CLINICAL AND PHYSIOLOGICAL JUSTIFICATION OF WEANING FROM MECHANICAL VENTILATION IN CHILDREN WITH RESPIRATORY FAILURE
Abstract
Children frequently are admitted to pediatric intensive care units due to acute respiratory failure and up to 64 % of them need to be mechanically ventilated and later weaned.
The aim was to develop strategy of weaning from mechanical ventilation in children with different types of respiratory failure.
Materials and methods. The work was based on results of treatment of 237 patients aged from 1 month to 18 years old, who were divided into control and study group. Patients of study group were randomized into group I (83 patients) and received traditional ICU monitoring and treatment and group II (79 patients), where was used proposed by us methods of monitoring and treatment.
Results. There was supplemented data on the etiology of respiratory failure in children with taking into account function of diaphragm, changes in hemodynamics, nutritional status, electrolyte balance and central nervous system function. It was established new mechanisms of inadequacy of spontaneous breathing during mechanical ventilation and found causes of unsuccessful weaning from mechanical ventilation. In addition, it was developed a weaning strategy with goal-directed therapy for disorders treatment according the type of respiratory failure and children`s age. As a result, important scientific problem was solved and the results of treatment of children with respiratory failure was improved.
Conclusions. It was found that proposed strategy of weaning from mechanical ventilation allowed to reduce the duration of mechanical ventilation and the frequency of complications (reintubations). There were no significant differences in the frequency of tracheostomy among patients of I and II groups.
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References
Burns, J. P., Sellers, D. E., Meyer, E. C., Lewis-Newby, M., Truog, R. D. (2014). Epidemiology of Death in the PICU at Five U.S. Teaching Hospitals*. Critical Care Medicine, 42 (9), 2101–2108. doi: http://doi.org/10.1097/ccm.0000000000000498
Goligher, E. C. (2019). Myotrauma in mechanically ventilated patients. Intensive Care Medicine, 45 (6), 881–884. doi: http://doi.org/10.1007/s00134-019-05557-6
Moury, P.-H., Cuisinier, A., Durand, M., Bosson, J.-L., Chavanon, O., Payen, J.-F. et. al. (2019). Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study. Annals of Intensive Care, 9 (1). doi: http://doi.org/10.1186/s13613-019-0521-z
McCarthy, A., Delvin, E., Marcil, V., Belanger, V., Marchand, V., Boctor, D. et. al. (2019). Prevalence of Malnutrition in Pediatric Hospitals in Developed and In-Transition Countries: The Impact of Hospital Practices. Nutrients, 11 (2), 236. doi: http://doi.org/10.3390/nu11020236
Koh, J. W. J. C., Wong, J. J.-M., Sultana, R., Wong, P. P. C., Mok, Y. H., Lee, J. H. (2017). Risk factors for mortality in children with pneumonia admitted to the pediatric intensive care unit. Pediatric Pulmonology, 52 (8), 1076–1084. doi: http://doi.org/10.1002/ppul.23702
Keller, U. (2019). Nutritional Laboratory Markers in Malnutrition. Journal of Clinical Medicine, 8 (6), 775. doi: http://doi.org/10.3390/jcm8060775
Mueller, C., Compher, C., Ellen, D. M. (2011). ASPEN clinical guidelines: nutrition screening, assessment, and intervention in adults. Journal of Parenteral and Enteral Nutrition, 35 (1), 16–24. doi: http://doi.org/10.1177/0148607110389335
Verhulst, S., Haan, J., Toussaint, M. (2019). Influence of Body Mass Index and Prealbumin Levels on Lung Function in Patients with Spinal Muscular Atrophy: A Pilot Study. Journal of Clinical Neuromuscular Disease, 20 (3), 137–138. doi: http://doi.org/10.1097/cnd.0000000000000225
Abdullahi, S. M., Yakubu, A. M., Bugaje, M. A., Akuyam, S. M. (2018). Serum total protein and albumin levels among malnourished children aged 6- 59 months in Zaria. Nigerian Journal of Paediatrics, 45 (1), 15–18. doi: http://doi.org/10.4314/njp.v45i1.4
Filyk, O. V. (2020). Unsuccessful weaning from mechanical ventilation in children and ways to avoid it. Hospital Surgery. Journal named by L. Ya. Kovalchuk, 3, 82–89. doi: http://doi.org/10.11603/2414-4533.2020.3.11270
Copyright (c) 2020 Olha Filyk
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