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ГЕНЕТИЧЕСКИЕ ПРЕДПОСЫЛКИ К РАЗВИТИЮ СЕПСИСАЯкубцевич Р. Э. Гродненский государственный медицинский университет, Гродно, Беларусь Цель проведенного обзора литературы -обобщить результаты современных взглядов на генетические предпосылки к развитию сепсиса. Проанализировано 28 русскоязычных и англоязычных источников. Внимание уделено разным типам однонуклеотидных полиморфизмов, наличие которых способствует развитию сепсиса. Результаты приведенных исследований свидетельствуют о существовании взаимосвязи генетического полиморфизма каждого человека и риска развития септического процесса, его тяжести и исхода. На основании информации о генетических особенностях каждого человека станут возможны индивидуальные подходы к лечению и профилактике сепсиса.Ключевые слова: сепсис, однонуклеотидный полиморфизм, толл-подобные рецепторы.The purpose of this literature review was to summarize the results of recent research on the genetic background for the development of sepsis. A total of 28 Russian-and English-language literature sources were analyzed. A focus was put on various types of single-nucleotide polymorphisms, the presence of which contributes to the development of sepsis. The results of the recent studies point at the existence of the connection between the genetic polymorphism of each person and the risk of sepsis development, as well as its severity and outcome. With information about the genetic characteristics of each person available, individual approaches to the treatment and prevention of sepsis are possible.

Background: Endotracheal intubation is one of the basic methods for airway control during cardiopulmonary resuscitation. In the era of the prevailing pandemic of SARS-CoV-2, medical personnel may face a necessity of resuscitating aninfected patient. Objective: The objective was to compare three intubation methods for suspected/confirmed COVID-19 adult patient resuscitation performed by paramedics wearing personal protective equipment (PPE) for aerosol generating procedures (AGP). Material and Methods: The multicentre, single-blind, prospective, randomized, crossover simulation trial involved 32 paramedics. The participants wearing PPE AGP performed tracheal intubations with the Macintosh, Airtraq, and McGrath MAC laryngoscopes in a patient with suspected COVID-19 in two resuscitation scenarios: scenario A-without chest compressions; scenario B-with continuous chest compressions. The primary outcome was time to intubation. Results: In scenario A, the intubation time for the respective devices equalled 35 s (IQR: 29-46) vs. 44s (IQR: 35-67) vs. 49 (IQR: 34-72) (p = 0.003). The total efficacy of each intubation method was 100%; however, the efficacy of the first intubation attempt was highest for McGrath MAC (90.6%), followed by Macintosh (68.1%) and Airtraq 62.5%) (p<0.001). In scenario B, the results with McGrath MAC were significantly better than those with Macintosh and Airtraq(p<0.05) for all the analysed variables. Conclusions: In conclusion, the McGrath MAC videolaryngoscope offers better intubation conditions as compared with the Macintosh laryngoscope or Airtraq in the resuscitation COVID-19.

Background: There is a beneficial effect of adrenaline during adult cardiopulmonary resuscitation (CPR) from cardiac arrest but there is also uncertainty about its safety and effectiveness. The aim of this study was to evaluate the use of adrenaline versus nonadrenaline CPR. Methods: PubMed, ScienceDirect, Embase, CENTRAL (Cochrane Central Register of Controlled Trials) and Google Scholar databases were searched from their inception up to 1 st July 2020. Two reviewers independently assessed eligibility and risk of bias, with conflicts resolved by a third reviewer. Risk ratio (RR) or mean difference of groups were calculated using fixed or random-effect models. Results: Nineteen trials were identified. The use of adrenaline during CPR was associated with a significantly higher percentage of return of spontaneous circulation (ROSC) compared to non-adrenaline treatment (20.9% vs. 5.9%; RR = 1.87; 95% confidence interval [CI] 1.37-2.55; p < 0.001). The use of adrenaline in CPR was associated with ROSC at 19.4% and for non-adrenaline treatment-4.3% (RR = 3.23; 95% CI 1.89-5.53; p < 0.001). Survival to discharge (or 30-day survival) when using adrenaline was 6.8% compared to non-adrenaline treatment (5.5%; RR = 0.99; 95% CI 0.76-1.30; p = 0.97). However, the use of adrenaline was associated with a worse neurological outcome (1.6% vs. 2.2%; RR = 0.57; 95% CI 0.42-0.78; p < 0.001). Conclusions: This review suggests that resuscitation with adrenaline is associated with the return of spontaneous circulation and survival to hospital discharge, but no higher effectiveness was observed at discharge with favorable neurological outcome. The analysis showed higher effectiveness of ROSC and survival to hospital discharge in non-shockable rhythms. But more multicenter randomized controlled trials are needed in the future.

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