According to the published data, the rate of fistula formation in the postoperative period ranges from 0.3% to 29%. Currently, due to the high risk of suture failure in the postoperative period and tracheal and esophageal fistulas formation, the options for fistulas treatment by the regenerative rehabilitation methods are under consideration. The frequency of fistula healing and reduction of scar deformities after adipose tissue autografting ranges from 43% to 55%.OBJECTIVE:To develop the minimally invasive technology for postoperative fistulas treatment and describe the real-world experience of its use in terms of hospital stay reduction and patients' quality of life improvement.MATERIAL AND METHODS:Patients were selected as part of a pilot research project (Development of Personalized Approaches to Regenerative Rehabilitation for Surgical Patients, # 0394-2020-0011). Patients' quality of life was assessed using the Russian version of the EQ-5D-5L questionnaire (Russian version for Russia). This article presents a clinical example of successful repair of a cutaneous tracheal fistula by autografting of adipose tissue three months after fistula formation.RESULTS:In one month after autografting of adipose tissue, the tracheobronchial secretion through the fistula has stopped. According to the follow-up computed tomography of the neck and tracheobronchoscopy, the fistulous passage is not observed.CONCLUSION:The presence of a fistula worsens the patient's quality of life and increases the risk of secondary infection. When treating patients with tracheal fistulas of high and extremely high surgical risk, the method of autografting of adipose tissue can be a safe and effective alternative to conventional surgery. Further study of this method of regenerative rehabilitation is required.

Purpose of the study. Clarification of indications, assessment of technical aspects and results of intraoperative intraluminal endoscopic assistance in patients with diseases of the gastrointestinal tract, respiratory tract and in cardiosurgical patients.Materials and methods. Intraoperative intraluminal endoscopic assistance was performed for esophageal diverticula (41), gastroesophageal reflux disease and its complications (32), cicatricial stenoses and tracheal neoplasms (28), gastrointestinal tract neoplasms (17), and a mismatch between the diagnosis of the sending organization with intraoperative data (9) and for the anastomoses control (5). Intraoperative sanation tracheo-bronchoscopy with the definition of “background” flora was performed in 60 cardiosurgical patients with chronic diseases of the bronchopulmonary system.Results. The indications for performing the intraoperative intraluminal endoscopic assistance have been specified taking into account the impact of the study on the surgical course and scope, the method of anesthesia and the tactics of further treatment. Various aspects of the formed fundoplication cuff, completeness of diverticulum resection, and suture tightness were assessed. In a number of patients, the localization of neoplasms and stenoses was clarified, which affected the definition of the resection boundaries. In a number of cases, intraoperative intraluminal endoscopic assistance allowed reducing the average time of intervention and helped to minimize complications.Conclusion. Intraoperative intraluminal endoscopic assistance has its own peculiarities of execution, requires experience in data interpretation, requires a clear coordinated work and communication between the endoscopist, anesthesiologist and surgeon. In general, intraoperative endoscopy improves the results of surgical treatment and prevents complications.

The article is devoted to the study of the efficacy of the flexible spectral imaging color enhancement (FICE) in the visual assessment of the polyp morphology. A group of 166 patients had undergone screening colonoscopy, which showed polyps of different sizes and histological structure in different parts of the intestine. The accuracy of the visual assessment of the polyp type performed using FICE was compared with the histological examination results. 255 polyps in various parts of the colon were identified in 166 patients. Comparative analysis of the results of visual assessment and histological examination of the identified polyps showed that the diagnoses agreed in 190 (74.5%) cases, and preliminary diagnoses proved to be erroneous in 65 (25.5%) cases. The size of the polyp was found to be inversely correlated with the number of erroneous diagnoses, i.e. the smaller the size of the polyp, the greater the probability of error. The erroneous diagnosis was made most frequently in the cases of small and smallest tubular adenomas and hyperplastic polyps, which were taken as serrated one (p <0.05 – significant differences), and also in the case of small and smallest hyperplastic polyps, which were taken as tubular ones (p < 0.05). Based on the results of evaluation of the FICE informativeness in the visual assessment of colon polyps, the method has been shown to have high diagnostic accuracy with respect to tubular, serrated and hyperplastic polyps equal to 83.1, 81.2, 83.9%, respectively. The study showed the high efficacy of flexible spectral imaging colour enhancement in recognizing the morphological structure of epithelial neoplasms, which can be used as a screening method for the preliminary classification of colonic epithelial neoplasia.

BACKGROUND Nasal bleeding is a common complication during nasotracheal intubation (NTI). This is due to the ana- tomical prerequisites and the hemostatic system failure. Using of various research methods in practice can reduce the frequency of such complications. The purpose of the study is to identify predictors of high probability of epistaxis associated with the NTI and the pecu- liarities of the anatomical mucous membrane structure of the nasal passages, and to assess significance of blood coag- ulationfailures in these cases. MATERIALS AND METHODS 45 patients (f-25 and m-20), aged 23 to 47 years, with physical status I-IIASA were analyzed. Depending on the degree of surgical trauma manipulation during intubation were formed three groups of patients in whom the NTI was atraumatic, moderately traumatic and overly traumatic. During preoperative period all patients underwent a rhinoscopy. Intubation trauma of the trachea was assessed by visual analogue scale. The results and discussion. The study of the nasal mucosa structure showed that with atraumatic intubation (Group 1; n=9) were dominated by deep type of bedding nonplethoric nonkinking vessels (66.7% ofpatients (n=6)). During mod- erate trauma intubation (Group 2; n=24), superficial and deep vessels were found equally (50% and 50%). In patients with severe trauma during intubation (Group 3; n=13), 100% of the patients, the vessels were located superficially, 75 % were convoluted, plethoric, mucosa contact bleeding. There were no anatomical changes. CONCLUSION The source of bleeding are superficial, plethoric, kinking vessels of the mucous membrane. Hypocoagu- lation disorders, observed in patients during reconstructive surgeries, exacerbate such bleeding and can lead to fatal complications.

BACKGROUND In cardiac surgery, protective lung ventilation and/or preventive brdnchoscopy (PB) are able to decrease lung injury effects of cardiopulmonary bypass (CPB) and mechanical ventilation. OBJECTIVES define lung complication risks, evaluate the effect ofprotective lung ventilation (PLV) on lung functioning, and investigate the feasibility ofpreventive PB in higher pulmonary risk (PR) patients. MATERIALS AND METHODS 66 patients participated in prospective randomized research. Allocation was based on PR and intraoperative mechanical ventilation type. PLV includedfollowing parameters: PCK PIP - up to 20 cm H20, Vt - 6 ml/ kg of PBW, PEEP - 5-10 cm H20, IE ratio - 1:1.5-1:1, EtCO2 - 35-42 mm Hg, FiO2 - 45-60%, lung ventilation during CPB, alveolar recruitment. Four groups were formed: A - higher PR plus PLV- B - higher PR plus conventional LV (CLV), C - lower PR plus PLV- D - lower PR plus CLV PIP PEEP dynamic compliance, p/f ratio and intrapulmonary shunt (Qs/Qt) were recorded. Seventeen patients of group A underwent PB. RESULTS Advanced dynamic compliance, higher p/f ratio and lower Qs/Qt were seen in group A, in comparison with group B (p< 0.05). Lower Qs/Qt was seen in group C, in comparison with group D (p<0.05). Mucus obstruction of subsegmental bronchi was observed in 53.3% of higher PR patients. More than half ofpatients without PB sufferedfrom postoperative lung complications (70.4 vs. 34.2 7%, p<O.05). CONCLUSION Patients are able to successfully assigned to pulmonary risk groups based on our protocol. Protective lung ventilation improves lung biomechanics and oxygenating function in higher risk patients and decreases intrapulmonary shunt fraction in higher and lower risk patients. Addictive preventive bronchoscopy can be successfully used in higher risk patients.

THE AIM:To assess validity of EITL for mechanical ventilation optimization during GA.MATERIALS:26 cardiac surgery patients participated in non-randomized comparative study. Everyone was ventilated with protective regimen: Vt - 6-8 ml/kg, breath rate - by normal EtCO2, i/e - 1.1,5. PEEP setting in group A (n = 15) was based on EITL data, in group B (n = 11, controls) - on the discretion of the anesthesiologist. We compared PEEP peak airway pressure (PAP), dynamic compliance, SpO2 and postoperative pulmonary complications. Bronchoscopy (FTBS) was performed after the onset of mechanical ventilation in 15 patients.RESULTS:Mask ventilation contributed redistribution of ventilation to ventral regions in 88,4% ofpatients. Ventilation by the end of surgery was remained un-changed more often in gr A than in gr B (86,6% vs. 36,6%, p = 0,026). PAP was higher in gr B by the end of surgery (19?1,4 vs. 17,3±2,2 cm H20; p = 0,03). Compliance by the end of surgery was not reduced below baseline's more frequently in gr A (73,3% in gr A vs. 27,2% in gr B, p = 0,053). After FTBS, ventilation after of mechanical ventilation renewal was comparable with baseline ' in 80%, deteriorated in 13,3% and improved in 6,6% ofpatients.CONCLUSIONS:1) EITL is a convenient toolfor ventilation dynamic evaluation during anesthesia; 2) EITL advances the mask ventilation, allows to set up appropriate PEEP during anesthesia and to evaluate safety of the disconnection during FTBS; 3) EITL contributes to professional education of anesthesiologists.

The review presents an analysis of domestic and foreign literature on the use of bronchoscopy in patients with obstructive respiratory failure in the ICU. Separately considered the issue of additional research when performing bronchoscopy and create an algorithmfor the application of diagnostic and therapeutic bronchoscopy in cardiac surgical patients undergoing mechanical ventilation.

The article presents research conducted to evaluate the use of diagnostic and therapeutic fiberoptic bronchoscopy in the treatment of ventilator-associated pneumonia (VAP) and tracheobronchitis in patients in cardiac ICU. The paper presents the results of the study and comparison of invasive techniques for sampling from the respiratory tract for bacteriological analysis. We studied the bacterial profile of ICU, original content of the respiratory tract of cardiac patients in the intraoperative period and possible ways for prevention of VAP and tracheobronchitis in the postoperative period using bronchoscopy. In addition data on the effect of bronchoscopy on the respiratory and cardiovascular systems in cardiac surgical patients undergoing mechanical ventilation presented.

The article deals with a clinical case demonstrating that patient's elderly age is not an absolute contraindication for complex surgery in spite of high risk of postoperative complications. Early diagnostics, target treatment of the infection cite with vacuum-assisted therapy for wounds and the treatment of infectious complications based on individual characteristics of elderly patient with sepsis as an outcome of prosthetic thoracoabdominal aortic repair allowed avoiding multiple organ dysfunctions in the patient.