The aim of the study. To evaluate the effectiveness of multimodal selective lipopolysaccharide (LPS) hemoadsorption in combination with renal replacement therapy (RRT) in patients with gram-negative sepsis or septic shock.
Materials and methods. The study included 39 patients. In the main prospective group, patients received extracorporeal therapy in addition to standard of care (ET group, n = 10). In the retrospective comparison group, patients received only standard therapy (ST group, n = 29).
Results. In the ET group, the average SOFA score decreased by 3.4 [95% CI: 0.8; 5.2] scores after 72 hours of treatment, while in the ST group, the average SOFA value increased by 1.7 [95% CI: 0; 3.4] scores over the same period, p_adj = 0.002. Hospital mortality was 1/10 (10%) in the ET group and 19/29 (66%) in the ST group, and OR = 0.06 [95% CI: 0.01; 0.4] p = 0.003. The analysis, including consideration of severity of the condition at a baseline as a potential confounding factor, confirmed the robustness of the results: statistically significant differences in SOFA dynamics and mortality remained.
Conclusion. The use of selective hemoadsorption in combination with renal replacement therapy reduces the severity of organ dysfunction and mortality in patients with sepsis or septic shock.

The aim of this study was to investigate pharmacokinetics of polymyxin B (PMB) in patients with sepsis and preserved or impaired renal function.
Methods. A two-center, prospective, randomized study enrolled patients with sepsis. Blood samples for analysis were collected in a steady state (SS) to assess the pharmacokinetics of PMB. PMB concentration in the patients' serum was measured using a direct competitive ELISA to verify the achievement of target area under the concentration-time curve (AUC₂₄) value of 50–100 mg×h/L.
Results. The study included 34 patients with sepsis receiving PMB therapy who were distributed into two groups based on their glomerular filtration rate (GFR): patients with impaired renal function (GFR  80 mL/min, n = 17), and with preserved renal function (GFR  80 mL/min, n = 17). The mean AUC₂₄ value in 34 patients was 64.02 ± 11.64 mg×h/L, the median volume of distribution was 31.53 (23.79–43.72), and the median clearance was 3.72 (2.73–4.85). In patients with preserved renal function, the median AUC₂₄ was 48.38 mg×h/L, and the SS concentration was 2.02 mg/mL. In patients with impaired renal function, the AUC₂₄ was 71.78 mg×h/L, and the SS concentration was 2.99 mg/mL. The clearance of PMB differed considerably depending on GFR: the median clearance in patients with GFR  80 mL/min was 3.28 L/h versus 4.97 L/h in patients with GFR > 80 mL/min (p = 0.012). In 14 of 17 patients with reduced renal function, the AUC₂₄ values fell in the range of 50–100 mg×h/L. In the group with preserved and increased renal function, only 7 of 17 patients reached the target range, and in 53% of patients (9 of 17), the exposure to PMB was below the therapeutic level (AUC₂₄  50 mg×h/L).
Conclusion. Renal function affects the clearance of PMB and, consequently, the achievement of the target therapeutic range. Standard dosing regimens do not provide achieving the target concentrations of antibiotic in all patients, as some patients with preserved renal function have insufficient PMB exposure, while patients with impaired renal function have enhanced exposure, increasing the risk of drug failure or toxicity. To ensure the effectiveness and safety of treatment, regular therapeutic PMB concentrations monitoring and individual dose adjustments are necessary, especially in patients with altered renal function.

The aim of the study was to determine the contribution of cellular immune system parameters and the AQP4 (rs1058427) genetic polymorphism to the prognosis of course and outcome of patients with sequelae of severe brain injury (SBI), including patients who developed pneumonia.
Materials and Methods. The study included 464 intensive care unit (ICU) patients with prolonged or chronic critical illness (PCCI) admitted to the Federal Scientific and Clinical Center of Intensive Care Medicine and Rehabilitology (FSCCICMR) following SBI (strokes, traumatic brain and combined injuries, post-operative anoxic conditions, brain tumor surgery). Variants of the rs1058427 single-nucleotide polymorphism in the AQP4 gene were detected in DNA isolated from whole blood with organic solvents and using genotyping with tetraprimer PCR followed by electrophoretic identification of the products.
Results. The entire cohort was divided into three groups of patients: those admitted without signs of pneumonia in the first 48 hours of hospitalization but who developed nosocomial pneumonia after 48 hours (group 1); admitted without signs of pneumonia, in whom no signs of pneumonia were detected throughout the hospitalization (group 2); with pneumonia diagnosed upon admission, which developed in the previous medical institution prior to transferring to the FSCCICMR (group 3). For the cohort combining groups 1 and 2 (admitted without signs of pneumonia), increased values of the neutrophil-to-lymphocyte ratio (NLR) (OR = 1.8, 95% CI: 1.1–3.9, P = 0.0175, χ², N = 272) and neutrophil count (OR = 2.1, 95% CI: 1.3–3.5, P = 0.0038, χ², N = 272) on the first day of hospitalization were associated with an increased risk of pneumonia. In the same cohort, elevated neutrophil counts (over 6×10⁹/L) at admission significantly predicted adverse outcome, but only in the subgroup of patients with the AQP4 rs1058427 GG major genotype (95% CI: 1.0–4.5, HR = 2.1, P = 0.049, log-rank test). In group 3 (patients with pneumonia diagnosed upon admission), a significant association with adverse outcome was found for both neutrophils and NLR (HR = 3.1, 95% CI: 1.3–6.9, P = 0.019, log-rank test, N = 149, and HR = 2.9, 95% CI: 1.3–6.6, P = 0.026, log-rank test, N = 149, respectively) in patients with AQP4 GG genotype, not in alternative AQP4 allele T carriers. Thus, the prognostic value of elevated neutrophil counts in patients with PCCI («immunophenotype») depends significantly on the genetic polymorphism of AQP4, a gene that controls the initiation of immune cell migration and is pathogenically significant for the development of the infectious process.
Conclusion. For patients with consequences of SBI in PCCI, an increase in neutrophil counts above 6×10⁹/L upon hospitalization significantly predicts an adverse outcome only in patients homozygous for the AQP4 rs1058427 G allele (GG genotype). The unique genetically restricted clinical and laboratory phenotype («gene-immunophenotype») could be considered in personalized critical care medicine as an example of a candidate predicting paradigm.

Protein-energy malnutrition (PEM) remains one of the most pressing issues in patients with severe traumatic brain injury in intensive care units (ICUs), as it is highly prevalent, difficult to manage, and its causes are not fully understood.
The aim of the study was to assess the influence of gut microbial imbalance and gastrointestinal motility on the development of malnutrition in patients in a chronic critical state and severe brain damage.
Materials and methods. A single-center prospective observational study included 31 patients (median age 52 years; 68% males) aged 18–74 years with traumatic brain injury or stroke requiring ICU stay for more than 5 days and enteral tube feeding. Patients with diabetes mellitus, acute multiple organ failure (MOF), shock, implanted devices, or tracheoesophageal fistula were excluded. Nutritional status was assessed at baseline and on Day 20 using the Russian malnutrition scale and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Additionally, clinical outcomes, anthropometric data, gastrointestinal biomarkers, gut microbiota composition, electrogastroenterography (EGEG) and functional scales parameters were recorded.
Results. Moderate and severe malnutrition according to the GLIM criteria was found at baseline in 29.1% of patients, and in 27.7% of patients on Day 20 (p = 0.9), while according to the Russian scale these numbers were 61.3% and 78.6%, respectively (p = 0.8). Dynamics of clinical scales, functional indicators, and gastrointestinal biomarkers during the follow-up revealed no clinically significant changes. Significant and persistent deviations 2 from reference values in gut microbiota composition (decrease in the content of E. coli, p = 0.026; increase in Enterobacter spp., p = 0.020) and EGEG parameters were recorded at both evaluation time-points. Identified PEM was also associated with impaired gastrointestinal motility.
Conclusion. The data indicate a statistically significant relationship between PEM, changes in the gut microbiota and gastrointestinal motility, which confirms the important role of these factors in PEM pathogenesis in patients with severe brain damage in a chronic critical state.

Many cardiac diseases are associated with an excessive accumulation of myofibroblasts, characterized by increased production of extracellular matrix proteins and resistance to apoptosis, which leads to progression of fibrosis and cardiac dysfunction. Targeting the mechanisms of myofibroblast elimination is a promising strategy for treating fibrosis that requires further investigation.
The aim of this work was to determine the ability of the autophagy activator rapamycin to affect the staurosporin-induced death of cardiac myofibroblasts.
Materials and methods. In vivo modeling of cardiac fibrosis was performed using a mouse model of aortic arch ligation. In vitro studies used myofibroblasts obtained by differentiation of cardiac fibroblasts in presence of transforming growth factor beta 1 (TGFb1). To study the mechanism of myofibroblasts elimination, a cell model was developed using staurosporine, an alkaloid that can initiate apoptosis in a culture of cardiac myofibroblasts. The activity of apoptosis and autophagy was studied using immunofluorescence staining, immunoblotting, and flow cytometry.
Results. It was shown that pressure-induced cardiac overload causes the accumulation of myofibroblasts characterized by a low rate of apoptosis (annexin V+ cells in sham-operated hearts and after modeling pressure overload (0.0016 ± 0.0006% and 0.0019 ± 0.0009%; p = 0.32, n = 10), leading to marked interstitial fibrosis in the myocardium. It was found that rapamycin is able to enhance the effect of staurosporin and cause increased myofibroblast death due to autophagy-associated mechanisms (control 1.68 ± 0.66% (n = 4); staurosporin 65.8 ± 2.63% (n = 4); rapamycin + staurosporin 73.73 ± 0.67% (n = 4); control vs staurosporin p 0.0001; control vs rapamycin + staurosporin p 0.0001; staurosporin vs rapamycin + staurosporin p = 0.0071).
Conclusion. Rapamycin enhanced myofibroblast apoptosis induced by staurosporine, which may be related to regulation of the mTOR signaling and increased autophagy activity. The molecular mechanisms of this process require further research.

Objective. To evaluate clinical characteristics and results of individualized medical rehabilitation in children with brain tumors, including those with tracheostomy and/or gastrostomy, upon recovery from a state of minimal consciousness.
Materials and methods. A prospective observational study included 309 patients aged 6 to 17 years who completed treatment for central nervous system (CNS) tumors during 2019–024 yy. at the «Russkoye Pole» medical rehabilitation research center of the Dmitry Rogachev National medical research center for pediatric hematology, oncology, and immunology, Russian Ministry of Health. All patients underwent a comprehensive assessment of treatment effects, including clinical and functional examination, testing of cognitive and emotional functions, and individualized medical rehabilitation. A subgroup of subjects in a state of minimal consciousness with tracheostomy and/or gastrostomy included 9 patients (2.9%). Rehabilitation goals were set based on the domains of the International Classification of Functioning, Disability and Health (ICF), according to an interdisciplinary approach.
Results. Severe neurological deficit as the sequelae of cancer treatment toxicity was documented in 90% of children with CNS tumors. However, all 309 patients achieved the goals of specialized medical programs within 14–21 days. Patients in a state of minimal consciousness most often had impaired breathing, swallowing, eating, communication, and emotional regulation, endangering with life-threatening complications. Adhering to the protocols adapted for management of such patients helped minimize the risk of life-threatening complications. No serious complications were recorded in any patient during the rehabilitation process.
Conclusion. Even in cases of severe functional impairment, including patients requiring tracheostomy and gastrostomy, an individualized medical rehabilitation approach allows for stabilization of patient's condition, upregulation of basic vital functions, and improvement quality of life of patients and their families. Restoring cognitive and sensorimotor functions in children in a state of minimal consciousness requires early initiation of rehabilitation measures by a multidisciplinary team, including a resuscitator, pediatrician, physical therapist, speech therapist, medical psychologist, etc.

Objective: to evaluate the effects of correcting metabolic disorders in the post-resuscitation period in a clinical case report.
Materials and methods. Management and dynamic monitoring of acute poisoning in a 29-year-old patient after concomitant use of methadone and cocaine complicated by cardiac arrest and prehospital biochemical and acid-base balance alterations.
Results. The bradypneic and comatose patient developing out-of-hospital cardiac arrest (OHCA) was hospitalized after effective resuscitation by emergency team. Comprehensive lab examination revealed the presence of methadone and cocaine, decompensated metabolic lactic acidosis and hyperkalemia. Patient’s condition improved after intense correction of metabolic alterations with sodium hydrocarbonate, a glucose-insulin mixture, and a pharmaceutical containing inosine + nicotinamide + riboflavin + succinate. A positive trend including recovered consciousness, switch from ventilator support to spontaneous breathing, and stable hemodynamics was documented after 3 days of treatment. However, emerging complications such as hospital-acquired pneumonia and acute kidney injury had to be managed. The patient improved significantly by the 17th day of treatment, and was discharged on day 21.
Conclusion. Intensive care to promptly address decompensated metabolic lactic acidosis (sodium hydrocarbonate, a multi-component drug containing inosine + nicotinamide + riboflavin + succinate) and hyperkalemia (glucose-insulin solution), reduced the severity of metabolic alterations after cardiac arrest due to acute methadone and cocaine poisoning, favoring patient’s outcome.

There is a general agreement on the need to analyze critical incidents in the operating room (OR) in order to develop effective ways to predict associated fatal consequences, as well as to develop decision support cognitive tools that can be used in both routine and crisis situations.
Research objective. Developing and testing of a confidential questionnaire on perioperative critical incidents by anaesthesiologists and other intensivists, assessment of the initial results of the tool application including its possible relevance to further implementation in the Russian Federation health care
Materials and methods. The survey was conducted by anonymous questioning among doctors of large hospitals in St. Petersburg from 01.06.2024 to 31.12.2024 using an on-line form.
Results. Of the 32 questionnaires received, 27 (84.4%) were completed and contained complete information, which was systematized and analyzed. Respondents reported most often on critical incidents in male patients (15 patients, 55.6%), and in the age group of 45–59 years (8 cases, 29.6%). Most of the incidents occurred during minimally invasive video assisted surgery (18 cases, 66.7%). In 14 cases (51.8%), critical incidents were related to human error, and in 9 (33.3%) cases, they were related to unexpected complications in the perioperative period. Most of the respondents (20 out of 27, 74.1%) noted that the incidents could have been prevented with more accurate anesthesia monitoring and relying on more sophisticated and performant anesthetic equipment in the Intensive Care Unit. Doctors positively evaluated the trial version of the anonymous questionnaire (22 out of 27, 81.5%), noting its simplicity and usefulness in identifying problems. Several respondents suggested adding open-ended questions to provide a more detailed description of the incidents.
Conclusion. The study confirmed the usefulness of designing and implementing a national questionnaire on perioperative critical incidents in Russia. The data obtained demonstrate that such a tool, combined with improving the staff training, equipment upgrade, and standardization of protocols, can significantly contribute to enhancing patient safety in anesthesia. Ensuring the confidentiality of the provided data is crucial for obtaining statistically significant information. The development, implementation, and expansion of the proposed tool's database under the auspices of the Federation of Anesthesiologists and Resuscitation Specialists on a regular basis will undoubtedly contribute to improving the quality and safety of anesthesiology and resuscitation services in Russia.
Highlights
— 76.5% of respondents believe that incidents can be prevented by improving anesthesia control and OR anesthetic equipment.
— 81.5% of the surveyed specialists positively assessed the need for implementing the questionnaire, as well as its simplicity and anonymity.

The COVID-19 pandemic has posed an unprecedented challenge to healthcare systems around the world. The mass influx of patients with severe hypoxemic respiratory failure, often progressing to acute respiratory distress syndrome (ARDS), has led to an acute shortage of beds in intensive care units (ICUs).
The aim of the study was to evaluate the effectiveness of an organizational model for the care of patients with severe COVID-19 pneumonia, including the creation of intensive observation wards (IOWs) for non-invasive respiratory support outside the ICU, and to develop a prognostic model for the risk of transferring patients to invasive mechanical ventilation (IMV) or non-invasive mechanical ventilation (NIMV).
Materials and methods. A retrospective observational study was conducted at the V. P. Demikhov city clinical hospital of the Voronovskoye Moscow clinical center for infectious diseases from January to December 2021. We analyzed data from 950 patients with confirmed COVID-19 and hypoxemic respiratory failure who started anhigh-flow oxygen therapy (HFOT) in the IOW. The demographic structure, premorbid background, clinical and laboratory parameters, and respiratory and anti-inflammatory therapy regimens (glucocorticoids — GCS: dexamethasone or methylprednisolone, and/or monoclonal antibodies — MAbs) were studied. For 573 patients transferred from the IOW to the ICU, we assessed outcomes and risk factors for the need for NIMV/IMV using binary logistic regression.
Results. Of the 950 patients who started HFOT in the IOW, 573 (60.3%) were transferred to the ICU for escalation of respiratory support. The mortality rate in the ICU group was 25.7% (147 of 573 patients hospitalized in the ICU). When comparing GCS regimens with or without MAbs, the mortality rate in patients receiving methylprednisolone in any treatment regimen was lower than in patients receiving dexamethasone: 14.1% vs. 25.8% (with MAbs, p 0.001) and 15.3% vs. 37.4% (GCS only, p 0.001). According to the logistic regression model, predictors of increased risk for the need for NIMV/IMV were: older age (OR   1.014 for each year [1.024; 1.058], presence of diabetes mellitus (OR   1.530 [1.038; 2.2123]), and a higher NEWS score upon transfer to the ICU (OR   1.342 for each score [1.153;1.562]). The use of methylprednisolone compared to dexamethasone was associated with a reduced risk of requiring NIMV/IMV (OR = 0.346 [0.238; 0.503]).
Conclusion. The organization of IOW for the implementation of HFOT according to a strict protocol made it possible to provide assistance to a large number of patients in conditions of ICU resource shortages. The use of methylprednisolone was associated with lower mortality in the ICU compared to dexamethasone. The developed prognostic model may be useful for stratifying the risks of escalating respiratory support methods and making timely decisions to transfer patients to non-invasive/invasive mechanical ventilation.

Pain remains a major clinical challenge in the intensive care unit (ICU), especially in sedated, mechanically ventilated, or curarized patients due to their inability to self-report and the limited accuracy of behavioral tools. Therefore, innovative approaches must be developed. In this scenario, objective and observer-independent pain assessment can support and improve personalized analgesic management.
The aim of this review is to analyze the current artificial intelligence (AI) applications for automatic pain assessment (APA) in the ICU, focusing on the integration of biosignals, behavioral indicators, and multimodal data to detect nociceptive responses.
A systematic search was conducted in PubMed, Web of Science, and IEEE Xplore databases (2015–2025) using the terms pain assessment, critical care, artificial intelligence, machine learning, facial expression, pupillometry, heart rate variability, and nociception monitor. The scientific output was grouped into three main domains: behavioral and computer-vision methods, autonomic and electrophysiological indices, and multimodal and AI-driven integrated systems.
Conclusion. Although AI systems for APA in the ICU show promising performance, several challenges limit their clinical translation. Signal variability due to pharmacological, neurological, or hemodynamic factors may compromise model reliability. Moreover, the scarcity of labeled ICU datasets can affect generalizability. Ethical, regulatory, and interoperability issues should be addressed. Therefore, for routine implementation, large-scale validation across diverse ICU populations is required to confirm reliability, ensure fairness, and establish clinical utility.