The objective wasto evaluate the efficiency of the highly realistic simulator “Test Chest” in training residents in the specialty “Anesthesiology and Resus-citation” in the alveolar recruitment maneuver and the de-escalation option for setting positive end-expiratory pressure in ARDS during a practical session. Materials and methods . The study included 28 residents of the first year of study in the specialty «Anesthesiology and Resuscitation», who were divided into two groups. The 1st group – residents who were given theoretical classes before the study: lectures and a seminar on the topic: «Respiratory support in ARDS» and the 2nd group (simulation) – in addition to the lectures, the trainees had preliminary practical classes in the simulation center with a demonstration of the method of selecting ALV parameters in ARDS and independent performance of the alveolar recruit[1]ment maneuver, setting the positive pressure at the end of exhalation. In the simulation center, students were offered a situational task, the solution of which involved determining the clinical picture and selecting the necessary ALV parameters. The evaluation was carried out by two teachers independently using a checklist modified for objective student evaluation. Results . In the 1st group, 4 (28%) trainees coped with the task, in the 2nd group, in 13 cases (95%), the task was successfully completed. In the course of the study, the trainees of both groups revealed difficulties in selecting ALV parameters in ARDS, which required a more detailed consideration of these issues, both in theoretical and practical classes. Conclusion. The use of the highly realistic simulator “Test Chest” in the selection of ALV parameters in ARDS during a practical session makes it possible to increase the effectiveness of training in the alveolar recruitment maneuver and the de-escalation option for setting positive end-expiratory pressure in ARDS for residents in the specialty “Anesthesiology and resuscitation”.

Highlights. Mechanical thrombectomy is the “gold standard” treatment of patients with large-vessel occlusions. Five randomized trials conducted in 2015 made a significant contribution to the development and introduction of mechanical thrombectomy into clinical practice. The DAWN and DEFUSE-3 trials have provided new insights into the pathophysiology of ischemic stroke and ensured the advancement in the therapeutic field.Abstract. Stroke is one of the leading causes of death and disability worldwide. The general strategy for the treatment of ischemic stroke is aimed at restoring blood flow to the ischemic regions of the brain. Intravenous thrombolysis has been the treatment for acute ischemic stroke since 1996. However, since 2015, as a result of 5 randomized trials, endovascular mechanical thrombectomy has become the gold standard for the treatment of patients with large cerebral artery occlusion. The DAWN and DEFUSE 3 trials have provided new insights into the pathophysiology of ischemic stroke, shifting the paradigm from “time = brain” to “collaterals = brain”. In this article, the authors will consider development of endovascular devices, modern mechanical thrombectomy techniques, and directions for further research of endovascular treatment for ischemic stroke.

The objective: to evaluate the effect of high-flow oxygen and non-invasive ventilation on the mortality rate in adults with severe respiratory failure caused by the new coronavirus infection in the intensive care unit (ICU).Subjects and methods. A one-center retrospective study was conducted. Electronic medical files of patients treated in the ICU from April 1 to May 25, 2020, were analyzed. Totally, 101 medical files were selected, further, they were divided into two groups. Group 1 (n = 49) included patients who received oxygen insufflation, and should it fail, they received traditional artificial ventilation. No non-invasive respiratory therapy was used in this group. Group 2 (n = 52) included patients who received high-flow oxygen therapy and non-invasive ventilation. The mortality rate in the groups made a primary endpoint for assessing the impact of high-flow oxygen therapy and non-invasive ventilation. The following parameters were also analyzed: drug therapy, the number of patients in whom non-invasive techniques were used taking into account the frequency of cases when these techniques failed, and the number of patients in whom artificial ventilation was initiated.Results. In Group 2, non-invasive methods of respiratory therapy were used in 31 (60%) cases. High-flow oxygen therapy was used in 19 (36%) of them; in 13 cases this method allowed weaning them from the high flow. Non-invasive ventilation was used in 18 cases, in 12 patients it was used due to progressing severe respiratory failure during humidified oxygen insufflation, in 6 patients – after the failed high-flow oxygen therapy. In Group 1, 25 (51%) patients were intubated and transferred to artificial ventilation, in Group 2, 10 (19.2%) underwent the same. The lethal outcome was registered in 23 (47%) cases in Group 1, and in 10 (19.2%) in Group 2 (p = 0.004). Analysis of drug therapy in the groups revealed the difference in the prescription of pathogenetic therapy. Logistic regression demonstrated the effectiveness of the combination of tocilizumab + a glucocorticoid in reducing the frequency of lethal cases (p = 0.001).Conclusion. The use of non-invasive respiratory support in adults with severe respiratory failure caused by the new coronavirus infection combined with therapy by tocilizumab + a glucocorticoid can reduce the incidence of lethal cases.

Introduction. In patients with spontaneous breathing and respiratory failure, various methods of delivering the gas mixture to the respiratory tract have been developed. The use of high-flow oxygen therapy is alternative standard oxygen therapy. Objectives. Experimental study of the effects of high-flow oxygen therapy and evaluation of its clinical effectiveness in comparison with traditional oxygen therapy in patients with severe community-acquired pneumonia. Materials and Methods. During the experimental stage of the study, the level of mean airway pressure was determined depending on the flow of the gas mixture using a lung model with parameters of biomechanics of respiration. During the clinical stage, a comparative analysis of the effectiveness of respiratory support in groups of patients with severe community-acquired pneumonia using high-flow and traditional oxygen therapy was carried out. Results. During experimental study, flow of gas mixture 30 l/min was determined, at which mean airway pressure registered on models of healthy lungs and lungs with modified respiratory biomechanics significantly increases. During the clinical phase of the study, a statistically significant decrease in the frequency of initiation of artificial (invasive and non-invasive) lung ventilation, an increase in oxygenation (saturation hemoglobin with oxygen, partial pressure oxygen in arterial blood) and partial pressure carbon dioxide with simultaneous decrease in respiratory rate. Conclusion. The value of gas flow over 30 l/min has significant effect on the recorded mean airway pressure calculated using models of lungs in experiment. However, clinical significance of this indicator is not clinically significant. The use of high-flow oxygen therapy in patients with severe community-acquired pneumonia in comparison with standard method reduces the frequency use of ventilation (invasive and non-invasive) with a significant increase in oxygenation indicators. This reduces hyperventilation, which is confirmed by a significant increase in partial pressure carbon dioxide and a decrease in respiratory rate.

The use of ultrasound examination of the lungs gives an idea of the lung tissue, lesion volume and affect the tactics of treatment. However, different lungs ultrasound examination protocols gives the opportunity to get different data. Using ROC analysis by standard of computed tomography were compared the sensitivity and specificity of ultrasound techniques, specifically the protocol for bedside ultrasound examination of the lungs, as well as the 4-zone and 9-zone protocols in the diagnosis of pneumonia. It was revealed that the sensitivity of the researched protocols was 97, 93 and 97%, respectively, specificity – 80, 80 and 90%, respectively. At the same time, the modified 9-zone scanning protocol makes it possible to more accurately search for pneumonic lesions, not only taking into account the lobar structure, but also taking into account the segments of the lungs. The sensitivity of the protocols of bedside ultrasound examination of the lungs, 4-zone and 9-zone in the diagnosis of pneumonic lesions in shares was 69, 80 and 97%, respectively, specificity – 60, 62 and 71%, respectively. The sensitivity of the protocols of bedside ultrasound examination of the lungs, 4-zone and 9-zone in the diagnosis of pneumonic lesions in segments was 73, 68 and 93%, respectively, specificity – 66, 68 and 92%, respectively. In the diagnosis of pneumonia, it is possible to use any of the three protocols with high specificity and sensitivity. The modified 9-zone scanning protocol makes possible to diagnose pneumonic lesions taking into account the lobar structure and taking into account the segmental structure of the lungs with higher sensitivity and specificity.

Проведено изучение локализации пневмонии, микробиологического спектра и чувствительности возбудителей к антибиотикам при внебольничных и нозокомиальных пневмониях. Материалом для исследования послужили медицинские карты пациентов, которые находились на лечении в клиниках Военно-медицинской академии им. С.М.Кирова в период с 2010 по 2017 год. Полученные данные показали, что пневмония чаще локализуется в нижних долях легких. Основной возбудитель внебольничной пневмонии - Streptococcus pneumoniae, нозокомиальной пневмонии - Klebsiella pneumoniae. Выявлена высокая антибиотикорезистентность к возбудителям пневмонии. Возбудитель Klebsiella pneumoniae был резистентен ко всему исследованному спектру антимикробных средств, сохраняя чувствительность в отдельных случаях только к колистину. Бактериологический анализ возбудителей пневмонии необходим для последующей своевременной целенаправленной антибактериальной терапии. Поэтому важно вести постоянный мониторинг возбудителей пневмонии и их чувствительности к антибиотикам для эффективного лечения.

Aim. To study the dynamics of inspiratory pressure and volume in two versions of the experiment - mechanical pressure-controlled air-oxygen and helium-oxygen ventilation in the models of «healthy lung», «chronic obstructive pulmonary disease», «acute respiratory distress syndrome». Methods. Inspiratory pressure and tidal volume were recorded during 10 respiratory cycles at each predetermined level from 5 to 20 cm H2O with a step of 5 cm H2O. TestСhest® was used as a model of the lungs which allows simulating normal function and some pathological states of the lungs sucj as COPD and ARDS. Results. In the model of «healthy lung» inspiratory pressure in the application of air-oxygen mixture and helium-oxygen mixture was: at level 5 cm H2O - 6.4 (6.26; 6.50) and 7.17 (6.94; 7.17) cm H2O; 10 cm H2O - 11.31 (11.2; 11.43) and 12.11 (12.11; 12.27) cm H2O; 15 cm H2O - 16.8 (16.8; 17.03) and 15.24 (15.07; 15.24) cm H2O and at the level of 20 cm H2O - 18.83 (18.65; 19.04) and 21.52 (21.34; 21.67) cm H2O. At this, the respiratory volumes were 262.1 ml and 280.3 ml at the level 5 cm H2O; 541.8 ml and 577.9 ml at 10 cm H2O, 836.9 ml and 925.9 ml at 15 cm H2O; 1109 ml and 1265 ml at 20 cm H2O. In other studied models the inspiratory pressure and respiratory volume were also determined. Comparison of indicators revealed a statistically significant increase of the studied parameters in the simulated pathological conditions. Conclusion. Pressure-controlled use of helium-oxygen mixture in the simulation of normal breathing mechanics, acute respiratory distress syndrome and chronic obstructive pulmonary disease is accompanied by a statistically significant increase in inspiratory pressure in the airways and inspiratory volume.

The aim of the study was to assess the effect of the composition of the inhaled gas mixture on the recorded indicators of inspiratory respiratory volume in ventilator with controlled volume, and inspiratory pressure in the Airways, in ventilator with controlled pressure. To carry out the ventilation with a mixture of helium and oxygen, the Hamilton G5 (Hamilton Medical, Switzerland) ventilator was used with a unit that provides the possibility of supplying this type of mixture. To simulate the lungs, we used TestChest Respiratory Flight Simulator (Organis GmbH, Switzerland) with settings reflecting the patientʼs respiratory system, both in normal and in pathological conditions. According to the results of the study, the composition of the inhaled gas mixture during lung ventilation with controlled volume does not affect the recorded inspiratory respiratory volume on the models of normal and pathological lungs. However, during artificial ventilation of lungs with a mixture of helium and oxygen with controlled pressure, statistically significant differences in the recorded inspiratory pressure in the Airways on the model of lungs were revealed in comparison with the mechanical ventilation oxygen-air mixture.

Aim. Current registry is the continued national study on cryoablation in atrial fibrillation (AF). The aim of the project is assessment of safety and efficacy of cryoballoon ablation of pulmonary veins from AF treatment in real clinical practice prospective observation.Material and methods. The project has been developed for prospective inclusion of the data to guarded automatic informational system, on clinical data of patients, ablation parameters, repeat ablation and results of 12-month follow-up. To participate in the project in January of 2017, the representatives of 33 in-patient facilities were invited, that routinely perform the procedure.Results. Twenty five institutions confirmed their participation, and by December of 2017, the database was completed by specialists from 13 clinics: information on the ablation procedure and outcomes is included for 451 patient. The enrollment is ongoing with estimated end by January 2019; prospective follow-up to be completed by January 2020.Conclusion. Prospective registry of AF cryoablation is important for gathering of experience and common analysis of the procedures throughout the country. Detailed analysis will make it to reveal predictors of efficacy and methods for procedural risk decrease.

Objectives. The goal of study was to compare the effectiveness of using Fastrach ™ and iLTS-D® on a manikin by novices 1st year resident-anesthesiologists under normal and simulated difficult airways. Material and Methods. At the first stage the participants conducted four consecutive trials on a manikin. Each trial included insertion, ventilation and blind intubation the manikin using iLTS-D® and Fastrach™. ‘Time to ventilation’, ‘time to tracheal ventilation’, success rates and number of attempts were recorded for the both devices. At the second stage participants performed one attempt of ventilation and blind intubation under simulated difficult airways (midline head stabilization and limited mouth opening 3 cm). It was estimated the difference between devices in ‘time to ventilation’ and ‘time to tracheal ventilation’; differences in success rates at trial 4 and at the second stage. Results. There was no difference in ‘time to ventilation’ between either device in trial 4 (median: Fastrach: 14.7 s, iLTS-D: 13.2 s, p = 0.14). Also there was no difference in ‘time to tracheal ventilation’ between either device in trial 4 (median: Fastrach: 15.4 s., iLTS-D: 13.9 s, p = 0.55). Both devices were equally effective in a simulated difficult airway, ventilation and intubation at the first attempt was successful in all cases, there was no significant difference in ‘time to ventilation’ (Fastrach: 12.3 s, iLTS-D: 13.5 s, p = 0.14) and ‘time to tracheal ventilation’ (Fastrach: 12.6 s, iLTS-D: 12.5 s, p = 0.77).

Aim. To evaluate the effectiveness of the stent use Calypso Angiolain Russia with primary percutaneous transluminal coronary angioplasty (PTCA).Methods. The study prospectively included 150 patients who underwent PTCA in acute coronary syndrome (ACS) for the period from January to December 2015. During the one-year follow-up period were evaluated indicators insolvency target lesion (cardiac death, myocardial infarction in the pool target artery, target lesion revascularization when clinically indicated), major adverse cardiac events (death from any cause, myocardial infarction, repeat revascularization as clinically indicated). Results. In one year, the incidence of target lesion failure was 6.66% for cardiac death rate of 1.33%, myocardial infarction in the target artery 3.33% and target lesion revascularization at 5.3%. The frequency of cardiac major adverse cardiac events was 12% at mortality 2.66%, myocardial infarction 4% and revascularization when clinically indicated 8.66%. Conclusion. The use of stents in primary PTCA Calypso is possible, the percentage of cardiovascular complications is comparable with the data of clinical trials.Received 31 January 2017. Accepted 17 March 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

Цель исследования. Проведение сравнительной оценки эффективности применения LMA Fastrach™ и iLTS-D® на манекене в условиях неосложненных и трудных дыхательных путей ординаторами 1-го года обучения. Материал и методы. На первом этапе участники выполняли четыре последовательных попытки на манекене. Каждая попытка включала установку, вентиляцию и слепую интубацию манекена с использованием LMA Fastrach™ и iLTS-D®. Время до начала вентиляции, время до начала вентиляции трахеи, частота успеха и число попыток фиксировались при использовании обоих устройств. На втором этапе участники выполняли одну попытку вентиляции и слепой интубации в условиях симулированных трудных дыхательных путей (срединная фиксация головы и ограниченное открывание рта до 3 см). Оценивали различия между устройствами по времени до начала вентиляции, времени до начала вентиляции трахеи, по частоте успеха при 4-й попытке на первом и втором этапах. Результаты. Не было установлено разницы по времени до начала вентиляции между устройствами при 4-й попытке (медиана Fastrach: 14,7 с, iLTS-D: 13,2 с, p = 0,14), а также по времени вентиляции до начала вентиляции трахеи (медиана Fastrach: 15,4 с, iLTS-D: 13,9 с, p = 0,55). Оба устройства были одинаково эффективны в условиях симулированных трудных дыхательных путей, вентиляция и интубация с первой попытки были успешны во всех случаях. Не выявлено значимой разницы между устройствами по времени до начала вентиляции (Fastrach: 12,3 с, iLTS-D: 13,5 с, p = 0,14) и времени вентиляции до начала вентиляции трахеи (Fastrach: 12,6 с, iLTS-D: 12,5 с, p = 0,77).

Aim. Current registry is the continued national study on cryoablation in atrial fibrillation (AF). The aim of the project is assessment of safety and efficacy of cryoballoon ablation of pulmonary veins from AF treatment in real clinical practice prospective observation. Material and methods. The project has been developed for prospective inclusion of the data to guarded automatic informational system, on clinical data of patients, ablation parameters, repeat ablation and results of 12-month follow-up. To participate in the project in January of 2017, the representatives of 33 in-patient facilities were invited, that routinely perform the procedure. Results. Twenty five institutions confirmed their participation, and by December of 2017, the database was completed by specialists from 13 clinics: information on the ablation procedure and outcomes is included for 451 patient. The enrollment is ongoing with estimated end by January 2019; prospective follow-up to be completed by January 2020. Conclusion. Prospective registry of AF cryoablation is important for gathering of experience and common analysis of the procedures throughout the country. Detailed analysis will make it to reveal predictors of efficacy and methods for procedural risk decrease.

The endoscopic monitoring when performing percutaneous dilatation tracheostomy requires continuous (up to several dozens of minutes) presence of fiberotic bronchoscope in the endotracheal tube. Under a certain proportion of the outer diameter of fiberotic bronchoscope and the inner diameter of the endotracheal tube it is not always possible to provide proper volume of the artificial pulmonary ventilation and it can result in the hypoventilation. Goal: using the lung model of TestChest® Respiratory Flight Simulator to define the most important factors limiting the increase of minute pulmonary ventilation (MPV) on APV during bronchoscopy through the endotracheal tube. Materials and methods: fiberotic bronchoscope of 5.9 mm outer diameter was put through endotracheal tube no. 8 which was pressure-proof installed to the inspiratory limb of the TestChest lung model with setup parameters reflecting the respiratory system of a patient with no disorders of respiratory mechanics. APV was under volume control. The respiratory volume was increased from 350 ml up to maximum with 25 ml step under the respiratory rate of 12, 16 and 20 respiratory movements per minute. Peak pressure, plateau pressure, autoPEEP, pressure behind the tip of endotracheal tube were registered before and after insertion of fiberotic bronchoscope. Results: increase of MPV was limited by the preset maximum pressure in the respiratory tract. Under the respiration rate of 12 movements per minute, MPV was 9.6 l/min; under the respiration rate of 16 movements per minute it was 12 l/min; under the respiration rate of 20 movements per minute it was 13.5 l/min. However, under the respiration rate of 12 movements per minute autoPEEP made 5 cm. w. c. with maximum MPV, and under the respiration rate of 16 and 20 movements per minute autoPEEP made even 14 and 24 cm. w. c. respectively. On the compared level of PEEP of 5 cm. w. c. MPV made 7.6 l. under the respiration rate of 16 movements per minute; and under the respiration rate of 20 movements per minute with the volume of 350 ml. the autoPEEP made 7 cm. w. c. Conclusion. Factors limiting MPV during APV in bronchoscopy through the endotracheal tube are peak pressure in the endotracheal tube and development of autoPEEP.

Цель. Оценить эффективность использования стента «Калипсо» (ООО «Ангиолайн», Россия) при первичной чрескожной транслюминальной коронарной ангиопластике. Методы и результаты. В исследование проспективно включили 150 пациентов, которым проводили чрескожную транслюминальную коронарную ангиопластику при остром коронарном синдроме с января по декабрь 2015 г. В течение 12-месячного наблюдения оценивали показатели несостоятельности целевого поражения (кардиальная смерть, инфаркт миокарда в бассейне целевой артерии, реваскуляризация целевого поражения по клиническим показаниям), серьезных неблагоприятных кардиальных событий (смерть от любых причин, инфаркт миокарда, повторная реваскуляризация миокарда по клиническим показаниям). За один год частота развития несостоятельности целевого поражения составила 6,66% при частоте сердечной смерти 1,33%, инфаркта миокарда в бассейне целевой артерии 3,33% и реваскуляризации целевого поражения 5,3%. Частота серьезных неблагоприятных кардиальных событий составила 12%, смертности — 2,66%, инфаркта миокарда — 4% и реваскуляризации по клиническим показаниям — 8,66%. Заключение. Использование стента «Калипсо» при первичной чрескожной транслюминальной коронарной ангиопластике возможно, процент сердечно-сосудистых осложнений сопоставим с данными клинических исследований. Поступила в редакцию 31 января 2017 г. Принята к печати 17 марта 2017 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов.

The article presents the results of a study of TNF-α, MMP-1, MMP-9, MMP-complex 9/TIMP-1 in 70 patients with acute myocardial infarction undergoing percutaneous coronary intervention. A significant increase in systemic levels of TNF-α and MMP-1 in the group of in-stent restenosis compared with the group without restenosis. A significant increase in TNF-α, MMP-1, MMP-9 and the reduction of the complex MMP-9/TIMP-1 in the groups I and II compared to the control group.

The objective: to evaluate the effect of high-flow oxygen and non-invasive ventilation on the mortality rate in adults with severe respiratory failure caused by the new coronavirus infection in the intensive care unit (ICU). Subjects and methods . A one-center retrospective study was conducted. Electronic medical files of patients treated in the ICU from April 1 to May 25, 2020, were analyzed. Totally, 101 medical files were selected, further, they were divided into two groups. Group 1 (n = 49) included patients who received oxygen insufflation, and should it fail, they received traditional artificial ventilation. No non-invasive respiratory therapy was used in this group. Group 2 (n = 52) included patients who received high-flow oxygen therapy and non-invasive ventilation. The mortality rate in the groups made a primary endpoint for assessing the impact of high-flow oxygen therapy and non-invasive ventilation. The following parameters were also analyzed: drug therapy, the number of patients in whom non-invasive techniques were used taking into account the frequency of cases when these techniques failed, and the number of patients in whom artificial ventilation was initiated. Results. In Group 2, non-invasive methods of respiratory therapy were used in 31 (60%) cases. High-flow oxygen therapy was used in 19 (36%) of them; in 13 cases this method allowed weaning them from the high flow. Non-invasive ventilation was used in 18 cases, in 12 patients it was used due to progressing severe respiratory failure during humidified oxygen insufflation, in 6 patients – after the failed high-flow oxygen therapy. In Group 1, 25 (51%) patients were intubated and transferred to artificial ventilation, in Group 2, 10 (19.2%) underwent the same. The lethal outcome was registered in 23 (47%) cases in Group 1, and in 10 (19.2%) in Group 2 (p = 0.004). Analysis of drug therapy in the groups revealed the difference in the prescription of pathogenetic therapy. Logistic regression demonstrated the effectiveness of the combination of tocilizumab + a glucocorticoid in reducing the frequency of lethal cases (p = 0.001). Conclusion. The use of non-invasive respiratory support in adults with severe respiratory failure caused by the new coronavirus infection combined with therapy by tocilizumab + a glucocorticoid can reduce the incidence of lethal cases.