Aleksey V. Vlasenko

Nutritional support is a critical component of intensive care for patients with abdominal sepsis. This paper systematizes modern methods for assessing metabolic status (anthropometric, laboratory, and instrumental) and determining daily energy requirements (calculation equations, fixed standards, and indirect calorimetry). It is demonstrated that an optimal strategy requires a comprehensive, personalized approach with priority use of indirect calorimetry as the «gold standard» for determining energy expenditure. Practical recommendations for the selection of assessment methods and the frequency of nutritional status monitoring in patients in intensive care units are developed.

Distributive shock in combination with acute respiratory distress syndrome (ARDS) is an extremely serious condition in terms of the complexity of pathogenesis mechanisms, timely differential diagnosis, high-cost treatment, and is accompanied by high mortality. The simultaneous development of such disorders of vital functions leads to severe acute cardiovascular and acute hypoxemic respiratory failure, in which traditional, standard and documented treatment approaches often prove ineffective. The article will present current data on the features of cardiopulmonary interaction in normal and acute renal failure in combination with severe acute respiratory failure and ARDS, the significant role of right ventricular pulmonary-arterial conjugation and the mutual influence of pathological lung mechanics and impaired vascular regulation. Various cardiac hemodynamic disorders in pulmonary, extrapulmonary, and mixed ARDS phenotypes will be considered, as well as their effect on transpulmonary pressure, venous return, and right ventricular afterload. It will be shown that advanced monitoring methods such as esophageal manometry, echocardiography, and pulmonary artery catheterization are necessary tools for timely detection and phenotyping of respiratory circulatory disorders for personalized selection of respiratory support parameters, cardiohemodynamic correction methods, and adjuvant therapeutic technologies such as pronation and extracorporeal support. The integration of these theoretical data and clinical practice will improve the safety and clinical effectiveness of multicomponent treatment to reduce mortality in this cohort of high-risk patients.

This article is devoted to current approaches to non-invasive ventilation (NIV) and methods of respiratory rehabilitation in patients with acute respiratory failure (ARF). Data from domestic and international studies over the past 10 years are systematized, covering the physiological basis of NIV, a comparative analysis of interfaces, as well as indications and limitations of the method. Issues of respiratory muscle dysfunction in ARF, methods for its assessment, and possibilities for restoring breathing function using respiratory trainers are considered. The review summarizes research findings demonstrating the potential for integrating NIV and respiratory trainers into the comprehensive management of patients with ARF. The prospects for further investigation of the effectiveness and safety of these approaches in various clinical settings are discussed.

Arterial hypotension and shock of unknown origin are common reasons for intensive care unit admissions and are characterized by significant pharmacoeconomic costs and high mortality. The effectiveness of treatment for patients with shock is determined by the timely and accurate identification of the underlying causes and the implementation of personalized therapy. Differential diagnosis of shock is often possible through the analysis of clinical, laboratory, and non-invasive instrumental data. Echocardiography is now an indispensable tool for urgent and routine assessment of the cardiovascular system, providing rapid information on the anatomy, physiology, and causes of cardiovascular failure. The use of high-quality ultrasonography methods, based solely on 2D visualization, significantly expands diagnostic capabilities. However, accurate diagnosis requires the use of more advanced, semi- quantitative or quantitative ultrasonography methods to identify the underlying mechanisms of shock pathogenesis, allowing the clinician to implement personalized treatment for this patient population.

This article is devoted to current approaches to non‑invasive ventilation (NIV) and methods of respiratory rehabilitation in patients with acute respiratory failure (ARF). Data from domestic and international studies over the past 10 years are systematized, covering the physiological basis of NIV, a comparative analysis of interfaces, as well as indications and limitations of the method. Issues of respiratory muscle dysfunction in ARF, methods for its assessment, and possibilities for restoring breathing function using respiratory trainers are considered. The review summarizes research findings demonstrating the potential for integrating NIV and respiratory trainers into the comprehensive management of patients with ARF. The prospects for further investigation of the effectiveness and safety of these approaches in various clinical settings are discussed.

Introduction. Robot-assisted radical prostatectomy is one of the leading methods of prostate cancer treatment. A common complication of general anesthesia during this operation is intraoperative hypotension. In recent years, the use of preoperative ultrasound examinations to predict this condition and carry out personalized prevention has been gaining popularity. Machine learning methods trained with additional predictors can improve the accuracy of these predictions. Objective. To improve the treatment outcomes of patients with prostate cancer by optimizing their volemic status in the perioperative period before robot-assisted prostatectomy. Materials and methods. The prospective study included 64 patients scheduled for robot-assisted radical prostatectomy. Before surgery, patients underwent bedside ultrasound examination to determine the diameters and collapsibility indices of the inferior vena cava and subclavian veins, corrected carotid flow time (cCFT), and respiratory variation of blood flow peak velocity (ΔV). These data were used in the training of machine learning predictive models to ameliorate intraoperative hypotension prediction efficacy. Results. The respiratory variation of blood flow peak velocity had the highest predictive value (AUROC 0.843, accuracy 75 %). The indicator’s optimal threshold for intraoperative hypotension prediction was 8.33 %. The accuracy of the prediction has been increased using the machine learning model based on gradient boosting with additional predictors (AUROC 0.933, accuracy 95 %). Conclusions. Determining the respiratory variation of blood flow peak velocity is the most prognostically valuable indicator for intraoperative hypotension prediction during robot-assisted radical prostatectomy. The use of machine learning methods to predict intraoperative hypotension increases the accuracy of prediction.

Treatment of hypoxemic acute respiratory failure remains one of the urgent and applied problems of modern intensive care, as it is the leading cause of critical conditions and high mortality in patients in intensive care units. Patient self-inflicted lung injury plays a special role in maintaining and worsening respiratory failure, which can develop under any method of respiratory support. A number of studies in recent years have demonstrated significant clinical effectiveness of non-invasive respiratory support compared to traditional mechanical ventilation. Due to this, the concept of respiratory failure treatment has changed in favor of more active use of non-invasive ventilation and high-flow oxygen therapy. However, their rational and personalized use remains a labor-intensive task due to the polymorphism of clinical manifestations, diversity of etiological factors and pathogenetic mechanisms of respiratory disorders. The purpose of this publication is to review the literature data on the use of non-invasive respiratory support methods at different stages of hypoxemic acute respiratory failure treatment. The first part will consider the current mechanisms of development of patient self-inflicted lung injury and the general characteristics of noninvasive ventilation and high-flow oxygen therapy.

Intraoperative hypotension is a clinical problem, the essence of which is a decrease in blood pressure during surgical procedures, leading to various complications in the intra- and postoperative period (acute kidney injury, postoperative delirium, stroke, and myocardial infarction). According to a number of studies, intraoperative hypotension is associated with increased hospital mortality in any operated patients, which explains the practical significance of this pathologic condition. Therefore, the issues related to the study of pathogenesis mechanisms, methods of prediction and prevention of intraoperative hypotension remain the subject of actual scientific search. For example, a number of studies are aimed at individual normal blood pressure determination, but this problem still unsolved. The pathophysiology of this condition is also a subject for study. It is known that during induction of anesthesia, the most common cause of hypotension is the side effects of drugs, and during the main stage of surgery it is blood loss. In both cases, the leading pathogenetic mechanism of hypotension is the insufficiency of the patient’s cardiovascular system to the onset of hemodynamic changes. Taking into account the heterogeneity of the cardiovascular system’s preoperative state in different patients and the extremely diverse format of surgical interventions, a personalized approach to the prediction, prevention and correction of intraoperative hypotension becomes of key importance. In recent years, the prediction and prevention of hypotension has become a subject of scientific interest. Hypovolemia is one of the main intraoperative hypotension’s pathophysiologic factors. Therefore, correction of volemic status is considered as a perioperative pressure reduction prevention method. As part of the personalized approach, the intraoperative hypotension prevention algorithms are used. These algorithms are based on the preoperative assessment of the patient’s volemic status using different instrumental tools. Some of such algorithms are summarized in the review.

INTRODUCTION: Annually, approximately 230 million patients undergo general anesthesia and mechanical ventilation, which is associated with a high incidence of postoperative pulmonary complications (PPC). Despite the proven efficacy of protective ventilation, the actual respiratory support strategies in Russian operating rooms remain insufficiently studied, underscoring the relevance of the RuVent-A study. MATERIALS AND METHODS: In the multicenter observational study RuVent-A, data will be collected using specialized electronic forms (Center Card and Patient Protocol) integrated into a secure web platform that ensures anonymization, regular backup, and quality control of the data. onditions: This is a multicenter observational study of patients undergoing surgical interventions under mechanical ventilation. Patients: The study includes all patients over 18 years of age undergoing surgical interventions under general anesthesia over a period of 5 working days. Interventions: The study records respiratory support parameters (tidal volume, PEEP, FiO₂, ventilation modes, etc.), the type of surgical intervention, comorbidities, and the subsequent occurrence of PPC, while no changes to clinical protocols are made. RESULTS: The developed study design has been registered in the ClinicalTrials.gov database, confirming its compliance with international standards and ensuring the transparency of the research. CONCLUSIONS: It is anticipated that the results of RuVent-A will help identify current respiratory support strategies, determine key risk factors for PPC, and formulate recommendations for optimizing perioperative ventilation in Russia, ultimately enhancing the quality of medical care and patient safety.

Postoperative pain syndrome, which is experienced by up to 75% of operated patients, is a significant factor in the long-term recovery of the patient and the development of complications. To solve this problem, modern surgical care adheres to the concept of accelerated recovery of patients, while anesthetic care is focused on the use of a multimodal approach to analgesia. In the formation of this approach, which meets the criteria of efficiency and safety, anesthesiology has gone through an evolutionary path associated with the emergence of drugs (both general and local anesthetics), new methods of anesthesia, improvement of equipment for monitoring the patient’s condition and the active introduction of ultrasound technologies into the practice of an anesthesiologists. Laparoscopic technologies are common in surgical interventions and, due to their high information content, low trauma and the possibility of rapid recovery of patients, are currently used in almost all areas of surgery, including for emergency nosologies. In conditions of limited time resources and, in some cases, the absence of a personalized examination during urgent interventions, as well as when surgical tactics are reduced to diagnostic laparoscopic intervention, it is advisable to study in more detail the types of anesthetic aids from the point of view of the possibility and safety of their use. In particular, one of the modern methods is interfascial blockades as part of a multimodal approach to anesthetic support of urgent laparoscopic interventions.