The study objective was to evaluate the effectiveness of primary percutaneous coronary interventions (PCIs) in patients with ST-elevation acute coronary syndrome (ST↑ ACS), taking into account the life-threatening signs that occur before and during early or delayed procedures, and the characteristics of myocardial infarction (MI) morphogenesis after restoring the epicardial blood flow.

Materials and methods. A total of 337 patients with ST↑ ACS admitted to the regional vascular center (RVC) from 01.03.2023 to 31.08.2023, were studied, their age being from 26–99 years old. Group I consisted of 192 patients who underwent PCI in the first 6 hours from the onset of disease, Group II included 47 patients with PCI performed within 6–12 hours, and Group III included 82 patients in whom PCI was performed after 12–72 hours of the onset of the disease. We took into consideration a decreased blood pressure (BP) <90 mmHg, decreased heart rate (HR) <50 bpm, and ventricular fibrillation (VF) that occurred at the prehospital stage and during PCI; the baseline mortality risk by TIMI Risk Score. In 39 patients who died after PCI, the characteristics of MI morphogenesis were assessed after the infarct-related artery (IRA) had been restored.

Results. In a comparative analysis of the PCI results, 79 % of deceased patients had no ECG signs of reperfusion; and the blood flow in IRA was assessed as TIMI 0 or TIMI III in 26 and 74 %, respectively; in 71 % of cases, the target artery was the left anterior descending (LAD) artery with acute occlusion in the proximal third in triple-vessel disease, more often present in older age groups. In all cases, a decrease in blood pressure <90 mm Hg, a heart rate fall <50 bpm and VF either preceded PCI or occurred during the PCI procedure; cases of Killip Class II, III, and IV acute heart failure (AHF) made 33, 26, and 41 %, respectively. In patients with a favorable outcome, ECG signs of reperfusion were achieved in 72.5 %, the blood flow was assessed as TIMI III in all cases, IRA was represented by LAD artery in 48 % more often in the form of an isolated lesion among individuals under 65 years of age; life-threatening signs occurred in isolated cases; AHF cases of Killip Class I, II, III, and IV accounted for 47, 48, 4 and 1 %, respectively.

Conclusion. The presented data have indicated that primary PCI does not prevent fatal outcome in patients admitted with cardiogenic shock on prolonged CPR. Extensive MI area with proximal LAD occlusion and triple-vessel disease is accompanied by AHF of varying severity degree. Interventions for this condition in older age groups require practical skills to ensure success. Microcirculation disturbances, such as multiple spasms and thromboses as identified by morphological examination are associated with life-threatening symptoms that arise both in cardiogenic shock, and during procedures accompanied by the acute heart failure progression, which can develop into multiple organ failure in patients with associated pathology. The differences in the acute heart failure development, which underlie the characteristics of thanatogenesis, make possible the assessment of mechanical reperfusion effectiveness and the possibility of preventing death.

Introduction. Ischemic stroke remains one of the leading causes of mortality and persistent disability worldwide. Early carotid endarterectomy (CEA) within 14 days of symptom onset significantly reduces stroke recurrence in patients with symptomatic carotid stenosis. Rapid and reliable identification of surgical candidates in the acute stroke setting is crucial. This study aimed to develop a short screening protocol for duplex ultrasound of carotid arteries and assess the agreement between the results of the short protocol and those of extended ultrasound examination and computed tomography angiography (CTA) in patients with acute stroke.

Materials and methods. This prospective study included 76 patients who were admitted at the Botkin Hospital in 2023–2024 with acute ischemic stroke and who underwent CEA within 14 days of symptom onset. All patients underwent carotid duplex ultrasound using a screening protocol within 30 minutes of admission, assessing stenosis degree per ECST criteria. If stenosis exceeded >50 %, a comprehensive duplex scan was performed. All patients also underwent CTA as part of preoperative workup.

Results. The screening protocol identified 50–69 % stenosis in 29 (38 %) patients, 70–99 % stenosis in 41 (54 %), and ICA occlusion in 5 (7 %) patients. Agreement between the shortened and comprehensive duplex protocols was high, with a weighted Cohen’s kappa (κ) of 0.73 (95 % CI 0.59–0.87). Agreement between ultrasound and CTA was also good (κ=0.61 for comprehensive protocol and κ=0.58 for screening protocol). The mean examination time was 15 (±3.2) minutes for the screening protocol and 40 (±6.8) minutes for the standard examination.

Conclusion. A shortened, focused duplex ultrasound protocol demonstrates substantial agreement with a comprehensive protocol for grading carotid stenosis in acute stroke patients. The use of the screening protocol significantly reduces examination time without compromising diagnostic accuracy. Implementation of the screening protocol in the emergency hospital setting facilitated the early identification of patients with indications for surgical intervention and the selection of patients for CEA in acute stroke.

Background. Providing oxygenating lung function is a difficult task during minimal invasive direct coronary artery bypass surgery (MIDCAB).

The objective was to study the possibility of using high-frequency jet ventilation (HFJV) of an independent lung during MIDCAB operations.

Materials and methods. 69 patients were examined. Single-lung ventilation (SLV) was performed in 32 patients, and differentiated SLV with HFJV of an independent lung was performed in 37 patients. The gas composition of arterial blood, parameters of artificial ventilation and metabolic markers were analyzed. The nature and frequency of postoperative complications were assessed.

Results. In the SLV+HFJV group, compared with the SLV group, the level of oxygen tension in arterial blood (PaO₂) and the PaO₂/FiO₂ ratio were higher at all stages of SLV. The number of patients with PaO₂/FiO₂ ≤200 in the OVL group compared to the OVL+HFV group was higher at the same stages. No difference was found between the groups in the number of postoperative complications, duration of artificial lung ventilation (ALV), and stay in the intensive care unit (ICU).

Conclusions. The use of differentiated OVL with HFJV of an independent lung in MIDCAB operations allows for better oxygenating function of the lungs, prevents the development of hypoxemia, and does not lead to an increase in the number of postoperative complications.

Treatment of hypoxemic acute respiratory failure remains one of the urgent and applied problems of modern intensive care, as it is the leading cause of critical conditions and high mortality in patients in intensive care units. Patient self-inflicted lung injury plays a special role in maintaining and worsening respiratory failure, which can develop under any method of respiratory support. A number of studies in recent years have demonstrated significant clinical effectiveness of non-invasive respiratory support compared to traditional mechanical ventilation. Due to this, the concept of respiratory failure treatment has changed in favor of more active use of non-invasive ventilation and high-flow oxygen therapy. However, their rational and personalized use remains a labor-intensive task due to the polymorphism of clinical manifestations, diversity of etiological factors and pathogenetic mechanisms of respiratory disorders. The purpose of this publication is to review the literature data on the use of non-invasive respiratory support methods at different stages of hypoxemic acute respiratory failure treatment.

The first part will consider the current mechanisms of development of patient self-inflicted lung injury and the general characteristics of noninvasive ventilation and high-flow oxygen therapy.

Introduction. Robot-assisted radical prostatectomy is one of the leading methods of prostate cancer treatment. A common complication of general anesthesia during this operation is intraoperative hypotension. In recent years, the use of preoperative ultrasound examinations to predict this condition and carry out personalized prevention has been gaining popularity. Machine learning methods trained with additional predictors

can improve the accuracy of these predictions.

Objective. To improve the treatment outcomes of patients with prostate cancer by optimizing their volemic status in the perioperative period before robot-assisted prostatectomy.

Materials and methods. The prospective study included 64 patients scheduled for robot-assisted radical prostatectomy. Before surgery, patients underwent bedside ultrasound examination to determine the diameters and collapsibility indices of the inferior vena cava and subclavian veins, corrected carotid flow time (cCFT), and respiratory variation of blood flow peak velocity (ΔV). These data were used in the training of machine learning predictive models to ameliorate intraoperative hypotension prediction efficacy.

Results. The respiratory variation of blood flow peak velocity had the highest predictive value (AUROC 0.843, accuracy 75 %). The indicator’s optimal threshold for intraoperative hypotension prediction was 8.33 %. The accuracy of the prediction has been increased using the machine learning model based on gradient boosting with additional predictors (AUROC 0.933, accuracy 95 %).

Conclusions. Determining the respiratory variation of blood flow peak velocity is the most prognostically valuable indicator for intraoperative hypotension prediction during robot-assisted radical prostatectomy. The use of machine learning methods to predict intraoperative hypotension increases the accuracy of prediction.

Introduction. Sepsis in patients with prolonged or chronic critical illness is associated with a high mortality and prolonged exposure to antimicrobial therapy. However, data on the microbiological profile and trends in antimicrobial resistance in this population remain limited.

Objective. To assess the microbiological profile, antimicrobial consumption, and dynamics of antimicrobial resistance in patients with sepsis who experienced prolonged stays in intensive care units (ICUs).

Materials and methods. We performed an analysis of the Russian Intensive Care Dataset (RICD v2.0, FNCC RR, 2017–2024). The study included patients with confirmed sepsis according to Sepsis-3 criteria who remained in the ICU for ≥24 hours. Data on microbiological testing, antimicrobial prescriptions, and resistance patterns were extracted. Antimicrobial consumption was quantified using standardized units of DDD per 100 bed-days. Integrated resistance was assessed using the Drug Resistance Index (DRI).

Results. A total of 336 patients were included (median age 64 years; male – 43.5 %, median ICU stay 44 days). The leading causative pathogens were Klebsiella pneumoniae and Pseudomonas aeruginosa. Between 2022 and 2024, consumption of aminoglycosides, cephalosporins, cotrimoxazole, linezolid, and tigecycline increased, while use of carbapenems, levofloxacin, and metronidazole declined. Resistance to ceftazidime-avibactam rose from 37 % to 87 % (p=0.004), whereas resistance rates decreased for tigecycline, vancomycin, and gentamicin (p<0.01). The overall DRI reached 32.6 % in 2022, 41.2 % in 2023, and 34.1 % in 2024.

Conclusions. This study demonstrates persistently high levels of antimicrobial resistance among septic patients with prolonged ICU stays, with a predominance of Gram-negative pathogens in the etiological structure of infections. Every third empirical prescription of antibiotic therapy was accompanied by resistance of the infectious agent. These findings highlight the need for continuous microbiological surveillance, optimization of antimicrobial stewardship programs.

Introduction. The COVID-19 pandemic has exposed the inadequacy of treatment strategies for viral pneumonia, highlighting the need for new treatment approaches.

Objective. To compare hospitalization outcomes between patients with COVID-19 pneumonia and those with non-COVID viral pneumonia.

Materials and methods. This retrospective cohort study compared hospitalization outcomes of patients with COVID-19 pneumonia treated in Intensive Care Unit of Demikhov Hospital, 2019–2020, with those of patients with non-COVID viral pneumonia (data from the eICU-CRD database). Propensity score matching (PSM) was used to adjust for confounding factors, including age, sex, and comorbidities. Assessed outcomes included hospital length of stay, duration of MV, ventilator-free days, and incidence of complications.

Results. A total of 511 patients were included, with 104 patients matched in each group after PSM. Hospital mortality was higher among patients with COVID-19 pneumonia (41.3 vs. 6.7 %, p<0.001), especially in those requiring MV (87.8 vs. 8.8 %, p<0.001). The median hospital and ICU lengths of stay were longer in the COVID-19 group (15.5 and 7.1 days vs. 5.0 and 3.8 days, p<0.001 and p=0.002, respectively). Among survivors, the duration of MV was longer in the COVID-19 group (10.0 vs. 4.0 days; p=0.039).

Conclusions. COVID-19 pneumonia is associated with greater severity, higher mortality and prolonged hospitalization. Mortality among MV was ten times higher and complications occurred more frequently.

Annually, 0.1–0.3 % of all hospitalized patients in Russia die from purulent-inflammatory diseases of the maxillofacial region. The issues of rationalization of methods of prevention and treatment of purulent processes of the maxillofacial region in connection with the resistance of microorganisms of infectious and inflammatory diseases to antibacterial drugs still remain unresolved. This article is devoted to the study of morphological features due to the use of vacuum therapy in the treatment of odontogenic phlegmon of the maxillofacial region. An applied randomized study was conducted in which 56 people with a diagnosis of «odontogenic phlegmon» of the submandibular region, pterygomandibular, near-pharyngeal, and subasseteral spaces participated, at an average age of 34.8±8.6 years. During the study, the patients were divided into groups: some (the control group) received treatment using the traditional method (opening of a purulent lesion, passive drainage before fixing a drainage vacuum flushing device, removal of the «causal» tooth if present, medical support), while others (the comparison group) had the traditional method supplemented by a local one. vacuum therapy according to the developed method. The drugs received intraoperatively and on the 1st day after surgery in both groups corresponded to cytograms of the necrotic type. On day 3, a few degenerative forms were visualized in the samples of the control group, while in the comparison group a large number of them were detected in combination with monocytes and endothelial cells. By day 5, degenerative-inflammatory types of cytograms dominated in the control group, while inflammatory-regenerative types dominated in the comparison group. The conducted cytological study demonstrates that the inclusion of vacuum therapy according to the developed method in the treatment regimen of patients with odontogenic phlegmon of the maxillofacial region helps to reduce the time for wound cleansing and the formation of granulation tissue, which allows for secondary sutures to be applied at an earlier date.

Introduction. Although urolithiasis is more common in adults, kidney stones can be visualized in children. The increased incidence of urolithiasis in children is associated with changes in diet, genetic factors, and lifestyle. Extracorporeal shock wave lithotripsy (ESWL) is a minimally invasive treatment option for urolithiasis in children.

Objective: to evaluate the effectiveness of extracorporeal shock wave lithotripsy in children at the City Clinical Hospital of Emergency Medical Care (hereinafter referred to as the City Clinical Hospital of Emergency Medical Care) in Stavropol.

Materials and methods. A retrospective analysis of the treatment outcomes for urolithiasis in pediatric patients (n=37) using extracorporeal shock wave lithotripsy was conducted between 2015 and 2023. Treatment efficacy was assessed based on the number of procedures required for a given patient to achieve satisfactory fragmentation of the calculus, as well as the presence of complications.

Results. From 2015 to 2023, extracorporeal shock wave lithotripsy was performed on 37 pediatric patients (hereinafter n) in the Stavropol City Clinical Hospital of Emergency Medical Care, including 24 (64.9 %) boys and 13 (35.1 %) girls. The average age of the patients was 12.1±3.2 years.

The most common location of stones in pediatric patients was the renal pelvis (17; 45.9 %). Most patients required one fragmentation session (n=20; 54.0 %), 14 (37.8 %) patients required two sessions, and the remaining children required a third (n=2; 5.4 %) or even a fourth session (n=1; 2.7 %) to achieve satisfactory fragmentation of the stone. We did not observe any complications during the lithotripsy session itself in pediatric patients. After performing extracorporeal shock wave lithotripsy in children, we encountered the following complications: hematuria (n=9; 24.3 %), renal colic (n=5; 13.5 %), urinary tract infection (n=2; 8.3 %), which were stopped by conservative therapy methods.

Conclusion. Extracorporeal shock wave lithotripsy is an effective, virtually non-invasive treatment for urolithiasis in children with stones up to 20 mm in diameter. Its high efficacy, feasibility, and minimal recovery time make it the preferred treatment method for urolithiasis in children.