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[The characteristics of changes in the hemodynamics and respiratory function of children with severe closed abdominal
Insights
Children with severe closed abdominal trauma often experience vital function impairment and hypoxemia. Early resuscitation and intensive care are crucial for survival, though severe injuries can lead to fatal outcomes.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Critical Care Medicine
Context:
- Study conducted at EMI "Pirogov" over five years.
- Involves 566 children with closed abdominal trauma.
- Focuses on 79 children with serious impairment of vital functions.
Purpose:
- To analyze the outcomes of resuscitation and intensive care in children with severe closed abdominal trauma.
- To identify key hemodynamic and gas exchange parameters in these patients.
- To understand the patterns of acid-base metabolism and organ failure.
Summary:
- 79 out of 566 children required intensive care due to impaired vital functions and blood loss.
- 67 children recovered, while 12 died.
- Characterized by tachycardia, normal/increased arterial pressure, significant hypoxemia, and metabolic acidosis initially, progressing to alkalosis.
- Severe combined injuries led to rapid death from shock or delayed multiple organ failure.
Impact:
- Highlights the critical role of timely resuscitation and intensive care in pediatric abdominal trauma.
- Provides insights into the physiological disturbances and their management.
- Informs clinical practice for improving outcomes in critically injured children.
Abstract:
Out of 566 children with closed abdominal trauma, treated in the EMI "Pirogov" over a five-year period, 79 present serious impairment of the basic vital functions (respiration, hemodynamics and the like) connected with the trauma and not infrequently with massive blood loss, necessitating the undertaking of resuscitation measures and intensive care. Of the latter 67 are restored to health, and in twelve the outcome is fatal. In terms of hemodynamic parameters a significant tachycardia along with maintaining normal or even increased arterial pressure are the most characteristic, whereas hypotension is present in 6.4 per cent of successfully cured children only on the first day. Regardless of the fact that merely 13.4 per cent of them have direct chest traumas, the gas exchange is considerably disturbed by hypoxemia--in 89 per cent on the first, and in 100 per cent of the children on the third postinjury day; in one-fourth of the cases the hypoxemia is markedly expressed--below 8.0 kPa (60 mm Hg). Along with the decrease in hemoglobin level the latter accounts for pronounced oxygen transport impairment. During the first postinjury day, the acid-base metabolism is characterized by metabolic acidosis development (in 44 per cent of children), with metabolic alkalosis becoming manifest during the next few days. Twelve children presenting severe combined injuries die within several hours of the accident with signs of a serious traumatic-hemorrhagic shock, or within 2-3 days thereafter with evidence of multiple organ failure.