Objective. The aim of this study is to assess the safety of the use of regional anesthesia for performing carotid endarterectomy (CEA) in patients in the acute phase of ischemic stroke.

Material and methods. The study included 66 patients in the acute phase of ischemic stroke (atherothrom-botic subtype according to the TOAST classification) who underwent carotid endarterectomy. The inclusion criteria for the study were as follows: acute phase of atherothrombotic ischemic stroke (first 28 days), ipsilateral symptomatic ≥ 50% stenosis of the internal carotid artery, 1-4 points neurological deficit according to the modified Rankin Scale (mRS), 1-13 points neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), size of the cerebral ischemic lesion ≤ 4 cm. This single-center prospective cohort study compared two anesthetic approaches, regional anesthesia (RA, 46 patients) and general anesthesia (GA, 20 patients). The RA techniques included ultrasound-guided superficial and deep cervical plexus blocks on the side of the surgery.

Results. The study found no significant differences in the baseline patient characteristics, surgery techniques and clinical outcomes between the groups. There were no neurological or cardiovascular toxic reactions to the local anesthetics. Conversions from RA to GA were not performed. In the RA group, recurrent ipsilateral ischemic strokes, myocardial infarctions, wound hemorrhagic complications and lethal outcomes did not occur.

Conclusion. This pilot study has demonstrated the safety of RA for performing CEA in patients in the acute phase of ischemic stroke. RA provides adequate neuromonitoring and timely intraoperative recognition of «new» ischemic complications. To compare the efficacy of RA and GA for performing CEA in patients with acute ischemic stroke, large randomized controlled trials are needed.

The timely diagnosis of both sepsis and septic shock can be challenging in severely burned patients. Monitoring methods providing early diagnosis of organ dysfunction development are of great importance. Assessment of the glomerular filtration rate with central hemodynamic parameters can be considered as a component of comprehensive monitoring of effectiveness of septic shock therapy.

Aim: to determine the relationship between the target mean arterial pressure and glomerular filtration rate parameters in the treatment of severely burned patients with septic shock.

Material and methods. 158 severely burned patients with septic shock were included in the study, of them 121 patients represented a retrospective historical group, and 37 patients constituted a prospective group. The main criteria of treatment efficacy were 28-day and hospital mortality.

Results. In the patients of prospective group, 28-days mortality decreased down to 16.2% compared with 33.9% in the retrospective group, and hospital mortality dropped down to 29.7% vs 42.1%, respectively (P<0.05). Conclusion. Extended hemodynamic and metabolic (renal function assessment) monitoring of intensive therapy of severely burned patients with septic shock helps targeted adjustment of fluid therapy and provides earlier beginning of extracorporeal blood therapy thus favoring better survival rate.

Rhabdomyolysis (RM) is a clinical and laboratory syndrome with the underlying destruction of myocytes and the release of intracellular debris into the systemic circulation. In more than 55% of cases, RM is complicated by acute kidney injury (AKI), which necessitates various methods of extracorporeal detoxification and currently is a controversial issue.

Aim: to improve the results of treatment of patients with RM of toxic origin complicated by AKI by using early selective hemoadsorption (SH).

Material and methods. The study included 36 patients divided into 2 groups. Group 1 included 24 patients who received standard therapy and hemodiafiltration (HDF) as a life-saving intervention. Group 2 comprised 12 patients who underwent early SH to prevent the progression of AKI. We performed a comparative analysis of clinical and laboratory parameters and treatment outcomes in the groups.

Results. The use of SH was associated with reduced level of myoglobin on day5 of therapy from 384.1 to 112.4 gg/l (70.7%) vs 335.15 to 219.1 gg/l (34.6%) reduction in the conservative therapy group. By day 7, this parameter was 18.8 (95.1%) and 142.4 (57.5%), respectively (7=0.012). The level of cystatin-C decreased on day 5 from 17.3 to 3.2 mg/l (81.5%) in group 2 and from 14.9 to 11.7 mg/l (21.5%) in group 1. By day 7, this parameter decreased to 2.5 (85.6%) and 14.1 (5.3%) mg/l, respectively (7=0.001). The length of ICU stay in group 2 was 7 (6; 9) days, while in the conservative therapy group it was 12 (7; 13) days (7=0.04). The hospital stay was 12 (10; 16) and 22 (14,5; 24,5) days, respectively (7=0.028).

Conclusion. The early use of SH in the intensive therapy helped decrease the levels of markers of endogenous intoxication, AKI severity, improve the filtration capacity of the kidneys, and reduced the length of stay in the ICU and hospital.

Multiple organ failure (MOF) is the leading cause of neonatal mortality in intensive care units. The prevalence of MOF in newborns is currently unclear, since its incidence varies in asphyxia, sepsis, prematurity, and comorbidity, and depends on the level of development and funding of health care in different countries. Sepsis and acute respiratory distress syndrome prevail among the causes of MOF in this category of patients.

Aim of the review. To summarize the available literature data on the pathogenesis, therapeutic strategies and outcomes of MOF in newborns.

Material and methods. We searched PubMed, Scopus, Web of Science, and RSCI databases using the following keywords: «newborns, multiple organ failure, etiology, pathogenesis, premature, diagnosis, treatment, respiratory support, cardiotonic support», without language limitations. A total of 144 full-text sources were selected for analysis, 70% of which were published in the last five years and 50% were published in the last three years. Criteria for exclusion were low information value and outdated data.

Results. The prevalence of MOF in neonates is currently unclear. This could be due to common association of neonatal MOF (as well as the adult one) with various diseases; thus, its incidence is not the same for asphyxia, sepsis, prematurity, and comorbidities. There is no precise data on neonatal mortality in MOF, but according to some reports, it may be as high as 13-50%.

In newborns, MOF can be caused by two major causes, intrapartum/postnatal asphyxia and sepsis, but could also be influenced by other intranatal factors such as intrauterine infections and acute interruption of placental blood flow.

The key element in the pathogenesis of neonate MOF is cytokinemia, which triggers universal critical pathways. Attempts to identify different clinical trajectories of critical illness in various categories of patients have led to the discovery of MOF phenotypes with specific patterns of systemic inflammatory response. This scientific trend is very promising for the creation of new classes of drugs and individual therapeutic pathways in neonates with MOF of various etiologies.

The pSOFA scale is used to predict the outcome of neonatal MOF, however, the nSOFA scale has higher validity in premature infants with low birth weight.

Central nervous system damage is the major MOF-associated adverse outcome in newborns, with gestational age and the timing of treatment initiation being key factors affecting risk of MOF development in both full-term and premature infants.

Conclusion. The study of cellular messengers of inflammation, MOF phenotypes, mitochondrial insufficiency, and immunity in critically ill infants with MOF of various etiologies is a promising area of research. The pSOFA scale is suggested for predicting the outcome of MOF in full-term infants, while the nSOFA scale should be used in premature infants with low birth weight.

End-expiratory pressure remains one of the few parameters of mechanical respiratory support whose values have not been strictly regulated using the evidence-based approach. The absence of «gold standard» for end-expiratory pressure optimization together with its obvious significant contribution to the efficiency and safety of respiratory support has driven the search for the optimal method of choosing its values for several decades.

Aim of the review: to identify the optimal methods for determining the values of end-expiratory pressure based on the analysis of its positive and negative effects in the used strategies of mechanical respiratory support.

Material and methods. We analyzed 165 papers from the PubMed, Scopus, and RSCI databases of medical and biological publications. Among them we selected 86 sources that most completely covered the following subjects: respiratory support, end-expiratory pressure, recruitment, ventilation-perfusion relationships, metabolography, and gas analysis.

Results. We outlined the main positive and negative effects of the end-expiratory pressure with regard to both lung biomechanical characteristics and pulmonary perfusion. The evolution of views on the methods of determining optimal values of the end-expiratory pressure was reviewed with the emphasis on a certain «fixation» of the scientific community in recent decades concerning the opening of the alveoli. The promising techniques based on the analysis of the diffusion capacity of the lungs were presented.

Conclusion. Focusing on mechanical lung opening prevents the scientific community from advancing in the optimization of the end-expiratory pressure. Dynamic assessment of pulmonary diffusion efficiency provides a new perspective on the issue, offering additional ways to the development of «gold standard».

We present a case of mechanical hemolysis as a complication of extracorporeal membrane oxygenation (ECMO) occurring in a COVID-19 patient as a result of pump head thrombosis. After emergency extracorporeal circuit replacement, hemoadsorption was initiated to address the negative hemolysis effects and plasma free hemoglobin rise in the setting of rapid clinical deterioration and impaired renal function. During therapy hemolysis severity reduced, the lactate dehydrogenase (LDH) levels decreased, while the P/F ratio increased two-fold. The patient was discharged from hospital on day 54 without the need for either oxygen therapy or dialysis. In the discussion section we addressed frequent issues of choosing therapy for ECMO complications.

Conclusion. The timely, properly chosen, and clinically relevant use of hemoadsorption combined with advanced high-technology therapeutic procedures can have a positive impact on the patient's outcome.

Aim of the study: to develop an additional professional competence «Emergency care in cardiac arrest» and to evaluate a set of tools for its development among the graduating students majoring in general medicine (code 31.05.01).

Material and methods. The study was done in two stages. During the first stage, within the framework of PC (professional competence)-11 «Readiness to participate in providing first medical aid in conditions requiring urgent medical intervention» an additional professional competence «Emergency care in cardiac arrest» was developed with the definition of performance assessment. During the second one, the scientific research was conducted at the medical institute of the Immanuel Kant Baltic Federal University during the study of Anesthesiology, resuscitation, and intensive care, which has been included in the block 1 discipline (module) list, being a basic part of the General Medicine curriculum (code 31.05.01). The study involved 140 six-year students majoring in general medicine (code 31.05.01). The students were divided into two groups. The main group included 80 students who studied in 2021 (average age 25±1.5 years), while the control group comprised 60 participants who studied in 2019 (average age 25.9±1.6 years, retrospective analysis).

Results. An additional professional competence «Emergency care in cardiac arrest» and its stratified structure have been developed. Specific elements were elaborated for each component stratum. Based on the developed elements, which were mastered by the student in the process of training, the necessary competence was developed. The novel pedagogical technologies in the curriculum contributed to more effective learning and development of the competence. The levels of development of additional professional competence «Emergency care in cardiac arrest» differed between the groups. Most students in the control group had a threshold level of competence. The basic and advanced levels of competence were significantly higher among the students in the main group compared with the control group (P<0.05).

Conclusion. We have shown the necessity of developing an additional professional competence «Emergency treatment in case of cardiac arrest» within the «Readiness to participate in providing first medical aid in conditions requiring urgent medical intervention» PC-11. We have successfully implemented and validated in practice the system of development of additional professional competence using pedagogical innovations, including those based on advanced information and communication technologies.