@article{Filyk_2019, title={Changes of serum phosphorus level in critically ill children with acute respiratory failure: a prospective observational cohort study}, url={https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1178}, DOI={10.22141/2224-0586.7.102.2019.180360}, abstractNote={<p><strong><em>Background.</em></strong> Severe hypophosphatemia lead to life-threatening complications. There is a little knowledge about impact of hypophosphatemia on long-term outcomes in children on mechanical ventilation. The aim of this study was to investigate the prevalence, causes and risk factors of hypophosphatemia in children with acute respiratory failure. <strong><em>Materials and methods. </em></strong>We complete a prospective single-center cohort study (May 2018 — May 2019) at the Department of Anesthesiology and Intensive Care, Danylo Halytsky Lviv National Medical University; Department of Anesthesiology and Intensive Care, Lviv Regional Children’s Hospital “OCHMATDYT”. We have examined patients aged 1 month to 3 years old with acute respiratory failure on invasive mechanical ventilation. Serum phosphorus level was evaluated on days 1, 3, 5, 7 and 9. Results described in this article is the part of the clinical study “Diaphragm ultrasound and trends in electrolyte disorders and transthyretin level as a method to predict ventilation outcome in children: the prospective observational cohort study”; ISRCTN84734652. We enrolled 57 patients with acute respiratory failure, in 4 patients, phosphorus level data weren’t monitored. Thus, we included 53 children in study results analysis. <strong><em>Results.</em></strong> The causes of acute respiratory failure in children were: acute heart fai­lure — 2 cases (3.8 %); sepsis — 5 (9.4 %); septic shock — 10 (18.9 %); encephalopathy — 4 (7.5 %); pneumonia — 36 (67.9 %); acute obstructive bronchitis/bronchiolitis/bronchial asthma — 6 (11.3 %); bronchopulmonary dysplasia — 2 (3.8 %). All patients were divided into groups according to phosphorus level at admission. As a result, in 6 patients with normophosphatemia at admission, phosphorus level decreased to 0.9 mmol/l on day 3, to 0.75 mmol/l on day 5 and to 0.72 mmol/l and 0.65 mmol/l on days 7 and 9, respectively. In patients with mild hypophosphatemia at admission (n = 31; phosphorus level 0.68 ± 0.09 mmol/l), levels of phosphorus on days 3 and 5 were 0.42 ± 0.05 mmol/l and 0.40 ± 0.07 mmol/l, respectively. Moreover, on day 7 it reached level of severe hypophosphatemia (0.30 ± 0.04 mmol/l), and on day 9 slightly increased to 0.38 ± 0.08 mmol/l. In patients with severe hypophosphatemia at admission (n = 16; phosphorus level 0.22 ± 0.04 mmol/l), phosphorus level on day 3 increased to 0.28 ± 0.03 mmol/l, and remained virtually unchanged on days 5, 7 and 9. <strong><em>Conclusions.</em></strong> The incidence of hypophosphatemia in children with acute respiratory failure at admission was 88.7 %, and on day 5 of treatment increased to 100 %. The causes of hypophosphatemia were combinations of different mechanisms: phosphorus transport into the cells as a result of respiratory alkalosis, metabolic acidosis and sepsis; use of beta-adrenomimetics and steroids; refeeding syndrome as well as the inability to provide correction of hypophosphatemia with enteral nutrition alone.</p>}, number={7.102}, journal={EMERGENCY MEDICINE}, author={Filyk, O.V.}, year={2019}, month={Nov.}, pages={63–71} }