mesЭкстремальная биомедицинаExtreme Medicine3033-89643033-8972Centre for Strategic Planning of the Federal Medical and Biological Agency10.47183/mes.2026-479mes-479Research ArticleДИАГНОСТИКА И ПРОГНОЗИРОВАНИЕDIAGNOSTICS & PROGNOSISНеинвазивный мониторинг и прогностические индикаторы в критических состояниях: от гемодинамики до метаболизма (систематический обзор)Non‑invasive monitoring and prognostic indicators in critical conditions: from hemodynamics to metabolism (systematic review)https://orcid.org/0000-0002-6974-5196БерсеневЕ. Ю.BersenevE. Yu.

Берсенев Евгений Юрьевич, канд. биол. наук

Москва

Evgeny Yu. Bersenev, Cand. Sci. (Biol.)

Moscow

bersenev_evgenii@mail.ruhttps://orcid.org/0009-0002-2368-9421ЛапинаТ. А.LapinaT. A.

Лапина Татьяна Александровна

Москва

Tatiana A. Lapina 

Moscow

tatianaalapina@gmail.comhttps://orcid.org/0000-0003-3082-5161КуриловаО. В.KurilovaO. V.

Курилова Ольга Валерьевна

Москва

Olga V. Kurilova 

Moscow

olga_kurilova81@mail.ruhttps://orcid.org/0009-0000-6810-1666СеллоЕ. О.SelloE. O.

Селло Екатерина Олеговна

Москва

Ekaterina O. Sello 

Moscow

katiasello@yandex.ruhttps://orcid.org/0000-0003-3740-2938ДавыдоваЛ. А.DavydovaL. A.

Давыдова Любовь Алексеевна, канд. мед. наук

Москва

Lyubov A. Davydova, Cand. Sci. (Med.), 

Moscow

ldavyd@yandex.ruhttps://orcid.org/0000-0002-7065-5331ЦаренкоС. В.TsarenkoS. V.

Царенко Сергей Васильевич, д-р мед. наук, профессор

Москва

Sergei V. Tsarenko, Dr. Sci. (Med.), Professor

Moscow

s9637501492@yandex.ruhttps://orcid.org/0000-0002-4904-7366ГорбуновК. С.GorbunovK. S.

Горбунов Константин Сергеевич

Москва

Konstantin S. Gorbunov 

Moscow

k.gorbunov@sysbiomed.ruНаучно-исследовательский институт системной биологии и медицины Роспотребнадзора; Всероссийский научно-исследовательский институт гигиены транспорта РоспотребнадзораРоссияScientific Research Institute for Systems Biology and Medicine of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare; All-Russian Research Institute of Transport Hygiene of the Federal Service for Supervision of Consumer Rights Protection and Human WelfareRussian FederationМосковский государственный университет им. М.В. ЛомоносоваРоссияLomonosov Moscow State UniversityRussian FederationНаучно-исследовательский институт системной биологии и медицины РоспотребнадзораРоссияScientific Research Institute for Systems Biology and Medicine of the Federal Service for Supervision of Consumer Rights Protection and Human WelfareRussian FederationМосковский государственный университет им. М.В. Ломоносова; Национальный медицинский исследовательский центр «Лечебно-реабилитационный центр»РоссияLomonosov Moscow State University; National Medical Research Treatment and Rehabilitation CentreRussian Federation20262107202600Online First479Copyright © Берсенев Е.Ю., Лапина Т.А., Курилова О.В., Селло Е.О., Давыдова Л.А., Царенко С.В., Горбунов К.С., 20262026Берсенев Е.Ю., Лапина Т.А., Курилова О.В., Селло Е.О., Давыдова Л.А., Царенко С.В., Горбунов К.С.Bersenev E.Y., Lapina T.A., Kurilova O.V., Sello E.O., Davydova L.A., Tsarenko S.V., Gorbunov K.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.extrememedicine.ru/jour/article/view/479Введение

Введение. Современная медицина критических состояний ориентирована на интегративный мониторинг в реальном времени, объединяющий оценку гемодинамики, вегетативной регуляции и метаболизма для раннего выявления рисков и оптимизации терапии. Однако, несмотря на технический прогресс, в широкой реанимационной практике сохраняется высокая потребность в систематизации сведений именно о тех параметрах, которые остаются доступными для быстрого измерения, оценки и коррекции лечения непосредственно в процессе наблюдения, вне зависимости от специфики оснащения конкретного стационара.

Цель

Цель. Определение возможности использования методов неинвазивной оценки гемодинамики, вегетативного тонуса и лабораторных биомаркеров для прогнозирования и упреждающего управления рисками.

Материалы и методы

Материалы и методы. Систематический обзор выполнен в соответствии с рекомендациями PRISMA 2020. Проведен поиск c помощью поисковой системы Google Scholar, а также в библиографических базах PubMed/MEDLINE, РИНЦ (eLIBRARY), КиберЛенинка и реестре ClinicalTrials.gov за период 2010–2025 гг. Включали оригинальные исследования и систематические обзоры, посвященные неинвазивному гемодинамическому мониторингу, оценке диастолического шокового индекса (ДШИ), отношению частоты сердечных сокращений к температуре тела (ЧСС/Т), а также уровню лактата и его клиренсу у взрослых пациентов отделений реанимации и интенсивной терапии. Из-за гетерогенности исследований проведен качественный анализ данных.

Обсуждение

Обсуждение. Рассмотрены технологии неинвазивного гемодинамического мониторинга (метод разгруженной артерии, биореактанс, торакальная биоимпедансная спектроскопия) и прогностические индексы. Показано, что ДШИ более 2,2 мм рт. ст./мин является независимым предиктором летальности при септическом шоке, особенно при динамической оценке и в комбинации с уровнем лактата. Значение ЧСС/Т > 20,5 уд/мин/°C отражает нарушение вегетативной регуляции и ассоциировано с неблагоприятным исходом при сепсисе, осложненной инфекционной патологии и сердечной недостаточности. Недостижение клиренса лактата (< 10% за 6 ч) более значимо, чем его исходный уровень, и служит ключевым метаболическим маркером. Наибольшая эффективность достигается при многопараметрической интеграции данных.

Заключение

Заключение. Современный подход к мониторингу в интенсивной терапии должен быть многомерным и динамическим. Комплементарное использование неинвазивного гемодинамического мониторинга, простых расчетных индексов (ДШИ, ЧСС/Т) и биомаркеров (лактат) позволяет создать целостную предиктивную модель состояния пациента. Перспективными направлениями развития мониторинга являются персонализация пороговых значений и интеграция данных в системы поддержки принятия решений.

Introduction

Introduction. Modern critical care medicine focuses on integrative real-time monitoring that combines the assessment of hemodynamics, autonomic regulation, and metabolism to enable early detection of risks and optimization of therapy. However, despite technological advances, there remains a high demand in routine intensive care practice for the systematization of information precisely on those parameters that remain amenable to rapid measurement, evaluation, and treatment adjustment during ongoing patient observation, regardless of the specific equipment available in a given hospital.

Objective

Objective. Determination of the feasibility of using non-invasive methods for assessing hemodynamics, autonomic tone, and laboratory biomarkers for prognosis and proactive risk management.

Materials and methods

Materials and methods. This systematic review was conducted in accordance with the PRISMA 2020 guidelines. A search was performed using Google Scholar, as well as the bibliographic databases PubMed/MEDLINE, RSCI (eLIBRARY), CyberLeninka, and the ClinicalTrials.gov registry for the period 2010–2025. Original research and systematic reviews addressing non-invasive hemodynamic monitoring, assessment of the diastolic shock index (DSI), the heart-rate-to-body-temperature ratio (HR/T), as well as blood lactate levels and lactate clearance in adult patients admitted to intensive care units were included. Due to heterogeneity among the studies, a qualitative data synthesis was performed.

Discussion

Discussion. Technologies of non-invasive hemodynamic monitoring (the unloaded artery method, bioreactance, thoracic bioimpedance spectroscopy) and prognostic indices were reviewed. A DSI > 2.2 mmHg/min has been shown to be an independent predictor of mortality in septic shock, particularly when used with dynamic assessment and combined with lactate levels. A HR/T > 20.5 bpm/°C reflects impaired autonomic regulation and is associated with an unfavorable outcome in sepsis, complicated infectious diseases, and heart failure. Failure to achieve lactate clearance (< 10% over 6 h) is more informative than its initial level and serves as a key metabolic marker. The greatest predictive utility is achieved through multi-parameter data integration.

Conclusions

Conclusions. The modern approach to monitoring in intensive care should be multidimensional and dynamic. The complementary use of non-invasive hemodynamic monitoring, simple calculated indices (DSI, HR/T), and biomarkers (lactate) enables the creation of an integrated predictive model of the patient’s condition. Promising directions for the development of monitoring include the personalization of threshold values and the integration of data into clinical decision support systems.

интенсивная терапиянеинвазивный гемодинамический мониторингдиастолический шоковый индекслактатклиренс лактатапрогнозсептический шоккритическое состояниеintensive carenon-invasive hemodynamic monitoringdiastolic shock indexlactatelactate clearanceprognosisseptic shockcritical conditionисследование выполнено в рамках государственного задания (ФБУН НИИ СБМ Роспотребнадзора) № 122030900062-5 на проведение прикладных научных исследований.the study was carried out within the framework of a state assignment (Research Institute for Systems Biology and Medicine) No. 122030900062-5 for applied scientific research.ReferencesPadte S, Samala Venkata V, Mehta P, Tawfeeq S, Kashyap R, Surani S. 21st century critical care medicine: an overview. World Journal of Critical Care Medicine. 2024;13(1):90176. https://doi.org/10.5492/wjccm.v13.i1.90176Padte S, Samala Venkata V, Mehta P, Tawfeeq S, Kashyap R, Surani S. 21st century critical care medicine: an overview. 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The authors declare that there are no conflicts of interest present.