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Sufficient levels of nitric oxide (NO) ensure adequate blood flow to all organs and tissues. Despite the contradictory data on the role of endogenous NO as an organоprotector, NO insufflation is a promising direction, which is supported by evidence of modeling the protective effect on the myocardium, kidneys, and liver with exogenous NO in experimental and clinical studies. The largest number of studies have been conducted on models of ischemia-reperfusion injury in cardiovascular surgery. There are very few studies in abdominal and other non-cardiac surgery and they are mostly experimental. This review describes possible ways of implementing the organоprotective effect of NO, however, the exact mechanism remains not fully understood. One of the main links in the development of abdominal organ injury is intra-abdominal hypertension (IAH), which always accompanies laparoscopic surgeries and can last up to several hours. IAH causes ischemia of the kidneys and gastrointestinal mucosa with possible subsequent development of organ dysfunction. The degree of damage will depend not only on the duration of IAH but also on the patient’s premorbid background. The prognosis will be especially aggravated by the presence of atherosclerotic vascular lesions, which creates a preoperative background for hypoperfusion of visceral organs, which, due to the characteristics of vascularization, anatomical structure, and functioning, are very sensitive to the slightest disturbances in perfusion pressure and to the systemic inflammatory reaction, which will subsequently lead to an increase in vascular permeability, the formation of transcapillary leakage and interstitial edema, which is the beginning of organ dysfunction. Dysregulation of the mechanisms involved in NO production may be a link in the pathogenesis of the development of organ’s dysfunction, so maintaining adequate NO levels may be a target for therapy.

Currently, there is no uniform respiratory support strategy during cardiopulmonary bypass (CPB) in cardiac anesthesiology.The aim of the study was to examine possible variants of respiratory support during CPB and determine the most effective technique capable to reduce the incidence of postoperative pulmonary complications.Material and methods. Ninety cardiac surgery patients were enrolled in the pilot study and divided into groups (CPAP, VC, and apnea). In the CPAP group, positive airway pressure of + 5 cm H2O was maintained during CPB. The VC group patients underwent mechanical ventilation during CPB with a reduced tidal volume of 3 mL/kg, respiratory rate of 6/min, and REER of + 5 cm H2O. In the apnea group, patients received no respiratory support (non-rebreathing system).Results. In both the apnea and CPAP (constant positive airway pressure) group, there was a decrease in oxygenation index (OI) at the end of the CPB compared with baseline values. In the apnea group, the OI dropped from 316.31±81.76 to 230.10±102.48, while in the CPAP group it decreased from 319.37±80.01 to 223.17±152.36 (P

An important place in the structure of the causes of postoperative respiratory failure in cardiac surgery is occupied by atelectasis of the lung tissue, which is formed during cardiopulmonary bypass (CPB). The incidence of this complication makes 54–92%.The objective: to evaluate the effectiveness of various respiratory support techniques during CPB.Subjects and methods. 60 patients were randomly included in the study. CPAP Group (positive airway pressure +5 cm H2O) and VC Group (lung ventilation during CPB with parameters: tidal volume 3 ml/kg, respiratory rate 6/min, positive end-expiratory pressure +5 cm H2O).Results. The oxygenation index in VC Group was higher than in CPAP Group at the stages after the end of CPB (289.6 ± 100.0 in VC Group and 223.1 ± 152.0 in CPAP Group), at the end of surgery (in VC Group 318,7 ± 73.8 and in CPAP Group 275.2 ± 90.0) The frequency of intraoperative (VC 16% and CPAP 43%) and postoperative recruiting lung maneuvers (VC 7% and CPAP 26%) in VC Group was lower versus CPAP Group. The incidence of atelectasis in VC Group (10%) decreased compared to CPAP (36.6%).Conclusion: Low-volume ventilation during cardiopulmonary bypass has a more favorable effect on the oxygenating function compared to respiratory support in the CPAP mode.

Aim. In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19. Materials and methods. We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure. Results. We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70). Conclusion. The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.

The objective: to provide information and discuss the most justified and rational ways of anemia management in the perioperative period and in critically ill patients.Results: anemia as a syndrome associated with the perioperative period and critical conditions occurs in patients of the intensive care unit in 30–70% of cases. Currently, there is a clear trend towards restrictive blood transfusion tactics, the individualization of the anemic status of the patient, as well as the personalization of the treatment. Alternative approaches to blood transfusion are encouraged to improve the oxygen transport function of the blood, including the use of iron supplements in adult patients with hypoferric anemia and treatment with drugs that stimulate erythropoiesis.