более 90 % используют небулайзеры с вибрирующей пластиной), критериях их отмены (крайне разрозненные ответы). Выводы. Результаты анкетирования позволяют обосновать целесообразность дополнительных рандомизированных контролируемых исследований по данной проблеме.

Objective: to present data and analyze current data on diagnostics of acute skin failure in children. The term “acute skin failure” is rarely used in the literature. Among the works published in Russian, we found only one study of our colleagues from the Republic of Belarus, where we met the definition and description of this term. When searching the Pubmed database, we found 58 scientific works, only 7 of them were devoted to children. When determining the presence or absence of multiple organ failure syndrome, none of the scales used for adults and children included skin disorders. The majority of scales described changes in the respiratory system, kidneys, liver, cardiovascular system, neurological status and blood system. However, acute skin failure is a serious problem similar to insufficiency of internal organs. The clinical case demonstrates the possibility of effective intensive care in a child with acute skin failure. We believe that the diagnosis of acute skin failure as a primary or secondary component of multiple organ failure syndrome in children in the intensive care unit is an important step towards the correct and adequate treatment of such patients.

Many hospitals use β-blockers in adult patients, however, their use in children has not yet been determined. The objective: to collect data on the use of β-blockers in children in intensive care units (ICU). Methods: an anonymous survey containing 17 questions regarding the use of β-blockers was distributed through social networks, messengers and email. The answers were compared with published data. Results. 48 respondents provided their replies. The survey has shown that 66.7% of them use β-blockers in children while 33.3% do not. Differences in the use of β-blockers in general and pediatric ICUs are statistically insignificant. Most clinics (50%) use β-blockers in patients with congenital heart defects, followed by sepsis (18.5%). Esmolol (34.4%) is the first-line drug, followed by propranolol (31.3%). The doses ranges vary significantly (excluding esmolol). Basic monitoring and echocardiography (40.6%) are most often used to monitor the use of β-blockers. Conclusion: The survey results have shown that in Russia, the use of β-blockers in children in ICU is very limited. It is necessary to conduct big randomized, multicenter, placebo-controlled studies that will determine the effectiveness of β-blockers in children in various clinical conditions.

Objective. To assess the discriminatory ability of the PELOD 2 and pSOFA scales in the conditions of multidisciplinary neonatal intensive care unit. Material and methods . It is a prospective, observational, single-center study. The end points are to assess the severity of the condition on the PELOD 2 and pSOFA scales; 28-day survival. The study includes 121 patients. Results. While studying the discriminating power of the scales we have found that all scales have good model quality. At the same time, the pSOFA evaluation system has a statistically more significant (p<0.05) area under the ROC curve (0.903±0.09). Our analysis has not found significant differences in the characteristics of surrogate endpoints between the compared scales in the conditions of comparable points of separation of death risks (p<0.05). Conclusion. The high discrimination ability of the pSOFA scale allows us to recommend it for clinical use in neonatal intensive care units.

Introduction. The prevalence of nosocomial infections in Moscow hospitals is 7.61 %. In conditions of almost total poly- and pan-resistance of nosocomial pneumonia pathogens in intensive care units, the search for alternative methods of antibiotic therapy is urgent. One such alternative is inhaled antibiotics (IA). This publication presents the results of the study “nhalation antibiotics in resuscitation” based on a questionnaire survey of anesthesiologists-resuscitators. The purpose of this study is to analyze the frequency of use of inhaled forms of antibiotics for NP in intensive care patients in hospitals of the Russian Federation. Materials and methods. This survey was reviewed by two leading specialized specialists, approved on November 25, 2017 by the Committee for Recommendations and Organization of Research of the Federation of Anesthesiologists (http://www.far.org.ru/research/362-ingabx). The survey was conducted on 10.01.2018–30.10.2018. Results. According to the results of the study data were obtained on the prevalence of the use of IA for the treatment of nosocomial pneumonia (64 % of the respondents); indications (all respondents use Russian national guidelines; 80 % prescribe IA if the current antibiotic therapy regimen is ineffective); drugs used (colisthimetate sodium is used in 52 % of cases, tobramycin — 9 %, amikacin — 24 %, other (acetylcystein antibiotic, gentamicin, cephalosporins of various generations, bacteriophages) — 15 %) and equipment (more than 90 % use mesh-nebulizers), criteria for their cancellation (extremely scattered answers). Conclusion. The results of the questionnaire allow us to substantiate the advisability of additional randomized controlled trials on this issue.

Objective: to present the evolution and modern concept of pediatric sepsis.According to many authors, pediatric sepsis is considered to be the main cause of death from infectious diseases; and the mortality is associated with a late diagnosis and non-compliance with treatment guidelines. The article discusses the evolution of views on sepsis over the past 30 years. It analyzes the changes of sepsis concepts in adults from Sepsis-1 to Sepsis-3. Currently, sepsis is considered as a life-threatening organ dysfunction due to dysregulation of the body’s response to infection rather than a progressive systemic inflammation. Since sepsis is based on a pathobiological process, its definitions should be applied both to adults and children. However, the terminology and intensive care of pediatric sepsis is beyond the recommendations of Sepsis-3. Over the last 3 years the scientists have studied various pediatric scales to verify sepsis and introduce the Sepsis-3 ideology into pediatrics. Currently, the consensus and multidisciplinary approach of pediatricians and intensive care physicians is extremely important to achieve real success in early diagnosis and reduce mortality in children with sepsis.

According to the recommendations of the Surviving Sepsis Campaign (SSC), antibiotics should be administered within 1 hour after the onset of sepsis, and the centers for Medicare & Medicaid Services prescribe their administration within 3 hours.The objectiveof this publication is to analyze the literature data on the start time of ABT when a patient with sepsis is admitted to the ICU.Results. Currently, basing on literature analysis, it is impossible to conclude about advantages of administering an antibiotic within an hour after the patient with sepsis is admitted to a medical unit. In the vast majority of cases, an antibiotic should be administered up to three hours of the early IT complex (bundle). The change in the time algorithm for drug administration is due to the heterogeneity of the clinical situation, the lack of the unified "scenario" of interaction between the infection and host, and the need for more detail diagnostics.Conclusion. It is preferable to approach each case individually when deciding about the time to start ABT, considering the history, clinical and laboratory characteristics by the admission to the ICU. However, ABT should be started within 3 hours in any case.

The review of publications and the results of the authors' study of the main issues of strategy and tactics of intensive therapy in the first hours after injury in children with severe thermal injury are presented. It is noted that shock is a complex pathophysiological response to thermal damage, but its development can be prevented. The current problems of infusion therapy, treatment of pain syndrome, evacuation of victims from the scene to the near-est medical institution or a specialized burn center are considered.

Purpose: pilot development of the system estimating the risk for sepsis in newborns and determining its discrimination power.Methods. Design: a retrospective observational single-center study. 124 newborns with sepsis are included; 34 of them died. Kullback’s measure was used to estimate the information value of the examined clinical and laboratory variables. Disease outcome (whether survived or dead) was the response function. The discrimination power was determined using ROC-analysis.Results. The information value of the examined clinical and laboratory variables in the newborns was analyzed as related to the risk for sepsis. Early neonatal sepsis predictors include platelet count, total protein content, body mass and neutrophil count. Discrimination power of the mentioned predictors was calculated.Result. Determination of the risk for sepsis in a newborn based on the estimation of platelet count, neutrophil count, total protein and body mass is of moderate value.

The article describes the achievements of pediatric anesthesiology and intensive care in recent years. The author focuses on the humanization of critical medicine in children, effects of anesthesia on the developing brain, pain management in children, and also examines problems of respiratory support, diagnosis and intensive therapy of sepsis in children and newborns, nutritional support in critically ill children.