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The Aim: to determine if an increased extravascular lung water level (EVLW) would be a predictor of multiple organ failure in pediatric patients with severe burn injury., Materials and Methods: a prospective study included 33 pediatric patients with burn surface from 30 to 90% of the total body surface area, admitted to PICU. All the patients were monitored with PICCO-technology advanced hemodynamic monitoring, that included an analysis ofEVLW level every 6 hours during first 48 hours after PICU admission., Results: the diagnosis of multiple organ failure received according to DENVERII score. Normal values of weight indexed ELWI (extravascular lung water index)were 9-29 ml/kg for children under 1-year-oldage, 7-25 ml/kg for children from 1 to 5 years old and 5-13 ml/kg for children older than 5 years., Conclusions: a normal value of height indexed ELWI was up to 315 ml/m. The height indexed ELWI level correlated reliably with multiple organ dysfunction syndrome rate in all time measurements. So ELWI can be used as a MOD prognostic factor There was no correlation between surface of burned skin and EVLW level.

The secondstudy of nutritional support in the pediatric intensive care unit in critical conditions in Russia "NutriPed-2015" were presented. The authors noted that modern clinical nutrition technologies were widely used among 167 critical patients aged 0 to 18 years in 31 PICU in Russia. The number ofpatients receiving all components of the preparations for parenteral nutrition has increased significantly in comparison with the study NutriPed-2013. There were the wider use of last generation lipids for parenteral nutrition, multi-chamber containers in children older than 2 years were used in 2 times more often, the vast number ofpatients was carried out calculation of energy needs in the present time. The main problems for solve are the individual methods ofcalculating energy andprotein needs, resolution dysfunction ofthe gastrointestinal tract, the active introduction of assessing the effectiveness of nutritional support in the PICU.

Unlabelled: Purpose of this part of the "RuVent" research is to study the real use of the various modes and parameters of prolonged respiratory support in children in Russia., Materials and Methods: The study included 104 children from 29 ICUs (28 in Russian Federation, 1 in Ukraine) under the age of 15 years with ALV duration more than 12 hours in the period from February 7 to 11, 2011. The collection of information performed through online forms., Results: Total lethality was 20.7% (18 of 87 patients). The main reasons for prolonged respiratory support in children were the pathology of the respiratory system: acute respiratory distress syndrome (21.2%), community-acquired pneumonia (9.5%), sepsis (8.2%), and congenital disorders of the central nervous system (8.2%) and cardiac arrest (8.2%). According to the study "RuVent" doctors mostly prefer managed modes of respiratory support (SIMV 41.3%, A/C 28.8%, BIPAP 12.5%). Frequency of non-invasive respiratory support use amounted to 1%. Real respiratory volume based on ideal body weight calculation, averaged for boys 9.2 (7.3; 11.2) ml/kg (n = 54), for girls--8.7 (7.1; 10.1) m/kg (n = 38). PEEP median amounted to 4 mbar Tracheostomy was performed in 12 children out of 104 (11.5%), predominantly classic (n = 11), puncture dilated tracheostomy was performed in 1 child. The median of the tracheostomy installation in children was 24.5 days. The duration of respiratory support in children was 11 days (5; 25) (n = 43). The incidence of ventilator-associated pneumonia in children was 27.9% (12 of 43 cases)., Conclusions: The results of the Russian national epidemiological study of the use of mechanical ventilation in the Intensive care unit ("RuVent") showed comparable data with real international clinical practice. The researchers noted significant differences during prolonged mechanical ventilation in children compared with adult patients.

The article deals with results of the first Russian national observational study of nutritional support in children in the ICU. We assessed a frequency of use of enteral and parenteral nutrition and analyzed preparations for enteral and parenteral nutrition. The article discusses methods of the calculation of malnutrition in children in critical states.

Comparing analysis of randomized study was conducted. 40 Pediatric patients (2-15 years old) with heavy thermic burns and concomitant injuries were recruited into the study to assess the glutamine solution intravenous use efficiency. Parenteral feeding and feeding with glutamine solution intravenous use were clinicaly and laboratory compared Duration of mechanical ventilation decreased in group of feeding with glutamine solution intravenous use. Preliminary results of the study recommend to include glutamine in the programs of parentreral feeding.

Unlabelled: The purpose of the research is to study the real use of the various modes and parameters of prolonged respiratory support in Russia., Materials and Methods: The study included all patients from ICU with no limitation by sex and age with ALV duration more than 12 hours in the period from February 7 to 11. 2011. 470 patients, including 104 children under the age of 15 years, from 101 ICU in Russian Federation, 2 ICU in the Republic of Belarus and 1 ICU in Ukraine (total 104 centres). The collection of information performed through online forms., Results: Total lethality was 35.1% (139 from 396 patients), in case of the ARDS development - 44.9%. The frequency of ARDS development - 18.7%. According to the study "Ru Vent" doctors mostly prefer managed modes of respiratory support (SIMV 45.1%, A/C 20.2%, BiPAP 12.6%) which can partly be explained by a large proportion ofpatients with Central nervous system pathology, included in the study (39.8%). Frequency of non-invasive respiratory support use amounted to 1.1%. Real respiratory volume based on ideal body weight calculation, averaged for men 8.13 (6.84-9.33) ml/kg, for women - 9.1 (7.6-10.9) ml/kg, which is above the "ideal" respiratory volume 6 ml/kg in 1.35 times (1.14-1.56) for men (n=251) and in 1.51 times (1.27 - 1.81) for women (r=161). PEEP median amounted to 5 mbar, in case ofARDS development - 6 mbar., Conclusion: The results of the Russian national epidemiological research of ALV use in ICU ("RuVent) showed comparable data with real international clinical practice. The used tidal volumes are slightly overestated, and the values ofthe PEEP are understated in comparison with the national and international recommendations.

The purpose of the research is t objectify the indications for use of catecholamines and/or change of the infusion therapy volume based on transpulmonary thermodilution in children with severe traumatic injuries. The examined group consisted of 22 children with thermal concomitant or isolated trauma and drowning. All the patents were transferred to the Intensive Care Unit from other hospitals. Hemodynamic parameter estimation was based upon transpulmonary thermodilution. Results indicate, that based upon dynamic assessment of cardiac output, preload (global end diastolic volume index) and postload (systemic vascular resistance index) it is possible to carry out an early targeted correction of the fluid therapy and chose the right type of inotorpic support. Transpulmonary thermodilution in children with severe traumatic injuries allows achieving optimal parameters of blood circulation just 24 hours after its adaption.

The article presents the experience of the BIS monitoring in comparison with indicators of the pediatric Glasgow coma scale in 20 children with severe traumatic brain injury. Analyzed sample consists of 881 observations that contain two variables that contain high-quality sequence (a score on a scale of Glasgow in grades) and quantitative discrete values (the values of BIS). The Analysis is carried out by the nonparametric statistics with the definition of the relation between quality and quantity of ordinal traits by the rank correlation. The Spearman's coefficient rank correlation between scoring on Glasgow coma scale and the magnitude of BIS was R = 0.85 p < 0.001. Thus, the results showed that during severe traumatic brain injury in children the values of BIS have a high degree of correlation with the depth of coma on the Glasgow coma scale.

The aim of the study was to elucidate a relationship between the development of hypernatremia and the frequency of poor outcomes in children with severe brain injury (SBI). The retrospective study enrolled 77 children (54 boys and 23 girls) aged 1 month to 18 years, who had SBI in the period of January 2008 to September 2009, and were divided into 3 groups after treatment termination. The admission injury severity criterion was Glasgow coma scale (8 scores or less) rating. Group A comprised 51 children with SBI without hypernatremia; Group B included 14 children with SBI and hypernatremia. Group C consisted of 12 children with SBI, hypernatremia, and polyuremia. The latter group was appraised as a group with evolving central diabetes insipidus. A total of 26 (33.8%) patients had hypernatremia. Poor outcomes (Glasgow outcome scores of 1-3) at 30 days were noted in only Groups B and C: comparison of outcomes in Groups B and C showed the higher incidence of poor outcomes in 10 (84%) Group C patients (with hypernatremia and polyuria) and 4 (28%) children in Group B. Comparison of Groups B and C children indicated that the hazard ratio was 0.3. Therefore, the risk of poor outcomes is much higher in the development of central diabetes insipidous in the presence of hypernatremia.

The paper describes some experience in organizing and delivering specialized emergency health care to children who have suffered during traffic accidents in the Moscow Region, by attracting the forces and means of a disaster medicine service. In May 2004 to October 2008, examinations were made among 615 children, 552 of whom were evacuated to Moscow by intensive care cars (n = 469) and medical helicopters (n = 83). The paper shows that the two-stage medical victim medical evacuation provision system is effective and provides evidence for prospects for putting the developed model into practice of rendering a medical aid to traffic accident victims on out-of-town highways.

It is difficult to make an objective assessment of postoperative pain in children so anesthetic methods must ensure prolonged effective analgesia. The study was undertaken to determine the efficiency and duration of analgesia when using ketoprofen in a combined regional anesthesia (CRA) program in children aged 13 to 15 years who had correctable supracondylar osteotomy of the hip. Preference is given to preventive parenteral administration of ketoprofen. Comparative assessment of intra- and postoperative monitored variables and needs for postoperative analgesia in the traditional CRA (n = 10) and preventive ketoprofen (n = 10) groups indicated a significant increase in the duration of postoperative analgesia when ketoprofen was used.

The paper describes the authors' experience in using prolonged venovenous hemofiltration in the complex treatment of children with severe thermal injury complicated with multiple organ dysfunction, showing the higher efficiency of treatment in patients with the above condition and the reduction in the number of complications and mortality. This technique is not limited by renal function replacement.

The aim of this study was to estimate the validity of pediatric severity rating scales at general pediatric intensive care units. This was a prospective, observational multicenter study that was performed from November 1, 2007, to January 31, 2008. The end points were the estimation of the severity of disease, by using the PRISM, PIM II, RELOD scores, and 28-day survival. The investigation covered 226 patients whose mean age was 4.1 +/- 0.3 years. Twelve (5.3%) patients died during the study. The Medcalc computer program was employed for statistical analysis. The area under the receiver operating curve (ROC) was 0.623 +/- 0.116 for PRISM (p = 0.289); 0641 +/- 0.116 for PELOD (p = 0.224); 0.833 +/- 0.096 for PIM II (p < 0.001). The calibration of scores according to the intervals of mortality risk (Hosmer-Lemeshov test) showed that the observed and predicted mortality rates were similar for PIM II scores (chi2 = 8.23; p = 0.084) and were different for PRISM scores (chi2 = 203.5; p < 0.001) and PELOD ones (chi2 = 26.16; p < 0.001). Thus, the PIM II scores showed the best validity. PRISM and PELOD can be used to estimate the severity of disease in individual subgroups of high mortality-risk patients.

The efficiency of using various formulations of the antiemetic ondansetron to prevent postoperative nausea and vomiting (PONV) in the surgical treatment of postburn scars and deformities in children with a family history of PONV was compared. The patients were randomized into 4 representative groups. Preoperative administration of ondansetron (zofran) as lingual tablets was shown to be most effective. When the drug was used as syrup, PONV developed 2 times more frequently (PONV in 20% of the patients and 3 times more commonly when the drug was intravenously injected as jets during induction to anesthesia (PONV in 30% of the patients. When antiemetics were not given (a control group), the incidence was 7.5 times greater (75% of cases).

The efficiency of using prolonged venovenous hemofiltration (PVVH) was studied in 12 children with severe thermal injury in the presence of multiple organ dysfunctions. All the children were critically ill (having artificial ventilation, inotropic support, states of coma, renal dysfunction) and received the whole package of intensive care measures. Five of the 12 children were diagnosed as having sepsis, as verified by the procalcitonin ( >10 ng/ml) test. All the patients received 2 to 10 sessions PVVH on a PRIZMA apparatus ("Gambra", Sweden). Five of the 12 children died; the remaining children were observed to feel better; they were all transferred to somatic units. Thus, PWVVH is the method of choice in complex therapy for severe thermal injury followed by the development of multiple organ dysfunctions.

The problem of spinal epidural anesthesia used in pediatric surgery has been inadequately studied. This investigation was undertaken to develop a balanced spinal epidural anesthesia schedule and to analyze its efficiency during orthopedic operations on the lower extremities in 119 children aged 2 to 16 years. Preference is given to sequential subarachnoidal and epidural space punctures via the same access. Comparative assessment of monitored indices during surgery and a need for postoperative analgesia in the groups of patients with conventional general anesthesia (n = 60) and those who had undergone spinal epidural anesthesia (n = 59) demonstrated a reliable intraoperative and early effective postoperative analgesia after balanced spinal epidural anesthesia.

The hypnotic components of balanced anesthesia under regional anesthesia were estimated in 60 children during operations on the limbs and urogenital area. BIS monitoring was to assess the grade of sedation. Analysis of the findings showed that balanced anesthesia could ensure an adequate and stable anesthesia throughout the surgical intervention. The optimal BIS index for moderate sedation was 40-60 units. Among all the types of balanced anesthesia, sevoflurane-based anesthesia was most effective.

The paper considers the main causes and clinical manifestations of the short bowel syndrome in children, defines the clinical and physiological features of the disease in children. The world experience in managing patients with short bowel syndrome is summed up. Indications for total parenteral or parenteral-and-enteral feeding in relation to the site of intestinal resection are analyzed. Artificial therapeutic feeding is shown to play the leading role in the complex of rehabilitation of children with short bowel syndrome.

The paper focuses on the developmental mechanisms and triggers of hypermetabolism, by describing the specific features of pathophysiological reactions occurring in the child's body. It also shows the leading role of artificial therapeutic feeding included into the multimodality therapy of children under stresses in restoring plastic and energy demands and in preventing the development of multiple organ dysfunction.

Caloric and nutrient requirements significantly increase in a pediatric patient with severe injury. This is attributable to catabolism and metabolic features in children cause postoperative complications, increases mortality rates in pediatric surgical patients. This generates the need for early administration of diet therapy using specialized formulas that correct nutrient deficiency. Therefore, the aim of our study was to evaluate the effect of enteral feeding in the early postoperative period: early enteral feeding caused a more rapid increase in the concentrations of transferin and albumin, decreases in C-reactive protein and orosomucoid, and a reduction in the number of the patients who were on early enteral nutrition versus those on a routine postsurgical diet.

The paper presents the results of studies of microcirculation, central hemodynamics, and oxygen status in 120 children aged 2-14 years who had traumatic shock of various etiology (40 with burn injury, 50 with mixed injury, and 30 with brain injury). The following studies were used: biomicroscopy of conjunctival microvessels with photo recording and processing on a computer; central hemodynamic monitoring; studies of a thromboelastogram, acid-alkali balance, and blood gases. The authors found the previously unknown parallels of the impairments of microcirculation, the severity of traumatic injury, and the parameters of central hemodynamics, and oxygen status in the patient. Traumatic shock was characterized by spastic impairments of all the components (perivascular, vascular, and intravascular) of microcirculation progressing to spastic-and-atonic ones. The degree of microcirculatory disorders depended on the severity of shock and the nature of injury. The criteria for compensation and decompensation in the microcirculatory module were defined. The routine infusion therapy initiated in the compensation period promotes to a significant alleviation of microcirculatory disorders; however, the mentioned shifts long persist. In this connection, a package of additional measures (infucol GEC solutions, disaggregatory, antihypoxic, and antioxidant agents, and coenzymes of vitamins) has been developed.

Research results of the central hemodynamics, microcirculation and of oxygen status are described for 48 children (aged 8 months to 14 years) as observed during surgeries aggravated by massive hemorrhage in the routine infusion-transfusion therapy plus a 6% solution of INFUKOL GEK. Solution dosages of 6% were approved; the drug's positive effect on the central-hemodynamics condition, microcirculation and on the oxygen regime, as observed in the process of the infusion therapy made to compensate for a massive blood loss, was demonstrated; besides, the related shrinking of the infusion therapy total volume and the possibility to give up totally or to significantly reduce the blood-drug preparations, administered intraoperatively, were shown.

The advantages and disadvantages of intravenous and inhalation anesthesias in pediatric anesthesiology are analyzed. Causes of complications induced by myorelaxants and measures for preventing these complications are discussed. Basic protocols of intravenous or inhalation anesthesias with the minimum fresh gas flow for pediatric anesthesiology are presented.

The efficiency and safety of low flow inhalation anesthesia for children were evaluated on the basis of oxygen transport parameters. Sixty-seven children aged 3 months to 15 years (mean age 5.7 +/- 2.5 years) were subjected to inhalation halothane and isoflurane anesthesia with fresh gas flow of 0.5 liter/min. Oxygen delivery, consumption, and tissue extraction were evaluated. Oxygen transport parameters remained optimal at all stages of anesthesia, which confirmed the safety of this method in children for routine interventions.

The adequacy of anesthesia with propofol is evaluated in 48 children aged 3 months to 7 years (ASA I-III) subjected to abdominal and urological interventions. The children were divided into groups administered different general anesthesias: 9 children aged 3-7 years operated under total intravenous anesthesia (TIVA) with propofol and fentanyl and 39 children aged 3 months to 6 years operated under TIVA with propofol, ketamine, and fentanyl. The efficiency of anesthesia was evaluated by electroencephalography and hemodynamic monitoring. TIVA with propofol, fentanyl, and ketamine did not notably decrease arterial pressure during induction; the course of anesthesia and recovery ran a smooth course; the doses of propofol and fentanyl were appreciably decreased. Use of this protocol in children aged under 3 years ensured adequate anesthesia with the minimum risk of hemodynamic disorders.

The responses of m. adductor pollici to TOF stimulation of the ulnar nerve were recorded by electromyography (EMG) and acceleromyography (AMG) in 36 children aged 2-12 years with ASA classes I-II during 36 planned surgeries. In 14 children myoplegia was attained by intravenous bolus and infusion atracurium (Tracrium) and in 22 by cisatracurium (nimbex). The data on the function of this muscle after the initial bolus injection of myoplegics do not provide reliable information on the function of the larynx and respiratory muscles during intubation and do not allow a conclusion on the possibility of endotracheal intubation. The threshold sensitivities of EMG and AMG recording of the neuromuscular function starting from the fifth minute after the myorelaxant injection till the end of anesthesia are different. EMG permits evaluating the recovery of neuromuscular conduction early after the infusion of myoplegics; complete recovery of the block is shown virtually simultaneously by AMG and EMG. EMG as a more accurate method is preferable for research, while AMG is a simpler and stable method, preferable for routine practice.

Central hemodynamics, aminotransferases, and alpha-fetoprotein were studied during surgery in 26 children with cirrhosis of the liver. In contrast to total intravenous anesthesia with preinjection of clofelin, in anesthesia with neuroleptanalgesia agents and N2O circulation hyperdynamia develops in the course of surgery, the process grows more active, and liver capacity to regeneration in the early postoperative period is depressed.

The urgent porto-system bypass has been used in 26 children with portal hypertension to prevent acute gastro-esophageal bleeding. This method may be used in all types of portal circulation blockade. The bleeding stopped within first two postoperative days and there were no cases of its relapse within 6 years.

Intraoperative examinations of 15 patients with extrahepatic portal hypertension carried out to elucidate the effect of pituitrin infusion on the central and portal hemodynamics and analysis of the clinical results of treatment of gastroesophageal hemorrhages with pituitrin infusions in 17 patients showed that infusions of pituitrin solution were sufficiently effective in this patient population. The drug exerted the minimal effect on the central hemodynamics and appreciably improved the portal pressure and bloodflow.

Analysis of the results of infusion hemodilution and traditional restitution of surgical blood less in 32 children subjected to urological surgery showed that hemodilution is associated with an increase of cardiac output and a reduction of the peripheral vascular resistance. Despite an increase of the volume of blood loss in hemodilution, the parameters of oxygen transport remain the optimal in the course of operation and the immediate postoperative period, an increased level of inorganic phosphates being conducive to maintenance of adequate oxygen metabolism. The authors claim that under conditions of infusion hemodilution donor blood preparations should not be transfused to children with surgical blood loss of up to 20%.

Central hemodynamics, blood gas composition, portal blood flow, and hepatic function have been studied in 30 children with extrahepatic portal hypertension during various types of intraoperative anesthesia. Neuroleptanalgesia and combined halothane and calypsol anesthesia ensure an adequate patient protection from surgical trauma. Each type of anesthesia has its specific effect on portal blood flow. This type of surgical interventions is characterized by frequent use of blood transfusions. According to the data of histochemical and biochemical studies all types of anesthesia have an equal effect on the liver.

Nondepolarizing shortly acting myorelaxant trakrium (0.5 mg/kg) during surgical interventions in children makes it possible to perform tracheal intubation 1.5 min later and to maintain optimal myoplegia at various stages of the operation by bolus injections in doses making up 1/2-1/3 of the initial one or by non-stop infusion at a rate of 0.008 mg/kg per min. Trakrium may be used along with arduan administered at the end of the operation. Trakrium administration is accompanied by the recovery of adequate respiration 25-30 min after discontinuation of administration. Trakrium has no unfavourable effect on hemodynamics and ensures retention of the myocardial reserve capacities.

It has been observed that controlled lung ventilation during surgery in children is accompanied by an increase in intrapulmonary blood shunting, which averages 7.3% in urological surgery, 12% in abdominal surgery and 16.8% in thoracic surgery. The shunting is caused by ventilation-perfusion disturbances. The use of high-frequency jet ventilation, i.e. application of 16.7 Hertz oscillatory modulations together with conventional controlled lung ventilation enables one to decrease intrapulmonary shunting, reduce the signs of circulatory hyperdynamia and the load on the heart ventricles and leads to normalization of pulmonary flow in thoracic surgery.

The blood coagulation system and fibrinolysis were studied in 16 children with chronic bronchopulmonary diseases, aged from 4 to 15 years, before surgery, immediately, and on the first day after the operation. The method of infusion hemodilution, under the control of hematocrit, hemoglobin and total protein, was used for the treatment of operation hemorrhage. The investigations conducted have revealed hypercoagulation signs in the patients before the beginning of the operation (as compared to normal children). Operative intervention has intensified many signs of hypercoagulation, however, in the postoperative period no clinical signs of hypercoagulation were observed in all the cases, that was associated with the positive effect of hemodilution.

The effect of infusion hemodilution on hemodynamic parameters and oxygen-transport homeostasis was studied during elective chest surgery in 18 children with chronic bronchopulmonary diseases. The data obtained have evidenced the expediency of using the method of infusion hemodilution in children for the operative hemorrhage therapy, ensuring the adequate hemodynamics and oxygen-transport supply at all the operation stages and in the early postoperative period.