Pediatric sepsis – time to reach agreement

Lekmanov, A. U.; Миронов, П И

doi:10.21508/1027-4065-2020-65-3-131-137

Cited by 6 publications

(1 citation statement)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to international protocols [23][24][25][26][27][28][29][30][31], confirmed sepsis / SS requires rapid provision of venous access and initiation of infusion (vasopressors, if necessary), administration of antibiotics 1-3 hours before sampling for microbiological examination. Studies have shown a correlation between increased mortality and delayed ABT prescription after sepsis / SS is identified.…”

Section: Discussion Of Research Resultsmentioning

confidence: 99%

Pediatric surgical sepsis: diagnostics and intensive therapy

Сатвалдиева

Ashurova

Fayziev

et al. 2021

SR:MS

View full text Add to dashboard Cite

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

show abstract

Section: Discussion Of Research Resultsmentioning

confidence: 99%

Pediatric surgical sepsis: diagnostics and intensive therapy

Сатвалдиева

Ashurova

Fayziev

et al. 2021

SR:MS

View full text Add to dashboard Cite

show abstract

Algorithm for predicting sepsis in newborns with respiratory pathology and perinatal lesions of the central nervous system on mechanical ventilation

Pukhtinskaya

Эстрин

2022

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

View full text Add to dashboard Cite

BACKGROUND: Predicting sepsis in ventilated neonates remains a challenge in neonatology. AIM: To increase the efficiency of predicting sepsis diagnosis in newborns by developing a decision rule for its development based on decision trees. MATERIALS AND METHODS: This clinical study retrospectively reviewed 200 full-term newborns with respiratory pathology that are admitted to the intensive care unit and are on mechanical ventilation without clinical signs of bacterial infection. Upon admission to the department on days 1, 35, and 20, an enzyme-linked immunosorbent assay determined the plasma concentration of interleukin (IL)-1, IL-6, IL-8, tumor necrosis factor-, granulocyte colony-stimulating factor, soluble Fas ligand, fibroblast growth factors, and nitric oxide (NO), and immunophenotyping method determined CD3+CD19, CD3CD19+, CD3+CD4+, CD3+CD8+, CD69+, CD71+, CD95+, HLADR+, CD34+, CD14+, CD3CD56+; lymphocytes expressing AnnexinV-FITC+PI, and AnnexinV-FITC+PI+. The possibility of diagnosing sepsis upon intensive care unit admission was assessed by statistical cluster analysis of the total studied immunological criteria. The method of decision trees in the statistical environment R formed a diagnostic rule for predicting sepsis. RESULTS: Visualization of the cluster analysis results of admitted patients did not exclude the presence of two clusters among them (with and without sepsis, which explain the 60.81% of the point variability). Sepsis prediction rule are as follows: disease progression occurs if on day 1 CD95 is 16.8% and NO is 9.6 mkmol/l or CD95 is 16.8%, CD34 is 0.2%, CD69 is 4.12% or CD95 is 16.8%, CD34 is 0.2%, CD69 is 4.12%, and lymphocytes expressing AnnexinV-FITC+PI is 12.3%. The diagnostic accuracy was 96.00%; sensitivity was 97.00%; specificity was 94.90%; the false-positive proportion of diagnoses was 5.10%; the false-negative proportion of diagnoses was 2.94%; the positive result accuracy was 95.19%; and the negative result was 96.88%. The disease was complicated by bacterial sepsis development on 45 days of observation in 45 newborns. CONCLUSIONS: Significant importance in sepsis development belongs to the prevalence of altered immunocompetent cells over proliferation and endogenous synthesis of nitric oxide. The cumulative determination of CD95+, CD69+, AnnexinV-FITC+PI, CD34+, and plasma nitric oxide concentration helped diagnose sepsis development at the preclinical stage. The obtained results indirectly confirm the relevance of studies on sepsis prevention and treatment by drug correction of apoptosis and inhaled NO.

show abstract

Multiple-organ dysfunction in children with central nervous system infections

Ermolenko,

Pshenisnov,

Aleksandrovich

et al. 2024

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

View full text Add to dashboard Cite

BACKGROUND: Multiple-organ dysfunction syndrome is one of the most dangerous complications of critical illness in children, which helps determine the disease outcomes. AIM: This study aimed to examine the features of multiple-organ dysfunction syndrome in children with severe central nervous system (CNS) infection and identify factors that determine disease outcomes. MATERIALS AND METHODS: This single-center, retrospective, observational study enrolled 98 patients, which included 66 (67%) boys and 32 (33%) girls. The average age was 3.6 ± 2.5 years. The Glasgow coma scale (GCS) score was 8.8 ± 2.4 points. Shock was diagnosed in 43 (44%) patients. The average treatment duration in the intensive care unit (ICU) was 9.5 ± 6.2 days, the duration of mechanical ventilation was 6.0 ± 3.9 days, and the mortality rate was 9%. Depending on the outcome, the children were divided into groups I (recovery, n = 88) and II (death, n = 10). All indicators were recorded in the first 12 h from ICU admission. RESULTS: The most pronounced phenomena of cardiovascular dysfunction, such as decreased Teicholtz ejection fraction (62.3 L/min), were observed when the pSOFA scale score was 10 points, which was statistically significant when compared with the indicators in children with a pSOFA scale score of 8 points. In all patients, regardless of age, a negative correlation of moderate strength was found between the pSOFA scale score and the Teicholtz ejection fraction, and it was pronounced in children aged 7–17 years (R = –0.41; p = 0.008). A positive correlation was found between heart rate and pSOFA scale score in children aged 7–17 years (R = 0.72; p = 0.009). In the evaluation of the discriminatory ability of the pSOFA scale and Phoenix sepsis scores regarding the outcome on the first day of treatment in the ICU, the latter has greater prognostic significance (area under the curve, 0.866 vs 0.838; sensitivity, 76% vs 72%; specificity, 82% vs 79%). CONCLUSIONS: Low cardiac output syndrome and systemic hypoxia are key factors associated with fatal outcomes in children with severe CNS infections. The high clinical significance of the ejection fraction in predicting the outcomes of severe CNS infections in children, regardless of age, allows the use of this parameter for goal-oriented therapy.

show abstract

Pediatric sepsis – time to reach agreement

Cited by 6 publications

References 22 publications

Pediatric surgical sepsis: diagnostics and intensive therapy

Pediatric surgical sepsis: diagnostics and intensive therapy

Algorithm for predicting sepsis in newborns with respiratory pathology and perinatal lesions of the central nervous system on mechanical ventilation

Multiple-organ dysfunction in children with central nervous system infections

Contact Info

Product

Resources

About