The dissertation complements the data on etiology of respiratory failure in children according to the study of diaphragm function, changes in hemodynamics, nutritional status, electrolytes level and central nervous system function; it was found out mechanisms of inadequate spontaneous breathing and causes of unsuccessful weaning from mechanical ventilation and it was developed weaning strategy with goal-directed treatment technologies for these disorders with taking into account the form of respiratory failure and children age; the specific scientific problem has been solved and the results of treatment of children with respiratory failure were improved, duration of mechanical ventilation and frequency of its complications were reduced.
This issue remains relevant due to the high incidence of respiratory diseases in children and wide spread of acute respiratory failure due to coronavirus infection. Nowadays, most of the features of mechanical ventilation are known, international recommendations are provided for ventilation parameters, there are wide opportunities for choosing of ventilation modes, however, the issue of weaning from mechanical ventilation is still relevant and unresolved completely.
The work is based on the own experience of treatment and analysis of medical records of 237 patients aged 1 month - 18 years. We conducted open prospective randomized non-interventional controlled single-center study.
To assess age-dependent data, patients were divided into age subgroups: 1 subgroup - children 1 month - 1 year; 2nd subgroup - children 1 - 3 years; 3 subgroup - children 3 - 6 years; 4 subgroup - children 6 - 13 years; 5 subgroup - children 13 - 18 years.
Stages of the study: 1st day (d1), 3rd day (d3), 5th day (d5), 7th day (d7), 9th day (d9), 14th day (d14), 28th day (d28).
In this work, based on our study, for the first time were obtained new data on diaphragm function, was implemented into clinical practice the method of checking the function of diaphragm in children. It gives us opportunity to develop the strategy how to change the ventilation parameters depending on inspiration time measured by ultrasound of the diaphragm and depending on speed of diaphragm contraction. Therefore, we might use patient-based individualized approach of mechanical ventilation. We found the diagnostic value of determining the function of the diaphragm in children undergoing mechanical ventilation in terms of their readiness to wean from mechanical ventilation (UA Pat. No. IPC (2020.01) A61B 5/083 (2006.01) A61B 8/00 A61B 10/00. Determination of diaphragm function in children undergoing mechanical ventilation and their readiness for weaning from mechanical ventilation). In addition, scientific data on how diaphragm dysfunction affects the results of weaning were supplemented.
It was proposed and implemented in clinical practice strategy for diaphragm-protective ventilation in children with different types of respiratory failure. For the first time it was developed comprehensive technologies for prevention of ventilator-associated damage of diaphragm in children during mechanical ventilation.
It was shown advantages of providing diaphragm-protective mechanical ventilation in addition to lung-protective strategy in children with acute respiratory failure both during the entire period of respiratory therapy and weaning from mechanical ventilation.
We justify the feasibility of determining the level of serum transthyretin and the splitting patients into groups according to received data which confirms development and persistence of acute nutritional insufficiency. The transthyretin / C-reactive protein ratio has been shown to be valuable in determining the effectiveness of nutritional therapy in patients with systemic inflammatory response syndrome. It was developed by us the goal-directed technology for the correction of severe nutritional disorders in children who need mechanical ventilation.
In mixed (restrictive and obstructive) disorders, stroke volume and stroke index were high and have no change during the first 3 days of treatment. On study day 7 they were decreased by 11% in comparison with study day 1 (p = 0.12), it was accompanied by a gradual decrease in cardiac output.
The cardiac index was high in patients with all forms of acute respiratory failure in study stages d1, d3, d5, and then gradually was decreased from the mom
