PLACE OF LOW-MOLECULAR-WEIGHT HEPARINS IN INTENSIVE THERAPY OF HEPATIC INSUFFICIENCY

The practical significance of heparin low-molecular fractions as inhibitors of inflammation and antithrombin III consumption reduction were studied. That is most critical in acute hepatic failure. The study was performed using the low-molecular-weight heparin (Nadroparin calcium) in low (prophylactic) doses of 2000 anti-factor Xa units daily per 1 meter squared in the form of continuous intravenous infusion. The cohort study proved the nadroparin positive effect on carbohydrate and protein metabolism in children with acute poisoning by hepatotoxic poisons, The significant decrease in the quantitative assessment of disseminated intravascular coagulation relative to the comparison group has been revealed, and the decrease in 28-day mortality from 42 to 13 % has been found in children receiving nadroparin. Conclusions are drawn on the feasibility of introducing low molecular weight heparins into the intensive care regimen of liver failure

Evaluation of deadspace effects created by heat and moisture exchange filter during artificial lung ventilation in newborns

Heat and moisture exchange filters create additional dead space, comparable in volume to physiological, in premature newborns. It makes carbon dioxide remove difficultу. Reducing the dead space volume by increasing the flow in the ventilator circuit can lead to the hypocapnia. Aim of the study was to determine the safety and efficiency of gas flow boost in the ventilator circuit to hypercapnia compensation created by the additional dead space. Material and methods. The effect of the additional dead space created by a heat and moisture exchange filter on hemoglobin saturation and partial pressure of carbon dioxide at the end of expiration in premature newborns at flows of 5 and 6 l/min was studied. Results and discussion. It has been demonstrated that flows of 5–6 l/min satisfactorily compensate for the effect of additional deadspace without hypocapnia. Conclusions. It is possible to recommend the widespread use of heat and moisture exchange filters in newborn weighing at least 1.0 kg during long-term transportation

Значимость маркеров транзиторной ишемии миокарда и гемодинамической перегрузки у новорожденных в критическом состоянии

Monitoring of cardiospecific markers is significant during intensive care.The objective: to compare the diagnostic and prognostic significance of cardiac markers in newborns with somatic and surgical pathology.Subjects and Methods. The study included 76 newborns aged 1 to 14 days with somatic or surgical disorders. The changes in the concentration of cardiomarkers in newborns and their relationship with echocardiography data and non-invasive hemodynamic parameters are presented, their prognostic ability is assessed.Results. Rigidity of non-invasive hemodynamic parameters, and echocardiography data was revealed. In the somatic group, regression of NT-proBNP from 8,307 ng/ml (3,600; 9,000) to 1,717 ng/ml (1,041; 5,011) was regarded as a marker of resolution of hypervolemia against the background of cardiovascular maladaptation. The increase in NT-proBNP from 4,710 ng/ml (3,400; 6,989) to 7,987 ng/ml (3,397; 9,000) in the postoperative period requires a revision of the infusion therapy program with the priority of volume restriction.Conclusions. Stabilization of the condition of patients in the groups is accompanied by a decrease in the concentration of markers of myocardial tension (MB-fraction of creatine phosphokinase, troponin T).Measurement of NT-proBNP concentration allows assessment of fluid overload in critically ill neonates.Мониторинг кардиоспецифических маркеров значим при проведении интенсивной терапии.Цель: сравнить диагностическую и прогностическую значимость кардиомаркеров у новорожденных с соматической и хирургической патологией.Материалы и методы. В исследование включены 76 новорожденных соматического или хирургического профиля в возрасте от 1 до 14 суток. Представлены динамика концентрации кардиомаркеров у новорожденных и их взаимосвязь с данными эхокардиографии, неинвазивными показателями гемодинамики, оценена их прогностическая способность.Результаты. Выявлена ригидность неинвазивных показателей гемодинамики, данных эхокардиографии. В соматической группе регресс NT-проМНУП от 8 307 нг/мл (3 600; 9 000) до 1 717 нг/мл (1 041; 5 011) расценен как маркер разрешения гиперволемии на фоне сердечно-сосудистой дезадаптации. Рост концентрации NT-проМНУП от 4 710 нг/мл (3 400; 6 989) до 7 987 нг/мл (3 397; 9 000) в послеоперационном периоде требует пересмотра программы инфузионной терапии с приоритетом рестрикции объема.Выводы. Стабилизация состояния пациентов в группах сопровождается снижением концентрации маркеров миокардиальной напряженности (МВ-фракция креатинфосфокиназы, тропонин Т). Измерение концентрации NT-проМНУП позволяет оценивать перегрузку жидкостью у новорожденных в критическом состоянии

CUMULATIVE FLUID BALANCE OF INFUSION THERAPY OF NEWBORNS WITH NECROTIZING ENTEROCOLITIS

The aim of the research is to study the connection between the five-day cumulative fluid balance and the outcome of a critical condition in the surgical group of newborns. Material and methods. The study involved 30 newborns with necrotizing enterocolitis in stage IIIB according to Walsh - Kliegman. Groups were formed by the criterion of outcome. Analyzed parameters were age and body weight of participants, hematocrit number; the cumulative five-day fluid balance expressed as a percentage of the initial body weight. The data were carried out by nonparametric statistics. Results and discussion. The only independent factor determining the probability of death from necrotizing enterocolitis of newborns is the gestational age and the body weight as its derivative. The likelihood of an unfavorable outcome in necrotizing enterocolitis of the newborn doesn’t depend on the five-day cumulative fluid balance