Management of complicated pneumonia is а difficult task and it’s open to research. Hypoxia and endotoxicosis are the main linkages in the pathogenesis of complicated pneumonia. The aim of the work – to increase the effectiveness of intensive care (IC) in children aged 1-7 years old with complicated community-acquired pneumonia (CAP) by substantiating diagnostic criteria for inclusion of discrete plasmapheresis (DPF) into the complex IC and evaluating its effectiveness in terms of endotoxemia, changes in the hemostasis’ system. Object and methods. 89 children with complicated CAP (4-th, 5-th degree of severity), 28 somatic almost healthy children were enrolled in the study after singing an informed consent. Group I included children with DPF in complex IC, group II – children who received baseline therapy (BT), group III – control group. Each of the groups were divided into subgroups: A – children aged 1-3 years old, B – children aged 3-7 years old. Results and discussing. In children who received DPF on the second day of BT, febrile temperature and respiratory rate (RR) was detected as indicators of pneumonia severity. The leukocyte index of intoxication (LII), the nuclear index of intoxication (NII), the index of leukocyte displacement (ILD) in groups IA and IB were greater than in the group III respectively at 8,5-17,5 times, 3,5-4,2 and 5-7 times. After the last session of plasmapheresis, a febrile temperature’s regression was observed in most children for the third day, a decrease in LII, NII and ILD, normalization of the level of fibrinogen A for a one day. Conclusions. 1. In children who received PF, a higher degree of endogenous intoxication was observed at the second day of therapy by temperature and RR (p<0.05). Body temperature above 38.0°C (Se 0.8, Sp 0.88 – for children aged 1-3 years old, Se 0.91, Sp 0.63 – for children aged 3-7 years old, p<0.05), RR>37 for children aged 1-3 years old (Se 1.0, Sp 0.5, p<0.001), RR>42 for preschool children (Se 0.91, Sp 0.7, p=0.01) at the second day of baseline therapy can be as the indications for PF. 2. Conduction of PF contributes to regress of febrile temperature in most children after the last session of PF for the third day (p<0,05). Plasmapheresis contributes to normalization of fibrins formation process in a day after the last session of PF (p<0,05) and does not lead to thrombocytopenia.
endotoxemia, hemostasis, plasmapheresis, pneumonia, child.
«Bulletin of problems biology and medicine» Issue 4 Part 1 (153), 2019 year, 78-82 pages, index UDK 616.24-002-053.3/.4-06-099-008.6-005.3-08]-079.8
