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The Protocol isn't seen as directive. The goal of the Protocol is to define theframes ofdiagnostic criteria and therapeutic action, within which a doctor working in an intensive therapy children have freedom of choice. The Protocol takes into account that the critical and postagressive states are characterized by the features of malnutrition, particularly manifested in the period of intensive growth (first life year). The Protocol submitted by: contraindications to artificial nutricion in any form; indications for parenteral nutrition; components ofparenteral nutrition; calculation of water and energy needs; calculation of substrate requirements; the system of "two in one" and "three in one "; monitoring the effectiveness ofparenteral nutrition; the use of adjuvants and active additives to artificial nutrition, indications for early enteral nutrition, time of the beginning of enteral nutricion and tolerance to it: trial feeding; trophic nutricion; the technique ofprobe feeding; selection offormulas for enteral nutrition; monitoring the effectiveness of enteral nutrition. The Protocol does not discuss the issues of planned nutritional preparation for surgery, nutritional support in chronic malabsorption, sipping.

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 article presents a clinical case of severe anaphylactic reaction to first introduced as complementary foods in the diet of the 3.5 months-life child formula based on cow milk.protein. Issues for discussion: the distribution of anaphylactic reactions in children, especially early age, causes, clinical features and the complex life-saving activities.

Sedation is a controllable level of medication depression of consciousness during which protective reflexes, adequate breathing, and responsiveness to physical stimuli and verbal commands are retained A number of physical and psychological factors affect the psyche of patients in the intensive care unit. Central nervous system (CNS) is a primary target of action of anesthetics and analgesics, and the bi-spectral index reflects the level of sedation of CNS, regardless of what drug caused sedation. The aim of this study was to use volatile anesthetics sevoflurane and isoflurane in children for sedation in the intensive care unit. Constant use of the inhalation route of administration helps to maintain the desired level of sedation depth for the required period of time in patients who are on long-term sedation and is practical for correction.

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.

Nosocomial infections and their rational antibiotic treatment represent a major challenge for the healthcare nowadays. In this context, gramnegative bacteria including Pseudomonas aeruginosa, Acinetobacter baumanii and Enterobacteriaceae spp. are etiologically important and characterized by a significant level of antibiotic resistance. To examine dynamics of the respiratory tract colonization by hospital flora, tracheal aspirates obtained at three time points from 69 children with severe craniocerebral trauma during their stay in ICU were analysed. Colonization was observed on the 4th day of the ICU stay with predomination of K. pneumoniae (45%) and A. baumanii (27-37%). P. aeruginosa was detected after the 8th day of the ICU stay with the isolation rate of 33%. Substantial proportions of P. aeruginosa (61%), A. baumanii (78%) and K. pneumoniae (25%) were resistant to carbapenems. In 65 carbapemen resistant isolates, the presence of carbapenemases was examined using PCRs. OXA-48 carbapenemase was detected in 11 out of 14 (78%) K. pneumoniae isolates. Among the A. baumanii isolates, 30/31 (97%) carried OXA-40 and 1/31 (3%) had OXA-23 carbapenemases. None of the examined A. baumanii and K. pneumoniae isolates produced metallo-betalactamases (MBL). In contrast, all 20 carbapenem resistant P. aeruginosa isolates produced a MBL, and in 12 out of 20 (60%) of theme VIM-2 was detected. Thus, gramnegative nosocomial microflora rapidly colonizes ICU patients and has a high level of resistance to antibiotics, including carbapenems.

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.

Tushino City Pediatric Hospital disposes years of experience treating patients with stenosis of the larynx in specialized units. The problem of acute epiglottitis is interesting for a number of specialists. This article discusses the clinical symptoms of acute epiglottitis, diagnosis and risk factors of acute epiglottitis in children.

The purpose of the study was to define the depth of a sedative effect during continuous intravenous drug co-administration by BIS monitoring in children in intensive care units. Sixty-eight patients aged 12 to 15 years who had severe purulent abdominal processes and somatic diseases on artificial ventilation were examined. The patients were divided into 4 main groups by the types of a combination of taken drugs: sodium oxybutyrate with promedole, sodium oxybutyrate with fentanyl, sodium thiopental with promedole, and sodium thiopental with fentanyl. Changes in BIS values were studied and sedation was comparatively assessed with the data of clinical scales. Out of the clinical scales, the Ramsey, SAS, and Comfort ones were used. At Stage I before drug administration, all patient groups were observed to have a wakefulness level, where BIS is an initial index. At Stage II during drug co-administration, there was a significant reduction in BIS values in all the groups, which was indicative of a sedative effect. The depth of sedation therapy was estimated during infusion of each type of a combination of the drugs tested in the study. Thus, to eliminate undesirable outcomes of sedation therapy in children during continuous intravenous drug co-administration, it is necessary to monitor the depth of sedation; where possible, BIS may be used to monitor central nervous system performance.

The depth of sedation was studied in children at intensive care units. Sixty-five children aged 4 to 14 years who had severe purulent abdominal processes and somatic diseases were examined. The depth of sedation was recorded by BIS monitoring and the Ramsey clinical sedation scale was used to make a clinical evaluation. Changes caused by relanium administration were observed in two groups. Midazolam was given in Group 3. There were differences when these agents were administered. The depth of sedation was found to depend on the given dose of an agent.

The increase efficacy of treatment of children in intensive care departments a system of dietary provision of children in critical status was developed. A way of determining the time to start entheral nutrition of such children was determined.

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.

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.

New technologies of diagnostics of post-operative period complications in newborns (measure of procalcitonin level, serum wedge-shaped dehydration method), as well as introduction of discrete plasmopheresis and fiber-optic bronchoscopy via the laringeal mask, present necessery additions to traditinally used methods of treatment in a children's intensive care unit, improving the results of its work.

The article contains a survey of medical instruments represented at the Healthcare-2000" exhibition--the largest one in the recent years; the instruments are designed to equip the operating units, technological, stomatological, intensive-care and pediatric departments, as well as wards, procedure units and mobile medical units. The conclusion is that an extensive range of medical equipment is represented at the exhibition; any medical institution would be able to choose their instruments it needs.

Tube feeding was used in 97 children aged 0 to 8 years hospitalized in intensive care wards. Daily rations were calculated on the basis of daily requirements. The feeding was carried out continuously or intermittently. Algorithms of the methods are presented. If requirements to tube feeding are strictly adhered to, the incidence and severity of complications are minimal.

Thirty-six patients aged 2 months to 14 years were observed. Noninvasive assisted ventilation of the lungs (NAVL) was performed through Respironix Inc. masks (USA) with Puritan-Bennet 7200, Bear 1000, and Bear 750 respirators in the SIMV + PS, CPAP + PS modes with manual regulation of the supporting pressure level. Respiratory rate, heart rate, respiratory volume, pO2, pCO2, SpO2, stroke volume, and minute volume of the heart were evaluated. During development of central respiratory failure in the early postoperative period or in case of forced deep medicamentous neuroplegia NAVL normalized the external respiration function and promoted adequate ventilation of the lungs; in the majority of cases with development of restrictive respiratory failure (RF) it improved ventilation of the lungs and therefore no intubation of the trachea and transfer to forced ventilation was needed. NAVL is indicated as a component of multiple-modality treatment for obstructive RF.

Comparative activity of cefepime, ceftazidime, ceftriaxone, ciprofloxacin, imipenem and piperacillin/tazobactam against isolates from patients of pediatric intensive care units within October-December 1998 was studied. The isolates were identified with the Walkaway-40 System. The antibiotic susceptibility was evaluated by the E-test on the Mueller-Hinton II agar. The data were interpreted in accordance with the NCCLS. The number of the isolates totaled 100. Among them not more than 10 to 12 strains belonged to the same species. 92 per cent of the isolates was susceptible to cefepime and 70 to 75 per cent of the isolates were susceptible to the third generation cephalosporins. Piperacillin/tazobactam proved to be highly susceptible, the number of the isolates resistant and moderately resistant to it being 6 and 1 per cent respectively. The results showed that cefepime was intermediate between the third generation cephalosporins and carbapenems.