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Registration Number

0213U006017, 0109U002830 , R & D reports

Title

The diagnostic criteria of severeti and intensive care critical states in pediatric patientes and optimization of perioperative intensive care

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Head

Georgiyants Marine Akopovna,

Registration Date

04-04-2013

Organization

The Kharkiv Post-graduate Medical Academy

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The present study is dedicated to the current aspects of diagnostics and intensive care of hemodynamic disorders in pediatric patients with sepsis. Central and regional (pulmonary, splanchnic and renal) hemodynamic disorders were estimated based on test results and intensive care of 170 patients with sepsis, severe sepsis and septic shock. It was determined that septic states in children are characterized by unequal organ perfusion, such as increased blood flow in a. mesenterica superior and v. porta, and pulmonary and renal vasoconstriction. Decreased liver perfusion is caused mainly by decreased blood flow in a. hepatica. The above hemodynamic disorders correlate with development of respective organs failure and disbalances between vasoconstrictors/vasodilators towards the formers. Based on obtained data, the prognostics and diagnostics criteria of organ dysfunction (based on estimation of regional perfusion by Pulsed Wave Doppler technology), and a protocol of goal-oriented intensive care of hemodynamic disorders (based on initial infusion therapy with Hydroxyethylstarch 130/0,4, differentiate use of inotropic agents - dopamine and dobutamine, and vasodilator - NO-donator - 4,2% solution of L-arginine) have been developed. The use of the proposed methods of intensive care has enabled us to decrease the lethality rate in septic multiorgan dysfunction by compared with the prognostic level. The work covers the questions of medical care improvement to preterm infants in critical state on the basis of study central, cerebral and mesenterial hemodynamic during the first days of life and implementation of a modern type critical neonates feeding. The perinatal risk factors of critical state development in preterm infants were determined. The changes of cerebral, cardiac and mesenterial hemodynamic in preterm infants were defined during time and after early enteral feeding administration. The correlation between data of cardiac, cerebral and mesenterial hemodynamic was studded and there's changes in preterm infant in critical state were separate out. The prognostic equation of ischemia in superior mesenterial arteries estimated on the basis regression statistic. The diagnostic and prognostic model of critical state in preterm infants with the justification of early enteral feeding administration were elaborated.The study summarizes the results of examination and treatment of 89 patients with scoliosis III - IV degree that were operated in 2003 - 2007 in Child Spine and Joint Pathology Clinic, and were in the postoperatively in the Department of Anesthesiology and Intensive Care in Sytenko Institute of Spine and Joints Pathology AMS Ukraine. The average age was 13,7±4,5 years. Female were dominated (n = 78, 87,6%). In the dissertation, the theoretical generalization and solution of scientific problems of optimization of infusion therapy of blood loss during surgical treatment of severe spinal deformities in children. Its solution is achieved through the development and introduction into clinical practice individualized approach to the infusion-transfusion therapy of blood loss during surgical treatment of severe spinal deformities in children. Conducting a restrictive fluid therapy leads to the development of hypovolemia in the postoperative period, which was manifested in the simultaneous reduction from baseline of left ventricular volumes, as the end-systolic (at 63,0±4,5%), and end-diastolic (at 59,4±7,3%) and related these changes in stroke volume (at 53,8±6,7%) in the second stage. These changes were compensated most rapidly in patients treated with modified gelatin and perfluorocarbon and reinfusion of postoperative drainage of blood - by the end of the first day after surgery. Carrying out a restrictive fluid therapy leads to the development of hypovolemia in the postoperative period, which was manifested in the simultaneous reduction from baseline of left ventricular volumes, as the end-systolic (at 63,0±4,5%), and end-diastolic (at 59,4±7,3%) and related these changes in stroke volume (at 53,8±6,7%) in the second stage. These changes most rapidly in patients with compensated group III - to outcome of the first day after surgery. When using drugs donated blood in the infusion-transfusion therapy perioperative period of surgical correction of scoliotic spinal deformity rates of oxygen-transport function of blood normalized for a short time (24 - 36 h) after blood transfusions. In patients not receiving blood products was a high rate of extraction of oxygen until the end of the study (5-days after surgery). The optimal method of perioperative infusion-transfusion therapy in the surgical correction of severe spinal deformities in adolescents should recognize the use of modified gelatin emulsion in combination with perfluorocarbon and postoperative reinfusion of drain blood, which in the presence of control indicators of central hemodynamics and oxygen transport allows you to activate patients to 7,9±0,6 days, whereas the use of blood transfusions - only 12,9±0,9 days.

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Власенко Л.С.
Георгіянц М.А.
Корсунов В.А.
Кузенков Р.В.
Кухар Д.І.
Одинець І.Ю.
Раскова Т.Ю.
Хмизов А.А.

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2020-04-02