We analyzed the results of anaesthesiology and critical care services of Moscow’s Department of Health. The data on the structure of the service, its staffing and analysis of anesthesia and critical care efficacy and safety are performed in the paper.

The results of our long-term experimental studies and clinical observations scientifically substantiated the need for differential diagnostics, differentiated and personalized treatment of patients, injured and wounded with severe acute respiratory failure of various genesis. The analysis of the results of treatment of this contingent of patients in a multi-field hospital showed a significant improvement in the clinical effectiveness of the therapy with the participation of specialists of different profiles. It was shown that a differentiated choice of therapeutic and diagnostic measures, taking into account the leading mechanisms of pathogenesis, the stage of the disease and the nature of the concomitant pathology, as well as the treatment by a team of specialists of various profiles significantly improve the results of treatment of these patients. It was proved that in the treatment of severe acute respiratory failure equally important is the rational use of multiple respiratory, non-respiratory and pharmacological methods, and the use of a wide range of diagnostic, preventive and curative measures with the participation of a team of physicians of different specialties. This will not only improve the functional state of the lungs, but also avoid the development of a wide variety of pulmonary and extrapulmonary complications. On the basis of the data obtained, algorithms for the complex and personified treatment of severe respiratory failure with the participation of specialists of various specialties at all stages of the patient s stay in a multidisciplinary hospital have been scientifically substantiated, developed and proposed.

The article is devoted to the problem of effective treatment of one of the severe forms of pneumonia. The study included 218 patients with community-acquired pneumonia hospitalized in the department of general resuscitation of the State Clinical Hospital named after. V.M. Buyanov Moscow. Results of the study. For patients with severe community-acquired pneumonia complicated by acute respiratory distress syndrome (ARDS), signs of a decrease in pumping function of the heart were recorded. The best predictors of death were cardiac index (СІ), cardiac power index (CPI), central venous pressure (CVP), elevation of blood lactate level. The blood levels of the NT-proBNP myocardial stress marker were significantly increased. The results of the studies gave grounds to conclude that in patients with severe community-acquired pneumonia complicated by ARDS, without concomitant heart diseases, the main syndrome of hemodynamic disturbance is right ventricular dysfunction / insufficiency. This conclusion determined the need for optimization of infusion therapy with preload (GEDI) control, as well as the early appointment of sympathomimetic with ß1- and ß2-adrenergic effect of dobutamine to improve the function of the right ventricle. These measures provided an improvement in hemodynamic parameters, a reduction in the overall severity of the condition by SOFA, and a reduction in mortality.

The article presents two clinical cases of using extracorporeal membrane oxygenation in the complex treatment of secondary acute respiratory distress syndrome at the ineffectiveness and inability of the traditional intensive care. The first case of veno-venous extracorporeal membrane oxygenation in a patient with severe pneumonia complicated by the development of acute respiratory distress syndrome and bilateral intense pneumothorax. The second case of extracorporeal membrane oxygenation in a patient with complicated postoperative cesarean section in the form of development of a syndrome of massive blood transfusion with damage to the lungs and bilateral intense pneumothorax, extracorporeal membrane oxygenation is a measure of temporary effective replacement of pulmonary function in the impossibility and inefficiency of artificial lung ventilation.

ANCA-associated vasculitis is a group of autoimmune diseases affecting small caliber vessels with the development of necrotizing vasculitis, which are characterized by a diverse clinical picture with the involvement of the inflammatory process of vital organs - lungs, kidneys, upper respiratory tract, central nervous system, gastrointestinal tract - and with a serious prognosis. The treatment of ANCA-CB includes therapy with corticosteroids, cytostatics, monoclonal antibodies. However, with the development of life-threatening conditions (hemoptysis, pulmonary bleeding, cerebrovascular) aferente treatments are used, i.e. herapeutic plasma exchange, therapeutic plasmapheresis (TPE) and double filtration plasmapheresis (DFPP).

The lecture is intended for practicing doctors-pediatricians, nutritionists, surgeons, intensivists, who are faced with questions of enteral nutrition in children. The lecture examines the main indications for the use of mixtures based on hydrolyzed protein. The author considers in detail the composition of mixtures based on hydrolyzed protein, the indications of the designation of specialized mixtures are determined.

The study is devoted to the problem of organization of medical assistance to the victims of earthquakes. The structure of the affected, medical forces involved in the elimination of medical consequences is presented. Attention is drawn to the deterioration of the sanitary and epidemiological situation in the disaster area. It is noted that a well-organized preliminary readiness for possible catastrophes can significantly reduce their harmful consequences.

The article again considers one of the debatable topics of the general pathology - the conventionality of the concept of syndrome’. A long dispute between supporters of monocausalism and conditionalism in this issue, the authors propose to consider from the pragmatic positions necessary for intensive therapy of critical states. In this case, two important points must be considered: the meaning of the concept of syndrome’ in reanimatology and in general therapeutic practice is fundamentally different; contradictions between the reanimatologists themselves are due to the fact that in analyzing the critical state, different authors operate with different levels of parameter integration.