Red blood cells are the most required blood transfusion products worldwide. Safety and efficacy of blood transfusion are still relevant issues. Clarification of the causes and mechanisms of post-transfusion complications requires additional research.

Aim of the review is to summarize the data of clinical and research studies on transfusion of red blood cell suspension with various storage times.

Material. We selected 76 sources from Web of Science, Scopus, and RSCI databases containing pertinent clinical and scientific research data, as well as blood transfusion guidelines.

Results. We reviewed the main stages of preparation and storage of filtered red blood cells, described biochemical and structural alterations occurring during blood storage, summarized clinical data on post-transfusion complications, and analyzed clinical consequences and molecular structure abnormalities of red blood cells in relation to their storage time.

Conclusion. During long-term storage, red blood cells undergo significant structural and metabolic changes. The clinical use of relatively «old» red blood cells increases the risk of post-transfusion complications. However, the pathophysiological differences between «young» and «old» erythrocytes remain unclear. Large clinical and molecular research studies may add to our understanding of the complex issues related to blood transfusion.

Choking is a relevant public health problem. Data in medical literature are scarce and fatal events are dramatically under-reported.

The aim of this manuscript is to give a real estimation of this problem and to raise awareness about this topic.

Materials and methods. All deaths caused by choking reported by Italian Mass Media over a two years period were collected. Suspected sudden infant death syndrome was an exclusion criteria.

Results. 76 deaths due to foreign body airway obstruction were identified, 51% during 2018 and 49% in 2019, without identifiable time clusters. Choking affected every age, including pre-scholar children (25%), children 6 to 18 years old (3%), adults (38%), and elderly patients (34%). Witnessed cases were 61 (80%) but in almost half 26 cases (42%) the fatal event occurred before or without first aid maneuvers being performed.

Conclusion. On the Italian territory, during a 2 years period, three cases per month of fatal choking due to foreign-body airway obstruction occurred, many of them in adult patients (38%). Italian people seem not to be educated to provide first aid in these settings.

Aim: to validate the use of heart rate variability monitoring during dexmedetomidine administration in patients with brain injury of various etiologies.

Material and methods. The study included 25 patients (14 male, 11 female, mean age 58.2±1.81 years) 20 and more days after traumatic brain injury (TBI) (n=9; 36%), acute stroke (n=4; 16%), anoxic brain injury (n=6; 24%), subarachnoid hemorrhage (SAH) (n=6; 24%). Dexmedetomidine was prescribed because of sympathetic hyperactivity as diagnosed by heart rate variability (HRV). The following indices were measured: SI (stress index, in normalized units [nu]), SDNN (standard deviation of all normal sinus RR intervals over 24 h, in ms), RMSSD (root-mean-square of successive normal sinus RR interval difference, in ms), pNN 50% (the percentage of successive normal sinus RR intervals >50 ms), TP (total power of the frequency spectrum, in ms2). HRV parameters were determined prior to dexmedetomidine infusion (baseline), on days 1–3, 4–5, 9–10, 15–20 of drug administration. Sympathetic hyperactivity was diagnosed by determining following values: SDNN < 13.31 ms, RMSSD < 5.78 ms, pNN 50% < 0.110%, SI > 900 nu, and TP < 200 ms2. Normal reference ranges for HRV parameters were as follows: SDNN (13.31–41.4 ms), RMSSD (5.78–42.3 ms), pNN5 0% (0.110–8.1%), SI (80–900 nu), and TP (200–2000 ms2).

Results. The starting dose of dexmedetomidine for sympathetic hyperactivity was 0.12–0.24 µg/kg/hr (mean dose 0.16±0.01; total 200 µg/day). According to digital HRV data, the effective dose ED50 of dexmedetomidine was 0.26±0.03 µg/kg/hour (353.8±35.1 µg total per day) that was achieved on day 9–10 of drug administration.

Conclusion. Electrophysiological neuromonitoring of the autonomic nervous system function increases the efficacy of dexmedetomidine administration in patients with brain injury of various etiologies.

Finding a simple reproducible routine test is relevant for the determination of post-pyloric feeding tolerance.

Aim. To evaluate in a pilot study the usefulness of acetaminophen absorption test with post-pyloric drug administration in patients with generalized secondary peritonitis.

Materials and methods. Acetaminophen absorption test was performed in patients with generalized secondary peritonitis. 0.5 g of drug was administered into the lumen of the small intestine through the nasojejunal tube and after 5, 10, 15, 20, 30, 40, 50 and 90 min its blood level was determined. The first group (n=14) of variables was taken from patients whose test was performed immediately after the surgery. The second group results (n=10) were obtained from the same patients who were tested when they were able to absorb >1 l/day of enteral nutrition without signs of intolerance.

Results. When comparing the concentration of acetaminophen in the blood after the drug administration into the bowel of patients with peritonitis immediately after surgery and at the time when the assimilation of bowel feeding had become possible, it was found that the most significant differences were detected within the time interval of 5–20 minutes after the drug administration (P<0.001). This time interval is optimal for harvesting blood samples during the acetaminophen test procedure.

Conclusion. Bowel absorption of acetaminophen may be informative for predicting the feasibility of adequate post-pyloric enteral feeding of patients with generalized secondary peritonitis.

Necrotizing soft tissue infection (NSTI) is a severe surgical infection which can result in sepsis and septic shock when generalized.

The aim of the study was to determine the frequency of thrombocytopenia in patients with generalized NSTI, the factors promoting its development, and its association with septic shock.

Materials and Methods. We examined 129 patients with NSTI treated between 09.2015 and 12.2019 at St. George Hospital in St. Petersburg, Russia. Surgical treatment, hematological and biochemical examinations, and bacteriological analysis of blood and wound discharge were performed in each patient. The studied group included 22 patients with systemic inflammatory reaction syndrome, 63 patients with sepsis, and 44 patients with septic shock.

Results. We found a decrease in platelet count in NSTI patients with septic shock as early as on the first day of the disease and its further decrease within the next 3 days, with the mean platelet volume (MPV) increasing during the same period and significantly exceeding that in patients with sepsis and systemic inflammatory response syndrome. In NSTI patients with thrombocytopenia on admission, we found a significant correlation between the platelet count and the percentage of segmented neutrophils (r=0.349; P<0.001; n=40). The maximum incidenсe of septic shock was observed in patients infected with Klebsiella pneumoniae (13 out of 19, 65%). These patients had the highest MPV but did not develop thrombocytopenia. Maximum frequency of thrombocytopenia and elevation of MPV and platelet distribution width (PDW) was found in patients with NSTI and underlying chronic viral hepatitis C. However, the relative frequency of septic shock in these patients was not increased.

Conclusion. The development of septic shock in NSTI is associated with a specific platelet activation pattern

Objective: to develop criteria of inclusion/noninclusion of patients for further randomized clinical trial of meglumine sodium succinate in patients with acute pancreatitis based on analysis of individual outcomes.

Material and methods. The efficacy of treatment of patients with moderate-to-severe and severe acute pancreatitis (n=100, 23–65 years old) with meglumine sodium succinate (intravenous drip infusions, 10 ml/kg daily, for 11 days) was assessed. Data were collected by 10 medical centers as a part of an observational program developed in accordance with the requirements of the Guidelines and Clinical Trial Committee of the AllRussia Public Organization «Federation of Anesthesiologists and Reanimatologists» (FAR) and approved by local ethical committees of the institutions. Treatment was prescribed in accordance with national and international standards. The patients were divided into two groups based on the outcome: group 1 (n=81) included patients who survived, while the patients of group 2 (n=19) died. We analyzed demographic characteristics of the groups, life and illness history, physical examination, routine laboratory and instrumental investigation data. The obtained results were statistically analyzed.

Results. We identified several factors occurring during hospitalization and/or transfer to intensive care unit (ICU), which could be predictors of adverse outcome and had varying impact on the risk of death in patients treated with the study drug. High-risk factors included stupor, platelet count below 248.5×10⁹/l, base excess (BE) less than -2.9 mmol/l, and urea above 11.85 mmol/l. Risk factors included body temperature below 37.1°C, plasma creatinine above 237 µmol/l, and glucose above 9.45 mmol/l. Mottled skin and plasma ionized calcium levels below 1.13 mmol/l were considered probable risk factors.

Conclusion. Determined prognostically significant predictors of adverse outcome in patients with acute pancreatitis receiving Reamberin should be considered when selecting inclusion/exclusion criteria for the randomized controlled comparative clinical study of the efficacy of meglumine sodium succinate in patients with acute pancreatitis.

The aim of the study was to investigate the effect of ethylmethylhydroxypyridine on the ultrastructural alterations in endothelial cells of liver sinusoidal capillaries (SC) and primary hemostasis in the acute phase of traumatic brain injury (TBI).

Materials and methods. Ultrastructural endothelial cell changes were studied in 36 female outbred rats in the acute phase of TBI using electron microscopy, and the platelet count was determined using a blood analyzer. The experimental group (n=18) animals received intraperitoneal injections of ethylmethylhydroxypyridine at the dose of 8.0 mg/kg per day for 12 days, and the control group (n=18) rats were administered with normal saline solution at the same dose.

Results. Administration of ethylmethylhydroxypyridine in the early post TBI period reduced microvilli damage in endothelial, hepatic and stellate cells in the Disse space, whereas in the control group a significant decrease of these cells counts was detected. In contrast to the control group, the experimental group animals did not demonstrate thrombocytopenia on the days 1, 3, and 7 after injury. There was a significant increase in the platelet count compared with the baseline values, which was highest on day 12 after injury.

Conclusion. Intraperitoneal administration of ethylmethylhydroxypyridine in rats in early post TBI period inhibited the TBI-associated damaging effect of secondary factors on liver sinusoid endothelial cells and platelet consumption.