The article analyzes the literature data and the results of their own research on the diagnosis and treatment of pneumonia, developed on the background of influenza infection. The clinical and radiological picture of various forms of pneumonia is described. Emerged on the background of influenza, the etiology of the disease, recommendations for antiviral, antimicrobial and symptomatic pharmacotherapy are presented.

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 respiratoiy 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.

Acute kidney injury is a serious complication that occurs frequently in critically ill patients, and is associated with worse outcomes. The review is presented current recommendations for renal replacement therapy.

The article is devoted to various aspects of extracorporeal detoxification - dynamically developing field of medicine, which involves the active use of hardware technologies. The scope of their application is constantly expanding, what is associated with obtaining new information about the mechanisms of disease development, including sepsis, improvement of production technology of semipermeable membranes, obtaining new sorption materials with a unique structure of the sorption matrix etc. Discusses the advances in basic immunology - deciphering the structure of hundreds of inflammatory mediators, the mechanism of intercellular information transfer in immune reactions has been thoroughly studied.

20 patients with gram-negative sepsis were enrolled in the study. The criteria for including patients into the study were as follows: clinical signs of septic shock, procalcitonin blood concentration more than 2 ng/ml. The patients received from 1 to 6 hemoperfusion procedures applying LPS-adsorber Duration of each procedure was 2 hours. The following values were determined in the patients before and after each hemoperfusion procedure: the values of IL-4, IL-6, IL-8, IL-10, IL-18 in serum and washout from LPS-adsorber; concentrations of LPS in serum LPS-adsorber were measured by LAL-test and modified micro gel clot test. The decrease in the level of LPS was accompanied by the normalization of clinical and laboratory indicators. In particular, in the group of surviving patients there was a significant increase in mean arterial pressure, a decrease in body temperature and a decrease in the catecholamine load and the PCT level. LPS-adsorber (Alteco) is able to eliminate from the bloodstream not only LPS, but excess cytokines. The obtained data testify to the prospects of further randomized studies of the efficacy of LPS-adsorbers in patients with sepsis and septic shock to clarify the indications for their use.

Acute cerebral insufficiency is a complex symptom complex that initiates the development of nonspecific reactions of hypermetabolism with violation of the metabolism of proteins, fats, carbohydrates. Evaluation of nutritional status is a necessary component of intensive care strategy in such patients, as developing as a result of gross violations of metabolism and lack of adequate nutritional support, nutritional deficiency is accompanied by an increase in mortality. The emergence of modern neuromonitoring methods has significantly expanded the notion of the effect of glucose on cerebral metabolism. The fight against hyperglycemia is recognized as the primary task in correcting disorders of carbohydrate metabolism in this category of patients, since this is directly related to the prognosis of the disease. Preventing hyperalimentation, balanced component composition, inclusion of drugs that can affect metabolic, immune and inflammatory processes (pharmaco-in-tranents) are all tasks of adequate nutritional support in intensive care in patients with acute cerebral insufficiency.

One of the most important components of the clinical pattern of severe trauma is hypermetabolism-hypercatabolism syndrome. Nutritional support plays significant role in improving clinical outcomes of ICU patients. The goal of this trial was to determine the optimal metabolic targets for protein and energy provision for severe trauma ICU patients, improving the indicators of clinical outcome and reducing the infectious complications rate. Materials and methods. 86 ICU patients with severe trauma of chest and abdomen were included. Priority in nutritional suppori was previously enteral nutrition. The critical level of protein and energy provision on the 3rd day of treatment in the ICU was determined by incrementally increasing protein delivery by 0.1 g/kg per day, starting from 0.5 g/kg per day and energy delivery to 1 kcal/kg per day, starting from 20 kcal/kg per day and forming 2 comparison groups, respectively. Results. The statistically significant level of protein provision was 1.3 g/kg per day and more for protein and 31 kcal/kg per day and more for energy targets. The average length of stay (LOS) in the hospital of the group «Protein > 1.3 g/kg per day)> (n = 64) was 1.6 day less than in the group «Protein < 1.3 g/kg per day)> (n = 22), p = 0.03; the group «Energy > 31 kcal/kg per day» (n = 62) demonstrated significantly lower LOS in the hospital (1.8 day) than the group «Energy < 31 kcal/kg per day (n = 24), p = 0.011. Nosocomial infectious complications were found out in 8 (13 %) patients in the group «Protein > 1.3 g/kg per day)>, in the group «Protein < 1.3 g/kg per day)> in 8 (36 %) patients (Y2 = 4.68; p = 0.031). In the group «Energy > 31 kcal/kg per day» infectious complications rate was 11 %, and in the group «Energy < 31 kcal/kg per day»-38 % (Y2 = 6.21; p = 0.013). Summary. Protein provision at least 1.3 g/kg per day and energy of at least 31 kcal/kg per day on the 3rd day of ICU treatment led to significant reduction of nosocomial infectious complications rate and LOS in the hospital.

The review of work of Burn Treatment Centre of Research Institute for Emergency Medicine n.a. N.V. Sklifosovsky after reconstruction was made. On the grounds of 25 years of working the recommendations for organization of burn treatment centre were presented. We presented trends of the main scientific developments and the effectiveness of their implementation in clinical practice which were confirmed by a significant improvement in the results of treatment activities.

The study of the presence of endogenous bacteriophages in burned patients with bacteremia has been made. The data on the frequency of virulence and moderate phage are presented. It was been established that sepsis and fatal outcomes in patients with endogenous phages, regardless of the form of interaction with the microbial cell, were less common than in patients without phages.

Despite a small share of electric trauma in the structure of burn injuries, it is the most severe and destructive, leading to disability and high mortality. In the work a retrospective analysis of the structure of victims with electric trauma, methods of surgical treatment and composition of microflora wound detachable. Among the patients men predominated. The area of the lesion was 11.5 (3; 30) % of the total body surface area (TBSA), the area of deep burn was 5 (1; 13) % TBSA. 55 patients were operated, 142 surgical interventions were performed. The overall mortality was 12.6 %o, mortality in operated patients was 7.3 %. The age of the patients, the total burn area and the area of deep lesion in the deceased were statistically significantly greater than those of the survivors. Leading pathogens of wound infection in patients with electric trauma were non-fermenting gram-negative bacteria.