Material and methods. We examined 23 patients with chronic critical illness who were in a minimally conscious state (MCS) with 10.9±2.5 scores on the FOUR (Full Outline of Unresponsiveness) Score Coma Scale. Indicators of carbohydrate, lipid, protein and energy exchange metabolism were evaluated using specimens sampled in the morning hours. Nutritional support was provided by isocaloric isonitrogenic mixtures.

Results. Blood biochemistry showed decreases in total protein and albumin levels in 86.9% and 91.3% of patients, respectively. The tests also revealed decreased concentrations of several amino acids, including essential amino acids: histidine (38.3±13.07 µmol/l), methionine (12.68±3.81 µmol/l), threonine (61.6 [58.5;

87.7] µmol/l), tryptophan (33.06±15.95 µmol/l), and non-essential amino acids: arginine (40.50 [22.2; 46.9] µmol/l), glutamic acid (124.5±39.29 µmol/l), tyrosine (37.97±10.12 µmol/l). Some correlations between the concentrations of individual amino acids and other indicators were revealed, such as histidine and CRP (r=–0.68, P=0.043), tryptophan and CRP (r=–0.86, P=0.002), histidine and leukocyte count (r=–0.76, P=0.015), methionine and lysine (r=0.88, P=0.008), methionine and patient's weight (r=–0.68, P=0.042). A relationship between threonine concentration and the level of consciousness on the FOUR scale (r=–0.73, P=0.037) was also found. All patients demonstrated significant alterations of carbohydrate and lipid metabolism.

Conclusion. Alteration of adequate protein metabolism seems to be the most affected constituent in the nutritional status of patients with chronic critical illness. It is manifested by a decrease in the concentration of total protein and a number of essential and non-essential amino acids, which implies the importance of highprotein nutritional support and correction of the amino acid profile. 

The aim of the study was to develop a risk model for upper gastrointestinal tract (GIT) bleeding in patients with brain injury of various etiologies.

Material and methods. Case histories of 33 patients were included into a retrospective descriptive study: 22 patients had severe brain injury of various etiologies, and 11 patients after elective surgery for cerebral aneurisms with uneventful postop period were taken for comparison. The patients were grouped in two arms: Group 1 included patients with obvious signs of GIT bleeding (N=11) and Group 2 had no obvious signs of bleeding (N=22). Complaints, life and medical history, comorbidities, specialists’ exams data, results of laboratory and instrumental examinations, therapeutic regimens were analyzed. Presence of disproportionate pathologic sympathetic overreaction to acute brain injury, i.e., paroxysmal sympathetic hyperactivity (PSH), was assessed on admission and on Days 1, 3 and 5 after brain injury. 

Results. A model for upper GIT bleeding risk assessment was designed using logistic regression. The resulting model gains high quality rating: χ²=33,78, 3; p<0,001; OR=315. The risk of upper GIT bleeding exceeded 95% in patients having combination of 4 symptoms in their medical history (presence of PSH on Day 1 after acute brain injury; Karnofsky performance scale index 75; lack of neurovegetative stabilization in the acute period of brain injury; gastric and/or duodenal ulcer).

Conclusion. Determining the risk factors thresholds enables stratification of patients by the risk for upper GIT bleeding. Modification of the identified four risk factors (presence of PSH on Day 1after acute brain injury; Karnofsky performance scale index 75; lack of neurovegetative stabilization in the acute period of brain injury; gastric and/or duodenal ulcer) will probably reduce the occurrence of upper GIT bleeding in patients with acute brane injury of various etiology.

The history of the study of postoperative neurocognitive disorders (PND) looks as a long and thorny path of more than 400 years. Despite all accumulated data on PND risk factors and outcomes, there’s still no complete understanding of the etiology and pathogenesis of this complication. Moreover, current anesthesiologyresuscitation practice still faces challenges and has pending questions in diagnosis and classification of postoperative neurocognitive disorders.

The purpose of the review. To contemplate the evolution in the perceptions of the international medical community (IMC) regarding diagnostic approaches and algorithms in PND management. The review covers the history of development of such PND concepts as postoperative delirium, postoperative cognitive dysfunction, emergence agitation and emergence delirium. Also, the pre-existing and current international classifications of postoperative neurocognitive disorders are discussed in chronological order, supplemented by the analysis of their strengths and weaknesses. The paper also delves into current viewpoints concerning the etiology of particular postoperative neurocognitive disorders, and PND potential relevance for postoperative outcomes.

Conclusion. Current algorithms and modalities used for PND diagnosis, are novel but yet not ultimate for IMC in the context of continuous progress in medical practice. Early postoperative neurocognitive disorders remain the most poorly studied phenomena with no approved definitions and diagnostic modalities to identify. It is probably the time for IMC to undertake a joint effort to find answers to current unresolved questions regarding postoperative neurocognitive disorders.

Aim. To analyze the contribution of V. K. Kulagin, Doctor of Medical Sciences, Professor of the Department of Pathological Physiology of the Military Medical Academy into development of scientific perspectives concerning the etiology, pathogenesis and therapy of traumatic shock, following thorough analysis of 1950–1980s series of featured publications. We analyzed the general theoretical views of the scientist, his methodological preferences in organizing laboratory experiments, the methodology for developing standard models for conducting experiments, choosing indicators and evaluation criteria. We brought to recollection the proposed by V. K. Kulagin approach to traumatic shock staging and phases relative to the leading pathogenetic factor; highlighted some of the key topics and results of his experimental research related to individual resistance to shock, prerequisites of shock irreversibility and factors complicating the course of traumatic shock.

Conclusion. Theoretical and experimental inventions of V. K. Kulagin are relevant to the present day and are of great importance for further progress of medical science. 

The aim of the study. To evaluate effects of carboxyperitoneum and steep Trendenburg position on respiratory biomechanics and gas exchange indicators in patients with different body mass index (BMI) during robotic-assisted radical prostatectomy (RRP). To develop an algorithm for choosing the optimal mechanical lung ventilation (MLV) regimen. 

Materials and methods. The study included 141 patients with verified prostate cancer who were candidates for RPR. Participants were divided into 2 groups based on BMI: group I included 88 patients with BMI30 kg/m², group II — 53 patients with BMI30 kg/m². Indicators of respiratory biomechanics and gas exchange during ventilation in various modes (Volume Controlled Ventilation (VCV), Pressure Controlled Ventilation (PCV), Pressure Controlled– Inverse Ratio Ventilation (PC-IRV) were analyzed in each group at 5 consecutive stages of the procedure.

Results. The key parameters evidencing the effectiveness and safety of MLV during RRP procedure did not vary significantly under various ventilation regimens in the group of patients with a BMI30 kg/m². Whilst in obese patients the use of VCV mode resulted in a significant increase of airway peak pressure (P_peak) already at the stage of placing them into a steep Trendelenburg position (35°), thus endangering with the development of ventilator-induced lung injury. Increased Ppeak was also accompanied by the drop in oxygen saturation and significantly lower SpO₂ values, starting from the stage of applying carboxyperitoneum and until the end of surgical intervention.

Conclusion. In non-obese patients, there’s no particular ventilator regimen that is crucial for achieving the safety and effectiveness of RRP anesthesia management, all regimens can be used. In patients with BMI30 kg/m² PCV regimen and PC-IRV with inhalation/exhalation ratio of 1.5:1  can be considered as the optimal strategy for MLV during anesthesia for RRP surgery.