Currently, the issue of organ protection is being actively studied. According to results of a big number of studies conducted all over the world, dexmedetomidine, the agonist of α2-adrenoreceptors, possesses certain protective properties. Further multi-center randomized studies are needed in order to prove that this drug can be used to reduce the number of peri-operative complications and the risk of organ dysfunction, and to improve outcomes of surgical treatment in patients with cardiac and non-cardiac operations.

From the time when special tools for delivery of volatile anesthetics in the intensive care units ( ICU ) became available, inhalation sedation is getting more and more popular among emergency physicians. Despite some persisting questions, it should be acknowledged that currently there are no technical problems when providing inhalation sedation. Currently, it is recognized that inhalation sedation is simple, reliable, convenient to use and it causes no significant unfavorable consequences. The above is fairly enough to recommend this method for the intensive care when it is necessary. The contemplated therapeutic properties of haloge n-c ontaining anesthetics could be an additional reason to use inhalation sedation. However, the clinical value of anesthetic pr e-c onditioning and ant i-i nflammatory effect is still doubtful. New clinical trials are needed in order to define the place of inhalation sedation in ICU .

Search for most effective way of management of non-specific delirium is an important aspect of treatment of severe concomitant trauma. The objective of the study: to investigate the correlation and impact of sedation method on those injured with delirium during the intensive care of severe concomitant trauma. Subjects and Methods. The retrospective prospective analysis of two groups of patients with delirium was performed, 30 patients in each group, who received sedation with dexmedetomidine or propofol. Results. After stopping delirium, the intensity of multiple organ dysfunctions was lower in the group of patients who had sedation with dexmedetomidine. The complex of unfavorable events – death within 1 year and continuous cognitive deficiency was 4 times more frequent in the group of patients after sedation with propofol. Evaluation of the trauma severity was a significant predictor of unfavorable outcomes. Conclusions. The use of dexmedetomidine for management of delirium resulted in the reduction of multiple organ dysfunctions versus propofol. The severity of trauma was associated with chances to develop a continuous cognitive dysfunction and lethal outcome. Use of dexmedetomidine promoted early rehabilitation in case of cognitive dysfunction.

Cardiac surgery is often complicated by oxidative stress (the evidence of this is the increase of carbonyl proteins in blood plasma), however the relation between these changes and post-operative complications and unfavorable outcomes stills remains uninvestigated and lacks the relevant proof. The above facts served as a basis for this research. Goal of the article: to investigate the impact of oxidative stress assessed as per the level of carbonyl proteins in blood plasma on systemic inflammation response syndrome (SIRS), acute heart (AHF) and renal failure (ARF) in cardiac surgery. Methods. Prospective observational cohort study was conducted in order to investigate the relation of oxidative stress intensity, assessed as per the level of carbonyl peptides in blood plasma, and development of SIRS, AHF, ARF in the patients undergoing cardiac surgery. 67 adults patients admitted to Cardiac Intensive Care Department of M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow, were examined. Results. The significant positive correlation has been found between intensity of oxidative stress assessed as per the level of carbonyl peptides in blood plasma, and composite frequency of post-operative complications (SIRS, AHF and ARF) in cardiac surgery (Spearman rank correlation (r) = 0.6; p < 0.0001). It was found out that the area under ROC-curve made 0.81 and 0.83 for the risk of developing acute renal lesions and heart failure respectively (p < 0.01 in both cases) thus the investigated model can be evaluated as "a model of very good quality". Conclusion. The important role pf oxidative stress in the development of SIRS, AHF and ARF has been confirmed. No advantages of off pump technique when performing coronary artery bypass grafting have been detected. Testing carbonyl peptides in blood plasma during first hours after surgery can be recommended in order to predict the risk of developing SIRS, AHF and ARF.

Delirium in the intensive care ward is actively being discussed by anesthesiologists for a long period of time. However at present there are fairly scarce evidences on the efficiency of various techniques of prevention and management of this disorder. Goal of the research: to assess the impact of inhalation sedation on the intensity and duration of sepsis-associated delirium in the intensive care ward of the surgical hospital. Methods. The one-centered, prospective, randomized comparative study was conducted in order to assess the efficiency of inhalation sedation in the patients with sepsis-associated delirium. Propofol was used for the intravenous sedation in the control group. 187 adult patients, admitted to the intensive care ward of Vorokhobov City Clinical Hospital no. 67, were included into the study. Results. Inhalation sedation reduced the delirium duration compared to intravenous use of propofol: delirium was fully managed on the 5th day in the group where sevorane was used [4; 7], while in the group where propofol was used delirium lasted for 7 days [6; 8] (p = 0.03). The study did not detect any effect of inhalation sedation on the intensity of oxidative stress (level of oxidized peptides in the blood plasma of the patients) and degree of neuronal damage (differences between groups are not significant, p = 0.37). No differences were recorded in the value of procalcitonin and SOFA score at any stage of the study. Conclusion. The frequency of delirium in the mixed population of sepsis patients makes 27.9%. Use of inhalation sedation with sevoflurane compared to intravenous administration of propofol reduces the duration of delirium therapy from 7 to 5 days.

Postoperative delirium is being actively discussed by anesthesiologists for a long period of time. This article has been written due to new guidelines on prevention and management of this disorder compiled by the group of experts under umbrella of European Society of Anaesthesiology. Comparing this edition with the previous recommendations of American Society of Anesthesiologists the authors attempt to follow the evolution of doctors' views (anesthesiologists and intensive care physicians) on the discussed issue.

Rationale : Delirium would deteriorate the outcomes and treatment results in the patients with severe concomitant trauma. Its treatment efficacy is especially relevant for such patients. Aim : To identify an optimal sedation strategy for delirium in the sufferers with severe concomitant trauma. Materials and methods : Sixty (60) patients with delirium that developed against the background of severe concomitant trauma were included into this randomized, retrospective-prospective study. One group of patients (n=30) was sedated with dexmedetomidine, the other one (n=30), with propofol. Results : In the group with dexmedetomidine sedation, the duration of delirium was 6 [5–6] days, whereas in the propofol group, 7 [6–8] days (p=0.003). The type of sedation was not associated with the severity of delirium, whose maximum ICDSC score was 7 [4–7] points in the propofol group and 6 [4–6] points in the dexmedetomidine group (p=0.32). Conclusion : Compared to propofol, dexmedetomidine may help to reduce the duration of treatment for non-specific delirium in severe concomitant trauma by 1 day.

The purpose of the study was to determine the efficacy of a synthetic leu-enkephalin stabilized analogue to prevent damage of endothelial cells monolayer in vitro caused by serum samples from septic shock patients.Materials and methods. The experiments were performed using the EaHy.926 endothelial cells monolayer. We studied the in vitro effect of synthetic leu-enkephalin analogue on the cell damage caused by serum samples from five septic shock patients. The status of endothelial intercellular junctions was estimated by immunofluorescence microscopy and western blot with antibodies against adherens junction protein, VE-cadherin, and against the tight junctions protein, claudin. Cell viability was determined by staining with propidium iodide.Results. Preconditioning with a synthetic leu-enkephalin analogue (10, 50 and 100 μg/ml) of endothelial cells in vitro prevented the destruction of both tight and adherens junction and partially prevented endothelial cell death.Conclusion. Preconditioning with a synthetic leu-enkephalin analogue partially prevents endothelial cell damage caused by exposure to septic patients’ sera in vitro. These data ensure the need for clinical trials on the effectiveness of a synthetic leu-enkephalin analogue for prevention of sepsis-associated endothelial dysfunction in clinics.

Mental illnesses in patients with sepsis occur in 23—32% of cases and are an unfavorable prognostic sign. At present, the causes of these disorders are adequately explained by the theory of neuroinflammation that takes into account the pathogenic influence of the systemic inflammatory reaction and related endothelial dysfunction on the central nervous system function.The purpose of the study was to evaluate the relevance of the severity of the systemic inflammatory response, the intensity of oxidative stress and the severity of patient's general state to prediction of the duration of delirium and therapy outcomes in patients with sepsis-associated delirium.Materials and methods. A pilot, single-center, prospective, cohort study was performed in 187 adult patients diagnosed with sepsis who were treated in the intensive care unit of L. A.Vorokhobov Municipal Clinical Hospital No. 67. The following tests and examinations were performed: Vasoactive-Inotropic Score (VIS), Sepsis-related Organ Failure Assessment score (SOFA), Intensive Care Delirium Screening Checklist (ICDSC); plasma levels of carbonylated peptides, procalcitonin (PCT), and neuromarkers were monitored; and a correlation analysis with the severity of the sepsis, its duration and therapy outcomes was performed.Results. A moderate correlation (R=0.68; P<0.05) between the plasma concentration of carbonylated peptides and the duration of delirium was found. The S100b protein level, a marker of neuronal damage, also closely correlated (R=0.75; P<0.05) with the duration of delirium. In the group of ICDSC, SOFA, and VIS, the latter turned out to be the most significant predictor of the delirium duration (P=0.02). In the group in which SOFA, carbonylated peptides and PCT levels monitored, the organ failure scale was the leading one (P=0.02).Conclusion. The vasoactive-inotropic score (VIS) is a more relevant predictor of the delirium duration than ICDSC and SOFA; the organ failure scale assessment has a greater correlation with the delirium duration than carbonylated peptides and PCT level monitoring; the VIS is the best predictor of the mortality in patients with sepsis.

Background. Currently, the incidence of complications and perioperative mortality in cardiac surgery is still higher than in general surgery. This is partly associated with the development of oxidative stress, which is regarded as excessive accumulation of reactive oxygen species and nitrogen species. There are nowadays few studies demonstrating an increase of nitrotyrosine plasma level in patients during cardiac surgery. The relationship of these changes with post-operative complications and adverse outcomes has not been studied yet. Aim. Investigation the dynamics of the nitrotyrosine plasma level in patients after cardiac surgery and the assessment of its prognostic significance in terms of the development of early postoperative complications.Methods. The prospective observational cohort study involved 28 adult patients admitted at the cardiac intensive care unit of Moscow Regional Research and Clinical Institute (Moscow, Russian Federation). The relationship of the oxidative stress severity measured by intraoperative nitrotyrosine plasma levels and the development of acute kidney injury, cardiac failure and systemic inflammatory response syndrome was studied. Results. There was no significant perioperative dynamics of nitrotyrosine plasma levels when studying this oxidative stress marker in patients undergoing cardiac surgery. The level of nitrotyrosine plasma by the end of surgery was 12.1 [9.9; 13.0] nmol/mg of protein, which was 5% higher (p>0.5) than the initial level of 11.6 [9.3; 12.2] nmol/mg of protein, and returned to 11.5 [10.9; 12.4] after the 1st postoperative day. The same perioperative dynamics occurred in the subgroups with different surgery techniques: valve surgery, сoronary artery bypass grafting with cardiopulmonary bypass and off-pump сoronary artery bypass grafting.Conclusion. The negative result achieved in the given study might suggest that there are no significant changes of the perioperative nitrotyrosine plasma level in patients undergoing cardiac surgery, as well as that there is no significant correlation between the nitrotyrosine plasma level of and the incidence of postoperative complications.Received 26 December 2016. Accepted 4 May 2017.Funding: The study was carried out within the state-funded research project “Oxidant stress in cardiac surgery: new markers-predictors of complication development and pathogenetically substantiated therapy” granted to Moscow Regional Research and Clinical Institute.Conflict of interest: The authors declare no conflict of interest.Author contributionsConceptualization, study design: V.V. Likhvantsev.Data collection and analysis: T.S. Zabelina, Yu.V. Skripkin, O.N. Ulitkina. Drafting the article: O.A. Grebenchikov, Zh.S. Philippovskaya.Critical revision of the article: O.A. Grebenchikov.Final approval of the version to be published: V.V. Likhvantsev.

Delirium in the intensive care ward is actively being discussed by anesthesiologists for a long period of time. However at present there are fairly scarce evidences on the efficiency of various techniques of prevention and management of this disorder. Goal of the research: to assess the impact of inhalation sedation on the intensity and duration of sepsis-associated delirium in the intensive care ward of the surgical hospital. Methods. The one-centered, prospective, randomized comparative study was conducted in order to assess the efficiency of inhalation sedation in the patients with sepsis-associated delirium. Propofol was used for the intravenous sedation in the control group. 187 adult patients, admitted to the intensive care ward of Vorokhobov City Clinical Hospital no. 67, were included into the study. Results. Inhalation sedation reduced the delirium duration compared to intravenous use of propofol: delirium was fully managed on the 5th day in the group where sevorane was used [4; 7], while in the group where propofol was used delirium lasted for 7 days [6; 8] (p = 0.03). The study did not detect any effect of inhalation sedation on the intensity of oxidative stress (level of oxidized peptides in the blood plasma of the patients) and degree of neuronal damage (differences between groups are not significant, p = 0.37). No differences were recorded in the value of procalcitonin and SOFA score at any stage of the study. Conclusion. The frequency of delirium in the mixed population of sepsis patients makes 27.9%. Use of inhalation sedation with sevoflurane compared to intravenous administration of propofol reduces the duration of delirium therapy from 7 to 5 days.

Objective: to show the problems of differential diagnosis and treatment of atypical hemolytic-uremic syndrome in a 23-year-old patient.Results. Eculizumab (Soliris), (Alexon Pharmaceuticals Inc., USA) that is a glycosylated humanized monoclonal antibody to immunoglobulins (IgG2/4k) is shown to be effective in treating this disease.Conclusion. Atypical hemolytical-uremic syndrome in pregnancy is a disease, whose treatment difficulties are largely associated with the problem of differential diagnosis with thrombotic thrombocytopenic purpura and man-ifestations of multiple organ dysfunction. The treatment for this disease gives a key role to Eculizumab.

The article describes perioperative periods of two patients who underwent surgical repair of acquired heart valve disease with artificial circulatory support. In both cases, there was decompensation of chronic heart failure, with levosimendan (Symdax, Orion Pharma, Finland) being used for its treatment. In the first case the drug was infused in the early postoperative period, without a loading dose, at a rate of 0.05–0.1 mcg/kg/min for 26 hours. After 3 hours, an improvement was observed and after 36 hours classic inotropes were stopped. After further 36 hours (day 3) the patient was moved to a surgical department ward. In the second case, due to an extremely low cardiac index, levosimendan was administered proactively starting one day before surgery. However, a long period of artificial circulation, perfusion problems due to thrombosis during artificial circulatory support led to deterioration of chronic renal failure, chronic heart failure and to death within the first 10 hours after surgery. Conclusion: Levosimendan is an effective drug for treatment of heart failure in cardiac surgery patients. However, it is unlikely to solve all problems of early postoperative period in patients with multiple organ failure.