Korsunov V. "Intensive care of pediatric sepsis related multiorgan dysfunction"

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.