Introduction. The management of children in the acute period of severe mechanical trauma (SMT) requires multi-parameter monitoring, a constant assessment of the severity of the condition and the adequacy of intensive care. The abundance of heterogeneous information about the patient determines the need for the development of integrated indices, enabling the rapid assessment of the status and prognosis of the course of the traumatic disease. The assessment of the acid-base state (ABS) of the blood is one of the day-to-day components of multi-parameter monitoring. The aim of the study was to determine the effectiveness and validity of the integral homeostasis index (IHI) obtained on the basis of the results of the ABS testing, for assessing the clinical state, its dynamics and determination the prognosis of the outcome of an acute period of trauma in children. Material and methods. The study included 345 SMT patients. The determination of ABS indices with the automatic calculation of the IHI was routinely performed 2 or more times a day. The obtained values of IHI were expertly compared with the assessment of the severity of the condition and the dynamics of this evaluation in the acute period of the traumatic illness. Results. The study demonstrated 97% accuracy in the determination of the prognosis of the course of the traumatic disease and 93% coincidence with an expert assessment of the severity of the patient’s condition. The results obtained make it possible to recommend the use of IHI for the practical use in the department of anesthesiology and resuscitation under the conditions of a unified information system combining databases (an electronic medical history, a laboratory information system, and a prognostic status and outcome module integrated in the information system and operating in a continuous mode).
Introduction. A comparative study on the effects of osmotic diuretics (OD) at parameters of water-electrolyte metabolism in children with brain injury was conducted. The researchers analyzed these effects depending on the treatment algorithm whether it was done by the Protocol or by generally accepted indications. Material and methods. 51 case-histories of children with severe, combined TBI were taken for the analysis. The patients were treated with osmotic diuretics (OD) to relieve intracranial hypertension (ICH). All patients were divided into two groups: Group 1 ( studied group) – 25 children enrolled prospectively. In this group, OD were administered according to the Protocol. Group 2 (control group) – 26 children (retrospective group). In this group, OD was administered according to the accepted clinical recommendations. Results. As it has been revealed, OD in the control group (Group 2) were used 8.7 % more often than in patients from Group 1 at Step 3 of the Protocol. In patients from Group 2, hypernatremia and hyperosmolarity had more persistent and pronounced type; such tendency persisted for the next 5–7 days of the study. However, there were no statistically significant differences between the groups in average values of sodium levels and osmolarity of blood plasma under ICH therapy. The conducted statistical analysis has shown that the lack of reliable differences is associated with a significant variance of analyzed indicators in Group 2. At the same time, we registered a statistically significant increase (p < 0.05) of unfavorable outcomes in Group 2 by 24.9 %. Conclusion. Regular and rationally frequent administration of osmotic diuretics leads to less persistent violations of water-electrolyte metabolism. A prerequisite for the effective management of traumatic ICP in children is monitoring the intracranial pressure (ICP) and cerebral perfusion pressure (CPP).
Background. Nutrition is one of the most important aspects of intensive care. While working over the nutritive program, one should take into account patient’s energy needs, which lie in a narrow range - to avoid under- or overfeeding. Purpose. To compare modern approaches to metabolic rate assessment in patients in ICU and to find the most effective one. Material and methods. The researchers have analyzed published data of clinical trials on metabolic monitoring in Russia and abroad. Results. After the scientific articles had been analyzed, it became evident that current calculation approaches cannot be considered reliable in pediatric clinical practice, especially in ICU. Thus, the indirect calorimetry, as an objective technique for calculating energy needs in patients, should be used in pediatric practice.
Introduction. Pancreatic injury is a leading cause of acute pancreatitis in children. The prescribed conservative therapy (nutrition therapy) excludes the pancreas from the process of digestion.Purpose. The aim of the study was to find an optimal algorithm of nutrition therapy for patients with pancreatic injury in a pediatric intensive care unit.Material and methods. Nutrition therapy protocols applied in 20 children with pancreatic injury were analyzed.Results. In pancreatic injury, the enteral feeding via an intestinal tube seems to be the most preferable nutrition strategy; in case of necessity, it can be combined with parenteral nutrition. The nutrition therapy program should be designed using objective techniques for assessing energy and protein needs.Conclusion. All patients with pancreatic injury should receive the enteral feeding via an intestinal tube since the first day of their stay in the hospital.
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