Presence and decompensation of comorbid conditions can directly affect levels of wakefulness and cosciousness in patients with chronic disorders of consciousness (DoC). Identifying and thorough assessment of comorbid conditions and concurrent diseases is a decisive step in diagnosing signs of consciousness, monitoring changes over time, and making prognoses in patients with DoC.  
Objective. To assess the incidence and severity of comorbid conditions in patients with chronic DoC using the Comorbidities Coma Scale (CoCoS). 
Materials and Methods. At the Russian Center of Neurology and Neurosciences, we conducted a retrospective review of the medical records of 52 patients with chronic DoC of various etiologies (31 men, 21 women; traumatic etiology, n = 18; non-traumatic etiology, n = 34). To determine the type of DoC, all patients were independently assessed twice by two investigators using the Coma Recovery Scale–Revised (CRS-R). To account for the severity and nature of brain injury, we analyzed etiology (traumatic/non-traumatic), time since injury, and the baseline CRS-R score as an integrated measure of neurological deficit. Comorbid status was assessed using the CoCoS scale. 
Results. Different types of stomas as life-sustaining medical devices (tracheostomy, gastrostomy, and suprapubic cystostomy) in 100%, and joint disorders in 98% were identified as predominant comorbid conditions in patients with chronic DoC. Less common comorbid conditions included urinary tract infections (71.15%), kidney diseases (57.69%), pressure ulcers (53.85%), infectious respiratory diseases (46.15%), malnutrition (38.46%), anemia (30.77%), fractures of bones and skull (28.85%), hydrocephalus (13.46%), and paroxysmal autonomic activity (13.25%). Сomorbidity of moderate severity was identified in one patient (1.96%); all others were classified as mild. When stratified by etiology, no significant differences in the total CoCoS score were found between the traumatic and non-traumatic groups (p  > 0.05). No correlation was observed between  CRS-R and CoCoS scores in the overall sample (p = 0.051, R = 0.227); similar results were obtained in the subgroup analyses (traumatic: p = 0.43, R = 0.19; non-traumatic: p = 0.28, R = 0.21). 
Conclusion. The analysis revealed a high prevalence of medical devices used to support vital functions and prevent joint contractures, reflecting apparent dependence of patients with chronic DoC on technical support and care. In most cases, the comorbidity burden was mild, indicating a relatively compensated somatic status. The absence of a significant correlation between the level of consciousness and comorbidity burden suggests that, in cases of mild comorbidity, somatic disorders are not the determining factor masking conscious activity. These findings underscore the need for an interdisciplinary approach to the management of such patients and the mandatory quantitative assessment of structural brain damage, otherwise it is impossible to distinguish the contribution of primary brain injury from that of concomitant pathology into development of chronic DoC. 

Conventional respiratory indices have limited accuracy for predicting weaning outcomes in critically ill surgical patients. Diaphragmatic ultrasound has emerged as a promising bedside tool for evaluating respiratory muscle function during liberation from mechanical ventilation.  
Aim. To evaluate the predictive value of ultrasound-derived diaphragmatic function indices for weaning outcomes in surgical intensive care unit (ICU) patients and to compare their performance with conventional respiratory parameters. 
Methods. This prospective observational study included mechanically ventilated adult patients undergoing spontaneous breathing trials (SBT) in a surgical ICU. Diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) were assessed by bedside ultrasound immediately before SBT initiation. Diaphragmatic rapid shallow breathing indices based on DE (DE-RSBI) and DTF (DTF-RSBI) were also calculated. Conventional respiratory parameters, including respiratory rate (RR), rapid shallow breathing index (RSBI), and PaO₂/FiO₂ ratio (P/F), were recorded simultaneously. Predictive performance was evaluated using receiver operating characteristic (ROC) analysis and DeLong comparison tests. Multivariable logistic regression was performed to identify independent predictors of successful weaning. 
Results. DE demonstrated the highest predictive performance for successful weaning, with an AUC of 0.793, followed by DTF (0.740) and DTF-RSBI (0.711). In contrast, RR and conventional RSBI showed limited discriminative ability, with AUC values close to 0.5. DeLong analysis demonstrated significantly greater AUC values for both DE and DTF compared with the P/F ratio and RSBI. The optimal cutoff values were  >1.26 cm for DE and >16.3% for DTF. In multivariable analysis, lower APACHE II score, higher P/F ratio, and greater DE remained independently associated with successful weaning. Each 1 mm increase in DE was associated with a 66.6%  increase in the odds of successful weaning (adjusted OR 1.67, 95% CI 1.31–2.12; p <  0.001). 
Conclusion. Ultrasound-derived diaphragmatic indices, particularly diaphragmatic excursion, demonstrated superior predictive performance compared with conventional respiratory parameters and may provide valuable adjunctive information during weaning assessment in surgical ICU patients. 

Aspiration-related complications remain one of the most significant causes of early postoperative pneumonia, and microaspiration often occurs without symptoms and is not recognized at an early stage. The sensitivity of chest X-ray and CT (computed tomography) for the earliest changes is limited, creating a diagnostic «gap» in which lung ultrasound (LUS) may play a key role. 
Patient case presentation. A 62-year-old patient with class III obesity (body mass index [BMI] 46.5 kg/m²), ASA class III, and a significant oncologic history experienced a prolonged (8-hour) neurosurgical procedure in the prone position. In the early postoperative period, after reintubation, she developed severe hypoxemia in the absence of specific changes on chest radiography or chest CT, while laboratory inflammatory markers were consistent with a nonspecific postoperative response. Lung ultrasound revealed a pattern atypical for atelectasis: multiple small (up to 1.5 cm²) subpleural consolidations scattered predominantly in the right lung, including nondependent areas, in the environment of preserved aeration of the surrounding tissue and a low lung ultrasound score. 
Diagnostic assessment and interventions. The initial impression of atelectasis was revised in favor of early aspiration pneumonia, despite a «negative» CT scan. On serial ultrasound, there was a rapid increase in the number and size of subpleural consolidations, a rise in the total ultrasound score from 7 to 17, and the appearance of a right-sided pleural effusion, which prompted repeat CT and escalation of respiratory and antibiotic therapy. The repeat CT confirmed multiple areas of consolidation and hydrothorax; aspiration pneumonia was ultimately confirmed by bronchoscopy and bronchoalveolar lavage culture, which grew polymicrobial oral flora. 
Conclusion. In the presented case, the specific lung ultrasound pattern and its progression preceded radiographic changes and made it possible to promptly suspect postoperative microaspiration as the cause of severe respiratory failure. Routine use of standardized lung ultrasound screening in high-risk patients may become a promising tool for the very early diagnosis of microaspiration, expediting the initiation of antimicrobial therapy. 

Maintaining oral hygiene in patients receiving respiratory support is critically important for preventing healthcare-associated infections. 
The aim of the study was to evaluate the clinical effect of octenidine dihydrochloride mouthwash added to local oral hygiene care protocol for patients receiving respiratory support. 
Materials and Methods. This prospective cohort study included 299 patients receiving respiratory support in the ICU setting during 2023–2026 years; after propensity score matching (PSM), 208 (104 pairs) patients were included in the final analysis. Oral hygiene protocol included twice-daily tooth brushing and oral rinsing at a frequency determined by the Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS). Octenidine dihydrochloride 0.1% solution was used as the rinse in the study group, and distilled water — in the control group. A dentist assessed oral health using the Challacombe Scale of Clinical Oral Dryness (CSCOD), Plaque Index (PI), and Modified Gingival Index (MGI) at predefined time points. 
Results. During days 1–3, the study group showed a decrease in the median MGI and PI values compared with the control group (p  < 0.001). By day 7, the favorable changes in the MGI and PI in the study group had boosted, and between-group differences remained significant (p  < 0.001). The effect of the intervention did not depend on the clinical outcome: the «group × outcome» interaction was not statistically significant for ∆MGI_1–3 and ∆MGI_1–7 (p = 0.269 and p = 0.141, respectively). Changes in xerostomia (CSCOD) did not differ significantly between the groups (p = 0.119). 
Conclusion. The use of 0.1% octenidine dihydrochloride mouthwash as a part of the oral hygiene protocol in patients receiving respiratory support results in rapid resolution of gingival inflammation (MGI) and effective removal of dental plaque (PI). However, the persisting rigidness of xerostomia (CSCOD) regardless of the hygiene care protocol warrants searching for additional correction strategies. 

Objective of the study: to investigate the neuroprotective potential of hypothermia under conditions of hypoxia and interleukin-6, which simulates systemic inflammation in vitro. 
Materials and methods. We established an in vitro model of a neurovascular unit (NVU) consisting of neurons, astrocytes, and endothelial cells. The NVU was cultured under anoxic conditions with the addition of serum containing either the maximum or minimum concentration of interleukin-6 (IL-6). Serum samples were obtained from a collection of serum samples from 78 pediatric patients aged 1 month to 6.5 years (13 [9–23] months) with body weights ranging from 3.3 to 21.5 kg (8.7 [6.9–11.0] kg), who underwent surgical correction of congenital septal heart defects under cardiopulmonary bypass. An intact NVU model was used as the control group. Cells were incubated for 15 minutes at different temperatures (20, 24, 28, and 37°C), followed by immunocytochemical assessment of the following NVU damage markers expression: claudin-5, occludin-1, and receptors for interleukin-1 (IL-1) and IL-6. 
Results. We found that, during incubation under anoxic conditions, a decrease in the fluorescence intensity of claudin-5 occurred at all temperature conditions, and hypothermia had no protective effect. For occludin-1, a temperature of 24°C counteracted the effect of anoxia only when exposed to serum with the minimum IL-6 concentration (p = 0.442). Exposure to serum with the maximum IL-6 concentration resulted in a significant decrease in the fluorescence intensity of this marker compared to the control group (p = 0.092). Hypothermia at 20°C did not restore the expression levels of IL-1 receptors to those of the control group; however, it had a protective effect on the expression of IL-6 receptors and neutralized the effects of anoxia (p = 0.044), but only in the absence of serum. 
Conclusion. Exposure to serum containing varying concentrations of IL-6 results in a more pronounced effect on the expression of NVU damage markers than hypoxia. Hypothermia within the temperature range studied generally did not provide the expected protective effect: the expression of claudin-5, IL-1 and IL-6 receptors was not comparable to that of the control group, even without the addition of serum. 

Objective. To substantiate the concept of perioperative infectious risk by analyzing current approaches to classifying complications, methods for predicting them, and the key factors influencing surgical outcomes. 
Materials and Methods. We conducted an analytical review based on expert judgement and a systematic search of publications from the preceding 10 years in PubMed and Lens.org. The analysis included data on the epidemiology of infectious complications, classification systems (CDC, Clavien-Dindo, Accordion), prognostic scores (ASA, SOFA, ACS-NSQIP, SORT), laboratory markers (CRP, IL-6, procalcitonin, neutrophil-tolymphocyte ratio), and machine learning models (PERISCOPE AI, Random Forest, SVM, ensemble methods). 
Results. The risk of infectious complications was shown to be determined by the cumulative effect of modifiable and nonmodifiable factors related to both the patient and the healthcare facility. Laboratory markers demonstrated high prognostic value: IL-6 levels above 432 pg/mL and CRP 150 mg/L on postoperative day 3 were statistically significantly associated with adverse outcomes. Advanced prognostic tools provided high accuracy: the AUROC for ACS-NSQIP reached 0.80, and for PERISCOPE AI, 0.82–0.91. The use of scoring systems and machine learning made it possible to identify high-risk patients before clinical symptoms appeared.  
Conclusion. Risk of perioperative infections is multifactorial and requires an integrated approach to risk stratification, incorporating clinical data, risk assessment scales, laboratory markers, and AI models. The use of structured prognostic tools enables early identification of complications, optimize prevention, and reduce mortality. 

The aim of this review is to assess the impact of frailty on outcomes in critical illness among older and very old patients, and to summarize current approaches to their management in the intensive care unit (ICU). 
Materials and Methods. The review included 66 publications from PubMed, Google Scholar, the Cochrane Library, and eLIBRARY.RU. The search was conducted using the keywords «frailty», «older patient in intensive care», «treatment of elderly and senescent patients», «critical conditions in older age», «immunosenescence», «cognitive impairment», and «sarcopenia». 
Results. We reviewed the processes encompassed by the concept of frailty or «senile asthenia» (SA); tools for assessing SA severity; identified the factors of physiological aging that affect the course of the underlying disease in elderly and senile patients in the ICU; and highlighted the specific features of their treatment approach. 
Conclusion. A number of physiological aging factors significantly influence the management strategy for the studied ICU patient cohort, including changes in hormonal regulation, immunosenescence, sarcopenia, and altered cognitive function. Comorbidities, medication use patterns, and mobility status should also be taken into account. Frailty leads to higher mortality among older and very old ICU patients compared with patients without SA. For management of frail patients a unified approach is recommended combining a multidisciplinary team and family caregivers to maintain patient’s motivation and adherence to the prescribed treatment.