Changes in visceral proteins pool in children with different types of respiratory failure

2020 ◽  
Vol 26 (2-3) ◽  
pp. 38-48
Author(s):  
O.V. Filyk ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Nutritional Status ◽  
Acute Respiratory Failure ◽  
Lung Protective Ventilation ◽  
Albumin Solution ◽  
Group I ◽  
Protective Ventilation Strategy ◽  
Group Ii

Malnutrition has substantial clinical and socioeconomic significance. Early nutritional disturbances may adversely affect the course of existing lung diseases in early childhood and increase the risk of lung disease in adults. Early diagnosis with combination of clinical examination, anthropometric and laboratory methods in children with acute respiratory failure help to improve results of treatment, and laboratory markers which quickly respond to changes in nutrition will provide optimal monitoring for patients and conditions for immediate correction of these disorders by physicians. The aim of the study was to determine the features of visceral proteins pool (albumin and transthyretin) in children with different types of respiratory failure and duration of their stay in the intensive care unit depending on the plan of nutritional disorders monitoring and correction. Material and Methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children's Clinical Hospital "OHMATDYT". We included 237 patients aged from 1 month to 18 years and distributed them into a control group, Group I, and Group II. In Groups I and II patients with acute respiratory failure were included who were mechanically ventilated for more than 2 days. Group I included patients who received lung-protective ventilation strategy and assessment of nutritional status; Group II included patients who received diaphragm-protective in addition to lung-protective ventilation strategy; the results of nutritional status assessment were taken into account as well. The atients were divided into age subgroups: 1st subgroup - children from1 month to 1 year of age; 2nd subgroup - children of 1 - 3 years; 3rd subgroup - children of 3 - 6 years; 4th subgroup - children of 6 - 13 years; 5th subgroup - children of 13 - 18 years. The stages of the study were the following: 1st day (d1), 3rd day (d3), 5th day (d5), 7th day (d7), 9th day (d9), 14th day (d14), 28th day (d28). The primary endpoint was the duration of stay in the intensive care department. The additional assessment criteria included serum albumin and transthyretin levels, the frequency of transfusions of albumin solution, and the frequency of changes in nutritional therapy procedure. The statistical analysis of the study results was performed using MS Excel 2017 with the calculation of the median [IQR - interquartile range], and p-values calculations. Results and Discussion. As a result of the analysis of data on the visceral pool of proteins, it should be noted that the most common disorders were found in patients of the 1st, 2nd and 5th age subgroups: in 1st age subgroup there were disorders related to albumin and transthyretin level; in 2nd age subgroup -to transthyretin level, in 5th age subgroup -to albumin. This might be explained in terms of malnutrition impact on development of body weight deficit and lower body mass index in children of 1st and 2nd age subgroups. On the other hand, in 5th age subgroup nutritional deficiency might be the basis for the emergence of serious diseases that are directly related to nutritional status (severe bacterial infections) and lead to their severe course. The analysis of the frequency of transfusions of albumin solution found that it was performed: in the 1st age subgroup - in 50% of patients of Group I and 0% patients of Group II; in the 2nd age subgroup there were no patient received albumin solution; in the 3rd age subgroup - in 30% of patients of I group and in 0% of patients of II group; in the 4th group - in 20% of patients in Group I and in 0% patients in Group II; in 5th age subgroup - in 0% patients of Group I and in 50% of patients in Group II. The change in the procedure of the nutritional therapy was carried out: in 1st age subgroup - 18% in Group I, 0% in Group II; in 2nd age subgroup - 0% patients in Group I and 30% patients of Group II; in 3rd age subgroup - 0% patients in Group I and 33% patients of Group II; in 4th age subgroup - 40% in Group I and 50% in GroupII; in 5th age subgroup - 0% in Group I and 43% in Group II. Conclusions. It was found that the duration of stay in the intensive care unit depends on principles of monitoring and correction of nutritional disorders in children with respiratory failure. A reliable twofold decrease of the time spent in the intensive care unit was achieved in Group II in comparison with Group I and in the 2nd age subgroup; the time of ICU stay also decreased 2.3 times in 5th age subgroup (p<0.05). Keywords: visceral proteins, children, acute respiratory failure

scholarly journals PERSONALIZED INTENSIVE CARE OF CARDIOVASCULAR DISORDERS IN CHILDREN WITH RESPIRATORY FAILURE

2020 ◽  
Vol 117 (3) ◽  
pp. 46-57
Author(s):  
Olha Filyk
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Stroke Index ◽  
Cardiovascular Dysfunction ◽  
Non Invasive ◽  
Group I ◽  
Hemodynamic Assessment ◽  
Group Ii

This article presents data on the frequency of incidence and duration of cardiovascular dysfunction in children with acute respiratory failure. The information on expediency of carrying out of personalized hemodynamic management in case of its insufficiency with use of multiparametric approach to estimate haemodynamic data are presented. The aim of the study was to compare the effectiveness of the standard approach and proposed by us additions to treatment of haemodynamic disorders in children with respiratory failure. It was summarized from the literature reviews that the presence and maintenance of patient`s spontaneous breathing pattern with use of non-invasive estimated cardiovascular monitoring, evaluation of preload with ultrasonography and reassessment of rate and volume of fluid replacement with taking into account solution`s composition might improve treatment results in children with acute respiratory failure. We conducted a prospective single-center non-interventional cohort study in children with acute respiratory failure 1 month - 18 years old. Patients were randomly divided into I and II groups. The data analysis included 43 patients of group I, who received conventional for this intensive care unit monitoring and treatment and 53 patients of group II, in whom we took into account the results of multiparametric monitoring during the correction of hemodynamics.Monitoring of hemodynamics included heart rate, non-invasive systolic, diastolic and mean blood pressure capillary refill time and presence of peripheral arteries pulsation with clinical verification of "warm" or "cold" shock, ScvO2 and lactate levels in the central venous blood; non-invasive estimated monitoring of stroke volume, cardiac output, cardiac index, stroke index using the esCCO technology, NIHON COHDEN (Japan) and the ratio of inferior vena cava diameter at inspiration and exhalation. Hemodynamic support in groups I and II included early goal-directad therapy, individualized and personalized treatment. In II group of patients there were taken into account the dynamics of changes of non-invasive esCCO data about stroke volume, cardiac output, cardiac index and stroke index, cumulative hydrobalance and the ratio of the of inferior vena cava diameter at inspiration and exhalation. Early goal-directed therapy was aimed to (supra) normalize of blood flow and was based on normal hemodynamic data for population, according to percentiles for specific age groups of patients. Individualized hemodynamic therapy included functional hemodynamic monitoring with assessment of to volemic therapy answer, individualization of target points and maximization of blood flow. Personalized hemodynamic management consisted of applying an adaptive multiparametric approach to hemodynamic assessment. Spontaneous diaphragmatic activity was maintained along all time of mechanical ventilation. The primary endpoint was 28-day mortality rate; secondary endpoints were the duration of cardiovascular dysfunction and the duration of intensive care unit stay. To assess age-dependent data, patients were divided into age subgroups: 1st subgroup - children 1 month - 1 year old; 2nd subgroup - children 1 - 3 years old; 3rd subgroup - children 3 - 6 years old; 4th subgroup - children 6 - 12 years old; 5th subgroup - children 12 - 18 years old. It was determined that the level of 28-day mortality was: in 1st age subgroup - 18.2% in group I and 3.1% in group II (p = 0.02), in the 2nd age subgroup - 11.1% and 0%, respectively (p = 0.11); in the 4th age subgroup - 10% and 0%, respectively (p = 0.28); in the 3rd and 5th age subgroups - was 0% in I and II groups. The prevalence of hemodynamic disorders was: in 1st age subgroup in patients of group I - 100%, while in group II - 62.5% (p = 0.001); in 2nd age subgroup - 55.6% in patients from group I and 42.9% in patients from group II (p = 0.05); in 3rd age subgroup in 100% of patients of group II and only in 75% of patients of group I (p = 0.02). In the 4th age subgroup no significant differences were found between I (30% of patients) and II groups (25% of patients), p = 0.28; in 5th age subgroup the frequency of cardiovascular dysfunction was 40% in group I, compared with 75% in group II (p = 0.008). It was found that duration of hemodynamic insufficiency was longer in patients of 1st and 4th age subgroups, and relatively shorter in patients of 5th age subgroup: in the 1st age subgroup it was 7.6 ± 0.5 days in group I and 8.8 ± 0.9 days in group II (p> 0.05); in 4th age subgroup - 6.7 ± 0.4 days in group I and 10.1 ± 1.2 days in group II (p> 0.05), while in 5th age subgroup - 4.1 ± 0.3 days in group I and 4.7 ± 0.5 days in group II (p> 0.05). We found that there were significant differences in the duration of stay in intensive care unit among patients of the 1st and 5th age subgroups. Specifically, in 1st age subgroup this indicator was in 1.3 times less in group II, compared with group I (p <0.05); in 5th age subgroup the situation was the opposite- the duration of intensive care unit stay in group II was in 1.4 times more in group I (p <0.05). Thus, obtained data demonstrated the results of the use of personalized management of hemodynamic disorders in children with acute respiratory failure. The use of a multiparametric approach to hemodynamic assessment in clinical practice may allow more differentiated use of volume replacement therapy as loop diuretics and will have a beneficial effect on the final clinical outcomes in patients with acute respiratory failure.

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

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