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.

UNLABELLED:Extracorporeal life support (ECLS) is used in pediatric patients with ARDS in recent 20 years with survival rate from 50 to 67% Venovenous ECLS was used in 1 year 2 months old patient with ARDS and pneumonia developed in postoperative period after gastral esophagoplasty. Purposes of ECLS use were stabilization child's condition and normalization of gas composition of blood with relative lungs repose. Indications for ECLS were increasing respiratory failure, hypoxemia, low respiratory index (PaO2/FiO2 ratio 47.3), alveolar-arterial gradient of oxygen (A-aDO) 630 mmHg and absence of positive effect from high frequency oscillation (HFO).MATERIALS AND METHODS:ECLS was used in 1 year 2 months old patient with ARDS and bilateral pneumonia developed in postoperative period after gastral esophagoplasty. Deltasteam system (Medos Medizintechnik AG, Germany) with centrifugal pump and servoregulation of blood flow pressure was used for ECLS. Double-lumen cannula with size 12 French was used ECLS was instituted via right internal jugular vein.RESULTS:The patient did not have expressed heart failure. Thus preference was given to venovenous ECLS and not to venoarterial ECLS. Duration of ECLS use was 72 hours. Auscultation parameters and gas exchange improved haemodynamics stabilized parameters of biochemical and haematological analysis normalized and the dynamics x-ray examination was positive after the ECLS use. Patient was decannulated and extubated.CONCLUSIONS:Venovenous ECLS was an only way of life support in child with heavy ARDS and pneumonia developed in postoperative period More observations are needed for more thorough analysis and recommendations.

Extracorporeal life support (ECLS) is used in pediatric patients with ARDS in recent 20 years with survival rate from 50 to 67 %. Venovenous ECLS was used in 1 year 2 months old patient with ARDS and pneumonia developed in postoperative period after gastral esophagoplasty. Purposes of ECLS use were stabilization child’s condition and normalization of gas composition of blood with relative lungs repose. Indications for ECLS were increasing respiratory failure, hypoxemia, low respiratory index (p aO/FiO 2 ratio 47.3), alveolar-arterial gradient of oxygen (A-aDO 2) 630 mmHg and absence of positive effect from high frequency oscillation (HFO). Materials and methods: ECLS was used in 1 year 2 months old patient with ARDS and bilateral pneumonia developed in postoperative period after gastral esophagoplasty. Deltasteam system (Medos Medizintechnik AG, Germany) with centrifugal pump and servoregulation of blood flow pressure was used for ECLS. Double-lumen cannula with size12 French was used. ECLS was instituted via right internal jugular vein. Results: The patient did not have expressed heart failure. Thus preference was given to venovenous ECLS and not to venoarterial ECLS. Duration of ECLS use was 72 hours. Auscultation parameters and gas exchange improved, haemodynamics stabilized, parameters of biochemical and haematological analysis normalized and the dynamics x-ray examination was positive after the ECLS use. Patient was decannulated and extubated. Conclusions: Venovenous ECLS was an only way of life support in child with heavy ARDS and pneumonia developed in postoperative period. More observations are needed for more thorough analysis and recommendations.

Objective: to study the impact of correcting immune disorders on the course of the disease in patients with abdominal sepsis. Subjects and methods. Ninety-five patients with abdominal sepsis were examined. APACHE III scores were 25—30. Humoral and cellular immunological parameters were studied in all the patients. The immunotropic drug Galavit was included into the combination treatment of 42 patients. Results. An immunodeficiency state was found in 74 (80%) patients. The incorporation of targeted immunotherapy into the package of medical measures activated the immune system of patients and, in a number of cases, could elevate the level of T lymphocytes, reduced the rate of laparostomy wound suppurations by 1.9 times and the number of fatal outcomes by 10.1%. Conclusion. Incorporation of targeted immunotherapy into the package of medical measures activates cellular immunity and tissue regeneration processes and reduces the degree of endogenous intoxication, the rate of laparostomy wound suppurations, and the number of fatal outcomes. Key words: abdominal sepsis, immunomodulation, Galavit.

Continuous intravenous infusion of promedol, 0.1 mg/kg, with additional boluses, 0.5 mg/kg, was used as postoperative analgesia in 20 newborns. Fifteen (25%) children were operated for congenital gastrointestinal defects or peritonitis, 2 children (10%)--for chylothorax, and tumor was eradicated in 3 (15%) children. On the basis of behavioral reactions, physiological indices (cardiac rate, arterial pressure, SpO2, and respiration rate/artificial pulmonary ventilation--APL) as well as of laboratory stress tests (blood glucose and cortisol and acid-base balance) it was proven that analgesia with continuous intravenous promedol infusion was effective. It was shown as possible to administer the promedol infusion in newborns while switching them from APL to independent breathing until the spontaneous breathing with constant positive pressure is ensured provided the pO2, pCO2 and SpO2 respiration indices are satisfactory.

Проведена сравнительная оценка безопасности послеоперационного обезболивания путем постоянной внутривенной инфузии промедола и традиционным внутримышечным введением промедола. Материал и методы. 20�и детям в возра� сте от 5�и месяцев до 3�х лет, которым были выполнены плановые оперативные вмешательства, в послеоперационном пе� риоде проводили обезболивание путем постоянной внутривенной инфузии различных доз промедола. Контрольную группу составили 20 детей, у которых в качестве обезболивания использовали внутримышечное введение 1% раствора промедола через каждые 6 часов в дозе 0,5 мг/кг. Анализировали параметры гемодинамики, длительности нахождения больных на ИВЛ и возможность их перевода на самостоятельное дыхание, а также необходимость в дополнительном на� значении седативных препаратов для синхронизации с аппаратом ИВЛ. Результаты. Было выявлено, что динамика восстановления самостоятельного дыхания не зависела от метода обезболивания. У пациентов, которым проводили по� стоянную внутривенную инфузию промедола, чаще возникали эпизоды брадипноэ. Однако, различия между группами не были статистически значимыми. Показатели газового состава крови в обеих группах оставались в пределах нормы. Пациентам контрольной группы достоверно чаще требовалось назначение седативных препаратов для синхронизации с респиратором (р<0,05). Гемодинамика была стабильной у детей обеих групп, но в контрольной группе достоверно чаще отмечалась тахикардия и артериальная гипертензия, что было расценено как недостаточное обезболивание. Заключе� ние. Продленная внутривенная инфузия промедола в дозе 0,1—0,2 мг/кг/час не оказывает выраженного угнетающего влияния на дыхание. Использование пролонгированного введения опиоидного анальгетика позволяет уменьшить коли� чество седативных препаратов для синхронизации с респиратором. При этом качество адаптации к аппарату ИВЛ не ухудшается. Ключевые слова: продленная инфузия промедола, послеоперационный период, ИВЛ. Objective: to evaluate the safety of postoperative analgesia via continuous intravenous infusion of promedol versus its tradi� tional intramuscular injection. Subjects and methods. In the postoperative period, analgesia via continuous intravenous infu� sions of different promedol doses was performed in 20 children aged 5 months to 3 years, who had undergone elective surgical interventions. A control group consisted of 20 children in whom 1% promedol solution was intramuscularly injected in a dose of 0.5 mg/kg every 6 hours. The authors analyzed hemodynamic parameters, the duration of mechanical ventilation (MV) in the patients, the possibility of their transition to spontaneous breathing, and the need for additional sedatives for synchro� nization with an MV apparatus. Results. The trend in recovery of spontaneous breathing was not found to depend on the modality of analgesia. Episodes of bradypnea occurred more frequently in the patients receiving continuous intravenous infu� sions of promedol. However, there were no statistically significant differences between the groups. The values of blood gas composition remained in the normal range in both groups. The control group more frequently needed sedatives for synchro� nization with a ventilator (p<0.05) Hemodynamics was stable in the children of both groups, but tachycardia and essential hypertension were more common in the control group, which was regarded as inadequate analgesia. Conclusion. Continuous intravenous infusion of promedol in a dose of 0.1—0.2 mg/kg/hour failed to exert a pronounced inhibitory effect on respira� tion. The prolonged administration of the opioid analgesic allows the amount of sedatives to be reduced for synchronization