Рекомендации по интраоперационной инфузионно-трансфузионной терапии у детей разработаны членами Ассоциации детских анестезиологов-реаниматологов России, имеющих большой опыт оказания анестезиолого-реаниматологической помощи детям� Целью данных рекомендаций является предоставление четких правил по составлению программы интраоперационной инфузии для уменьшения риска осложнений, связанных с ее проведением у детей разных возрастных групп, повышения эффективности и безопасности анестезиологического обеспечения в целом� Рекомендации не рассматривают частные вопросы проведения инфузионной терапии в специализированных областях медицины� Ключевые слова: инфузионно-трансфузионная терапия, острая кровопотеря у детей
Massive blood loss that develops during surgery is a common cause of life-threatening conditions and deaths in patients of any age. This study aimed to analyze domestic and foreign publications that present methods for determining the volume of intraoperative blood loss. The literature sources were searched in PubMed, Scopus, Web of Science, MEDLINE, eLibrary, and Russian Science Citation Index databases. The search was conducted in Russian and English using the following keywords: intraoperative blood loss, severity of blood loss, methods for assessing blood loss, direct methods, and indirect methods. The literature review included five articles from PubMed, nine from Scopus, six from Web of Science, two from MEDLINE, six from eLibrary, and four from Russian Science Citation Index. Massive blood loss is understood as a one-time loss according to some authors of 30% and according to others of 50% of the volume of the circulating blood or blood loss equal in volume to 23 mL/kg/min. Risk factors for the development of intraoperative complications such as massive blood loss are, in addition to surgical interventions, the features of surgical intervention, i.e., size of the incision, surgical duration, and anesthesia, which can increase blood loss. The intensity and degree of blood loss are very important in determining the indications for transfusion of blood components, replenishing the volume of circulating blood, and determining indications for intraoperative hemostasis, both medical and surgical. In neonates and young children, the risk of dangerous intraoperative blood loss is associated with anatomical and physiological features, i.e., a small volume of circulating blood and insufficiently mature compensatory mechanisms. In older children, a high risk of massive blood loss is associated with comorbidities, features of hemostasis, and use of drugs that slow down the blood coagulation process. To date, several methods are available for assessing intraoperative blood loss, but only a few are used in routine clinical practice. Each method has advantages and disadvantages. One of the main disadvantages is the complexity of the mechanisms for assessing blood loss, for example, weighing surgical materials or the patient before and after surgery, determining hemoglobin in the liquid after soaking the used surgical materials, and calculating indices using formulas. Most often, the assessment of blood loss is conducted according to the clinical picture (pallor of the skin and mucous membranes, weak pulse, lowering blood pressure, etc.). The results of the literature analysis showed insufficient research on determining the volume of intraoperative blood loss in pediatric practice, as evidenced by the small number of published scientific papers and the complete absence of randomized trials. Thus, further study of this problem is necessary.
The article describes clinical observation of treatment of a premature infant with chyloperitoneum. Accumulation of fluid in the abdominal cavity was diagnosed prenatally at 31–32 weeks of gestation. Premature surgical delivery was performed at 34– 35 weeks due to the high risk of antenatal fetal death. Paracentesis with fluid analysis was done; chylous exudate was confirmed. Total parenteral nutrition, octreotide and drainage of the abdominal cavity were used during conservative treatment. It was decided to perform a surgery as the therapy was ineffective. At the age of 2 months and 7 days laparotomy was conducted, abdominal organs were revised, lymph ducts were ligated, and abdominal cavity was drained producing a positive effect. The fluid outflow was terminated and the child was discharged in a satisfactory condition.
Neonatal sepsis is a problem still relevant for healthcare in Russia and worldwide due to high mortality and resistance to treatment. Generalization of infection in newborns occurs because of innate immunity deficiency that particularly leads to neutrophil and monocyte malfunction. Nowadays clinical practice of neonatal sepsis diagnostics does not include phagocytes functional testing. Purpose. The study aims at evaluating the ability of sepsis biomarkers (CRP, PCT, lactate, CD64, CD16, HLA-DR) to differentiate the pathogenesis of organ dysfunction in newborns in the ICU setting.Material and methods. We assessed the surface expression of neutrophil CD64 and CD16, as well as monocytic HLA-DR in newborn ICU patients with different genesis of multiple organ failure — sepsis, asphyxia and combined; as well as different outcomes of hospitalization in the ICU — survivors and deaths.Results. We have shown a significant increase in the neutrophil CD64 expression and a decrease in the monocytic HLA-DR in infectious and combined genesis of multiple organ failure compared with severe asphyxia; deaths were associated with reduced expression of neutrophil CD16.Conclusion. Our data could substantiate combined use of the phagocytes functional testing indicators together with conventional sepsis biomarkers in order to increase their prognostic and predictive value.
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