Particularities of hemodynamics and oxygen status in infants and preschool-age children with complicated community-acquired pneumonias

Abstract

Background:  The absence of the unanimity of views on the use of plasmapheresis, insufficiently studied issues of the course severity, hemodynamics disorders in children during intensive care (IC) of pneumonias with the use of efferent detoxication methods determine the rationale of the study.

Methods: This was a retrospective-prospective study.  Group I included children with discrete plasmapheresis (DPР) 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: Statistically significant differences in HR between the study group and the comparison group were revealed on the 1st day of BT in infants; during the ROC-analysis, the discrimination point was determined: HR>137 bpm, Se=65.2, Sp=82.4, p=0.004, AUC=0.74 and on the 2nd day of BT: HR>129 bpm, Se=73.3, Sp=70.6, p=0.014, AUC=0.73; arterial oxygen content (CaO₂) ≤126 ml/100 ml, Se=54.5, Sp=93.7, AUC=0.724, p=0.033. The DPP performance contributes to the restoration of circulatory normodynamia (mainly due to tachycardia regression), does not cause arterial hypotension; after its performance, a tendency to a decrease in oxygen delivery and consumption is observed, as well as base deficit reduction; the discrete plasmapheresis performance is associated with more frequent need in red blood cell transfusions.

Conclusion: In infants, the values of HR>137 bpm during Day 1 of BT or HR>129 bpm and/or CaO₂≤126 ml/100 ml during Day 2 of baseline therapy may be considered to be the risk factors of DPР prescription. Study showed effectiveness of discrete plasmapheresis.