Extracorporeal detoxification for septic complications in children during the acute period of severe combined craniocerebral trauma
- Authors: Novikova T.A.1, Yeletskaya E.V.1, Ivanova T.F.1, Amchislavsky V.G.1
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Affiliations:
- Scientific and Research Institute for Emergency Pediatric Surgery and Traumatology
- Issue: Vol 11, No 2 (2021)
- Pages: 151-160
- Section: Original Study Articles
- URL: https://journal-vniispk.ru/2219-4061/article/view/123176
- DOI: https://doi.org/10.17816/psaic938
- ID: 123176
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Abstract
BACKGROUND: The clinical application of extracorporeal detoxification methods in patients with severe concomitant traumatic brain injury has several features and limitations due to intracranial hypertension, traumatic cerebral edema, and the risk of their growth during extracorporeal detoxification. The modern literature presents the results of using extracorporeal detoxification methods in severe concomitant trauma in children. However, practically no data are available on the possibility of their use in severe concomitant craniocerebral trauma, which determines the relevance of research in this direction.
AIM: This study aims to improve the treatment results of affected children with severe concomitant craniocerebral trauma with the addition of septic complications using extracorporeal detoxification methods.
MATERIALS AND METHODS: The experience using extracorporeal detoxification methods, including prolonged veno-venous hemodiafiltration combined with LPS sorption and plasma separation membrane in patient intensive care with severe concomitant craniocerebral trauma complicated by sepsis and septic shock development, is presented.
RESULTS: The use of extracorporeal detoxification methods contributed to eliminating septic shock, stabilization of hemodynamic and internal homeostasis parameters, and regression of multiple organ failure in patients with severe concomitant traumatic brain injury. Monitoring the intracranial pressure and preventing disequilibrium syndrome development enabled avoiding an increase in intracranial hypertension in studied patients.
CONCLUSIONS: Timely and adequate use of extracorporeal detoxification methods improves the clinical course of the acute period of traumatic illness in children with severe concomitant traumatic brain injury. The safe use of efferent therapy methods in patients with severe concomitant traumatic brain injury is ensured by invasive monitoring of intracranial pressure and preventing the development of disequilibrium syndrome.
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##article.viewOnOriginalSite##About the authors
Tatyana A. Novikova
Scientific and Research Institute for Emergency Pediatric Surgery and Traumatology
Author for correspondence.
Email: increate.msk@mail.ru
ORCID iD: 0000-0003-4400-2457
SPIN-code: 1661-0509
anesthesiologist-resuscitator
Russian Federation, 22, Bolshaya Polyanka srt., Moscow, 119180Elena V. Yeletskaya
Scientific and Research Institute for Emergency Pediatric Surgery and Traumatology
Email: eleckaya@inbox.ru
ORCID iD: 0000-0002-2678-4865
SPIN-code: 5455-4751
anesthesiologist-resuscitator
Russian Federation, 22 Bolshaya Polyanka srt., Moscow, 119180Tatyana F. Ivanova
Scientific and Research Institute for Emergency Pediatric Surgery and Traumatology
Email: tat93320342@yandex.ru
ORCID iD: 0000-0001-6788-5091
SPIN-code: 3669-1982
anesthesiologist-resuscitator
Russian Federation, 22 Bolshaya Polyanka srt., Moscow, 119180Valery G. Amchislavsky
Scientific and Research Institute for Emergency Pediatric Surgery and Traumatology
Email: vamches@mail.ru
ORCID iD: 0000-0002-6880-8060
SPIN-code: 5095-9316
Dr. Sci. (Med.), Professor
Russian Federation, 22 Bolshaya Polyanka srt., Moscow, 119180References
- Krasnoyarov GA, Vaulina AV, Kozlov OO. Analysis of the treatment of polytrauma in children and adolescents. Klinicheskaya Medicina. 2009;(2):55–60. (In Russ.)
- Novokshonov AV, Lastaev TV. Traumatic brain injury in children with polytrauma. Politravma. 2015;(1):23–28. (In Russ.)
- Humanenko EK. Actual problems of concomitant injuries (clinical and pathogenetic aspects). Klinicheskaya Medicina i Patofiziologiya. 1995;1:9–21. (In Russ.)
- Khoroshilov SE, Karpun NA, Ilchenko AM, et al. Extracorporeal detoxification in patients with severe concomitant trauma. Obschaya Reanimatologiya. 2009;5(5):16–19. (In Russ.)
- Khoroshilov SE, Karpun NA, Ilchenko AM, et al. High-volume hemodiafiltration in a victim with massive crush of soft tissues in severe concomitant injury. Medical Journal of the Russian Federation. 2010;16(6):51–53. (In Russ.)
- Puras YuV, Talypov AE, Krylov VV. Mortality in victims with severe concomitant traumatic brain injury. Neirohirurgiya. 2010;(1):9–31. (In Russ.)
- Timofeev VV, Bondarenko AV. Epidemiological aspects of polytrauma in children in a large city. Politrauma. 2012;(4):5–8. (In Russ.)
- Akhmedov MM, Musaev TS. Analysis of combined and multiple injuries in children after a road traffic accident. Vestnik Ekstrennoi Medicini. 2015;(2):19–20. (In Russ.)
- Gupta DK, Kumar H, Mahapatra AK. Role of Invasive ICP Monitoring in Patients with Traumatic Brain Injury. Indi J Neurotrauma. 2006;3(1):31–36. doi: 10.1016/S0973-0508(06)80007-9
- Gorbachev VI, Likholetova NV, Gorbachev SV. Intracranial Pressure Monitoring: Present and Perspective (Communication 1). Politrauma. 2013;(4):69–78.
- Chaudhary AK, Tewari A. Increased Intracranial Pressure. Anaesth Clin Pharmacol. 2005;21(3):247–256.
- Czosnyka M, Picard JD. Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatr. 2004;75(6):813–821. doi: 10.1136/jnnp.2003.033126
- Eide PK, Egge A, Due-Tennessen BJ, Helseth E. Is Intracranial Pressure Waveform Analysis Useful in the Management of Pediatric Neurosurgical Patients? Pediatr Neurosurg. 2007;43(6):472–481. doi: 10.1159/000108790
- Jennifer R, Voorhees BA, Aaron A, et al. Early evolution of neurological surgery: conquering increased intracranial pressure, infection, and blood loss. Neurosurg Focus. 2005;18(4):14–18. doi: 10.3171/foc.2005.18.4.3
- Fakhry SM, Trask AL, Waller MA, Watts DD. Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges. Cent Nerv. 2004;56:492–499. doi: 10.1097/01.ta.0000115650.07193.66
- Robertson CS Valadka AB, Hannay HJ. Prevention of secondary ischemic insults after severe head injury. Crit Care Med. 1999;27(10):2086–2095. doi: 10.1097/00003246-199910000-00002
- Smirnov AV. Renal replacement therapy. Nefrologiya. 2011;15(1):33–46. (In Russ.) doi: 10.24884/1561-6274-2011-15-0-33-46
- Holt S, Moore K. Pathogenesis of renal failure in rhabdomyolysis: The role of myoglobin. Exp Nephrol. 2000;(8):72–76. doi: 10.1159/000020651
- Wuhl E, Trivelli A, Picca S, et al. Strict blood-pressure control and progression of renal failure in children. N Engl J Med. 2009;361(17):1639–1650. doi: 10.1056/NEJMoa0902066
- National Kidney Foundation. K/DOQI. 2006 updates clinical practice guidelines and recommendations. Available: https://docplayer.net/16321596-2006-updates-clinical-practice-guidelines-and-recommendations.html
- Kolykhalkina IA, Chernysheva TA, Amcheslavsky VG, et al. Protocol for stepwise therapy of intracranial hypertension in the acute period of severe mechanical trauma. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2013;3(2):74–78.
- Mukhoedova TV, Unarokov ZM, Malov AA. Jekstrakorporal’naja detoksikacija v lechenii bol’nyh s ostrym povrezhdeniem mozga. Patologiya Krovoobrascheniya i Kardiohirurgiya. 2010;(3):35–39.
- Burov AI, Savin IA, Abramov TA, Korotkov DS, Kostritsa NS. Complex intensive therapy using a combined technique of extracorporeal detoxification in a patient with septic shock after neurosurgical intervention. Anesteziologiya i Reanimatologiya. 2019;(5):81–87. doi: 10.17116/anaesthesiology201905181.
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