Advances data aboute microcirculatory distress in pediatric sepsis and novel ability of intensive care wiyh L-arginine infusion
DOI:
https://doi.org/10.15587/2313-8416.2015.39144Keywords:
sepsis, children, microcirculatory distress, intensive care, L-arginineAbstract
Aim. To analyze contemporary sources that contain information on the problems of microcirculation distress in sepsis, including children. The promising directions in intensive care are determined. Develop new approaches to intensive care of microcirculation distress in sepsis for children in light of the scientific data.
Methods. To achieve this aim we used scales SOFA, Glasgow, PRISM Murrey. Applied determination of central and organ hemodynamics by Doppler ultrasound were studied ABB parameters of central venous, arterial blood, electrolytes, creatinine, urea, alanine transaminase, lactate, endothelin, serum metabolites of nitric oxide in children with sepsis who received standard care and its modification using infusion of L-arginine.
Results. The results of the study gave reason to confirm that disorders of organ blood flow in the pulmonary, splanchnic circulation area are happened in sepsis of children. They are associated with a relative deficiency of nitric oxide and endothelin excess. Add to a goal-oriented therapy of septic conditions infusion of 4.2% solution of arginine helps eliminate pathological vasoconstriction of the renal vessels and the pulmonary circulation, leading to improve the kidney function. Change of hepatic blood flow characterized by a certain tendency to arterial vasodilation.
Conclusions. Infusion of 4.2 % solution of arginine in children with sepsis does not cause adverse impact on central hemodynamics, whereas improve perfusion of vital organs. The proposed intensive care contributes significant reduction in mortality compared to the predicted (p<0,001), (95 % CI 0.37-0.03)
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