Purpose: to study the dynamics of blood plasma electrochemical parameters in patients with severe combined trauma before and after fresh frozen plasma (FFP) transfusions.

Materials and methods. The open circuit potential (OCP) of platinum electrode and antioxidant activity of blood plasma were studied in 35 patients with severe combined trauma and 35 post-FFP samples with at least 6-month shelf life. The electrochemical parameters of patients’ blood plasma were analyzed before transfusion, and 1 hr. and 24 hrs. after transfusion.

Results. OCP measured in FFP was found to be more positive vs. OCP measured in recipients' blood plasma in 34 out of 35 cases (97%). It has been shown that in patients with severe combined trauma, OCP increased from 5.047 [-7.553; 12.976] mV to 12.827 [-1.372; 24.764] mV and antioxidant activity decreased 24 hours after FFP transfusion from 16.979 [11.302; 20.946] µC to 13.551 [9.288; 18.405] µC. After FFP transfusion, there were no significant changes in clinical blood parameters.

Conclusion. By measuring electrochemical parameters of blood plasma in patients with severe combined trauma before and after FFP transfusions, it was discovered that in spite of absence of changes in blood parameters by routine methods, there are changes in the condition of the antioxidant system of the body, which manifest in the bias of patients’ blood plasma OCP towards higher positive values and decreased antioxidant activity. Redox imbalance in the body might cause the oxidative stress development.

Acute respiratory distress syndrome (ARDS) is a serious challenge in the contemporary reanimatology due to its prevalence, versatility of pathogenesis mechanisms, and continuously high mortality. The development of an uncontrolled cascade of systemic inflammation reactions, ‘cytokine storm’, followed by multiple organ failure (MOF) is an essential pathophysiological trigger of acute lung injury. Besides, critically ill patients are characterized by a relative intestinal ischemia, wherein, according to the ‘intestine-lung axis’ concept that treats intestinal and pulmonary epithelium as a continuous surface, translocation of bacteria and/or endotoxin directly into blood flow might occur. Extracorporeal removal of excessively produced inflammatory response mediators and endotoxin (bacterial lipopolysaccharide, LPS) from systemic circulation by selective hemosorption might represent a life-saving approach in sepsis.

Purpose: to evaluate the efficacy of selective sorption in a combined therapy for acute lung injury related to postoperative injury after lung cancer surgery.

Results. A single 4-hour selective sorption procedure in the combined therapy of a critically ill postoperative patient produced fast (within 24 hrs.) effects: decreased leukocytosis (the leukocyte count fell down from 32X109 to 13X109, L-1) and endotoxin activity (EAA — from 0.67 to 0.32, units), reduced blood plasma anti-inflammatory cytokine (IL-6 — from 1860 to 62, pg/ml) and procalcitonin (PCT — from 46 to 0.32, ng/ml), recovery of gas exchange, discontinuation of hemodynamic support with pressor amines as no longer needed (as early as 2 hours after sorption).

Conclusion. The clinical case of a successful therapy including selective sorption based on hyper-crosslinked styrene-divinylbenzene copolymer with immobilized LPS-selective ligand warrants further clinical studies on the efficiency of a novel selective hemosorption column use to correct post-radical respiratory complications in oncological patients.

The number of dialysis patients is increasing every year and is estimated to be more than 2 million, with an annual increase of 6–12% in dialysis programs. There is a high correlation between cognitive impairment and mortality in dialysis patients, which suggests the relevance of screening cognitive functions in dialysis patients using different neuropsychological scales.

Aim of the study was to test the cognitive status and identify cognitive impairment in patients with terminal stage of chronic kidney disease treated using program hemodialysis, as well as to evaluate risk factors for cognitive impairment in this category of patients.

Material and methods. 83 patients aged 28 to 78 years (mean age 56.7±13.7 years) were examined. The main group included 53 people who received program hemodialysis, of them 23 men and 30 women. The mean age of patients in this group was 58.3±13.3 years. The control group composed of 30 individuals without kidney diseases, including 13 men and 17 women. The mean age in the control group was 53.6±14.9 years. The MoCA and SLUMS scales were chosen for detecting cognitive impairment and assessment of neuropsychological status. We used mathematical methods of research data processing such as inductive statistics and correlation analysis.

Results. Cognitive impairment was found to be significantly more frequent in dialysis patients (75.5–81.1% of cases, P=0.05) compared to those without kidney pathology. The SLUMS scale was shown to be more sensitive than MoCA (P=0.05, CI 95.0%). The risk factors of cognitive impairment in dialysis patients included increased dialysis duration, age (rs=–0.298) and low estimated urea dialysis adequacy index (Kt/V less than 1.2).

Conclusion. A high risk of cognitive impairment is common in dialysis patients. For its timely detection,  the screening neuropsychological test are recommended to be used by clinicians. Cognitive impairment, diagnosed by the tests, is an indication for a specialist consultation.

Nutritional support is central to prompt treatment of patients with generalized secondary peritonitis (GSP).
These patients desperately need a simple and affordable solution to evaluate their daily energy need.
Objective: to determine accuracy of estimating the Resting Energy Expenditure (REE) in GSP patients.
Materials and methods. Study design: a prospective, single center study. The inclusion criteria: diagnosed GSP and stay at the Intensive Care Unit (ICU). Three treatment arms were formed. The first arm included all patients (n=61), the second arm included patients capable to breath spontaneously and adequately (n=29), and the third arm included patients on artificial ventilation (n=32). Reference values of REE were calculated by Indirect Calorimetry (IC) method using Engstrom Carestation Lung Ventilator and Metabolic (General Electric,USA). Six equations were used to predict REE values: Ideal Body Weight multiplied by 25 (IBWX25); Actual Body Weight multiplied by 25 (ABWX25); J. A. Harris, F. Benedict (HB); HB with corrective ratio 1.25 (HBX1.25); C. Ireton-Jones, 1992 (IJ); PennState, 2003 equation, in modification (PS). SPSS Software Package was used for statistical analysis of the results. The zero hypothesis was rejected at P<0.05.
Results. In patients with GSP, the REE value determined by means of Indirect Calorimetry method was equal to 25.78±1.37 kcal/kg/day. If compared with Indirect Calorimetry results, predictive accuracy of calculation equations in the second and third arm, respectively, were as follows: IBWX25: 30 and 0%, HB: 36.7 and 9.9%, HBX1.25: 49.9 and 45.5%, IJ: 51.8 and 53.2%, ABWX25: 63.4 and 60.6%, PS (as determined in patients on mechanical ventilation only): 42.4%.
Conclusion. Indirect Calorimetry method is the only accurate way of REE evaluation in GSP patients. ABWX25 and IJ showed the highest predictive accuracy. IBWX25 and HB had the lowest predictive accuracy.

Hospital mortality in critical illness has decreased over the last decade. At the same time, there has been an increase in the number of patients diagnosed with post-intensive care syndrome (PIT-syndrome) which reduces the life quality after discharge. One of the most important components preventing the development of PIT syndrome is nutritional support.
The aim of the review is to highlight the need for a differentiated approach to nutritional support of critically ill patients during their treatment and rehabilitation.
Among more than 200 primary sources of literature from various databases (Scopus, Web of science, RINC, etc.), 82 sources mainly published in the last 5 years were selected for review. Earlier publications maintaining clinical relevance were also included into the analysis.
The review presents data on real practice of nutritional support in critically ill patients. In most cases, the risk of nutritional deficiencies is not assessed before treatment, and protein and energy requirements are not fully met. The algorithm of nutritional support is provided based on the phases of critical illness.
Conclusion. Contemporary approaches to the nutrient and energy provision to critically ill patients suggest the differentiated nutritive support prescription depending on the disease stage. The emphasis is made on gradual achievement of target values of protein and energy provision, priority of enteral administration of nutrients, continuity in nutritional support between departments, as well as hospital and outpatient treatment periods. This approach allows both optimization of medical care for this extremely challenging category of patients and a reduction in the severity and duration of the PIT syndrome.

Baclofen is a muscle relaxant, which is a beta-p-chlorophenyl derivative of an inhibitory neurotransmitter GABA. This drug may have serious side effects and cause life-threatening conditions which may recellular receptors to clarify the pathogenesis of life-threatening conditions caused by poisoning with this drug.
The search was done using the PubMed and Scopus databases, and the final selection of 82 sources was made based on the relevance to the topic of this review and the type of article. The review included both the results of randomized studies and individual reports.
The review briefly discusses the history of baclofen synthesis and its application in clinical practice, indications for prescription, mechanism of action and the specific features of its metabolism, its effect on the CNS, signs and symptoms of withdrawal syndrome, overdose and acute poisoning, as well as the interaction of baclofen with other drugs.
Conclusion. Multiple studies failed to make definite conclusions about mechanisms of baclofen toxicity. To completely reveal the pathogenesis of life-threatening conditions occurring due to baclofen use, further studies of molecular and cellular effects of this drug, as well as genetic factors controlling its metabolism, are warranted.

Advances in intensive care have enabled patients to survive an acute critical condition, producing a growing population of patients in a chronic critical condition with long-term dependence on intensive care. These patients make up 5–10% of all patients with acute respiratory failure and require a disproportionate share of resources in the intensive care units, with an overall yearly survival rate of 40–50%.
The aim of review is to identify the impact of comorbid complications on the course and outcome of patients with severe brain injury.
Ninety-six sources were selected according to the data characterizing the clinical (syndromic) model of the patient with consciousness disorders after coma of different etiologies. This model takes into account the stages and phases of the syndrome as well as a number of comorbid conditions that determine the course and outcome of the disease.
The list of sources includes papers addressing the issues of comorbidity in patients with brain injury and conditions such as strokes, consequences of severe brain injury and brain surgery.
The sources reflecting the most significant mechanisms of consistent development of comorbidities were examined. These include metabolic disorders with subsequent protein and energy deficiency and comorbidities of the gastrointestinal tract. The role of microbiome in the development of comorbidity in patients in chronic critical condition was also identified.
Conclusion. The comorbidity development starts from the moment of brain injury and extends until sustained stabilization or multi-organ failure and death. Timely detection and correction of comorbidities allows optimizing treatment and increasing efficiency of rehabilitation in patients with severe brain injury.