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:

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:

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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Respiratory mechanics and gas exchange during respiratory support in patients with necrotizing pancreatitis depending on the outcome

D.V. Gaigolnik1, K.Yu. Belyaev1, E.A. Gritsan2, A.I. Gritsan1,2

1 Krasnoyarsk Regional Clinical Hospital, Regional Public Health Institution, Krasnoyarsk

2 Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky, Ministry of Health of the Russian Federation, Krasnoyarsk

For correspondence: Alexey I. Gritsan, Dr. Med. Sci., Professor, Chief of the Department of Anaesthesiology and Intensive Care Krasnoyarsk of the State Medical University named after Professor V.F. Voyno-Yasenetsky, Ministry of Health of the Russian Federation, Krasnoyarsk; e-mail:

For citation: Gaigolnik DV, Belyaev KYu, Gritsan EA, Gritsan AI. Respiratory mechanics and gas exchange during respiratory support in patients with necrotizing pancreatitis depending on the outcome. Alexander Saltanov Intensive Care Herald. 2019;1:65–77.

DOI: 10.21320/1818-474X-2019-1-65-77

Objective. To compare the dynamics of ventilation parameters, mechanical properties of the lungs and gas exchange in the process of respiratory support in patients with a favorable and unfavorable outcome of intensive treatment of necrotic pancreatitis.

Methods. The work is based on the results of a single-center observational study. The results of treatment of 94 patients aged from 25 to 65 years with necrotic pancreatitis complicated by acute respiratory distress syndrome and sepsis are analyzed. All patients were divided into two groups: group 1 (68 patients with severe sepsis), group 2 (26 patients with severe sepsis complicated by septic shock). Within each group, patients were divided into two subgroups: the group of sepsis — patients with a favorable outcome (28 patients) and unfavorable outcome (40 patients), in the group of septic shock — patients with a favorable outcome (5 patients) and unfavorable outcome (21 patients). All patients were treated with complex therapy according to international and Russian guidelines for the treatment of pancreatic necrosis, sepsis, and acute respiratory distress syndrome. The evaluation of the mechanical properties of the lungs was performed in patients based on the parameters recorded in the IVL card: F, Vt, MV, PIP, PEEP, CPAP, Clt, Flow.

Dynamic assessment of gas exchange was carried out by continuous monitoring of SpO2, PetCO2, plethysmography and according to gas analysis. The data were recorded in the mechanical ventilation map with the subsequent calculation of some indicators: FiO2, PaO2, PaCO2, pH, AaDO2, PaO2/FiO2.

Results. Patients with necrotizing pancreatitis with a favorable outcome in the process of artificial ventilation of the lungs to ensure sufficient oxygenation during septic shock use significantly higher (by 16.0–18.3 %) levels of PIP and PEEP than in sepsis, as well as more significant disorders of gas exchange in the lungs (by AaDO2 and PaO2/FiO2) compared with sepsis. In sepsis and septic shock with an unfavorable outcome (in comparison with a favorable one), during respiratory support, more pronounced disorders of oxygen status are observed, which indicates the presence of a more severe acute respiratory distress syndrome. In sepsis with a favorable outcome, as opposed to unfavorable, there is a direct correlation between positive changes in oxygen status (PaO2/FiO2) and Vt, PIP, PEEP levels, whereas in septic shock there is no such relationship.

Conclusion. The obtained results allowed us to offer a starting regimen of respiratory support for ARDS in patients with necrotic pancreatitis.

Keywords: necrotic pancreatitis, sepsis, acute respiratory distress syndrome, respiratory support, respiratory biomechanics, gas exchange

Received: 05.11.2018


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Clinical predictors of neonatal sepsis

R.Kh. Gizatullin, P.I. Mironov

Bashkir State Medical University, Ufa, Russian Federation

For correspondence: Mironov Petr Ivanovich — Dr. Med. Sci., professor of the department of anesthesiology Bashkir State Medical University, Ufa; e-mail:

For citation: Gizatullin R.Kh., Mironov P.I. Clinical predictors of neonatal sepsis. Alexander Saltanov Intensive Care Herald. 2018;4:38–41.

DOI: 10.21320/1818-474X-2018-4-38-41

One of the key issues in the fight against sepsis is the early detection of its predictors. The aim of the work is to identify predictors the development of neonatal sepsis.

Methods. Design-retrospective, observational, single-center. The development included 163 newborns with sepsis, 34 died. The Kulbak measure was used to assess the informativeness of the studied clinical and laboratory variables. The function of response was taken as the outcome of the disease: survived or died.

Results. The analysis of the informative value of clinical and laboratory parameters in newborns on the risk of development of lethal outcome.

Conclusion. The predictors of early neonatal sepsis include indicators of the number of blood platelets, total blood protein, body weight and the number of blood neutrophils. Their critical threshold values are also calculated.

Keywords: sepsis, newborns, early predictors

Received: 29.08.2018


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LPS-adsorber in patients with septic shock

S.P. Loginov1, E.G. Gromova2, M.V. Kiselevskij2, N.P. Krotenko1, Ju.I. Doljikova2, R.Ja. Vlasenko2, L.S. Kuznetsova2

1 Botkinskaia State Hospital, Moscow

2 Federal State Budgetary Institution “N.N. Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, Moscow

For correspondence: Gromova Elena Georgievna — MD, Head of the Intensive Care Unit № 2 FBSI “N.N. Blokhin NMRCO”, Moscow; e-mail:

For citation: Loginov SP, Gromova EG, Kiselevskij MV, Krotenko NP, Doljikova JuI, Vlasenko RJa, Kuznetsova LS. LPS-adsorber in patients with septic shock. Alexander Saltanov Intensive Care Herald. 2018;3:46–52.

DOI: 10.21320/1818-474X-2018-3-46-52

The results of lipopolysaccharide (LPS) sorption using selective LPS adsorber (Alteco) in 20 patients with gram-negative sepsis were investigated. From 2 to 6 hemoperfusion operations were performed. Concentrations of interleukins (IL): IL-6, IL-8, IL-10, IL-18, lipopolysaccharide (LPS) in serum before and after the procedure, and in washouts from sorbents were controlled. Decrease in LPS was accompanied by improvement or normalization of clinical and laboratory parameters, more pronounced in the group of survivors. High sorption capacity of LPS-adsorber and its efficiency in elimination of not only LPS but cytokine excess from the blood flow have been demonstrated.

Keywords: sepsis, septic shock, Alteco LPS adsorber, LPS, interleukins

Received: 07.08.2018


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Selective Sorption of Endotoxin in Combined Therapy of Post-Traumatic Abdominal Sepsis

R.R. Zaitsev, A.Yu. Yakovlev, A.V. Abramov, D.V. Ryabikov, S.I. Chistyakov, Y.V. Il’in

Nizhny Novgorod Regional Clinical Hospital named after Semashko, Nizhny Novgorod

For correspondence: Aleksey Yurevich Yakovlev — doctor of medical sciences, Nizhny Novgorod Regional Clinical Hospital named after Semashko, Nizhny Novgorod; e-mail:

For citation: Zaitsev RR, Yakovlev AYu, Abramov AV, Ryabikov DV, Chistyakov SI, Il’in YV. Selective Sorption of Endotoxin in Combined Therapy of Post-Traumatic Abdominal Sepsis. Intensive Care Herald. 2017;2:21–25.

The investigations of the dynamics of lipopolysaccharide and presepsin in patients with closed abdominal trauma in the early post- traumatic period and after the development of abdominal sepsis. It revealed a biphasic rise of sepsis markers on stage fill hypovolemia and sepsis during subsequent development. High-performance determined early consistent application of selective sorption of LPS using «LPS adsorber» (Alteco, Sweden) and prolonged veno-venous hemofiltration in relation to the relief of endotoxemia and prevent the progression of multiple organ failure at post-traumatic abdominal sepsis.

Keywords: abdominal trauma, sepsis, LPS adsorber, hemofiltration, lipopolysaccharide, presepsin

Received: 10.03.2017


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The First Experience of Cytokine Adsorption in the Patient with Sepsis after Cardiosurgical Procedure

D.L. Shukevich1, 2, G.P. Plotnikov1, M.S. Rubtsov1, V.G. Matveeva1, E.V. Grigoryev1, 2

1Scientific research institute for complex issues of cardiovascular diseases, Kemerovo

2Kemerovo State Medical University, Kemerovo

For correspondence: Grigoryev Evgeny — PhD, MD, Kemerovo; e-mail:

For citation: Shukevich DL, Plotnikov GP, Rubtsov MS, Matveeva VG, Grigoryev EV. The First Experience of Cytokine Adsorption in the Patient with Sepsis after Cardiosurgical Procedure. Intensive Care Herald. 2016;4:59–61.

Systemic inflammatory response is the basic for the host response against infectious and noninfectious agents. Cytokines are the leading mediators of the systemic inflammation. In patients with sepsis reduction of cytokines production may be useful to decrease the severity of the systemic inflammatory response and to ameliorate the multiorgan failure. We produce the case report — the successful experience of the intensive care of the septic patient after cardiac surgery with the help of cytokine adsorption. The normalization of hemodynamic status, the reduction of the SOFA scale and the decrease of the level of interleukin 6 confirmed the effectiveness of adsorption.

Keywords: systemic inflammatory response, sepsis, cytokine adsorption

Received: 07.10.2016


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Sepsis and liver dysfunction: state of the art (review)

S.P. Sviridova, Yu.I. Patyutko, A.V. Sotnikov

N.N. Blokhin Cancer Research Center, The Ministry of Healthcare of Russian Federation, Moscow, Russia

For citation: Sviridova SP, Patyutko YuI, Sotnikov AV. Sepsis and liver dysfunction: state of the art (review). Intensive Care Herald. 2016;1:3–12.

Cellular and molecular mechanisms of liver injury in sepsis are described. The liver plays a major role in a wide range of metabolic, homeostatic and defensive reactions in sepsis: the binding of bacteria and production of inflammatory mediators, as well as immuno-modulation. Numerous studies showed that oxidative stress and cytokine/endotoxin-mediated damage are the main pathogenetic mechanisms of liver injury in sepsis. Novel translational researches of the molecular mechanisms of severe sepsis conducted by authors from Austria, Germany and the UK provide a valuable view on the pathogenesis of liver dysfunction during sepsis. Shifts of plasma concentrations of bile acids in the early hours of sepsis are associated with liver dysfunction with high sensitivity and specificity, and clinical outcomes are associated with the severity of these changes and correlate with prognosis. Metabolic shifts and inflammatory reaction reduce biological transformation in the liver (especially activity of cytochrome P450 is decreased), resulting in significant deterioration of endo- and xeno-biotisc excretion. It was established that sepsis induces the reprogramming of metabolic liver functions in accordance with the severity of phase I and phase II biotransformation and tubular transport disorders. Inflammatory cytokines produced by the Kupffer cells lead to hepatocytes’ suppression of various ATP-dependent transporters involved in bile current resulting in intralobular cholestasis. Liver dysfunction plays role in many pathological processes and causes serious damage to metabolic state, immune response, coagulation, detoxification and antimicrobial protection. A better understanding of the liver pathophysiology in sepsis, early detection of liver dysfunction and prompt appropriate treatment of severe sepsis are crucial for improving of the survival rates.

Keywords: sepsis, systemic dysfunction, liver failure, liver dysfunction, cytokines.


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Whether free hemoglobin can be a severity’s marker of general condition of the patient with sepsis?

Y.P. Orlov1, 3, V.T. Dolgikh2, A.V. Glushchenko3

1 The Department of Anesthesiology and Intensive Care, Federal state budgetary educational institution higher education “Omsk State Medical University” Ministry of Health of Russian Federation, Omsk

2 The Department of Pathophysiology with course of clinical pathophysiology, Federal state budget educational institution higher education “Omsk State Medical University” Ministry of Health of Russian Federation, Omsk

3 BUZOO “City clinical emergency hospital N 1», Omsk, Russia

For correspondence: Orlov Yuriy Petrovich — MD, Professor of Anesthesiology and reanimatology, Russian “Omsk State Medical University” the Ministry of health of Russia; e-mail:

For citation: Orlov YP, Dolgikh VT, Glushchenko AV. Whether Free Hemoglobin can be a Severity’s Marker of General Condition of the Patient with Sepsis? Alexander Saltanov Intensive Care Herald. 2018;1:48–54.

DOI: 10.21320/1818-474X-2018-1-48-54

Purpose of Research: to determine whether we can use free hemoglobin concentration as early prognostic marker and a predictor of mortality in sepsis. Materials and Methods. In a retrospective study in 60 patients aged 47,6 ± 7,2 years with sepsis (30,4 ± 2,1 points on the Mannheim’s scale for evaluation of the severity of peritonitis) modern methods of statistics (ROC-analysis) hypothesis was tested, whether level of free hemoglobin in the first 24 hours from the moment of admission can be used as a biomarker for diagnosis and prognosis for severe sepsis. Informative criterion was compared with the information of the procalcitonin test. Results. The present study had shown that the above average free hemoglobin concentration, measured on the first day of the heavy flow of sepsis, is directly connected with increased 30-days mortality, and the level of free hemoglobin in a first day of the disease has high sensitivity, specificity, and can determine the outcome of sepsis with accuracy up to 96,7 %. Conclusion. Free hemoglobin concentration above medium size identified on the first day of the currents of severe sepsis, is directly related to increased 30-day mortality, and researched level of free hemoglobin in day 1 of the disease has a high proportion of sensitivity and specificity. Level of free hemoglobin is Predictor outcome of sepsis in the first 24 hours after the start of therapy, but the results did not rule out the need to use the necessary test from septic patients, but rather the feasibility of combining the two dictates the criteria to assess the outcome of severe septic process that requires further research.

Keywords: free hemoglobin, procalcitonin, sepsis, ROC-analysis

Received: 15.01.2018


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On the diagnosis and treatment of nosocomial tracheobronchitis in intensive care medicine

A.N. Kuzovlev, A.K. Shabanov, A.V. Grechko

V.A. Negovsky research institute of general reanimatology of the 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:

For citation: Kuzovlev AN, Shabanov AK, Grechko AV. On the Diagnosis and Treatment of Nosocomial Tracheobronchitis in Intensive Care Medicine. Alexander Saltanov Intensive Care Herald. 2018;1:43–7.

DOI: 10.21320/1818-474X-2018-1-43-47

This review highlights the current state of the problem of nosocomial pneumonia and nosocomial tracheobronchitis. The important concept for nosocomial tracheobronchitis, the role of inhaled antibiotics in the treatment of this condition and their ability to prevent the development of nosocomial pneumonia are discussed.

Keywords: nosocomial pneumonia, nosocomial tracheobronchitis, sepsis, antibiotics, inhalation, colistin, tobramycin

Received: 04.03.2018


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