Aim: to determine the predictive value of selected routine clinical and laboratory parameters and to assess their prognostic significance for modeling mortality risk in intensive care unit (ICU) patients with SARS-CoV-2-associated pneumonia.

Materials and Methods. A retrospective case-control analysis of 73 medical records was performed. The control group included 20 records of surviving patients, while the primary group comprised 53 records of non-survivors treated between January and February 2022. The study parameters included leukocyte differential count, C-reactive protein (CRP), ferritin, blood oxygen saturation (SpO₂) via pulse oximetry, and the neutrophil ratio (NR) defined as the percentage of band neutrophils divided by the percentage of segmented neutrophils. The prognostic value of identified predictors was assessed using receiver operating characteristic (ROC) curve analysis. The area under the curve (AUC), 95% confidence interval (CI), sensitivity (Se), specificity (Sp), and cutoff point (CP) were determined, with CP defined as the predictor value yielding the highest sum of sensitivity and specificity.

Results. The most informative predictors of mortality in SARS-CoV-2-associated pneumonia were:

On the day of hospital admission: Ferritin levels (AUC=0.826; 95% CI: 0.717–0.905; P<0.001, CP≤0.473 mg/L; Se=78%; Sp=75%). On ICU day 1: Granulocyte count (GRA, AUC=0.711; 95% CI: 0.589–0.814; P<0.002, CP>6×10⁹/L; Se=94%; Sp=75%), NR (AUC=0.713; 95% CI: 0.541–0.850; P<0.016, CP>18; Se=91%; Sp=62%). On the final day in ICU: CRP (AUC=0.825; 95% CI: 0.522–0.973; P<0.013, CP>14 mg/L; Se=75%; Sp=100%); NR (AUC=0.862; 95% CI: 0.724–0.947; P<0.0001, CP>16; Se=94%; Sp=82%); SpO₂ (AUC=0.909; 95% CI: 0.819–0.963; P<0.0001, CP≤91%; Se=77%; Sp=100%); White blood cell count (WBC, AUC=0.833; 95% CI: 0.725–0.912; P<0.001, CP>12.2 × 10⁹/L; Se=80%; Sp=81%). Using a stepwise elimination approach, a mathematical model was proposed for predicting mortality probability (P) in SARS-CoV-2-associated pneumonia.

Conclusion. The most valuable prognostic model for predicting mortality risk is represented by the equation: P=1/(1+е^–Z)×100% using routine laboratory parameters such as ferritin, neutrophil ratio and blood oxygen saturation. The model showed a sensitivity of 84.0% and a specificity of 94.1%.

The study of predictors of adverse outcomes in liver failure is driven by the rapid increase in patients with obstructive jaundice (OJ) and the lack of standardized diagnostic criteria for assessing liver functional status.

Aim. To investigate the changes of liver injury biomarkers in liver failure associated with OJ.

Materials and Methods. A prospective observational cohort study was conducted on serum biomarkers of liver injury — L-FABP protein, 5'-nucleotidase, liver arginase, and hyaluronic acid — in patients with liver failure due to benign OJ. The study included 53 patients who underwent biliary decompression. Based on the course of disease, patients were divided into two groups: those with favorable outcomes (group 1, N=27) and those with unfavorable outcomes (group 2, N=26). A control group consisted of 25 healthy donors. Serum biomarker levels were assessed on admission and on days 3, 7 and 11 post-decompression. The study used enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using IBM SPSS Statistics 22, including Friedman two-way analysis, Kruskal–Wallis H test, Mann–Whitney U test, and two-sample Kolmogorov–Smirnov test, with significance set at P<0.05.

Results. At hospital admission, median biomarker levels were significantly higher in both patient groups than in the comparison group. Group 1 showed a statistically significant decrease in all biomarkers during treatment (P=0.01 for L-FABP, 5'-nucleotidase, liver arginase; P=0.03 for hyaluronic acid). In group 2, only L-FABP levels decreased significantly (P=0.04). Sensitivity and specificity for predicting disease outcome were 89.2–92.3% and 88.9–96.3% for L-FABP, 53.8–69.2% and 81.5–85.2% for 5'-nucleotidase, 57.7–76.9% and 77.8–88.9% for arginase, and 38.5–46.2% and 74.1–81.5% for hyaluronic acid, respectively.

Conclusion. Among the studied biomarkers, L-FABP showed the highest specificity and sensitivity values for prediction of outcome in liver failure associated with OJ, while other biomarkers demonstrated less significant results.

Poisoning is one of the most common causes for hospitalization of pediatric patients, often requiring admission to an intensive care unit (ICU).

Aim. To identify predictors of adverse outcomes in children with acute poisoning requiring ICU care.

Materials and Methods. A single-center, observational, retrospective study was conducted involving 262 children with severe poisoning. The median age was 15 [13-16] years. Patients were divided into two groups based on the clinical course of the poisoning: favorable and unfavorable. Hospitalization outcomes included duration of mechanical ventilation (MV), length of ICU stay, presence of complications (aspiration syndrome, seizures, etc.), and in-hospital mortality.

Results. The presence of toxic hepatitis/pancreatitis on admission increased the odds of adverse outcome by 4.63-fold, acute kidney injury by 5.32-fold, the need for MV by 14.34-fold, and aspiration pneumonia by 19.23-fold. The most significant markers of adverse outcomes during ICU care included shock (odds ratio OR=4.35), coagulopathy (OR=9.94), and hypocoagulation (OR=29.4). For assessing the severity of multiple organ dysfunction syndrome (MODS) in children with acute intoxication, the Marshall J. C. criteria showed the highest prognostic value (AUROC=0.894; sensitivity = 87.0%; specificity = 81.9%). A mathematical model was developed to predict the likelihood of adverse outcome in acute poisoning in children. The model includes 13 parameters: presence of pneumonia and seizures, need for MV, systolic and mean arterial pressure, catecholamine index, hemoglobin concentration, red and white blood cell counts, blood pH and glucose levels, SpO₂/FiO₂ ratio, and international normalized ratio (INR). The model demonstrated high predictive accuracy (accuracy=0.938; sensitivity=94.2%; specificity=92.5%; AUROC=0.981).

Conclusion. Impaired consciousness, severe hypoxemia, coagulopathy and acute liver failure are the main markers of severe acute poisoning in children.

Aim. To evaluate the efficacy of perioperative nitric oxide (NO) administration in reducing the incidence of acute kidney injury (AKI) during hemiarch surgery for nonsyndromic ascending aortic aneurysms under cardiopulmonary bypass and hypothermic circulatory arrest (HCA).

Materials and Methods. A single-blind, prospective, randomized, controlled study included 80 patients older than 18 years who underwent hemiarch aortic surgery with HCA for nonsyndromic ascending aortic aneurysms between 2020 and 2023. Patients were randomized (1:1) into two groups: the NO group (who received perioperative NO at 80 ppm) and the control group (who received standard perioperative management without NO administration). The primary endpoint was the incidence of AKI according to KDIGO criteria. Secondary endpoints included biomarker levels of subclinical renal injury and clinical outcomes.

Results. Postoperatively, the incidence of AKI was 25% in the NO group compared to 50% in the control group (OR=0.26; 95% CI: 0.10–0.69; P=0.036). Patients in the NO group had significantly lower levels of urinary neutrophil gelatinase-associated lipocalin (uNGAL, P=0.03) and cystatin C (P<0.001) 4 hours after surgery. In addition, the length of stay in the intensive care unit (ICU) was significantly shorter in the NO group (P=0.03) compared to the control group.

Conclusion. Perioperative NO therapy at 80 ppm during hemiarch aortic surgery with HCA reduces the incidence of acute kidney injury, lowers the levels of kidney injury biomarkers (uNGAL and cystatin C), and shortens the ICU stay.

Acute liver failure (ALF) is a rare pathologic syndrome in pediatric practice with a high risk of multiple organ failure and death. Despite extensive research on risk factors and clinical manifestations, there are no standardized critical care protocols for ALF in children and adolescents. Anesthesiologists and intensivists face significant challenges in the diagnosis and prevention of ALF.

The aim of this review is to analyze the main triggers, etiology, pathogenesis, clinical manifestations and both specific and supportive treatment approaches for ALF in pediatric intensive care units.

The Cochrane Library, PubMed, Medscape and Library.ru databases were used to conduct a systematic search and analysis of the scientific literature using the keywords «acute liver failure, children and adolescents, hepatic encephalopathy, cerebral edema, extracorporeal methods, liver transplantation». A total of 81 sources were selected for review. Inclusion criteria were studies that described the pathogenesis, clinical manifestations, diagnosis and treatment of ALF in the pediatric intensive care unit. Exclusion criteria were studies that focused on the diagnosis and treatment of ALF in adult patients.

This review summarizes the most common etiologic factors and clinical presentations of ALF based on the child's age, as well as the diagnostic tools used in the pediatric intensive care unit. It also focuses on the primary supportive and disease-specific management strategies for ALF in the ICU, taking into account the unique physiological characteristics of pediatric patients.

Conclusion. Infectious and idiopathic causes are the most common etiologies of ALF, leading to hyperammonemia, inflammatory response, and hepatocyte death. The primary clinical manifestations of ALF in children vary with age and include jaundice, abdominal pain, nausea, vomiting, and encephalopathy. Specific treatment in the intensive care unit focuses on correcting fluid and electrolyte imbalances, administering antibacterial therapy, and providing enteral nutrition. Supportive therapy is aimed at stabilizing vital organ function, implementing extracorporeal treatment methods, and performing liver transplantation when indicated.

Xenon is considered to be the safest general anesthetic agent with organ-protective properties. In subanesthetic doses, it is recognized as a promising therapeutic agent in various medical fields.

The aim of this review was to systematically summarize scientific data on the potential therapeutic use of xenon for organ system protection outside the context of anesthetic support during surgery and perioperative analgesia.

Publications were searched in the databases PubMed, Google Scholar, Cochrane Library, and eLIBRARY.RU from August to September 2024. A total of 33 publications on the clinical use of inhaled xenon for therapeutic purposes from 2002 to 2023 were selected, including 12 randomized controlled trials (RCTs), 8 prospective controlled studies, 2 prospective comparative studies, 6 prospective uncontrolled studies, and 2 clinical observations. An additional 32 publications were used to discuss various aspects related to the topic of the review.

Conclusion. The literature review showed that inhaled xenon at subanesthetic doses has potential neuroprotective, cardioprotective, and therapeutic effects for the treatment of addictive and neurotic disorders, as well as oncologic and pulmonary conditions. Despite some promising results, the number of RCTs remains limited, and the existing studies have methodological limitations, small sample sizes, and a high risk of systematic error. Definitive conclusions regarding the clinical efficacy and safety of inhaled xenon require further large-scale randomized trials.

The determination of brain death/death by neurological criteria (BD/DNC) is a critical medical and legal process. The Uniform Determination of Death Act (UDDA) provides a legal framework, yet significant state-by-state inconsistencies persist in its interpretation and implementation. These disparities create ethical concerns related to justice, patient autonomy, informed consent, and public trust in medical determinations of death.

This paper argues for urgently harmonizing BD/DNC criteria across the United States and globally to up-hold ethical medical practice, ensure consistency in end-of-life care, and preserve public confidence in the organ donation system.

Ethical considerations are examined, including fairness in healthcare access, respect for religious and cultural beliefs, and the implications for organ procurement policies. The call for national and international standardization aligns with bioethical principles and medical best practices, aiming to reinforce ethical and legal integrity in BD/DNC determination.