Objective: to evaluate efficacy of VAP prophylaxis bundle. Methods: 79 ICU pts were included in RCT. The reason of invasive mechanical ventilation was the depression of consciousness due to stroke or head injury. The pts were randomized to VAP prophylaxis bundle group 1 or to standard care group 2. In first group we used bundle including filter and HME, special antimicrobial ventilator circuit, closed aspiration system and special oral hygiene system. The oral care performed 3 time per 24 hours with visual inspection, 0,05 % chlorhexidine solution washing, dental and gun cleaning, only closed system aspiration. Results: VAP prophylaxis bundle decrease early onset VAP - 6.6 and 33 % in 1 and 2 groups respectively (p = 0.00167), increase VAP free-day - 7.5 ± 4.6 day in 1 group and 5.3 ± 6.5 day, (p = 0.00182) in group 2; decrease severity of VAP - CPIS on day 7 was 5.96 ± 3.2 and 7.2 ± 2.43 in 1 and 2 groups (p = 0.046), P/F on day 7 - 304.84 ± 22 and 255.9 ± 43 in 1 and 2 groups (p = 0.001). The multivariate analysis show that oral care protocol was he most significant part of bundle (OR 0.21, 0.15-0.61 95 % CI; p = 0.00014). Microbiology data show decrease of CFU colonization Klebsiella pneumoniae from 10⁶ to 10⁴ (p < 0.001), Streptococcus pneumoniae from 10⁷ to 10³ (p < 0.001), MRSA from 10⁵ to 10³ (p < 0.001), Proteus mirabilis from 10⁷ to 10³ (p < 0.001). Conclusions: VAP prophylaxis bundle decrease “early onset” VAP, severity of VAP, increase VAP free day.

This review focuses on the practical aspects of prevention and treatment of fungal infections in surgical patients. It covers epidemiology and risk factors for invasive candidiasis, updates on the etiological structure of fungal infections in patients in critical conditions, and provides the information on drug sensitivity of Candida species. The authors discuss the limitations of cultural and non-cultural diagnostic methods used in invasive candidiasis, emphasizing the importance of analyzing the existing risk factors in combination with a comprehensive assessment of clinical and laboratory data for timely initiation of adequate antifungal therapy. The review provides a brief description of currently available antimicotics, including polyenes, triazoles, and echinocandins. It also describes the benefits of anidulafungin, which does not interact with other drugs and has no negative effect on the liver and kidney. The article also covers indications for antifungal agents in surgical intensive care units in accordance with international and Russian guidelines. A cohort of patients with abdominal diseases requiring preventive and empirical treatment with antimicotics is described. In additions to that, the manuscript contains a rationale for the use of echinocandins in targeted therapy of invasive candidiasis.

Rhabdomyolysis (RM) is a clinical and laboratory syndrome with the underlying destruction of myocytes and the release of intracellular debris into the systemic circulation. In more than 55% of cases, RM is complicated by acute kidney injury (AKI), which necessitates various methods of extracorporeal detoxification and currently is a controversial issue.Aim: to improve the results of treatment of patients with RM of toxic origin complicated by AKI by using early selective hemoadsorption (SH).Material and methods. The study included 36 patients divided into 2 groups. Group 1 included 24 patients who received standard therapy and hemodiafiltration (HDF) as a life-saving intervention. Group 2 comprised 12 patients who underwent early SH to prevent the progression of AKI. We performed a comparative analysis of clinical and laboratory parameters and treatment outcomes in the groups.Results. The use of SH was associated with reduced level of myoglobin on day5 of therapy from 384.1 to 112.4 gg/l (70.7%) vs 335.15 to 219.1 gg/l (34.6%) reduction in the conservative therapy group. By day 7, this parameter was 18.8 (95.1%) and 142.4 (57.5%), respectively (7=0.012). The level of cystatin-C decreased on day 5 from 17.3 to 3.2 mg/l (81.5%) in group 2 and from 14.9 to 11.7 mg/l (21.5%) in group 1. By day 7, this parameter decreased to 2.5 (85.6%) and 14.1 (5.3%) mg/l, respectively (7=0.001). The length of ICU stay in group 2 was 7 (6; 9) days, while in the conservative therapy group it was 12 (7; 13) days (7=0.04). The hospital stay was 12 (10; 16) and 22 (14,5; 24,5) days, respectively (7=0.028).Conclusion. The early use of SH in the intensive therapy helped decrease the levels of markers of endogenous intoxication, AKI severity, improve the filtration capacity of the kidneys, and reduced the length of stay in the ICU and hospital.