The aim of the study was to evaluate the usefulness and safety of sevoflurane in patients in the acute phase of severe traumatic brain injury (TBI).

Materials and methods. A prospective, randomized, pilot clinical trial was conducted at the Sklifosovsky Research Institute for Emergency Medicine (Moscow) in adults with acute severe TBI, aged 18 years and older, undergoing intensive intracranial pressure (ICP)-guided therapy. To achieve the desired sedative effect, the inhaled anesthetic sevoflurane was administered in the main group, and standard doses of intravenous propofol were administered in the control group. ICP and cerebral oxygen extraction fraction (OEF) were monitored in all patients. Hemodynamic and respiratory support parameters, transcranial Doppler ultrasound scan, brain bioelectrical activity, brain CT scan, laboratory parameters, markers of inflammation, patients' need for sedation and mechanical ventilation, and length of ICU stay were also evaluated.

Results. The use of inhalation sedation contributed to the reduction of ICP on day 2 (9.5 mmHg in the sevoflurane group and 17.3 mmHg in the propofol group, P=0.003) and day 3 (10 mmHg and 14.2 mmHg, respectively, P=0.005). BIS monitoring showed no significant difference in depth of sedation between groups on day 2 (60 vs. 48.5, P=0.070) and day 3 (61 vs. 46, P=0.095). Inhalation sedation reduced cerebral OEF on the injury side compared to propofol on day 2 (23.3 vs. 30.2%, P=0.006) and day 3 (22.7 vs. 31.2%, P<0.001). After 24 hours of sedation therapy, there was a significant difference in P/F (PaO₂/FiO₂) ratios between the groups. On days 1, 3, and 7, the sevoflurane group had P/F ratios of 340, 324, and 323 mmHg, while the propofol group had significantly lower ratios of 271, 278, and 275 mmHg (P<0.001). Pneumonia was documented in 9 cases in the sevoflurane group vs. 18 cases in the propofol group (P=0.028), and a similar trend was observed in the total number of infectious complications: 13 vs. 21 cases, respectively (P=0.046).

Conclusion. Sevoflurane in the acute phase of severe TBI was not only safe, but also improved several vital functions, including ICP, blood pressure, P/F ratio, and also slowed brain metabolism via reduced oxygen consumption without affecting the depth of sedation according to BIS monitoring data. All of the above suggests that inhalation sedation may improve the prognosis for patient recovery. However, multicenter randomized clinical trials are needed to identify and verify all positive and negative effects of inhalation sedation in this patient  population.

The aim of the study was to identify factors associated with hospital mortality in patients with COVID-19associated acute respiratory distress syndrome (ARDS) receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO).

Materials and methods. The retrospective study included data from the medical records of 123 patients treated in the intensive care unit (ICU) № 7 of the City Clinical Hospital № 52 of Moscow Department of Health. ECMO was initiated in all patients for respiratory indications according to current recommendations. A number of factors potentially associated with mortality were systematized and analyzed. Statistical processing to identify predictors of death included univariate analysis and calculation of odds ratio (OR), ROC analysis with calculation of area under the ROC curve (AUROC).

Results. The resulting mortality rate was 87% (107/123), 11% (14/107) of all deaths occurred after weaning from ECMO. High VV-ECMO flow, delayed initiation of mechanical ventilation and ECMO therapy, and low pH at the time of ECMO initiation were identified as independent predictors of death in the study group. Low median albumin concentration and prolonged use of vasopressors were identified as predictors of death within 28 days of initiation of VV-ECMO. Development of acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT), septic shock and its recurrences, and the use of extracorporeal blood purification therapy for septic shock were found to be predictors of death during VV-ECMO therapy.

Conclusion. High-flow VV-ECMO regimen, delayed initiation of mechanical ventilation and ECMO support, hypoalbuminemia, prolonged need for norepinephrine infusion, development of AKI requiring CRRT, septic shock occurrence and the number of its recurrences requiring extracorporeal blood purification therapy during VV-ECMO support were identified as predictors of death in patients with COVID-19-associated ARDS after initiation of VV-ECMO therapy.

The aim of the study was to evaluate the effect of cytokine hemoadsorption on clinical manifestations and laboratory parameters in patients with severe acute pancreatitis (SAP).

Materials and methods. The single-center, observational, controlled pilot study included 34 patients, 25 men (73.4%) and 9 women (26.4%), treated for severe acute pancreatitis (SAP) at the N. V. Sklifosovsky Emergency Care Research Institute from May 2022 to August 2023 (ClinicalTrials.gov ID NCT05695001). The mean age of the patients was 42.7±12.6 years. Participants were divided into two groups. In the main group (8 men and 1 woman], mean age 37.2±9.4 years), standard care was supplemented by selective cytokine hemoadsorption (SCH) and renal replacement therapy (RRT) using continuous veno-venous hemofiltration (CVVH) in the first 72 hours after the onset of abdominal pain syndrome (APS). In the control group (N=25, 18 men and 7 women], mean age 44.7±13.2 years), patients were managed similarly except for SCH.

Results. After 24 hours in the ICU, the study group had significantly lower levels of lactate (P=0.045) and IL-6 (P<0.001) than the control group. Lactate and IL-6 concentrations remained significantly different between groups at 72 hours (P<0.001 and P<0.05, respectively). ICU stay was significantly shorter in the study group, with a median of 6 days [95% CI, 4–25] before transfer to the general ward, whereas patients in the control group spent 37 days [95% CI, 22–73] in the ICU (P<0.001).

Conclusion. CVVH is an effective method of extracorporeal detoxification in the management of SAP, but it is less specific than cytokine adsorption in terms of elimination of proinflammatory markers. The data obtained provide sufficient evidence to consider the combination of these two modalities as the most effective approach for the management of SAP.

The aim of the study was to assess the effect of hemoadsorption with CytoSorb on the inflammatory response, respiratory failure, and mortality in patients with severe novel coronavirus infection.

Materials and methods. A retrospective single-center cohort comparative study of hemoadsorbtion using the CytoSorb therapy included data from 124 COVID-19 ICU patients. Patients were divided into two groups: the study arm with hemoadsorption (group 1, N=93) and the control arm without hemoadsorption (group 2, N=31). Patients in group 1 had more severe respiratory failure at baseline, but were otherwise comparable to patients in group 2 in terms of clinical and demographic parameters.

Results. After hemoadsorption, group 1 patients showed significant improvement in 9 of 13 monitored clinical, instrumental, and laboratory parameters: fever (P=0.005), lactate dehydrogenase (LDH) (P<0.001), C-reactive protein (CRP) (P<0.001), and IL-6 (P<0.001) levels, as well as an increase in SpO₂/FiO₂ ratio (P=0.041), leukocyte count (P<0.001) and lymphocyte count (P=0.003), as well as no significant changes in SOFA score (P=0.068). The only improvement seen in group 2 patients was a reduction in fever (P=0.003). Other significant changes in group 2 were unfavorable, such as a decrease in SpO₂/FiO₂ ratio (P=0.002), an increase in inspiratory oxygen fraction FiO₂ (P=0.001), leukocyte count (P<0.05), LDH (P=0.038), procalcitonin (P<0.001), and IL-6 (P=0.005), as well as an increase in SOFA score from 3.0 to 7.0 (95%CI, 3.0–9.0) (P=0.001). The all-cause hospital mortality rate was 37,63% in group 1 and 74.20% in group 2.

Conclusion. The use of hemoadsorption with CytoSorb as a pathogenetic therapy targeting the hyperinflammatory response in the management algorithm of ICU patients with severe COVID-19 complications resulted in resolution of the inflammatory response and respiratory failure, as well as a significant reduction in mortality.

Respiratory infection is the most common nosocomial infection found in intensive care units (ICUs). Dental plaques and oral mucosa can be colonized by respiratory pathogens within a few days after tracheal intubation. Oral care plays an important role in reducing the incidence of ventilator-associated infections.

Aim of the study. To evaluate clinical effectiveness of the original oral care protocol in ICU patients on invasive mechanical ventilation (IMV).

Materials and Methods. A multicenter, open-label, randomized, prospective, controlled study was conducted in 55 surgical ICU patients on long-term mechanical ventilation. Oral care for patients in the study group (group 1, N=30) included brushing with disposable toothbrushes and rinsing with an aqueous solution of 0.05% chlorhexidine digluconate three times daily. In the control group (group 2, N=25), patients' oral care was performed twice a day using sterile cotton swabs soaked in 0.05% aqueous chlorhexidine digluconate solution. The results were statistically processed using IBM SPSS Statistics 21. The relative risk (RR) of events was calculated with a 95% confidence interval (95% CI). The 95% CIs for event density parameters such as incidence rate (IR) and incidence rate ratio (IRR) were calculated using the exact Poisson test.

Results. The incidence of ventilator-associated pneumonia (VAP) was 13.6 cases [95% CI: 4.4; 31.7] per 1,000 ventilation days in group 1 and 23.6 cases [95% CI: 7.7; 55] per 1,000 ventilation days in group 2. The incidence of VAP was 1.74 times lower [95% CI: 0.4, 7.54] in group 1 vs. group 2 (P=0.398). The identity of oral and tracheal flora on day 7 was 20% in group 1 and 50% in group 2, RR=0.4, 95% CI: 0.165–0.973, P=0.037. Serum C-reactive protein levels were significantly lower in group 1 on day 7 of ventilation compared to group 2 (P=0.04).

Conclusion. The original oral care protocol, based on toothbrushing 3 times daily with a set of disposable toothbrushes and 0.05% aqueous solution of chlorhexidine digluconate, is associated with a tendency to lower VAP incidence per 1000 days of ventilation, significantly lower similarity between oral and tracheal flora, and lower serum C-reactive protein levels on day 7 of IMV. Further research on various aspects of oral care in ICU patients is needed, especially in the absence of complete clinical guidelines and clearly effective strategies for the prevention of ventilator-associated infections.

While evaluating a new domestically produced pulse oximeter model in clinical practice, we discovered a lack of references in Russian-language publications on clinical trial methodologies to assess device reliability and performance.

The aim of the study is to create a methodology for conducting a multicenter, prospective, cohort, nonrandomized, controlled clinical trial evaluating a domestic pulse oximeter.

Methods. Measurements were performed on 20 preterm infants in the neonatal intensive care unit with a mean birth weight of 2340 [1250; 3125] g and a gestational age of 35 [30; 37] weeks using a new model pulse oximeter simultaneously with the reference monitor. Multiple oxygen saturation measurements of varying duration were taken alternately from the upper and lower limbs, and the number of false desaturation alarms was recorded. Pulse oximeter saturation data were evaluated for correlation with clinical findings.

Results. Attachment of sensors to the infant's feet was found to be optimal in terms of ease of use, minimal artifact generation, and minimal interference with routine medical procedures and neonatal care. To reduce motion-induced artifacts and false alarms, the optimal period of SpO₂ monitoring to detect desaturations and bradycardia was determined to be 120 min. Due to the high variability of pulse rate (PR) and saturation in neonates, two-second intervals were determined to be optimal for comparing records from the two monitors. Matching of ECG HR and pulse oximeter PR was required to eliminate artifacts. A mathematical software model required for accelerated analysis of data collected from all sensors during the study was approved.

Conclusion. The data analysis supported the proposed methodology for conducting a clinical trial to evaluate the performance and reliability of new pulse oximetry devices.