МЕДИЦИНА КАТАСТРОФ №1(105)•2019

ПРЕВЕНТИВНАЯ ПРОТИВОШОКОВАЯ ТЕРАПИЯ В ПЕРВЫЕ ЧАСЫ ПОСЛЕ ТРАВМЫ У ДЕТЕЙ С ТЯЖЕЛЫМ ТЕРМИЧЕСКИМ ПОРАЖЕНИЕМ Скачать статью в формате pdf

Лекманов А.У.1, Азовский Д.К.2, Пилютик С.Ф.2

1 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России, Москва

2 ГБУЗ «Детская городская клиническая больница №9 им. Г.Н.Сперанского Департамента здравоохранения г.Москвы»

УДК 616-053.2:616.001.32

С. 28–32

Представлены обзор публикаций и результаты авторского исследования основных вопросов стратегии и тактики интенсивной терапии в первые часы после травмы у детей с тяжелым термическим поражением.

Отмечено, что шок – это сложный патофизиологический ответ на термическое поражение, однако его развитие может быть предотвращено.

Рассмотрены текущие проблемы инфузионной терапии, лечения болевого синдрома, эвакуации пострадавших с места события в ближайшее лечебное учреждение или специализированный ожоговый центр.

Ключевые словадети, первые часы после травмы, превентивная противошоковая терапия, тяжелое термическое поражение, шок

Для цитирования: Лекманов А.У., Азовский Д.К., Пилютик С.Ф. Превентивная противошоковая терапия в первые часы после травмы у детей с тяжелым термическим поражением. Медицина катастроф. 2019; 1(105): 28–32.

https://doi.org/10.33266/2070-1004-2019-1-28-32

 

СПИСОК ЛИТЕРАТУРЫ

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3. World report on child injury prevention / Peden M., Oyegbite K., Ozanne-Smith J. et al. // World Health Organization. Geneva, 2008. 80 p.

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21. Survival after burn in a sub-Saharan burn unit: Challenges and opportunities / Tyson A.F., Boschini L.P., Kiser M.M. et al. // Burns. Elsevier Ltd and International Society of Burns Injuries, 2013. Vol.39, №8. P. 1619–1625.

22. Effect of primary admission to burn centers on the outcomes of severely burned patients / Ehrl D., Heidekrueger P.I., Ninkovic M. et al. // Burns. Elsevier Ltd and International Society of Burns Injuries, 2018. Vol.44, №3. P. 524–530.

23. Transfer time to a specialist burn service and influence on burn mortality in Australia and New Zealand: A multi-centre, hospital based retrospective cohort study / Cassidy T.J., Edgar D.W., Phillips M. et al. // Burns. Elsevier Ltd and International Society of Burns Injuries, 2015. Vol.41, №4. P. 735–741.

24. Лекманов А.У., Азовский Д.К., Пилютик С.Ф. Анализ выживаемости у детей с тяжелой термической травмой, доставленных в первые 72 часа после повреждения // Вестн. анестезиолог. и реаниматолог. 2018. Т.15, №5. С. 30–38.

25. Шатовкин К.А., Шлык И.В. Оптимизация инфузионной терапии у пострадавших с тяжёлой термической травмой, осложненной синдромом острого повреждения легких // Вестн. анестезиолог. и реаниматолог. 2011. Т.8, №2. С. 8–15.

26. Do school-aged children with burn injuries during infancy show stress-induced activation of pain inhibitory mechanisms? / Wollgarten-Hadamek I., Hohmeister J., Zohsel K. et al. // Eur. J. Pain. European Federation of International Association for the Study of Pain Chapters. 2011. Vol.15, №4. P. 423.e1–423.e10.

27. McGrath P.J., Frager G. Psychological barriers to optimal pain management in infants and children. // Clin. J. Pain. 1996. Vol.12, №2. P. 135–141.

28. Do burn injuries during infancy affect pain and sensory sensitivity in later childhood? / Wollgarten-Hadamek I., Hohmeister J., Demirakça S. et al. // Pain. International Association for the Study of Pain. 2009. Vol.141, №1–2. P. 165–172.

29. Плавунов Н.Ф. Алгоритмы оказания скорой и неотложной медицинской помощи больным и пострадавшим бригадами службы скорой медицинской помощи города Москвы / Под ред. Багненко С.Ф. М.: Департамент здравоохранения г.Москвы, 2013. 232 с.

30. Samuel N., Steiner I.P., Shavit I. Prehospital pain management of injured children: A systematic review of current evidence // Am. J. Emerg. Med. Elsevier Inc. 2015. Vol.33, №3. P. 451–454.

31. Эффективность обезболивания на догоспитальном этапе у детей с тяжелой термической травмой / Азовский Д.К., Лекманов А.У., Будкевич Л.И. и др. // Вестн. анестезиолог. и реаниматолог. 2016. Т.13, №3. С. 3–8.

32. Fein J.A., Zempsky W.T., Cravero J.P. Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems // Pediatrics. 2012. Vol.130, №5. P. e1391–e1405.

33. Manworren R.C.B., Hynan L.S. Clinical validation of FLACC: preverbal patient pain scale // Pediatr. Nurs. 2003. Vol.29, №2. P. 140–146.

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35. Barrow R.E., Jeschke M.G., Herndon D.N. Early fluid resuscitation improves outcomes in severely burned children // Resuscitation. 2000. Vol.45, №2. P. 91–96.

36. The association between fluid administration and outcome following major burn: A multicenter study / Klein M.B., Hayden D., Elson C. et al. // Ann. Surg. 2007. Vol.245, №4. P. 622–628.

37. Optimized fluid management improves outcomes of pediatric burn patients / Kraft R., Herndon D.N., Branski L.K. et al. // J. Surg. Res. Elsevier Ltd, 2013. Vol.181, №1. P. 121–128.

38. Saffle J.R. The Phenomenon of “Fluid Creep” in Acute Burn Resuscitation // J. Burn Care Res. 2007. Vol.28, №3. P. 382–395.

39. Decreased fluid volume to reduce organ damage: A new approach to burn shock resuscitation? A preliminary study / Arlati S., Storti E., Pradella V. et al. // Resuscitation. 2007. Vol.72, №3. P. 371–378.

40. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children* / Arikan A.A., Zappitelli M., Goldstein S.L. et al. // Pediatr. Crit. Care Med. 2012. Vol.13, №3. P. 253–258.

41. Fluid Overload in Infants Following Congenital Heart Surgery / Hazle M.A., Gajarski R.J., Yu S. et al. // Pediatr. Crit. Care Med. 2013. Vol.14, №1. P. 44–49.

42. Fluid Overload at 48 Hours Is Associated With Respiratory Morbidity but Not Mortality in a General PICU / Sinitsky L., Walls D., Nadel S. et al. // Pediatr. Crit. Care Med. 2015. Vol.16, №3. P. 205–209.

43. Sutherland S.M., Zappitelli M., Alexander S.R. Fluid Overload and Mortality in Children Receiving Continuous Renal Replacement Therapy: The Prospective Pediatric Continuous Renal Replacement Therapy Registry // Am. J. Kidney Dis. Elsevier Inc., 2010. Vol.55, №2. P. 316–325.

44. Rae L., Fidler P., Gibran N. The Physiologic Basis of Burn Shock and the Need for Aggressive Fluid Resuscitation // Crit. Care Clin. 2016. Vol.32, №4. P. 491–505.

45. Greenhalgh D.G. Burn Resuscitation // J. Burn Care Res. 2007. Vol.28, №4. P. 555–565.

46. The endothelial glycocalyx: composition, functions, and visualization / Reitsma S., Slaaf D.W., Vink H. et al. // Pflügers Arch. — Eur. J. Physiol. 2007. Vol.454, №3. P. 345–359.

47. Лекманов А.У., Азовский Д.К., Пилютик С.Ф. Пути снижения инфузионной нагрузки у детей с обширными ожогами в первые 24 часа после повреждения // Вестн. анестезиолог. и реаниматолог. 2016. Т.13, №4. С. 30–36.

 

 

DISASTER MEDICINE No. 1(105)•2019

PREVENTIVE ANTISHOCK TREATMENT IN FIRST HOURS AFTER INJURY IN CHILDREN WITH SEVERE THERMAL LESIONS Download the article in pdf format

Lekmanov A.U.1, Azovsky D.K.2, Pilyutik S.F.2

1 Federal State Budgetary Educational Institution of Higher Education «N.I.Pirogov Russian National Research Medical University» of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation

2 State Budgetary Health Institution “Children’s City Clinical Hospital №9 named after G.N.Speranskiy” of the Moscow City Health Department, Moscow, Russian Federation

UDK 616-053.2:616.001.32

Pp. 28–32

The review of publications and the results of the authors’ study of the main issues of strategy and tactics of intensive therapy in the first hours after injury in children with severe thermal injury are presented.

It is noted that shock is a complex pathophysiological response to thermal damage, but its development can be prevented.

The current problems of infusion therapy, treatment of pain syndrome, evacuation of victims from the scene to the nearest medical institution or a specialized burn center are considered.

Key words: children, first hours after injury, preventive anti-shock therapy, severe thermal damage, shock

For citation: Lekmanov A.U., Azovsky D.K., Pilyutik S.F., (Preventive Antishock Treatment in First Hours after Injury in Children with Severe Thermal Lesions), Disaster Medicine, 2019; 1(105): 28–32 (In Rus.).

https://doi.org/10.33266/2070-1004-2019-1-28-32

 

REFERENCES

1. World Health Organization. Burns – fact sheet. 2018, URL: http://www.who.int/news-room/fact-sheets/detail/burns (accessed: 06.03.2018).

2. Burd A., Yuen C., (A global study of hospitalized paediatric burn patients), Burns, 2005; 31; 4: 432–438.

3. Peden M., Oyegbite K., Ozanne-Smith J. et al., (World report on child injury prevention), World Health Organization, Geneva, 2008, 80 p.

4. Singer A.J., Dagum A.B., (Current Management of Acute Cutaneous Wounds), N. Engl. J. Med., 2008; 359; 10: 1037–1046.

5. Bull J.P., Squire J.R., (A Study of Mortality in a Burns Unit: Standards for the Evaluation of Alternative Methods of Treatment), Ann. Surg., 1949; 130; 2: 160–173.

6. Herndon D.N., Gore D., Cole M. et al., (Determinants of mortality in pediatric patients with greater than 70% full-thickness total body surface area thermal injury treated by early total excision and grafting), J. Trauma, 1987; 27; 2: 208–212.

7. Sheridan R.L., Remensnyder J.P., Schnitzer J.J. et al., (Current Expectations for Survival in Pediatric Burns), Arch. Pediatr. Adolesc. Med., 2000; 154; 3: 245.

8. Caruso D.M., (Monitoring End Points of Burn Resuscitation Burn resuscitation End points Burn shock End points of resuscitation), Crit. Care Clin. Elsevier Inc., 2016; 32; 4: 525–537.

9. Baranov A.A., Bagnenko S.F., Namazova-Baranova L.S. et al., Federal’nye klinicheskie rekomendacii po okazaniyu skoroj medicinskoj pomoshchi pri ozhogah u detej, (Federal clinical guidelines for emergency medical care for burns in children), Мoscow, Rossijskoe obshchestvo skoroj medicinskoj pomoshchi Publ., 2015, p. 13 (In Rus.).

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11. Lekmanov A.U., Azovskij D.K., Pilyutik S.F., (Hemodynamic profile in children with severe burn injury in the first hours after injury), Anesteziologiya i reanimatologiya, 2017; 62; 5: 387–393 (In Rus.).

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15. Cecconi M., Backer D. De, Antonelli M. et al., (Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine), Intensive Care Med., 2014; 40; 12: 1795–1815.

16. Bronicki R.A., Taylor M., Baden H., (Critical Heart Failure and Shock), Pediatr. Crit. Care Med., 2016; 17; 8: S124–S130.

17. Bronicki R.A., (Hemodynamic Monitoring), Pediatr. Crit. Care Med., 2016; 17: S207–S214.

18. About measures for further development and improvement of medical care to victims of burns in RSFSR, Order of the Ministry of Health dated April 3, 1991, No. 54 (In Rus.).

19. Palmieri T.L., Taylor S., Lawless M. et al., (Burn Center Volume Makes a Difference for Burned Children*), Pediatr. Crit. Care Med., 2015; 16; 4: 319–324.

20. Lekmanov A.U., Azovskij D.K., Pilyutik S.F. et al., (Intensive care in children with extensive burns in the first 24 hours after injury – results of an interactive survey), Vestnik anesteziologii i reanimatologii, 2018; 15; 1: 18–26 (In Rus.).

21. Tyson A.F., Boschini L.P., Kiser M.M. et al., (Survival after burn in a sub-Saharan burn unit: Challenges and opportunities), Burns. Elsevier Ltd and International Society of Burns Injuries, 2013; 39; 8: 1619–1625.

22. Ehrl D., Heidekrueger P.I., Ninkovic M. et al., (Effect of primary admission to burn centers on the outcomes of severely burned patients), Burns. Elsevier Ltd and International Society of Burns Injuries, 2018; 44; 3: 524–530.

23. Cassidy T.J., Edgar D.W., Phillips M. et al., (Transfer time to a specialist burn service and influence on burn mortality in Australia and New Zealand: A multi-centre, hospital based retrospective cohort study), Burns. Elsevier Ltd and International Society of Burns Injuries, 2015; 41; 4: 735–741.

24. Lekmanov A.U., Azovskij D.K., Pilyutik S.F., (Analysis of survival in children with severe thermal injury delivered in the first 72 hours after injury), Vestnik anesteziologii i reanimatologii, 2018; 15; 5: 30–38 (In Rus.).

25. Shatovkin K.A., Shlyk I.V., (Optimization of infusion therapy in patients with severe thermal trauma complicated by acute lung injury syndrome), Vestnik anesteziologii i reanimatologii, 2011; 8; 2: 8–15 (In Rus.).

26. Wollgarten-Hadamek I., Hohmeister J., Zohsel K. et al., (Do school-aged children with burn injuries during infancy show stress-induced activation of pain inhibitory mechanisms?), Eur. J. Pain. European Federation of International Association for the Study of Pain Chapters, 2011; 15; 4: 423.e1–423.e10.

27. McGrath P.J., Frager G., (Psychological barriers to optimal pain management in infants and children), Clin. J. Pain, 1996; 12; 2: 135–141.

28. Wollgarten-Hadamek I., Hohmeister J., Demirakça S. et al., (Do burn injuries during infancy affect pain and sensory sensitivity in later childhood?), Pain. International Association for the Study of Pain, 2009; 141; 1–2: 165–172.

29. Plavunov N.F., Algoritmy okazaniya skoroj i neotlozhnoj medicinskoj pomoshchi bol’nym i postradavshim brigadami sluzhby skoroj medicinskoj pomoshchi goroda Moskvy, (Algorithms of rendering emergency and emergency medical care to patients and injured crews of emergency medical service of the city of Moscow), Ed. by Bagnenko S.F., Мoscow, Departament zdravoohraneniya goroda Moskvy Publ., 2013, 232 p. (In Rus.).

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31. Azovskij D.K., Lekmanov A.U., Budkevich L.I. et al., (The effectiveness of analgesia in the prehospital phase in children with severe thermal injury), Vestnik anesteziologii i reanimatologii, 2016; 13; 3: 3–8 (In Rus.).

32. Fein J.A., Zempsky W.T., Cravero J.P., (Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems), Pediatrics, 2012; 130; 5: e1391–e1405.

33. Manworren R.C.B., Hynan L.S., (Clinical validation of FLACC: preverbal patient pain scale), Pediatr. Nurs., 2003; 29; 2: 140–146.

34. Garra G., Singer A.J., Domingo A. et al., (The Wong-Baker Pain FACES Scale Measures Pain, Not Fear), Pediatr. Emerg. Care, 2013; 29; 1: 17–20.

35. Barrow R.E., Jeschke M.G., Herndon D.N., (Early fluid resuscitation improves outcomes in severely burned children), Resuscitation, 2000; 45; 2: 91–96.

36. Klein M.B., Hayden D., Elson C. et al., (The association between fluid administration and outcome following major burn: A multicenter study), Ann. Surg., 2007; 245; 4: 622–628.

37. Kraft R., Herndon D.N., Branski L.K. et al., (Optimized fluid management improves outcomes of pediatric burn patients), J. Surg. Res. Elsevier Ltd., 2013; 181; 1: 121–128.

38. Saffle J.R., (The Phenomenon of “Fluid Creep” in Acute Burn Resuscitation), J. Burn Care Res., 2007; 28; 3: 382–395.

39. Arlati S., Storti E., Pradella V. et al., (Decreased fluid volume to reduce organ damage: A new approach to burn shock resuscitation? A preliminary study), Resuscitation, 2007; 72; 3: 371–378.

40. Arikan A.A., Zappitelli M., Goldstein S.L. et al., (Fluid overload is associated with impaired oxygenation and morbidity in critically ill children*), Pediatr. Crit. Care Med., 2012; 13; 3: 253–258.

41. Hazle M.A., Gajarski R.J., Yu S. et al., (Fluid Overload in Infants Following Congenital Heart Surgery), Pediatr. Crit. Care Med., 2013; 14; 1: 44–49.

42. Sinitsky L., Walls D., Nadel S. et al., (Fluid Overload at 48 Hours Is Associated With Respiratory Morbidity but Not Mortality in a General PICU), Pediatr. Crit. Care Med., 2015; 16; 3: 205–209.

43. Sutherland S.M., Zappitelli M., Alexander S.R., (Fluid Overload and Mortality in Children Receiving Continuous Renal Replacement Therapy: The Prospective Pediatric Continuous Renal Replacement Therapy Registry), Am. J. Kidney Dis. Elsevier Inc., 2010; 55; 2: 316–325.

44. Rae L., Fidler P., Gibran N., (The Physiologic Basis of Burn Shock and the Need for Aggressive Fluid Resuscitation), Crit. Care Clin., 2016; 32; 4: 491–505.

45. Greenhalgh D.G., (Burn Resuscitation), J. Burn Care Res., 2007; 28; 4: 555–565.

46. Reitsma S., Slaaf D.W., Vink H. et al., (The endothelial glycocalyx: composition, functions, and visualization), Pflügers Arch. — Eur. J. Physiol., 2007; 454; 3: 345–359.

47. Lekmanov A.U., Azovskij D.K., Pilyutik S.F., (Ways to reduce the infusion load in children with extensive burns in the first 24 hours after injury), Vestnik anesteziologii i reanimatologii, 2016; 13; 4: 30–36 (In Rus.).