INTRODUCTION. The literature has accumulated enough data on the treatment of children with acute bronchiolitis (OB). However, this information is formed mainly on the general population of patients with OB and is often not applicable to patients with a severe course of the disease. From the standpoint of evidence-based medicine, routine use of medications is not recommended in modern consent documents, and there are also no clear recommendations on respiratory support and certain aspects of intensive care in children with OB. OBJECTIVES. To analyze approaches to therapy in children with severe acute course in need of intensive care, and to assess the validity, effectiveness and safety of the use of the analyzed groups of drugs and respiratory strategies. MATERIALS AND METHODS. The analysis of publications in the electronic databases PubMed and the Russian Scientific Citation Index on the keywords “bronchiolitis”, “intensive care units”, “critical care”, “fluid therapy”, “respiratory therapy”, “ventilation”, “co-morbidity”; “respiratory syncytial virus”; “hypertonic saline” was carried out, “corticosteroids”; “epinephrine”; “high-flow oxygen therapy”, “inhalation”, “infant”, “bronchiolitis in children”. The date of the last search is January 15, 2022. RESULTS. This systematic review provides information on the etiology and risk factors of severe acute respiratory syndrome in children, from the standpoint of evidence-based medicine, studies on the treatment of severe acute respiratory syndrome are characterized, including in the intensive care unit with glucocorticosteroids, inhalations of bronchodilators, epinephrine, 3 % hypertonic sodium chloride solution, respiratory support, high-flow oxygenation, noninvasive ventilation, artificial ventilation, antibiotics, air-helium mixture. CONCLUSIONS. Currently, there is more information that infants with OB show a high degree of heterogeneity, while the main uncertainty lies in a misunderstanding of the processes, which patients will benefit most from a particular treatment method. Further research is needed to fill the research deficit in children with a severe course of OB.
Introduction. Acute bronchiolitis (АB) is a common infection in children under the age of 2 years. In modern clinical protocols, routine use of the studied drugs is not recommended. The effectiveness of a 3% hypertonic sodium chloride solution (HSCS) at vol.Аim. Тo study the etiology, risk factors, the therapy of acute care in children in intensive care units (ICU), the effectiveness of inhalations with 3% HSCS with hyaluronate sodium (HS) in comparison with therapy without the inclusion of this drug.Materials and methods. The medical documentation of 54 patients with AB from January 2021 to January 2023 who were treated in the ICU was analyzed. An ambispective comparative study of the effectiveness of therapy of 3% HSCS with HS AB was conducted in comparison with historical control.Results. Respiratory syncytial viral (RSV) etiology was established in 50% of patients. The most common risk factor for the disease was the age younger than 3 months (40.7%). The presence of risk factors for severe course of acute respiratory failure had an impact on the average bed-day and on the need for respiratory support (p = 0.04), in addition to which patients often received drug therapy. There were no statistically significant differences in the terms of hospitalization, the duration of respiratory support depending on the appointment of 3% of HSCS with HS (p > 0.05), however, there was an improvement in clinical and functional dynamics estimated by the modified clinical scale of Wood’s asthma by the 2nd day of the disease.Conclusion. AB in ICU patients most often has RSV etiology, developing in the presence of risk factors for severe course. The influence of modern guidelines for the treatment of AB in the ICU remains controversial. The addition of 3% HSCS with HS can improve the flow of AB.
Introduction. This article highlights the problem of thrombus formation in pediatric patients staying in ICU, namely, the problem of prevention and management of pulmonary embolism in children. Currently, there is a tendency to increasing pulmonary embolism occurrence in children, though there are no clear guidelines on the medicine dosage for the systemic thrombolytic therapy of pulmonary embolism in children and for the acute coronary syndrome in children with Kawasaki disease.Clinical observations. The authors present two clinical cases from their practice when a successful management was obtained in children with life threatening thrombotic complications due to the applied systemic thrombolytic therapy.Conclusion. The obtained success in the described clinical cases have resulted from a thorough analysis of ratios “risk-benefit” and “efficiency-safety”. But the authors conclude that further research work in this direction is still needed.
В статье представлено клиническое наблюдение недоношенного ребенка с бронхолегочной дисплазией, перенесшего тяжелый острый бронхиолит (ОБ), вызванный респираторно-синцитиальным вирусом (РСВ). Приведены сведения об эпидемиологии, этиологии, диагностике, терапии ОБ, пассивной иммунопрофилактике РСВ-инфекции с помощью паливизумаба, количестве его назначений в Москве, эффективности паливизумаба для профилактики инфекций нижних дыхательных путей, вызванных РСВ. Проведен подробный анализ течения, клинических, лабораторных и рентгенологических данных, терапии РСВ-ОБ у наблюдавшегося пациента с сопоставлением с современными данными литературы.Финансирование. Работа не имела спонсорской поддержки. Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.
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