Chronically critically ill patients are a rapidly growing population requiring long-term intensive care. Lower respiratory tract infections are the main infectious complications in these patients. Adaptive phage prophylaxis may be one of the perspective and insufficiently studied approaches for prevention of respiratory infectious complications in intensive care units. OBJECTIVE To study the effectiveness of complex cocktail complex drag of bacteriophages in prevention of infectious respiratory complications in chronically critically ill patients. MATERIAL AND METHODS The study included ICU patients at the Federal Research Clinical Center of Intensive Care and Rehabilitology. Overall sample consisted of 79 patients with severe brain damage. Group 1 (n=41) received complex drag of bacteriophages for prevention of pneumonia, group No. 2 (n=38) — standard therapy. All patients were followed-up for 28 days. RESULTS Both groups were comparable in gender, age and clinical severity. Microbiological examination revealed multidrug-resistant gram-negative bacteria (Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) in majority of patients. In the 1^st group, resistance genes were less common compared to the control group. Incidence of recurrent pneumonia was lower in the same group. CONCLUSION Prophylactic phage therapy can reduce the number of antimicrobial drugs. Incidence of nosocomial pneumonia recurrences after 14 and 21 days was lower in the main group.

Among all the latest technologies, virtual reality (virtual reality, VR) can be a powerful and promising tool for achieving the main goals of rehabilitation. It has been experimentally proven that rehabilitation based on virtual technologies is able to recreate a realistic perception and corresponding reaction in a patient, thereby improving the quality of cognitive and motor rehabilitation with the least cost. However, the success of such rehabilitation depends mainly on the technologies and techniques used by doctors. This study is devoted to the important problem application of virtual reality technologies in patients with acute impairment of cerebral circulation at the stage of early rehabilitation. We focus on the neurophysiological aspects of the VR technology application and the mechanisms of the brains neuroplasticity during application of virtual reality. The characteristic features of modern approaches to application of virtual reality are highlighted. Also, a novel concept is proposed for the modern VR-technology application in intensive care unit patients. In conclusion, we discuss the possibilities of VR-technologies application, allowing for the simulation of any situation, as well as a possibility of synchronous playback of a music track with walking simulation in ICU patients in the acute period of stroke at the stage of early rehabilitation.

Sixty-six patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 and pneumonia on chest computer tomography were prospectively recruited. A combined respiratory swab for polymerase chain reaction (PCR), urine sample for pneumococcal and Legionella antigen, and sputum or endotracheal aspirate were collected. Urinary antigen and blood culture tests were negative in all cases as well as the PCR tests for other respiratory viruses and atypical bacterial pathogens. In total, 5 patients (7.5%) had co-infection. By PCR a high prevalence of colonization with bacterial pathogens was found. In conclusion, co -infection is rare in coronavirus disease 2019 patients, and additional examination to identify other pathogens should be performed only in selected cases.

В настоящее время 5 пероральных антикоагулянтов (ПОАК) показали свою эффективность в отношении предотвращения повторных ишемических инсультов и/или системной эмболии у пациентов с неклапанной фибрилляцией предсердий. Тем не менее у 1,1—2,2% больных, принимающих ПОАК, развиваются ишемические инсульты. Применение ПОАК ограничивает возможность проведения системной тромболитической терапии, так как это сопряжено с повышенным риском развития симптомной геморрагической трансформации. Исключение составляют случаи, когда при помощи специфического антагониста возможно в кратчайший срок нейтрализовать действие антикоагулянта и добиться нормокоагуляции. В настоящее время в Российской Федерации разрешены два препарата для проведения системной тромболитической терапии пациентам с ишемическим инсультом в «период терапевтического окна» до 4,5 ч от начала заболевания — рекомбинантный тканевый активатор плазминогены (rt-PA) и неиммунногенная стафилокиназа, показавшая в исследовании FRIDA не меньшую эффективность и безопасность по сравнению с рекомбинантным тканевым активатором плазминогена. В статье описан клинический случай впервые проведенной системной тромболитической терапии при помощи неиммуногенной стафилокиназы после применения идаруцизумаба у пациентки, принимающей дабигатрана этексилат, с последующей тромбэктомией.

Relevance. The severe brain damage in most cases leads the patient to a long-term chronic critical condition (CCS). Regardless of the underlying disease that led to CCS, patients will have a certain imbalance of neurohumoral regulation and characteristic cognitive, muscle-reflex disorders. This cohort of patients is characterized not only by a cascade of typical pathological processes in the brain, but also by the consistent involvement of the cardiovascular system, respiratory organs, digestive organs, water metabolism, hormonal regulation, immunity, the addition of infectious-septic complications closes the circle of pathological processes, which often leads to death. Materials and methods. The search for domestic publications was carried out in the database on the RSCI website, foreign – in the PubMed, Google Scholar databases in the period 2000–2023. When analyzing the PubMed database, the query «sepsis neuroinflammation» found 5272 links. We also studied works on the following keywords: «neurotransmitters and sepsis». Publications describing the clinical picture, diagnosis, and sepsis were analyzed. A total of 40 articles were analyzed Such systems as immune, nervous and endocrine are interconnected due to regulatory peptides. Stable functioning of the central nervous system (CNS), or rather adequate secretion of neuropeptides are necessary for a normal immune response. Neuronal anti-inflammatory regulation of tissue macrophages is characterized by a local, rapid response to the pathogen through neuromediators.Confirmation of the neuropeptide theory of immunity regulation is the verification of neuropeptide receptors on peripheral blood lymphocytes and monocytes. These results indicate a possible mechanism of a «vicious» circle that occurs in infectious-septic complications and leads to damage to vital organs.To date, there are no widely available means for accurate monitoring of brain function at the patient’s bedside. There is no evidence or recommendations to support monitoring of cerebral perfusion or function in sepsis patients. At the same time, modern research on the phenotyping of patients taking into account brain dysfunction (sepsis associated encephalopathy) is based on the basic postulates of the pathophysiology and biochemistry of sepsis, but does not offer any methods of instrumental diagnosis of this condition, except for the use of validated delirium, coma scales (Glasgow coma scale, FOUR, CAM-ICU, etc.). Despite the described pathogenesis, there is currently no single definition of cardiac cardiomyopathy. However, most authors describe the fundamental features of this pathology: acute reversible one- or two-ventricular systolic or diastolic dysfunction with reduced contractility, not due to coronary heart disease. Primary cellular myocardial dysfunction in sepsis can manifest in several ways, including impaired function of the left and/or right ventricles during systole or diastole, as well as with insufficient cardiac output (CO) and oxygen delivery. To explain the changes in myocardial contractility associated with sepsis, several mechanisms have been proposed taking into account the host response. Since most of the parameters of the echo signal depend on the conditions of the volemic status, the evaluation of the echo signal should be repeated at several time points and supplemented with the definition of cardiac biomarkers. Conclusion. Analyzing the literature data on sepsis-associated encephalopathy and septic cardiomyopathy, it is possible to judge the interconnectedness of these events indirectly through damage to neurons during infectious-septic complications. Especially neuro-humoral mechanisms of regulation of the response to an infectious agent should be evaluated in patients with CCS, not only relying on laboratory diagnostics, but also using instrumental methods of visualization of brain, heart, and kidney damage. Such methods include magnetic resonance imaging (MRI), electroencephalogram (EEG), cerebral oximetry (CMRO2), echocardiography, ultrasound examination of the kidneys, etc

There is an increasing incidence of various cerebral eventsin Russia, as well as throughout the world. At the same time, despite of all the successes of modern medicine, the treatment outcomes of these patient groups haven’t improved. The main successes are based on faster patient delivery to hospitals and on the creation of specialized centers for this cohort of patients. At the same time, the effectiveness of pharmacological agents with neuroprotective activity is questionable. On the other hand, therapeutic hypothermia techniques have proven to be an effective method of neuroprotection in various cerebral events. These methods can be divided into local and general hypothermia. Each of these options has its own advantages and indications. Thus, the use of general hypothermia techniques maintains the target temperature of the whole body, these techniques are more controllable, but at the same time, the methods of local craniocerebral hypothermia allows to affect the target organ. The methods of hypothermia and thermostabilization have been proven to improve the treatment results of patients post-CPR and in children with neonatal hypoxia. The effectiveness of hypothermia in the remaining pathological conditions of the brain has not yet been investigated. Studies of the last 5 years have not revealed high efficacy of general hypothermia at TBI, so almost of all studies indicated that normothermia and hypothermia are equally effective. Studies are ongoing in patients with subarachnoid hemorrhage, subdural hematomas and ischemic stroke. Identifying groups of patients who are recommended for these methods for complex treatment can lead to progress in improving survival and neurological outcome.