V. S. Afonchikov

The objective was to evaluate the clinical efficacy and non-specific adsorption activity of cartridges for selective lipopolysaccharide hemosorption that do not contain immobilized polymyxin in the treatment of surgical patients with gram-negative septic shock (SS). Materials and methods . Forty-three surgical patients with gram-negative SS after debridement surgery were examined. Inclusion criteria: 18–90 years old, procalcitonin (PCT) ≥ 10 ng/ml, sympathomimetic support > 2 hours, normal central venous pressure, no hemo(dia)filtration. In group 1 (30 patients), 1–2 sessions of selective lipopolysaccharide hemosorption (HS) were additionally performed using cartridges that do not contain polymyxin. In group 2 (13 patients), traditional treatment for SS was carried out. HS was carried out for 120 minutes at a rate of 100 ml/min. Hypoagulation was performed with unfractionated heparin or sodium hydrocitrate. Laboratory monitoring: complete blood count, CD14+ monocytes, HLA-DR+ mononuclear cells, Def+ granulocytes, interleukins concentration, PCT, total and C-reactive protein, secretory IgA, fibrinogen, lactate. Results . Patients who survived up to 2 days after surgery were excluded. The final group I with hemoperfusion – 25 patients, group II without hemoperfusion – 11 patients. HS cartridges non-specifically adsorbed 2.6% of erythrocytes, 5.0–14.7% of leukocytes, 25.7% of platelets and 3.8–10.1% of various proteins. The level of cytokines did not change. On the next day, the following levels decreased in group 1: IL-6 from 538 [395; 784] to 290 [200; 726] pg/ml (p = 0.003), IL-8 from 48 [4; 373] to 4 [3; 19] (p = 0.087), PCT from 26.3 [11.1; 53.6] to 14.2 [8.6; 24.5] ng/ml (p = 0.003), platelets from 136 [69; 178] to 89 [50; 142]×109/l (p < 0.001). By days 7–8, in group I, compared to group II, SOFA, APACHE II, and the dose of sympathomimetics decreased. 28-day mortality rate: group I – 32%, group II – 72.7% (p = 0.034). Hospital mortality rate: group I – 56%, group II – 81.8% (p = 0.259). Conclusions . The use of selective lipopolysaccharides hemosorption reduces the severity of multiorgan dysfunctions, systemic inflammation, and mortality. The cartridges adsorb leukocytes, including activated ones. Platelet adsorption reduces their blood count by 25–35%.

Water-electrolyte imbalance disorders are one of the main manifestations of severe burn injury largely determining the course and prognosis of burn disease. Water balance and microcirculation disorders are followed by dyselectrolytemia. Understanding of these disorders and their timely correction are essential for successful treatment of severely burned patients. Objective. To assess severity of water-electrolyte imbalance in acute period of burn disease and to develop an optimal algorithm for correction. Material and methods. We retrospectively analyzed 44 victims with severe burns, whose daily fluid balance was determined. Standard laboratory tests were performed, including analysis of electrolyte composition and acid-base balance. Victims were divided into 2 groups depending on onset of intensive care. Correction of changes included infusion therapy. Infusion volume on the first day was determined by the Parkland formula, on the 2nd and 3rd days according to clinical situation. Composition depended on disturbances in electrolyte balance and acid-base balance. Conclusion. All severely burned patients develop hypovolemia, dyselectrolytemia and metabolic lactic acidosis in acute period of burn injury. Early initiation of infusion therapy with corrective and balanced solutions leads to restoration of water balance, electrolyte and acid-base disturbances on the 3rd day of burn disease. Delayed therapy was accompanied by more severe hypovolemia, electrolyte imbalance, and metabolic lactic acidosis. Recovery of fluid, electrolyte, and acid-base balance was observed on days 5—6 of burn injury. Conclusion. All severely burned patients develop hypovolemia, electrolyte imbalance, and metabolic lactic acidosis in acute phase of burn injury. Early fluid therapy with corrective and balanced solutions leads to restoration of fluid balance, electrolyte, and acid-base imbalances on day 3 of burn injury. This allows for early surgical treatment.

Objective : to evaluate the effects of correcting metabolic disorders in the post-resuscitation period in a clinical case report. Materials and methods . Management and dynamic monitoring of acute poisoning in a 29-year-old patient after concomitant use of methadone and cocaine complicated by cardiac arrest and prehospital biochemical and acid-base balance alterations. Results . The bradypneic and comatose patient developing out-of-hospital cardiac arrest (OHCA) was hospitalized after effective resuscitation by emergency team. Comprehensive lab examination revealed the presence of methadone and cocaine, decompensated metabolic lactic acidosis and hyperkalemia. Patient’s condition improved after intense correction of metabolic alterations with sodium hydrocarbonate, a glucose-insulin mixture, and a pharmaceutical containing inosine + nicotinamide + riboflavin + succinate. A positive trend including recovered consciousness, switch from ventilator support to spontaneous breathing, and stable hemodynamics was documented after 3 days of treatment. However, emerging complications such as hospital-acquired pneumonia and acute kidney injury had to be managed. The patient improved significantly by the 17th day of treatment, and was discharged on day 21. Conclusion . Intensive care to promptly address decompensated metabolic lactic acidosis (sodium hydrocarbonate, a multi-component drug containing inosine + nicotinamide + riboflavin + succinate) and hyperkalemia (glucose-insulin solution), reduced the severity of metabolic alterations after cardiac arrest due to acute methadone and cocaine poisoning, favoring patient’s outcome.

Perioperative management of patients receiving anticoagulants and antiplatelet agents is a complex task that requires a balance between the risk of thromboembolic complications and the risk of bleeding. Due to the increasing number of patients taking antithrombotic drugs, the relevance of developing modern recommendations for their perioperative management increases. Particular attention is paid to patients with comorbidities such as atrial fibrillation, ischemic stroke, myocardial infarction and coronary stenting. The article presents the guidelines of the Federation of Anesthesiologists and Reanimatologists and the National Association of Specialists in Thrombosis, Clinical Hemostasis and Hemorheology for the management of patients receiving anticoagulants and antiplatelet agents, revised in 2025. The guidelines for the perioperative management of patients receiving anticoagulants and antiplatelet agents have been updated, taking into account modern concepts of the risks of thromboembolism and bleeding. Particular attention focused to risk stratification, interruption and resumption of antithrombotic therapy, and the safety of regional anesthesia during anticoagulant therapy. The recommendations use data from modern studies, meta-analyses, and clinical trials on the perioperative management of patients receiving anticoagulants and antiplatelet agents. Various methods of thromboprophylaxis are considered, including the use of low molecular weight heparins, fondaparinux, and other anticoagulants. Particular attention is paid to risk stratification using the Caprini, HAS-BLED, and CHA2DS2-VASc scales. Recommendations are proposed for interruption and resumption of antithrombotic therapy depending on the risk of thromboembolism and bleeding. Criteria for the quality of compliance with recommendations, as well as algorithms for patient management during elective and emergency surgeries, are developed. The guidelines provide clinicians with practical tools to manage perioperative risk in patients receiving anticoagulants and antiplatelet agents. An important aspect is the individual approach to each patient, taking into account their clinical situation and risks.

Introduction. The knowledge and experience of anesthesiologists about predictors of unplanned ICU (intensive care unit) readmission are implemented into practical models for their prevention. However, differences in the time before patient’s ICU readmission make significant adjustments to the possibility of their implementation.The objective was to analyze intensivist opinions about predictors of early and late unplanned ICU readmissions. Materials and methods. The survey of intensivists was conducted in 9 hospitals in Saint Petersburg and the Leningrad Region from July 2023 to July 2024. Statistical information processing was carried out using the Jamovi software package.Results. The study included 381 questionnaires. Long ICU stay ( > 14 days) (AOR: 0.373; 95% CI: 0.183–0.758, p = 0.006; 0.492; 0.246–0.985, p = 0.045), emergency surgeries and procedural complications (1.283; 1.071–1.537, p = 0.007; 1.387; 1.136–1.694, p = 0.001), as well as lack of data on oxygen therapy and respiratory support in the transfer epicrisis (0.315; 0.172–0.576, p < 0.001; 0.505; 0.278–0.919, p = 0.025) increase the chances of 24- and 48-hour unplanned ICU readmission. Transfer of patients from the ICU to «off-hours» (1.244; 1.020–1.517, p = 0.031; 1.518; 1.243–1.853, p < 0.001) was a risk factor for the 48- and 72-hour periods. Registration of adverse acute cardiovascular events (2.876; 1.368–6.047, p = 0.005; 2.578; 1.390–4.780, p = 0.003) increased unplanned ICU readmission in the 48-hour and 7-day periods. Sepsis in a patient in the ICU was considered by respondents to be an independent predictor of ICU readmissions for all periods except the 24-hour period. Characteristic predictors of unplanned ICU readmissions also were: for 24-hour – the impossibility of conducting «round-the-clock» laboratory and instrumental diagnostics (0.764; 0.639–0.914, p = 0.003), patient readmission due to the need to free up a ICU bed (1.345; 1.138–1.589, p = 0.001), failure to hold council (0.507; 0.270–0.954, p = 0.035); for 72-hour – physician experience (0.968; 0.939–0.997, p = 0.033); for 14 days – Mechanical Ventilation > 7 days (1.674; 1.025–2.734, p = 0.040).Conclusion. The analysis of the opinions of intensivists made it possible to identify independent and determine modifiable predictors of early and late unplanned readmission of the patient to the ICU.

Introduction. Minor obstetric and gynecological operations are among the most frequently performed surgical interventions, including for emergency indications. At the present stage of anesthesiology, various anesthesia techniques are used, and there is no consensus regarding the optimal method of anesthesia for these operations. Purpose of the work: to determine the optimal method of anesthesia for minor obstetric and gynecological operations.Objectives: 1. to study and analyze literature data on methods of anesthesia for minor obstetric and gynecological operations in outpatient practice and for emergency interventions in a 24-hour hospital. 2. Determine the optimal methods of anesthesia for this category of patients. 3. Identify factors influencing the choice of anesthesia method.Material and methods. More than 20 literary sources have been studied, the main ones of which are presented in the list of references. A retrospective analysis of 2700 patients who underwent minor obstetric and gynecological operations at the Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine and 400 patients of the Medsi clinic St. Petersburg.Results. In our opinion, the optimal methods of general anesthesia are: usually non-inhalation or combined. The guarantee of effective and safe anesthetic care is preoperative preparation and selection of the optimal method of anesthesia in order to reduce the risks of negative effects, that is, a personalized approach is required. Propofol in combination with narcotic analgesics and combined anesthesia propofol-sevorane have proven to be the best in terms of controllability.Conclusions. 1. The issue of pain relief during minor obstetric and gynecological operations is relevant and unresolved. 2. In our opinion, the optimal methods of general anesthesia are: non-inhalation propofol and narcotic analgesic and combined propofol and sevoran. 3. The choice of anesthesia method depends on many factors and should have a personalized approach.

The article presents the main provisions of clinical guidelines for the diagnosis and treatment of hypovolemic shock in adults, approved by the All-Russian public organization "Federation of Anesthesiologists and Resuscitators" in 2024. The relevance of the problem is associated with a significant prevalence and high mortality rates in hypovolemic shock. The recommendations include issues of etiology, pathogenesis, clinical picture, methods of laboratory and instrumental diagnostics of hypovolemic shock. The features of intensive care for hypovolemic shock are presented, including approaches to the administration of vasopressor and inotropic drugs, recommendations for the choice of infusion and adjuvant therapy, including the correction of coagulopathy in hemorrhagic shock. The issues of resuscitation damage control strategy are discussed. The criteria for the quality of medical care for adult patients with hypovolemic shock and algorithms for the doctor's actions in the diagnosis and intensive care of patients with hypovolemic shock are presented.

Background. Acid-base disturbances accompany various critical illnesses, including severe burn injury, and result metabolic acidosis. In all victims with burn injury and shock, severity of metabolic lactate acidosis depends on severity of injury and timeliness of intensive therapy. Normalization of acid-base balance is one of the objectives of therapy. Objective. To analyze severity of acid-base disorders in patients with burn injury and shock in acute period of burn disease and develop the best option for correction. Material and methods. A prospective analysis included 65 severely burned patients who underwent standard laboratory testing including analysis of acid-base balance. Correction of disorders implied infusion of 4% sodium bicarbonate in patients with pH <7.25 or meglumine sodium succinate in those with pH 7.25—7.35. Doses of drugs for correction were calculated depending on bicarbonate deficiency. Results. We confirmed metabolic lactic acidosis as predominant type of acid-base imbalance (pH 7.27 (6.98; 7.31), lactate 4.5 (2.8; 5.1) mmol/l, bicarbonate 17 (14.4; 20.4) mmol/l). There was subcompensation of these disorders in most patients, so correction included meglumine sodium succinate with positive dynamics and normalization of parameters after 3 days. Conclusion. Lactic acidosis occurred in all severely burned in acute period of burn injury. Subcompensated metabolic acidosis not requiring correction with sodium bicarbonate prevails. Acid-base disorders are successfully corrected by infusion of 1.5% solution of meglumine sodium succinate.

The authors analyzed pain syndrome and effectiveness of NSAIDs in patients who underwent various surgical interventions for burns. Aggravation of postoperative pain and the most effective analgesic in burned patients were identified. Intravenous form of ibuprofen provided the best analgesic effect. This drug was characterized by fast and long-standing effect. There were no complications typical for NSAIDs.

ЦЕЛЬ ИССЛЕДОВАНИЯ Определить оптимальные критерии отбора пациентов для рандомизированного клинического исследования (РКИ) эффективности меглюмина натрия сукцината у больных с острым панкреатитом (ОП) алкогольно-алиментарного генеза на основе анализа индивидуальных исходов заболевания. МАТЕРИАЛ И МЕТОДЫ Провели анализ эффективности лечения 199 пациентов в возрасте 18—75 лет с ОП алкогольно-алиментарного генеза среднетяжелого и тяжелого течения. Сбор данных осуществляли специалисты 14 медицинских центров по единому протоколу наблюдательной программы. Лечение пациентов проведено в соответствии с общепринятыми стандартами. У всех пациентов в составе терапии применялся раствор для инфузий меглюмина натрия сукцинат 1,5% (реамберин). С учетом исхода заболевания больных разделили на две группы: 1-я группа (n=149) — пациенты выжили, 2-я группа (n=50) — летальный исход. Проанализировали демографическую характеристику пациентов обеих групп, анамнез жизни, болезни, данные объективного осмотра, стандартных лабораторных и инструментальных исследований. Полученные результаты статистически обработали. РЕЗУЛЬТАТЫ В ходе исследования подтвердили прогностическую ценность ряда лабораторных показателей (таких как количество тромбоцитов, уровень ионизированного кальция плазмы крови, уровень глюкозы, мочевины и креатинина крови), а также выявили новые показатели, с высокой вероятностью имеющие прогностическое значение: пол, масса тела, рост, уровень общего белка плазмы крови, уровень диастолического артериального давления до начала интенсивной терапии, объемы инфузии и диуреза во 2-е сутки лечения, динамика креатинина крови через 48 ч лечения. Для показателей «глюкоза крови», «мочевина крови», «креатинин крови», «объем инфузий на 2-е сутки лечения», «динамика креатинина крови за 48 ч лечения» определены пороговые уровни значений, за которыми риск неблагоприятного исхода статистически значимо повышается, несмотря на проводимую инфузионную терапию с применением раствора для инфузий меглюмина натрия сукцината 1,5% (реамберин). ЗАКЛЮЧЕНИЕ Для оценки с помощью рандомизированного клинического исследования эффективности меглюмина натрия сукцината при лечении острого панкреатита алкогольно-алиментарного генеза следует изучать его применение у пациентов, у которых лечение начато до появления данных маркеров неблагоприятного исхода. При этом использование «комплексных» факторов, т.е. применение правила «и» при оценке нескольких показателей по рассчитанным порогам отсечения, представляется авторам избыточно специфичным подходом, который не позволяет в достаточной мере учитывать риск наступления летального исхода при остром панкреатите. Предлагается использовать весь комплекс выявленных предикторов для наиболее полного охвата клинической характеристики каждого из пациентов.