The effect of local anesthetics against planktonic forms and film formation of S. aureus strains and its dependence on antiseptics activity.

Today surgical site infections (SSIs) remain the second among hospital acquired infections in Europe and the USA. Staphylococcus aureus as a pathogen of nosocomial infections occur more frequently in surgical hospitals. The work was aimed to establish the effect of local anesthetics against planktonic forms and biofilm-formation of S. aureus clinical strains and the relationship between the sensitivity of S. aureus strains to local anesthetics and antiseptics in vitro. The antimicrobial activity of local anesthetics (0.5%, bupivacaine, 2.0% lidocaine, 0.375% ropivacaine) and antiseptics (decamethoxine 0.02%, chlorhexidine 0.05%) against clinical strains of S. aureus was observed and studied their ability to produce biofilms. The antimicrobial effect of local anesthetics was lower compared to antiseptics, but we observed inhibition of growth and reproduction of S. aureus in their presence. The ropivacaine solution and the lidocaine solution demonstrated almost the same activity against the studied microorganism isolates. Along with this, bupivacaine solution had the highest activity against the studied microorganisms. The minimal inhibitory concentration of bupivacaine for S. aureus was 2.2 times lower than the minimal inhibitory concentration of lidocaine and 2.1 times lower than the minimal inhibitory concentration of ropivacaine significantly (p < 0.05). Scientific research on various aspects of the formation of bacterial biofilms is a relevant area that will change approaches to the prophylaxis and treatment of a number of infections, including SSIs.

DYNAMICS OF INDICATORS IN PLATELET HEMOSTASIS IN POLYTRAUMA AND ENLARGED BODY MASS INDEX.

OBJECTIVE: The aim: Analyze the dynamics of indicators in platelet hemostasis in polytrauma and enlarged body mass index. PATIENTS AND METHODS: Materials and methods: A comprehensive study of hemostasis was performed in 224 sick with polytrauma and high body mass index within a month and on the 360th day. RESULTS: Results: In Group I, the aggregation time was shortened during stimulation of ristomycin by 25% from day 1 to day 3. In patients in the II group, with the addition of ADP, the presence of hyperaggregation of platelets was determined from the 1st to the 3rd day and from the 30th to the 360th (a 36% reduction in time compared to the control was determined). In patients in the III group, ADP-aggregation was reduced on the 1st day (by 34%), after which hypoaggregation was noted (from the 3rd to the 14th and on the 360th day) with an increase in the rate of approximately 33% compared to the control group, after which there was a persistent hyperaggregation from 30 to 360 day with a 25% reduction in aggregation time. CONCLUSION: Conclusions: An individual response of platelets to damage was established depending on the severity of polytrauma and increased body mass index.

Adjunctive inhaled amikacin in infants with Ventilator-Associated Pneumonia optimizes the complex antimicrobial therapy: pilot study.

BACKGROUND AND AIM: VAP remains the second leading cause of death among the patients with nosocomial infections and its incidence varies significantly from 5% to 60% reaching on average 10 %. It is of crucial importance to develop novel treatment approaches and optimize the existing ones. Thus, the aim of this pilot study was to study the laboratory-microbiological effect of inhaled aminoglycosides in a complex treatment of patients with ventilator-associatedpneumonia(VAP).  Methods: To study the laboratory-microbiological effect of adjunctive inhaled aminoglycosides in the treatment of VAP, twenty enrolled patients were randomly subdivided into 2 groups (n=10). Amikacin was administered via a nebulizer starting from the first day of VAP manifestation. Inhalations were performed BID for 7 days via a nebulizer integrated into the breathing circuit. We assessed: cell membrane alterations in leukocytes, Annexin V/7-AAD staining for leukocytes, ROS detection assay for leukocytes. RESULTS: Adjunctive administration of inhaled amikacin reduced the fluorescence intensity ratio more efficiently compared with the intravenous antimicrobial treatment with no aerosolized amikacin following both 48 h and 96 h of treatment. The amount of dead necrotic annexin V-negative, 7-AAD-positive leukocytes was significantly lower under the use of inhaled amikacin than at the beginning of treatment. Conclusions In this pilot study, we found that administration of aerosolized amikacin combined with the systemic antimicrobial therapy improves the clinical outcome of patients with VAP, effective early microbial decrease in the sputum, reduces reactive oxygen species generation in leukocytes and the degree of leukocyte apoptosis and necrosis, decreases VAP-mediated cell membrane alterations of circulating leukocytes.

A 16-Year-Old Ukrainian Boy Shot at Close-Range to the Back of the Neck with a Handgun Who Required Surgical Removal of a 9×18-mm Bullet Shell from the Left Posterior Maxilla and Recovered Following Physical Therapy.

BACKGROUND The conflict in Ukraine during the past year has resulted in increased deaths and injuries to soldiers and civilians from military weapons and large and small caliber firearms. Unlike clinicians in some Western countries, until recently, clinicians working in Ukraine hospitals had little experience managing patients with gunshot wounds. CASE REPORT A 16-year-old boy was admitted as an emergency following a gunshot wound to the back of the neck from a Makarov pistol. The gun was reported to have been fired at a distance of more than 15 cm. Imaging showed the 9-mm bullet hit the cervical spine, causing nerve root involvement at C4 to C7, traveled upwards, and lodged in the left posterior maxilla. On examination, the patient had facial asymmetry and paralysis of the left shoulder, arm, hand, and wrist and was in pain and shock. Intubation and emergency surgery were performed, with the removal of a 9×18-mm bullet shell from the pterygopalatine fossa, deep to the infratemporal fossa, and posterior to the maxilla. The patient underwent postoperative physical therapy and continues to improve his physical function. CONCLUSIONS This report has shown the importance of immediate evaluation of gunshot wounds so that surgery can be planned and performed rapidly, with a view to postoperative recovery and active physical therapy.

Chronic pain in post-COVID syndrome.

Our body senses two types of pain, acute and chronic. Acute pain lasts for a short time. It occurs when our body wants to protect us from a dangerous situation. This way, our nerves are telling us that something is wrong. But if some time passes since our injury, treatment or surgery and the pain or discomfort persists, we are speaking of chronic pain. It is often difficult to determine its intensity or even prove its existence. The discomfort and pain are not relieved and physical pain may be accompanied by mental issues. At present, during the COVID-19 pandemic, chronic pain is becoming more prominent, and it is also associated with the post-COVID syndrome. In their efforts to help patients suffering from COVID-19, many new treatment protocols have been prepared and various antiviral drugs and other potentially useful drugs have been used (often without prior approval or testing). Basically, it was a kind of 'experimental' treatment. At present, thanks to quick therapy decisions and as part of COVID-19 prevention, we have succeeded in stabilising the situation all over the world. A relatively fast development of vaccines against SARS-CoV-2 with a view to achieve collective immunity has greatly contributed to this. On the other hand, 'quick decisions' have contributed to other significant issues which we are beginning to deal with now, i.e, in the effort to defeat the virus, many experts regarded the adverse effects of the medications used to be of secondary importance. In the article we would like to point out the other side of the 'successful' treatment of COVID-19, namely the possible iatrogenic conditions which significantly contribute to the post-COVID­19 syndrome and chronic pain. The importance of preventive measures over uncertain result of COVID-19 treatment is emphasised (Tab. 4, Fig. 1, Ref. 50). Text in PDF www.elis.sk Keywords: iatrogenic conditions; chronic pain; co-morbidity; pain syndrome; pandemic; post-COVID­19 syndrome.

Perioperative hemodynamic protective assessment of adaptive support ventilation usage in pediatric surgical patients.

BACKGROUND: The aim of this study was to evaluate the hemodynamic protective effects of perioperative ventilation in pressure-controlled ventilation (PCV) and adaptive support ventilation (ASV) modes based on non-invasive hemodynamic monitoring indicators. METHODS: The study included 32 patients who were scheduled for planned open abdominal surgery. Depending on the chosen ventilation strategy, patients were included in two groups of PCV mode ventilation (n=14) and ASV mode ventilation (n=18). The hemodynamic effects of the ventilation strategies were assessed by estimated continuous cardiac output (esCCO) and cardiac index (esCCI). RESULTS: Preoperative cardiac output (CO) was 6.1±1.3 L/min in group 1 patients and 6.3±0.8 L/min in group 2 patients, and preoperative cardiac index (CI) was 3.9±0.4 L/min/m2 in group 1 patients and 3.8±0.8 L/min/m2 in group 2 patients. The ejection fraction (EF) in group 1 subjects was 55.4%±0.3%; this rate was 56.5%±0.5% in group 2 subjects. Group 1 patients experienced a 14.7% CO decrease to 5.2±0.7 L/min, a 17.9% CI decrease to 3.2±0.6 L/min/m2 , and a 12.8% mean arterial pressure decrease to 82.3±9.4 mm Hg 30 minutes after the start of surgery. One hour after the start of surgery, the CO mean values of group 2 patients were lower than baseline by 7.9% and differed from the dynamics of patients in group 1, in whom CO was lower than baseline by 13.1%. At the end of the operation, the CO values were lower than baseline by 11.5% and 6.3% in patients of groups 1 and 2, respectively. Our data showed that the changes in EF during and after surgery correlated with CO indicators determined by the esCCO. CONCLUSIONS: In our study, perioperative ventilation in ASV mode was more protective than PCV mode and was characterized by lower tidal volume (16.2%) and driving pressure (12.1%). Hemodynamically-controlled mechanical ventilation reduces the negative impact of cardiopulmonary interactions.

Erector spinae plane block for affective and safe analgesia in a patient with severe penetrating chest trauma caused by an explosion in the battlefield.

The ongoing conflict in Ukraine continues to generate many complex traumatic injuries and provides unique challenges to anaesthesiologists who provide medical care at various levels of medical evacuation. We report the successful use of an ultrasound-guided continuous erector spinae plane (ESP) block in a patient with severe posterolateral chest trauma. The acute perioperative outcome of the patient was improved with the ESP block, the main benefits being excellent analgesia and minimal postoperative morphine requirements without influencing the risk of bleeding and coagulopathy. We conclude that continuous ESP block can be utilized to provide excellent analgesia following massive thoracic trauma. It's ease of placement under ultrasound guidance and low risk of complications makes this technique particularly useful in war medicine.

In vitro evaluation of the antimicrobial activity of antiseptics against clinical Acinetobacter baumannii strains isolated from combat wounds.

Healthcare-associated infections (HCAIs) are among the most prominent medical problems worldwide. In the context of increasing antibiotic resistance globally, the use of antiseptics as the main active agent and potentiator of antibiotics for the treatment of purulent-inflammatory complications of traumatic wounds, burns, and surgical wounds can be considered to tackle opportunistic infections and their prevention during war. This study presents a comparative investigation of the antimicrobial efficacy of antiseptics used for surgical antisepsis and antiseptic treatment of skin, mucous membranes, and wounds against multidrug-resistant clinical isolates of Acinetobacter baumannii as a wound pathogen of critical priority (according to the WHO). It was found that strains of A. baumannii, which have natural and acquired resistance to antimicrobial drugs, remain susceptible to modern antiseptics. Antiseptic drugs based on decamethoxine, chlorhexidine, octenidine, polyhexanide, and povidone-iodine 10% and 2% provide effective bactericidal activity against A. baumannii within the working concentrations of these drugs. Chlorhexidine and decamethoxine can inhibit biofilm formation by A. baumannii cells. In terms of bactericidal properties and biofilm formation inhibition, chlorhexidine and decamethoxine are the most effective of all tested antiseptics.

Optimization of the target strategy of perioperative infusion therapy based on monitoring data of central hemodynamics in order to prevent complications.

Enhanced Recovery After Surgery (ERAS) protocols are increasingly used in the perioperative period around the world. The concept of goal-directed fluid therapy (GDT) is a key element of the ERAS protocols. Inadequate perioperative infusion therapy can lead to a number of complications, including the development of an infectious process, namely surgical site infections, pneumonia, urinary tract infections. Optimal infusion therapy is difficult to achieve with standard parameters (e.g., heart rate, blood pressure, central venous pressure), so there are various methods of monitoring central hemodynamics - from invasive, minimally invasive to non-invasive. The latter are increasingly used in clinical practice. The current evidence base shows that perioperative management, specifically the use of GDT guided by real-time, continuous hemodynamic monitoring, helps clinicians maintain a patient's optimal fluid balance. The manuscript presents the analytical data, which describe the benefits and basic principles of perioperative targeted infusion therapy based on central hemodynamic parameters to reduce the risk of complications.

Elevated serum TLR4 level as a potential marker for postsurgical chronic pain in pediatric patients with different approaches to analgesia.

Introduction: The perioperative period of any surgery is accompanied by immune suppression. The level of Toll-like receptor 4 (TLR4) is known to increase in inflammation and after nerve injury and contributes to the development of neuropathic pain. The interaction of TLRs in response to the effect of opioids results in paradoxical hyperalgesia. Regional anesthesia techniques are the standard of care for perioperative pain management in children. Aim: The aim of the study was to determine and evaluate the indicators of TLR4 for different methods of pain relief in anesthetic management of hernia repair in children and their effect on pain chronification. Materials and methods: There were examined 60 children with inguinal hernia during 2020-2022. Children were divided into 3 groups: Group I included 20 children who underwent surgery under general anesthesia using the block of the anterior abdominal wall-transversalis fascia plane block (TFPB), combined with the quadratus lumborum block (QLB-4) via a single intramuscular injection; Group II included 20 children who underwent surgery under general anesthesia using the TFPB; Group III comprised 20 children who underwent surgery under general anesthesia using opioid analgesics. The levels of TLR4 were evaluated at a discharge from the hospital, 3 and 6 months after surgery. Results: There was no difference in age and body weight among all groups. In Group II, boys prevailed. In Group III, the length of hospital stay was the longest (3.28 ± 0.24 days, p < 0.05, t = 4.09) as compared to children of Group II and Group I (3.0 ± 0.30 (p < 0.05, t = 2.647) and 2.1 ± 0.16 days, respectively). While staying in the surgical department, children of Group III demonstrated significantly higher FLACC and VAS scores. The prevalence of chronic pain was the highest among children of Group III (35%) as compared to those in Group II and Group I (20 and 15%, respectively). The highest increase in the level of TLR4 was found in the group of opioid analgesia on the third and sixth months after surgery (68.86 + 10.31 pg/ml and 143.15 + 18.77 pg/ml (p < 0.05, t = 6.33), respectively) as compared to patients who received regional anesthesia. Conclusions: There were confirmed the following advantages of the transversalis fascia plane block combined with the quadratus lumborum block (QLB + TFPB) via a single intramuscular injection: ease of use; adequate perioperative pain control as evidenced by the FLACC and VAS pain assessment scales; reduced perioperative use of opioid analgesics; shortening the length of hospital stay.

GENETIC INFLUENCES ON PAIN MECHANISMS.

OBJECTIVE: The aim: To review the available results for genetic influences on pain syndrome development. PATIENTS AND METHODS: Materials and methods: In the period from 2009 to 2020, a total of 45 research papers describing the key points of genetic influences on pain mechanisms in both adults and children were published in Ukrainian and English and they are now included in the PubMed, EMBASE, Cochrane, and Google Scholar research databases. CONCLUSION: Conclusions: Pain is a comprehensive characteristic of a person; therefore, it is inevitable that several genes with little individual effect interact with each other and environmental factors, influencing pain susceptibility and chronic pain syndrome manifestation. This requires searching for biomarkers for diagnosing and predicting the development of acute and chronic pain syndromes, especially in pediatric practice.

Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project.

BACKGROUND AND OBJECTIVES: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. METHODS: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. RESULTS: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. CONCLUSION: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia.

5-HT3 SEROTONIN RECEPTOR BLOCKERS FOR INTENSIVE THERAPY OF TRAUMATIC DISEASE IN PATIENTS WITH MULTIPLE TRAUMA.

OBJECTIVE: The aim: To find the most rational choice of drugs that have anti-emetic effect in patients with polytrauma in acute and early periods. PATIENTS AND METHODS: Materials and methods: We examined 82 patients with polytrauma, 62 men and 20 women. The age of patients ranged from 19 to 50 years. Patients were divided into the main and control group with 36 and 46 people respectively, who did not differ significantly by sex, age, anthropometric data, the nature and severity of injuries, and the time from injury to admission to hospital. RESULTS: Results: Full antiemetic effect was achieved in 72.4% of patients, where metoclopramide was used. Сomplete antiemetic effect was achieved in 96.3% of patients, where sturgeon was used. Decrease of peristaltic activity does not increase postoperative intestinal paresis, and also prevents irritable bowel syndrome and diarrhea caused by dysbacteriosis on the background of antibiotic therapy. Anxiolytic effect without sedative effect and impairment of motor coordination, decrease of the somatic and psychopathological symptoms intensity in alcohol-toxic withdrawal syndrome contributes to the correct interpretation of the traumatic disease. CONCLUSION: Conclusions: Use of drugs with antiemetic effect is an important part of the complex of traumatic disease treatment in patients with polytrauma. The use of osetron is rational in patients with polytrauma with cranio-abdominal injuries.

PROGNOSTIC PARAMETERS OF THE SUSCEPTIBILITY OF STAPHYLOCOCCUS SPP. TO AMINOGLYCOSIDES AND DOXYCYCLINE.

OBJECTIVE: The aim: To perform microbiological investigation and analytic mathematic prediction of clinical isolates of S. aureus to aminoglycosides in patients with severe burns. PATIENTS AND METHODS: Materials and methods: We analyzed resistance of 199 S. aureus strains to aminoglycosides (gentamicin, tobramycin and amikacin) and doxycycline from 435 patients treated in the regional hospital due to burns for the period from 2011-2017. RESULTS: Results: We created predictive curves for the prediction of susceptibility of S. aureus strains to aminoglycosides and doxycycline based on the changes in S. aureus resistance during the years of observation and expressed in mathematic equations. Susceptibility of S. aureus to gentamicin was 42.86 % at the end of observation and will decline in future. Despite tobramycin was efficient against 72.86 % of strains in 2017, mathematic modeling indicates rapid decline in its efficacy in future. Efficacy of amikacin was dropping during the last years, but according to the equation it efficacy will increase over 60 % in 2018. S. aureus susceptibility to doxycycline was 65.38 % in 2017 and mathematic modeling indicates its gradual decline in the nearest future. CONCLUSION: Conclusions: Predicitive values of S. aureus susceptibility indicates not sufficient efficacy of these drugs in patients with infectious complications of burns. Tendency of the slight decline of S. aureus susceptibility to doxycycline still indicates sufficient levels of its efficacy in the nearest future. This justify its use as a second-line therapy with the causative agent in patients with burns.

Influence of different qualitative composition of infusion solutions on cerebral hemodynamics in patients with acute ischemic stroke.

OBJECTIVE: The aim: Investigate the effect of 0.9% NaCl, HES 130, HAES-LX-5% and mannitol 15% on cerebral hemodynamics in patients with AIS. PATIENTS AND METHODS: Materials and methods: The study included 100 patients with AIS. As the investigated solutions were used: isosmolar 0.9% NaCl, hyperosmolar mannitol 15%, colloid-isoosmolar HES 130, colloid-hyperosmolar HAES-LX-5%. The control group received only 0.9% NaCl compared: 0.9% NaCl+HES 130, 0.9% NaCl+HAES-LX-5%, 0.9% NaCl+mannitol 15%. Evaluation of cerebral hemodynamic (indexes of cerebral blood flow) was performed using doppler ultrasound of cerebral arteries. RESULTS: Results: The dynamics of specific volume velocity of blood flow per 100 grams of brain substance indicates that in the group of 0.9% NaCl and 0.9% NaCl+mannitol is the tendency to decrease the blood flow of the brain during 7 days of treatment, respectively: 2.8% and 7.5%. In patients with HES 130 solution cerebral blood flow increases by 14.2%, whereas when applied HAES-LX-5% during 7 days, it increases by 43.2% (p=0.004). CONCLUSION: Conclusions: The analysis of the data of treatment the patients with AIS showed the best effect (p=0.004) of improvement of the cerebral circulation in the use of the polyfunctional infusion solution HAES-LX-5% unlike the 0.9% NaCl group and group of 0.9% NaCl+mannitol where was a decrease of the dynamics of cerebral blood flow, which could lead to hypoperfusion of the brain.

Choosing of drug for anesthesia in intensive therapy of traumatic disease for geriatric patients.

OBJECTIVE: The aim of the study was to find the most rational approach to postoperative pain relief in the complex of intensive care for the acute and early periods of traumatic diseasein elderly patients. PATIENTS AND METHODS: Materials and methods: 132 gerontology patients with multiple trauma were included in the study. Respiratory and cardiovascular systems parameters were assessed, coagulogram and inflammatory response markers, pain severity and analgesia quality were assed. RESULTS: Results: According to the data obtained from the evaluation of VAS and Likerts scale, as well as other results, it was found that the use of NSAIDS and mu-opioid antagonists in the acute and early period of traumatic disease reduces significantly the severity of pain at a minimum daily dose (0.15 mg / kg), decreased the period of anaesthesia on demand, minimized negative respiratory and cardiovascular effects. Presence of sedative effect contributes to the improvement of emotional state of these patients. CONCLUSION: Conclusions: Age-related changes and concomitant pathology in geriatric patients define the need for the safe pain relief in this patients, in order to decrease possible adverse events. Optimal combination in geriatric patients with perioperative pain syndrome due to polytrauma is NSAIDs with antagonists-agonists. This combination reduce the prevalence and severity of negative respiratory and cardiovascular.

influence of anesthesia type on intraocular pressure during spine surgery in prone position.

OBJECTIVE: The aim was to examine intraocular pressure (IOP) during lumbar spine surgery in PP under general vs spinal anesthesia and to compare it with volunteers in PP. PATIENTS AND METHODS: Materials and methods: We performed randomized prospective single institutional trial. Patients were operated in PP with fixation of 1-2 spinal segments. Patients of group I (n = 30) were operated under SA, group 2A (n = 25) - under TIVA (total intravenous anesthesia) with 45° head rotation (left eye was located lower, than right eye), group 2B (n=25) - under TIVA with no head rotation (both eyes were located on the same level). IOP was measured with Maklakov method before and after surgery. Volunteers (n = 20) were examined before and 90 minutes after lying in PP with 45° head rotation. RESULTS: Results: In all patients and volunteers after lying in PP, we found that IOP have increased. In SA patients and in TIVA patients with no head rotation there was no difference between eyes. The most significant raise of IOP was found in the dependent eye of IIA group patients: it was higher than in volunteers and I group patients (p < 0.01), and IIB group patients (p < 0.05). In SA patients there was no difference in IOP comparing to volunteers. CONCLUSION: Conclusions: IOP increased in PP in healthy people and patients under anesthesia (SA and TIVA). IOP in SA patients did not differ from volunteers. IOP increased superiorly in the dependent eye in TIVA patients.

Pilonidal disease: changes in understanding of etiology, pathogenesis and approach to treatment

Data from Web of Science, SCOPUS, Pub Med, Medline, E-library, and other sources was used in writing this article. The main focus was directed towards literature written in English. The selection of literature was based on such concepts as: etiopathogenesis, historical principles of treatment, methods of surgical and non-surgical intervention. Data from metanalysis publications and randomized clinical trials pertaining to the treatment of the pilonidal sinus at various stages of its formation was used, as well.

Evaluation of influence of infusion therapy on the dynamics of acid alkaline balance indices in patients with acute ischemic stroke.

OBJECTIVE: Introduction: The problem of the influence of infusion solutions on the correction of acid alkaline balance disorders in acute ischemic stroke (AIS) remains unclear. The aim: Compare the dynamics of changes acid alkaline balance (AAB) in the application of isosmolar 0.9% NaCl solution and hyperosmolar solution of mannitol in patients with acute ischemic stroke. PATIENTS AND METHODS: Materials and methods: The study included 50 patients with AIS. As the investigated solutions were used: hyperosmolar mannitol 15% and isosmolar 0.9% NaCl. The control group received only 0.9% NaCl, compared with main group of 0.9% NaCl+mannitol. The research was carried out at 1, 4 and 7 day, a number of indicators were determined: рН, РаО2, РаСО2, АВ, SB, ВВ, ВЕ. RESULTS: Results: The conducted research showed that in all observation groups, on 1st day, manifestations of mixed acidosis were observed. On the 7th day of observation the group of 0.9% NaCl showed results close to the norm of the studied parameters, indicating the leveling of acidosis developed in this group on the 1st day of stroke. Somewhat worse correction of metabolic acidosis was in the group of mannitol, on the 7th day of observation the manifestations of acidosis were not significantly different from the 1st day and were respectively: pH = 7.33 (7.24; 7.36); pO2 = 36 (33; 39); AB = 23 (15; 26); BE = -3.4 (-13.5, 0.2), SB = 22.9 (18.0, 25.4). CONCLUSION: Conclusions: Analysis of changes in the parameters of AAB in the application of different circuits of infusion therapy in patients with acute ischemic stroke showed that all the observation groups had manifestations of metabolic acidosis on the first day of AIS. The ability to normalize the disturbances of acid alkaline balance did not differ significantly (p>0.05) for patients of group 0.9% NaCl solution and mannitol.