Features of acute respiratory failure diagnosis in children with sepsis

O.V. Filyk

Abstract


Background. In this article, we have described the basic principles of the diagnosis of acute respiratory failure in children with sepsis. The aim of the study was to examine the literature data about current diagnostic strategy of acute respiratory failure in children and to explore the changes of the respiratory and cardiovascular systems in children with sepsis. Materials and methods. This was an open, prospective, observational, non-randomized study of 12–16-year old children with surgical sepsis in the intensive care units. Results. We analyzed data on the use in children of Berlin definitions of acute respiratory distress syndrome and simplified criteria for resource-limited countries. Of 62 patients admitted to the intensive care unit with sepsis, 32 (54.8 %) did not need the respiratory therapy, 32 (29 %) required oxygen therapy, 6 (9.7 %) — mechanical ventilation. Only 55 % of children, who received oxygen therapy, had tachypnea. Furthermore, we assessed hemodynamic parameters (using esCCO technology, Nihon Kohden) and found that patients receiving oxygen therapy had higher cardiac output (5.90 ± 0.61 l/min) than children without respiratory failure (4.80 ± 0.31 l/min). In addition, we found that 50 % of children, who needed mechanical ventilation, had hypotension on admission and signs of hyperdynamic type of circulation with elevation of cardiac output and cardiac index to 6.30 ± 0.42 l/min and 5.60 ± 0.51 l/min/m2, respectively, but low stroke volume — 41.2 ± 6.1 ml compared to 48.1 ± 3.9 ml in patients without respiratory failure. Also, children, who required mechanical ventilation, had significantly lower SpO2/FiO2 index compared to the group of persons receiving oxygen therapy (212.4 ± 10.1 compare to 232.1 ± 41.5). Index PaO2/FiO2 in patients needed mechanical ventilation suggested mild hypoxemia according to Berlin definitions of acute respiratory distress syndrome and was 200.8 ± 16.4. Patients, who required mechanical ventilation, had decompensated mixed acidosis with the prevalence of its metabolic component. Conclusions. Such signs, as mixed decompensated acidosis and hyperdynamic type of the blood circulation, in patients with sepsis may help to verify those of them, who have a higher risk of developing acute respiratory distress syndrome.

Keywords


сепсис; діти; дихальна недостатність

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DOI: https://doi.org/10.22141/2224-0586.3.82.2017.102324

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