The aim: Optimization of diagnostics and schemes of pathogenetic intensive therapy of surgical sepsis in children based on clinical and laboratory criteria and bacteriological monitoring. Materials and methods: The research period is 2018-2020. The object of the study (n=73) – children with surgical pathology (widespread peritonitis, bacterial destruction of the lungs, post-traumatic brain hematomas, abdominal trauma, etc.). Research methods: microbiological monitoring to determine the sensitivity of the microorganism to antibiotics was carried out before and at the stages of treatment (sputum, urine, wound, bronchoalveolar lavage, tracheal aspirate, blood, contents from drainages, wound surface). Determination of the sensitivity of the isolated strains to antibiotics was carried out by the disk-diffusion method. To determine predictors of sepsis in surgical patients, clinical (mean arterial pressure (mAP), heart rate (HR), respiratory rate (RR), SpO2, etc. and laboratory parameters on days 1–2 (up to 48 hours) of sepsis identification, days 4 and 8 of intensive therapy. Procalcitonin was determined by immunofluorescence on a Triage® MeterPro analyzer (Biosite Diagnostics, USA). Blood gases and electrolytes were analyzed using a Stat Profile CCX analyzer (Nova Biomedical, USA). Results: studies have shown the effectiveness of complex intensive care in 86.3 % of cases. Mortality was found in 13.7 % of cases. Patients with severe surgical pathology died: widespread peritonitis, severe TBI + coma with irreversible neurological disorders, urosepsis against the background of chronic renal failure, after repeated surgical interventions, due to the development of refractory septic shock (SS). Conclusions. Early diagnosis of sepsis, rational early ABT under the control of microbiological monitoring, non-aggressive infusion therapy with early prescription of vasopressors (SS) with constant monitoring of the child's main life support organs contribute to an improvement in sepsis outcomes and a decrease in mortality
BACKGROUND: Sepsis is one of the leading causes of hospital mortality in children. A decisive role in improving the results of treatment of this group of patients belongs to early diagnosis and pathogenetic therapy. AIM: This study optimizes the diagnosis and intensive care of surgical sepsis in children based on clinical and laboratory criteria and bacteriological monitoring. MATERIALS AND METHODS: The study period is 20182020. The study subjects were children (n = 73) with surgical pathology (diffuse purulent peritonitis, bacterial destruction of the lungs, post-traumatic brain hematomas, injuries of the abdominal organs, and others). Clinical and laboratory parameters were analyzed, and microbiological monitoring was performed to determine antibiotic sensitivity. RESULTS: Patients who developed sepsis had a pronounced hypermetabolic syndrome, which was manifested by tachycardia and tachypnea, hyperthermia, low levels of albumin, and total protein in the blood. Protein catabolism in patients was accompanied by a decrease in globulins (IgG) synthesis and the development of a secondary immunodeficiency state. Both gram-positive and gram-negative microorganisms were involved in developing surgical sepsis in children, increasing the proportion of the latter. Given the high proportion of multi-resistant flora, empirical combined de-escalation antibiotic therapy (ABT) with broad-spectrum antibiotics was prescribed. This was followed by its revision based on microbiological monitoring and clinical and laboratory data of the patient with sepsis. Studies have shown the effectiveness of complex intensive care in 86.3% of cases. Mortality occurred in 13.7% of cases. Patients with severe surgical pathology died: fecal, generalized peritonitis, severe traumatic brain injury + coma with irreversible neurological disorders, and urosepsis against the background of chronic renal failure after repeated surgical interventions. CONCLUSIONS: Early diagnosis of sepsis, rational ABT under the control of microbiological monitoring, non-aggressive infusion therapy, and active sanitation of the surgical infection focus contributed to a decrease in mortality in this category of patients.
ABSTRACT. The article is devoted to the most difficult problem of intensive care - sepsis. The issues of the pathogenesis of the development of metabolic disorders, the significance of the syndrome of intestinal insufficiency in the formation of endogenous intoxication and multiple organ failure in sepsis are outlined. The review highlights the analysis of publications on the correction of protein-energy malnutrition in critical conditions. Currently, there are no targeted randomized clinical trials to assess the nutritional status and the adequacy of artificial therapeutic nutrition in children diagnosed with sepsis.
The aim. This review provides a meta-analysis of current guidelines on nutrition in critically ill patients, including SCCM–ASPEN (2017), SSC (2012, 2021), ESPNIC (2020), and SSC (2020) pediatric sepsis guidelines. While the ESPNIC (2020) guidance complements the existing ASPEN (2017) guidelines for critical paediatrics, the Children's SSC (2020) did not find sufficient direct evidence to develop strong nutritional recommendations for children with sepsis/septic shock. Materials and methods. Looking for publications on nutritional assessment and nutritional support in children with sepsis have been keywords sepsis in children, nutrition, and critical conditions. Literature searched and analyzed from PubMed, Google Scholar and ScienceDirect databases. Revealed under-a sufficient amount of work on pediatric sepsis (an exception is neonatal sepsis), there are no protocols for assessing nutritional status and its correction in children diagnosed with sepsis/SS. Results. Despite ongoing research in this area, many questions remain unresolved and require systematic study. While some small and large pediatric studies have recommended nutritional therapy, the heterogeneity of children's ICUs in terms of age, pathology, disease severity, comorbidities, and nutritional status precludes a one-size-fits-all approach to nutrition in critically ill children. Therefore, an individualized approach to nutrition is necessary, considering the patient's unique circumstances and the risk/benefit ratio of different nutritional therapies. Conclusions. An extensive literature review did not reveal strong nutritional recommendations for children with sepsis/SS, underscoring the need for future research on the assessment and correction of protein-energy malnutrition in this population. Overall, this review highlights the importance of tailoring nutritional therapy to the individual needs of critically ill children with sepsis/ septic shock to optimize outcomes
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