Postoperative ileus remains one of the main problems of surgical patients in the intensive care unit. Transformation of the microbiome into a pathobiome, failure of intestinal barrier function and immune function of microbiota leads to the development of systemic inflammation syndrome and multiple organ failure. Understanding the pathophysiological mechanisms of intestinal dysfunction and transformation of the microbiome into a pathobiome is necessary to conduct adequate intensive therapy and improve the prognosis of the disease in patients who have undergone surgical intervention.

The purpose of this work is to increase the alertness of doctors treating cancer patients due to the high risk of developing acute coronary syndrome (ACS) and understanding the pathogenetic mechanisms of the development of ACS. Antitumor therapy should be personalized and agreed upon by an interdisciplinary team with an assessment of the impact on the risk of developing ACS, especially in patients with high cardiovascular risk. Given the limited number of studies, principles for the management of cancer patients with ACS should be based on an assessment of ischemic and hemorrhagic risks.

All over the world, special attention is paid to cardiovascular diseases in patients. According to epidemiological studies, a large contribution to mortality from them is high blood pressure, effective normalization of blood pressure will lead to an increase in life expectancy. The purpose of the study: to study the features of the daily blood pressure profile in elderly patients with hypertension. It was revealed that hypertension in elderly patients is more severe and has significantly higher rates of rise in systolic and diastolic pressure during the day and night hours, high variability, and insufficient (non-dipper) night-time decrease in blood pressure.
Therefore, sick groups have a high risk of developing target organ damage, which is a predictor of the development of cardiovascular complications.

The article presents the results of a sociological study conducted at the Penza Institute for Advanced Medical Studies with the aim of studying the level of knowledge of endoscopists about the quality criteria for performing endoscopic examinations and equipping endoscopic rooms with specialized equipment. The questionnaires of 47 endoscopists who were trained at the Department of Surgery and Endoscopy were analyzed. 57 % of respondents are aware of the need to comply with quality criteria in endoscopy; all doctors take informed voluntary consent from the patient before the study; when formulating a conclusion, 15 % use validated international classifications; the detection rate of adenomas during colonoscopy is calculated to be 2 %; 21 % perform photo documentation; 6 % comply with biopsy protocols. This is largely due to the incomplete technical equipment of endoscopy rooms: only 17 % of doctors described the number of biopsy forceps as sufficient (20 or more), 43 % of doctors note the presence of video endoscopic equipment at the workplace, however, the condition of endoscopes in most budgetary medical institutions is satisfactory, closer to bad.

This article presents the Moscow Botkin Hospital experience of using combination of general and superficial cervical plexus regional anesthesia during carotid endarterectomy performed in patients in the acute period of atherothrombotic genesis ischemic stroke. The result of reliable antinociceptive protection of the body from the activation of the sympatho-adrenal system against the background of surgical manipulations was the prevention of episodes of critical hypertension and ensuring normalization of systemic hemodynamics. By reducing the need for opioids, patients’ awakening is accelerated, and their time in the operating room is minimized. In addition, the time of necessary observation in the intensive care unit and the need for anesthesia at the immediate postoperative period, is also reduced. The above factors, as well as a multidisciplinary approach to the patient, allowed not only to provide reliable prevention of recurrent vascular incidents in the acute period of ischemic stroke, but also to improve the neurological outcomes.

With the development of clinical pathophysiology, the basic concepts of maintaining fluid homeostasis of the body in normal and critical conditions were revised, and the negative effects of infusion therapy at all stages of its use were studied. Therefore, in the intensive care of shock, the main clinical questions are: when to start fluid therapy, when to stop active fluid therapy, when to start fluid removal from the body, and when to stop fluid de-resuscitation. Thus, in order to implement the principle of personalized treatment, it is important to determine not only the ‘tolerance’ of infusion therapy, but also the ‘sensitivity’ to the infusion of a particular patient – the ability to maintain hemodynamics without the risk of fluid overload. Evaluation of routine clinical, instrumental and laboratory indicators of the state of macro- and microcirculation does not provide an opportunity to accurately answer these questions. Modern sonographic methods for monitoring central and peripheral cardiohemodynamics, ‘venous excess’ using Doppler and extended focus echocardiography allow us to assess the ‘tolerance of infusion therapy’. The implementation of this new direction will increase the efficiency and safety of infusion therapy and improve the outcomes of the critically ill patients’ treatment.

The urgent nature of the surgical disease causes a high incidence of infectious complications. Surgical site infections account for 20% of all nosocomial infections and contribute to dramatically increased costs and higher readmission rates. About 38% of deaths in this category of patients are associated with infection.
Goal of the work. To identify possible risk factors in emergency abdominal surgery.
Results. Univariate analysis showed that risk factors such as diabetes had a significantly significant effect on the occurrence of surgical site infection in the study group (odds ratio [OR] = 4.27; 95% confidence interval [CI]: 1.67–14.19), arterial hypertension (OR = 3.80; 95% CI: 1.11–9.55), coronary heart disease (OR = 1.32; 95% CI: 1.23–10.13), duration hospital stay (OR = 1.78; 95% CI: 1.17–1.40).

Despite technologically advanced approaches to the treatment of patients with thermal lesions of II–III degree, a high percentage of development of cicatricial deformities and contractures with the formation of functionally significant disorders remains. According to a number of authors, post- burn cicatricial deformities and contractures develop in 45.0 %–76.5 %. In order to eliminate cicatricial deformities and contractures, various types of skin grafting are used in clinical practice, which depends both on the localization of scars, the state of surrounding and underlying tissues, the presence of donor sites, and on the goals and expected result of the planned surgical intervention. Considering these aspects and possibilities, the question of choosing the method of surgical treatment of cicatricial deformities and contractures of functional and aesthetically significant areas remains debatable. An analysis was made of the results of treatment of 603 patients who underwent reconstructive and restorative operations. In order to eliminate cicatricial contractures, accompanied by functional disorders in the area of the joints, as well as in aesthetically significant areas, reconstructive operations were performed, mainly using full-thickness autografts. Analysis of the results of surgical treatment of cicatricial contractures of functional and aesthetically significant areas using free autodermoplasty with full-thickness grafts showed its effectiveness, as it made it possible not only to eliminate functional disorders in the operated area and restore the mechanics of movements, but also to minimize the risk of recurrence of cicatricial contractures – repeated reconstructive operations amounted to no more than 1.5 % of all operated patients. Conclusions. In order to eliminate cicatricial contractures, as well as to improve the aesthetic results of treatment in patients with the consequences of a burn injury, it is most advisable to perform autodermoplasty with full-layer autografts in functional and aesthetically significant areas.

Drowning is the third leading cause of unintentional injury death worldwide. The largest number of victims of drowning falls on the young able- bodied population.
Objective. There are no recent intensive care protocols for drowning, it is relevant to formulate guidelines for the treatment of drowning. Clinical observation. A 25-year-old female patient was taken by an ambulance team to the intensive care unit with a directional diagnosis ‘drowning in fresh water’ of three degree of severity. The patient had got on ventilator with closed aspiration system. Emergency bronchoscopy was performed during which 200 ml of fluid aspirated into the lungs was removed. Respiratory support was determined by stepwise increase of the PEEP level and decrease in FiO2 level taking into account respiratory index. Given the development of a pro-inflammatory mediator response, lactatacidosis, hemolysis, hyperhydration, a high risk of infectious complications, it was decided to start extracorporeal treatment early by continuous veno-venous hemodiafiltration and de-escalation of systemic antibacterial therapy with meropenem by prolonged infusion. Against the background of the ongoing treatment, we managed to achieve target respiratory parameters and stabilize central hemodynamic parameters by the end of the first day, prevent the development of renal damage, correct water-electrolyte and metabolic disorders, and avoid severe septic complications. Vasopressor support was discontinued on the 4th day, and on the 5th day the patient was switched to independent breathing. The patient`s stay in the intensive care unit was 6 days.
Conclusions. Stepwise respiratory therapy using closed suction systems and urgent bronchoscopy prevent direct damage to the alveoli and ongoing translocation of fluid into the vascular bed. Prescribing broad-spectrum antibiotics prior to the growth of clinical and laboratory signs of infectious lung lesions allows to reduce the risk of severe septic complications with pulmonary destruction parenchyma. Early onset extracorporeal treatment by CVVHDF allows to correct homeostasis disorders, eliminate hypervolemia, prevent the development of acute renal damage as a result of hemolysis.