Concurrent cardiac failure is an universally accepted risk factor in surgical patients undergoiing cardiac or non-cardiac surgery.

The aim of this study was to search for and identify factors or markers, which would permit to predict early (up to 30 days) or late (up to 1 year) adverse outcomes in patients with acute heart failure (AHF) in the vascular surgery.

Materials and Methods. A randomized, multicenter, prospective — retrospective study was performed. 89 patients who had signed the Informed Consent Form were randomized. Throughout the four stages of the study, the cardiac index (CI) and the left ventricle ejection fraction (LVEF) values were recorded. At the same stages, blood was sampled to be tested for the NT-proBNP level. The TnT level was tested only at the 3rd stage of the study. The required stay in the intensive care unit (ICU) and in the in-patient hospital, the incidence of infarctions and strokes during the early postoperative period (up to 30 days), the 30&day and one-year mortality rates were recorded.

Results. Different AHF prevention methods were used in patients included into this study in the postoperative period. Predictors of adverse events were studied in a combined population. The incidence of acute myocardial infarction (AMI) was 12% and that of stroke was 2%. The in-hospital mortality rate in the combined group was 2%; the one-year mortality was 10%. Patients stayed in the intensive care unit for 3 (2—4) days; the hospital stay was 11 (10—13) days; the composite adverse outcome of the surgical treatment was registered in 15% of patients. As a result, the Troponin T level was the only significant prognostic factor during the first 24 hours of the postoperative period. A study of the prognostic significance of different parameters in relation to their effect on the one-year mortality rate demonstrated a similar result. Vasoactive Inotropes Score (VIS) turned out to be the most significant criterion for prediction of possible treatment duration.

Conclusion. The study results confirmed the predictive value of early determination of TnT levels after reparative vascular surgeries in patients with decreased left ventricular ejection fraction. The diagnostic value of the VIS calculation needs further confirmation. 

Aim: to study characteristics of the central hemodynamics (CHD) in patients with severe abdominal sepsis with different outcomes of the disease.

Materials and Methods. 18 patients with abdominal sepsis, aged 50.2±3, with the APACHE II and SOFA severity scoring of 13.7±0.8 and 8.4±0.5, respectively, were enrolled in the retrospective study. The CHD was studied using the transpulmonary thermodilution. The following groups were identified: Group 1 (deceased, n=9) and Group 2 (survivors, n=9). The groups did not differ (P>0.05) in age, sex, and the severity of the condition at admission to the ICU. The significance of differences was assessed using the t-test and the chi-squared test. The prognostic value of the parameters was studied using the ROC analysis.

Results. On Day 1, the intergroup differences included the average blood pressure (BPav) (85.3±3.3 and 101.6±4.6 mmHg, respectively (P<0.05)) and the cardiac power index (CPI) (306±22 and 429.9±48.9 W/m2, respectively) (Р<0.05). The intergroup difference in the CPI and the global ejection fraction (GEF) persisted on Day 3: 22.3±2.3 and 29.3±1.5%, respectively (P<0.05); there was no other difference. The intergroup difference in the GEF remained on Day 5. On Day 7, the CHD parameters demonstrated no intergroup difference. The SOFA severity scoring in Group 1 patients became greater than that in Group 2 starting from Day 5. According to ROC analysis, BPav (95 mmHg, sensitivity: 88.9%, specificity: 88.9%), CPI (373 W/m2, sensitivity: 88.9%, specificity: 77.8%), and GEF (26.1%, sensitivity: 66.7%, specificity: 77,8%) were the most important predictors of the lethal outcome on Days 1—3 (areas under ROC curves: 0.765—0.840; P<0.05). On days 5—7, the SOFA scoring >7 (sensitivity: 88.9%, specificity: 88.9%) was the most important predictor of the lethal outcome (areas under ROC curves: 0.957—0.994; P<0.05).

Conclusion: during the first five days of the intensive treatment of severe sepsis in patients with unfavorable prognosis, a moderate decrease in the cardiac power index and overall cardiac systolic function was registered. The prognostic significance of such parameters as CPI and GEF may become obvious within the first 3 days of the intensive treatment.

Objective: to analyze the oxygen balance in patients with injuries of abdominal cavity organs and acute blood loss during the operation and arrest of bleeding.

Material and methods: the study group included 50 patients (49 men and 1 woman, average age 33 (25,75; 44,5) years old) suffered from injuries of abdominal cavity organs complicated by acute massive blood loss requiring emergency surgical intervention. The severity of patients’ state was 38 (27,75; 48) scores according to ISS.

The investigators examined the following parameters: volume of blood loss, hemoglobin (Hg) level, hematocrit (HCT), blood gas composition, indices of oxygen balance, acid-base balance, electrolytes level, and tissue metabolism status. The continuous minimally invasive evaluation of central hemodynamics parameters was conducted.

The statistical analysis of received data was performed using SPSS software (SPSS Inc., USA).

Results: the parameters of central hemodynamics were not representative of the severity of patients’ state at their admission into operative theatre. The signs of hypovolemia were observed along with normal vascular tone and cardiac output. Meanwhile such parameters of oxygen balance as high oxygen consumption index (VO₂I) and oxygen extraction ratio (О₂ER) as well as low central venous saturation (SvО₂) confirmed the critical state of patients. These data testified that patients suffered from severe incident of respiratory or circulatory hypoxia during trauma, which had been corrected during first aid treatment and transportation until patient’s admission into operative theatre, so patients had laboratory findings of «oxygen debt». The high values of VO₂I accompanied by increase of О₂ER were still observed at the end of surgery while the low values of CvO₂, PvO₂ and SvО₂ testified the continuous circulatory hypoxia.

Conclusion: All patients with postoperative complications suffered from severe disturbances of oxygen delivery during preoperative period. The low cardiac efficiency was the main reason for ongoing state of shock at such patients.  The correlation between postoperative lethal outcomes and the value of cardiac index (CI) at the end of surgery in such group of patients was revealed. 

Most publications report on the use of methadone as a medication, however an increase of the illegal use of methadone has been demonstrated worldwide over the recent years, thus increasing the number of hospitalizations due to acute poisoning with this synthetic opioid. The aim of the present review was to summarize current data on the mechanisms of toxicity, selective toxicity, toxicokinetics and toxicodynamics of methadone (Dolphin). The involvement of CNS, respiratory, cardiovascular and urinary systems in acute poisoning with methadone was dis- cussed. The practice of use of methadone in many countries as a medicine for the replacement therapy for opiate addicts was analyzed. In addition, it was suggested that the results of the use of naloxone antidote therapy in acute opioid poisoning do not always clearly demonstrate its sufficient efficacy. Ways to improve of the intensive therapy of severe acute poisoning by methadone were substantiated; in addition to general critical care methods, treatment with a complex metabolic antihypoxant cytoflavin should be considered. 

Nowadays, in the age of rapid introduction of digital and fiber-optic technologies in neurosurgery, a technique for removal of tumors in the chiasmatic-sellar area via an endoscopic transsphenoidal endonasal approach is actively developed; this technique is considered less invasive and is well tolerated by patients, thus permitting to operate patients with somatic complications, as well as the elderly. Taking into account these facts, as well as world statistic data indicating a continuous trend of population aging in developed countries, including Russia, optimization of the perioperative care of elderly patients with a tumor of the chiasmatic-sellar area becomes the problem of highest priority. In order to solve it, this review discusses the basic peculiarities of the perioperative management of elderly patients (characteristics of their somatic status and possible variants of the pre-operational state) with a pathology in the chiasmatic-sellar region; it also presents the modern and most acceptable alternative solutions of this difficult problem (introduction of modern methods of anesthesia, management of the postoperative cognitive dysfunction, postoperative pain syndrome, and postoperative nausea and vomiting). 

The aim of the review is to present potentially negative effects of hyperoxia in various groups of critically ill patients, including those after cardiac arrest, brain injury or stroke, and in cases of sepsis. It was noted that in cases of these pathological processes and nosological forms there were evidences that hyperoxia could have a damaging effect, and that oxygen should be prescribed on an individual basis depending on the assessment of the current oxy- gen requirement. It has been established that hyperoxia commonly represent the last reserve to abrogate the progressive hypoxia. The mechanisms of adaptation of the body to hyperoxia are described and the possibility to reduce the toxic effects of oxygen with the aid of succinates is discussed. 

Aim. To asses of metabolism, lipid metabolism and oxygen status parameters in newborns with perinatal hypoxia.

Materials and Methods. 53 newborn babies born with signs of severe hypoxia and low Apgar scoring equal to 2 at the 1st minute of life were enrolled in the study. Newborns were divided into 2 groups depending on the presence of the clinical presentation of shock: Group 1 «Shock» and Group 2 «Acute intranatal hypoxia» (AIH). All newborns underwent testing for blood gas and acid-base balance, lactate level. Cholesterol and triglyceride levels in the central venous blood were also tested immediately after the birth and on the 5th day of life. Mechanical ventilation mode and parameters were registered. The mean airway pressure (MAP) and the oxygen saturation index (OSI) were calculated.

Results. Severe decompensated metabolic lactic acidosis was diagnosed in a «Shock» group newborns at birth, thus indicating severe perinatal hypoxia which had triggered the development of shock. As for the «AIH» group newborns, they had hyperlactatemia alone. The most severe hypoxemia at birth was diagnosed in newborns of the «Shock» group; the OSI value in these infants was significantly higher than that in «AIH» infants (P<0.01). Despite the treatment and mechanical ventilation, during the posthypoxic period, newborns from the «Shock» group were characterized by increased OSI values over 12 hours after birth. Significantly high levels of OSI persisted for 48 hours after the delivery. Severe hypotriglyceridemia and hypocholesterolemia were found in both group newborns.

Conclusion. The study demonstrated that there was intranatal complex metabolism impairment in the case of perinatal hypoxia; at birth, it manifested by metabolic acidosis of various degrees of severity and imbalance of triglycerides and cholesterol levels. The longer and more severe hypoxia is, the more severe acid-base balance and blood lactate level impairment at birth become. Critical pH and lactate values, blood buffer base deficiency, hypotriglyceridemia, are hypocholesterolemia are pathognomonic for perinatal hypoxia and shock development in newborns. This study demonstrated a relationship between the levels of triglycerides and cholesterol with parameters of the acid-base balance and blood lactate levels, and the duration of the mechanical ventilation.

Aim: to analyze the oxygen balance in patients with injuries of abdominal cavity organs and acute blood loss during surgery and arrest of bleeding.

Material and methods: the study group consisted of 50 patients (49 men and 1 woman, average age: 33 (25.75; 44.5) years) who experienced injuries of abdominal cavity organs complicated by acute massive blood loss requiring urgent surgical interventions. The severity of patients' state was 38 (27.75; 48) by ISS scoring. The study examined the following parameters: the blood loss volume, hemoglobin (Hg) level, hematocrit (HCT), blood gases, oxygen balance, acid-base balance, electrolyte levels, and the tissue metabolism status. A continuous minimally invasive monitoring of central hemodynamics parameters was performed. The statistical data processing was per- formed using the SPSS software (SPSS Inc., USA).

Results: the central hemodynamics parameters did not reflect the severity of patients' state at their admission into an operating room. The signs of hypovolemia were observed along with normal vascular tone and cardiac out- put. At the same time, such parameters of oxygen balance as high VO2I and О2ER, as well as low SvО2 indicated the severity of patients' state. These data demonstrated that patients experienced a severe episode of respiratory or circulatory hypoxia during trauma, which had been corrected during first aid treatment and transportation by patient's admission into the operating room, so patients presented lab test findings of «oxygen debt». The VO2I values remained high in addition to the increase in О2ER values by the end of the surgery. However, low CvO2, PvO2, and SvО2 values indicated the persisting circulatory hypoxia.

Conclusion: All patients with postoperative complications were admitted into the operating room with already existing impairment of oxygen delivery. The patients did not recover from shock, the low cardiac efficiency was the main reason for its persistence. The correlation between postoperative lethal outcomes and the value of cardiac index (CI) at the end of surgery in this group of patients was demonstrated.