Airway management in hospital. Russian Federation of anesthesiologists and reanimatologists guidelines (second edition, 2018)

A.A. Andreenko1, E.L. Dolbneva2, V.I. Stamov3

1 FGBVOU VO “Military Medical Academy named after S.M. Kirov” Ministry of Defence of Russia, Saint-Petersburg

2 FGBNU RNCH named by acad. B.V. Petrovsky, Moscow

3 UKB № 2 FGAOU VO “Moscow State Medical University named after I.M. Sechenov” Ministry of Health of Russia, Moscow

For correspondence: Aleksander A. Andreenko — Cand. Med. Sciences, Assistant Professor, Deputy Head of the Department of Anesthesiology and Resuscitation, FGBVOU VO “Military Medical Academy named after S.M. Kirov” Ministry of Defence of Russia, Saint-Petersburg; e-mail: aaa010803@gmail.com

For citation: Andreenko AA, Dolbneva EL, Stamov VI. Airway management in hospital. Russian Federation of anesthesiologists and reanimatologists guidelines (second edition, 2018). Alexander Saltanov Intensive Care Herald. 2019;2:7-31.

DOI: 10.21320/1818-474X-2019-2-7-31


The review presents the clinical guidelines of the Federation of Anaesthesiology and Resuscitation specialists of Russia, revised in 2018. The recommendations are based on a review of publications and modern international guidelines of the Difficult Airway Society (DAS, 2015), American Society of Anesthesiologists (ASA, 2013), the European Society of Anesthesiologists (ESA, 2018).

“Difficult airways” are encountered relatively infrequently in modern anesthesia practice, but if it is impossible to ensure adequate oxygenation of patients, they lead to post-hypoxic brain damage or circulatory arrest. Current requirements for patient safety during anesthesia determine the need for a thorough assessment of patients before surgery, identification of prognostic signs of difficult ventilation through a face mask or supraglottic airway device, difficult laryngoscopy and tracheal intubation, difficult cricothyrotomy. As a result of the examination, the anesthesiologist is obliged to formulate the main and reserve action plan, prepare the necessary equipment, and involve specialists if necessary.

The recommendations provide evidence of the effectiveness of modern devices for ventilation and tracheal intubation. Algorithms for making decisions and actions in various situations with predictable and unpredictable “difficult airways” in patients with different risks of aspiration are proposed. An algorithm for preparing, predicting possible complications and performing extubation of the trachea is also proposed. The recommendations presented in the review are aimed at achieving the goal of increasing patient safety during general anesthesia by reducing the risk of developing critical disorders of gas exchange due to airway management problems.

Keywords: tracheal intubation, difficult airways, difficult mask ventilation, difficult laryngoscopy, difficult intubation, supraglottic airway devices, cricothyrotomy, failed intubation

Received: 25.02.2019


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Sepsis-induced damage to endothelial glycocalyx (literature review)

Y.Y. Ilyina, E.V. Fot, V.V. Kuzkov, M.Y. Kirov

Department of Anesthesiology, City Hospital No 1, Arkhangelsk

Department of Anesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk

For correspondence: Yana Y. Ilyina, Department of Anesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk; e-mail: yana.ilyina@mail.ru

For citation: Ilyina YY, Fot EV, Kuzkov VV, Kirov MY. Sepsis-induced damage to endothelial glycocalyx (literature review). Alexander Saltanov Intensive Care Herald. 2019;2:2-39.

DOI: 10.21320/1818-474X-2019-2-32-39


Glycocalyx is a gel-like layer covering the surface of vascular endothelial cells. It consists of membrane-attached proteoglycans, glycosaminoglycan chains, glycoproteins, and plasma adhesive proteins. Glycocalyx plays a key role in maintaining vascular homeostasis, controls vascular permeability and the tone of the microvasculature, prevents microvascular thrombosis and regulates leukocyte adhesion. In sepsis and septic shock, damage and shedding of glycocalyx occurs. The degradation of glycocalyx is activated by reactive oxygen species and pro-inflammatory cytokines, such as tumor necrosis factor (TNF) and interleukin-1β (IL-1β). The inflammation-mediated degradation of glycocalyx leads to vascular hyperpermeability, unregulated vasodilation, microvascular thrombosis, and enhanced leukocyte adhesion. The inflammation-mediated degradation of glycocalyx leads to vascular hyperpermeability, unregulated vasodilation, microvascular thrombosis, and enhanced leukocyte adhesion. Clinical studies have demonstrated a correlation between the levels of glycocalyx components in the blood and organ dysfunction and mortality in sepsis and septic shock. Inflammation-induced damage to glycocalyx can cause a number of specific clinical effects of sepsis, including acute kidney damage, respiratory failure and liver dysfunction. Infusion therapy is an integral part of the treatment of sepsis, but super-aggressive infusion load methods (leading to hypervolemia) may increase the degradation of glycocalyx. Moreover, some markers of glycocalyx degradation, such as circulating levels of syndecan 1 or heparan sulfate, can be used as markers of endothelial dysfunction and sepsis severity.

Keywords: endothelial glycocalyx, endothelium, sepsis, septic shock, glycocalyx shedding, vascular permeability

Received: 08.02.2019


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Nosocomial pneumonia — principles of early diagnosis and prevention

A.N. Kuzovlev, V.V. Moroz

Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow

For correspondence: Artem N. Kuzovlev, MD, DrMed, vice-director for science, head of the laboratory of clinical pathophysiology of critical states of the V.A. Negovsky research institute of general reanimatology Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow; e-mail: artem_kuzovlev@mail.ru

For citation: Kuzovlev AN, Moroz VV. Nosocomial pneumonia — principles of early diagnosis and prevention. Alexander Saltanov Intensive Care Herald. 2019;2:40-47.

DOI: 10.21320/1818-474X-2019-2-40-47


Nosocomial pneumonia and nosocomial tracheobronchitis present an urgent problem of anesthesiology and critical care medicine. This review presents the results of our own research on the informativity of new molecular biomarkers in the early diagnosis of nosocomial pneumonia, as well as modern principles for the prevention of nosocomial pneumonia. A promising direction for the early diagnosis of nosocomial pneumonia and its complications is the study of new molecular biomarkers, in particular, Clara cell protein and surfactant proteins. Effective prevention of nosocomial pneumonia should be based on a complex of modern evidence-based methods.

Keywords: nosocomial pneumonia, nosocomial tracheobronchitis, biomarkers, prophylaxis, sepsis, antibiotics, inhalation

Received: 23.02.2019


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Failures of intensive treatment of multiple organ failure: pathophysiology and the need for personalization

E.V. Grigoryev1,2, D.L. Shukevich1,2, G.P. Plotnikov3, A.N. Kudryavtsev3, A.S. Radivilko1

Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo

Kemerovo State Medical University, Kemerovo

A.V. Vishnevsky National Medical Research Centre of Surgery, Moscow

For correspondence: Evgeny V Grigoryev, M.D., Ph.D., Head of Chair of Anesthesiology and Reanomation, Kemerovo State Medical University, Kemerovo; e-mail: grigorievev@hotmail.com

For citation: Grigoryev EV, Shukevich DL, Plotnikov GP, Kudryavtsev AN, Radivilko AS. Failures of intensive treatment of multiple organ failure: pathophysiology and the need for personalization. Alexander Saltanov Intensive Care Herald. 2019;2:48-57.

DOI: 10.21320/1818-474X-2019-2-48-57


Multiple organ failure (MOF) is the most severe outcome of the critical care patients of any reason (sepsis, trauma, ischemia and reperfusion), the mortality rate with this syndrome has no tendency to decrease. The review article offers, first of all, an introduction to the key research areas in which the MOF theory is currently developing (alarmines, mitochondrial dysfunction, barrier insufficiency, immunological and neurological conjugation, forms of programmed cell death, induced immunosuppression, resolution of inflammation). Studies prove the feasibility of introducing a personalized approach to the diagnosis of MOF by substantiating the endophenotype of the critical care patients on the basis of a complex of immunological, genomic and clinical indicators.

Keywords: systemic inflammatory response, multiple organ failure, alarmines, mitochondria, immune suppression, barrier deficiency, endophenotype

Received: 22.02.2019


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Perioperative management of patients with adrenal insufficiency

P.V. Dunts1,2, O.E. Li2, V.B. Shumatov1

1 Pacific State Medical University, Vladivostok

2 Regional Clinical Hospital, Vladivostok

For correspondence: Pavel V. Dunts, PhD, Chief of the Department of Anesthesiology and Reanimatology of the Regional Clinical Hospital № 2, Assistant Professor of the Department of Anesthesiology and Reanimatology, Pacific State Medical University; e-mail: dpv@bk.ru

For citation: Dunts PV, Li OE, Shumatov VB. Perioperative management of patients with adrenal insufficiency. Alexander Saltanov Intensive Care Herald. 2019;1:58–65.

DOI: 10.21320/1818-474X-2019-1-58-65


The article is a review of modern publications covering the issues of adrenal insufficiency in patients in the periopreparative period. The article covers the issues of epidemiology, etiology and pathogenesis, presents algorithms for examining patients with adrenal insufficiency. Topical issues such as the perioperative management of patients receiving steroid hormone replacement therapy, depending on the incidence of the operation and the problems of the hypoadrenal crisis are considered.

Keywords: adrenal insufficiency, perioperative management, anesthesia, hypoadrenal crisis

Received: 24.12.2019


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About efficiency of the pharmacological scores as a predictors of outcomes after cardiac surgery

A.E. Bautin, A.V. Ksendikova, S.S. Belolipetskiy, N.R. Abutalimova, A.O. Marichev, A.V. Naimushin, V.L. Etin, A.M. Radovskiy, L.I. Karpova, V.K. Grebennik, M.L. Gordeev

Almazov National Medical Research Centre, St. Petersburg

For correspondence: Andrei E. Bautin, MD. PhD, Head of research division in anesthesiology and intensive care, Almazov National Medical Research Centre, St. Petersburg; e-mail: abautin@mail.ru, tel. +79217539110

For citation: Bautin AE, Ksendikova AV, Belolipetskiy SS, Abutalimova NR, Marichev AO, Naimushin AV, Etin VL, Radovskiy AM, Karpova LI, Grebennik VK, Gordeev ML. About efficiency of the pharmacological scores as a predictors of outcomes after cardiac surgery. Alexander Saltanov Intensive Care Herald. 2019;2:66–74.

DOI: 10.21320/1818-474X-2019-2-66-74


Pharmacological scores, such as inotropic score (IS) and vasoactive-inotropic score (VIS) were created to quantify doses of vasoactive and inotropic drugs. The number of studies where IS and VIS were used for evaluation of postoperative period of adult patients after cardiac surgery is small.

Objective: to estimate IS and VIS as an approach for monitoring of the hemodynamic profile and clinical outcomes in the early postoperative period of cardiac surgery.

Methods. The study involved 144 patients older than 18 years who underwent cardiac surgery under cardiopulmonary bypass (CPB). In perioperative period we measured cardiac output using a Swan-Ganz catheter with the calculation of central hemodynamic parameters, and also VIS and IS wcre calculated. We evaluated the prognostic value of these pharmacological scores in the development of complications of the early postoperative period, as well as their correlation with the duration of respiratory support, the length of stay in the ICU, and total hospital time.

Results. IS ≥ 10 significantly associated with prolonged respiratory support, a long stay in the ICU and with a mortality rate of 28.6 %. Patients with IS ≥ 10 are characterized by a violation of tissue perfusion, main cause of which may be a low cardiac output syndrome. IS ≥ 10 can be used as criteria for the low cardiac output syndrome with impaired organ perfusion. The use of this pharmacological score as a predictor of adverse clinical outcomes and increased mortality is justified. The hemodynamic profile of patients with VIS ≥ 10 is characterized by the absence of signs of cardiac output decrease and normal organ perfusion. It has low prognostic significance for the adverse postoperative clinical outcomes and should not be used as perioperative criteria for low cardiac output. In addition, VIS ≥ 10 requires careful use as a predictor of adverse postoperative outcomes and mortality.

Keywords: Vasoactive-inotropic score, inotropic score, cardiac surgery, cardiopulmonary bypass, low cardiac output syndrome, vasoplegia syndrome, perioperative period, cardiac anesthesiology

Received: 11.03.2019


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Therapeutic hypothermia in treatment of different cerebral injuries

A.V. Butrov1, B.D. Torosyan1, D.V. Cheboksarov1,2, G.R. Makhmutova1,2

1 Peoples Friendship University of Russia (RUDN University), Moscow

2 Moscow City clinical hospital named author V.V. Vinogradov, Moscow

For correspondence: Andrey V. Butrov, DSci, Professor, department of anaestesiology and reanimatology with clinical rehabilitation course RUDN University, Moscow; e-mail: avbutrov@mail.ru

For citation: Butrov AV, Torosyan BD, Cheboksarov DV, Makhmutova GR. Therapeutic hypothermia in treatment of different cerebral injuries. Alexander Saltanov Intensive Care Herald. 2019;2:75-81.

DOI: 10.21320/1818-474X-2019-2-75-81


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.

Keywords: therapeutic hypothermia, craniocerebral hypothermia, traumatic brain injury, cerebral infarction, subarachnoid hemorrhage, cerebral hemorrhage

Received: 04.02.2019


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Hypophosphatemia and refeeding syndrome in the resumption of nutrition in critical care patients (review)

A.I. Yaroshetskiy1,2, V.D. Konanykhin1, S.O. Stepanova2, N.A. Rezepov2

1 Pirogov Russian National Research Medical University, Moscow

2 L.A. Vorokhobov Municipal Clinical Hospital No. 67, Moscow

For correspondence: Vasily D. Konanykhin, laboratory assistant of the Department of Anesthesiology and Critical Care of the Scientific Research Institute for Clinical Surgery at N.I. Pirogov Russian National Research Medical University; e-mail: v.konanykhin@ya.ru

For citation: Yaroshetskiy AI, Konanykhin VD, Stepanova SO, Rezepov NA. Hypophosphatemia and refeeding syndrome in the resumption of nutrition in critical care patients (review). Alexander Saltanov Intensive Care Herald. 2019;2:82–91.

DOI: 10.21320/1818-474X-2019-2-82-91


Refeeding syndrome is a life-threatening condition that occurs when nutrition is restarted in patients with initial malnutrition. For the first time refeeding syndrome was described more than 70 years ago but it still has not been studied enough. The pathophysiology of refeeding syndrome is based on severe electrolyte and metabolic disorders caused by the restoration of nutrition with an initial deficiency of phosphorus, potassium, magnesium which lead to organ failure. Hypophosphatemia is the main feature of the refeeding syndrome while in ICU patients there are many other causes of hypophosphatemia which complicates diagnostics. Most studies on refeeding syndrome have been conducted among patients with anorexia nervosa. In ICU refeeding hypophosphatemia occurs in about 34 % of cases but until recently all guidelines for the management of this condition have been extrapolated from the practice of treatment anorexia nervosa and were based on expert opinion. Several major studies have proven the effectiveness of a hypocaloric feeding during refeeding syndrome in critically ill patients recently.

This review is devoted to the problem of refeeding syndrome in patients with anorexia nervosa and critical care patients, differential diagnostics and treatment approaches for this condition.

Keywords: refeeding syndrome, hypophosphatemia, nutritional support, parenteral nutrition

Received: 03.03.2019


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Intraoperative intravenous lidocaine for prevention of chronic pain syndrome

Ya.I. Vasilev, N.G. Marova, A.E. Karelov, P.A. Grib, N.A. Timofeev

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg

For correspondence: Yaroslav I. Vasilev, associate professor Vladimir L. Vanevskii anaesthesiology and reanimatology Department of North-Western State Medical University named after I.I. Mechnikov, St. Petersburg; e-mail: vasiliev.yar@gmail.com, yaroslav.vasilev@szgmu.ru

For citation: Vasilev YaI, Marova NG, Karelov AE, Grib PA, Timofeev NA. Intraoperative intravenous lidocaine for prevention of chronic pain syndrome. Alexander Saltanov Intensive Care Herald. 2019;2:92-97.

DOI: 10.21320/1818-474X-2019-2-92-97


Chronic pain after a laparoscopic cholecystectomia represents a considerable problem. One of the directions of prevention and treatment of a chronic pain syndrome are attempts of use of various adjuvants from which the most promising results showed antidepressants, antikonvulsant, antagonists of NMDA of receptors, α2-агонисты and local anesthetics.

The purpose of this single center randomized, and placebo-controlled study was to evaluate the impact of IV lidocaine on CPPS (Chronic Postoperative Pain Syndrome).

Materials and Methods. Following approval of the study protocol by the University ethics committee 96 patients were randomized into 2 groups for participation in this study. All patients were ASA class II and III, aged 21 years and older and undergoing elective laparoscopic cholecystectomy under general anesthesia. All patients were randomly allocated into 2 groups of equal size to receive either lidocaine infusion (Lidocaine group), or 0.9 % sodium chloride infusion (Control group).

Results. The incidence of CPPS after 3 months was significantly lower in the Lidocaine group than in the Control group (10 vs 37,3 %, Fisher’s Exact Test P = 0.0069) with an overall incidence of 29.2 %, and after 6 months 18.3 % (16 vs 19.3 % accordingly, Fisher’s Exact Test P = 1.0). Date evaluation of PRI NWC (total and in each of 3 category) 6 month and 12 month after surgery with Fisher’s Exact Test and t Mann Whitney test, could not find any difference in groups.

Conclusion. No differences between control group and lidocaine in 6 and 12 months were found after surgery.

Keywords: Chronic Postoperative Pain Syndrome, CPPS chronic pain, prevention of chronic pain, lidocaine, adjuvants for CPPS treatment, intraoperative administration of lidocaine

Received: 31.01.2019


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Experience with the use of selective plasma exchange in patients with newly detected secreting multiple myeloma

N.E. Zuderman, N.D. Ushakova, I.B. Lysenko, N.V. Nikolaeva, E.A. Kapuza

Rostov research institute of oncology, Rostov-on-Don

For correspondence: Natalia Е. Zuderman, doctor anesthesiologist-resuscitator of the Block of extracorporeal methods of treatment of anesthesiology and resuscitation department of the Rostov Research Oncology Institute of the Ministry of Health of the Russian Federation, Rostov-on-Don; e-mail: natalka8n@yandex.ru

For citation: Zuderman NE, Ushakova ND, Lysenko IB, Nikolaeva NV, Kapuza EA. Experience with the use of selective plasma exchange in patients with newly detected secreting multiple myeloma. Alexander Saltanov Intensive Care Herald. 2019;2:98–104.

DOI: 10.21320/1818-474X-2019-2-98-104


The prospects of using the selective plasma exchange in the treatment of first identified multiple myeloma (secretory) is substantiated (MM). Twenty-four patients (16 men and 8 women) were examined with stage II−III of the disease. Patients were divided into two groups: the main group (n = 13) with inclusion in therapy selective plasma exchange were included in the treatment and a control group (n = 11) — were treated according to standard protocol. The patients received specific treatment according to the VCD scheme. The concentrations of paraprotein, free light chains Ig (FLC), glomerular filtration rate (GFR), blood toxicity and the functional characteristics of albumin were studied. The studies were conducted before and after the completion of chemotherapy. Additionally, the concentration of paraprotein, FLC and MSM (molecules with average mass) in the blood serum were determined before and 30 min after the end of selective plasma exchange, as well as in the plasma filtrate. The results of the study showed that the inclusion of selective plasma exchange in the treatment ensured the excretion of more than 50 % of the paraprotein and FLC in the blood, a decrease in their concentration after the completion of the procedure: paraprotein 32 %, κ — FLC 43 %, λ — FLC 68 %. There was a greater regression of monoclonal protein levels and FLC production with a marked decrease in the indices of endogenous intoxication and an improvement in the functional properties of the albumin in the main group as compared with the control after completing the chemotherapy course. In the group of patients a more best to the therapy was obtained: a good response — in 69.2 % of the patients (in the control group — in 45.5 %); a negative response — in 30.8 % of cases against 54.5 % in the control group. The obtained results suggested that including selective plasma exchange in the specific complex therapy of patients with first identified multiple myeloma allows to reduce the volume of paraprotein, increase the degree and rate of reduction of LC, without affecting the toxicity of the therapy, which contributes to the strengthening of hematological and renal response to ongoing treatment.

Keywords: First identified multiple myeloma, selective plasma exchange

Received: 15.02.2019


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  2. San-Miguel J.F., Mateos M.-V. How to treat a newly diagnosed young patient with multiple myeloma. Hematology (American Society of Hematology Education Program Book, New Orleans, Louisiana, December 508, 2009); 2009: 555–565.
  3. Рехтина И.Г., Менделеева Л.П., Варламова Е.Ю., Бирюкова Л.С. Сравнение эффективности бортезомибсодержащих программ в достижении раннего гематологического и почечного ответа у больных миеломной нефропатией с диализзависимой почечной недостаточностью. Гематология и трансфузиология. 2015; 60(4): 4–7. [Rekhtina I.G., Mendeleeva L.P., Varlamova E.Yu., Biryukova L.S. Comparison of the effectiveness of bortezomibsoderzhaschih programs in achieving early hematological and renal response in patients with myeloma nephropathy with dialysis-dependent renal failure. Gematologiya i transfuziologiya. 2015; 60(4): 4–7. (In Russ)]
  4. Dimopoulos M.A., Terpos E., Chanan-Khan A., et al. Renal impairment in patients with multiple myeloma: a consensus statement on behalf of the international myeloma working group. J. Clin. Oncology. 2010; 28(33): 4976–4984.
  5. Бессмельцев С.С., Абдулкадыров К.М., Замотина Т.Б. Лечебный плазмаферез в лечении больных с множественной миеломой. Эфферентная терапия. 2001; 3: 34–43. [Bessmelʼtsev  S.S., Abdulkadyrov K.M., Zamotina T.B. Therapeutic plasmapheresis in the treatment of patients with multiple myeloma. Efferentnaya terapiya. 2001; 3: 34–43. (In Russ)]
  6. Диагностика и лечение множественной миеломы Рекомендации Британского форума по множественной миеломе и Скандинавской исследовательской группы по множественной миеломе. 2005. [Diagnosis and treatment of multiple myeloma Recommendations of the British Forum on Multiple Myeloma and the Scandinavian Multiple Myeloma Research Group. 2005. (In Russ)]
  7. Рехтина И.Г., Марьина С.А., Тангиева Л.М. и др. Эффективность экстракорпоральных методов в элиминации легких цепей у больных множественной миеломой на программном гемодиализе. Гематология и трансфузиология. 2013; 58(2). [Rekhtina I.G., Marʼina S.A., Tangieva L.M., et al. Efficacy of extracorporeal methods in the elimination of light chains in patients with multiple myeloma on programmed hemodialysis. Gematologiya i transfuziologiya. 2013; 58(2). (In Russ)]