Детская хирургия. Журнал им. Ю.Ф. Исакова. 2021; 25: 386-391
Жизнеугрожающие тромботические осложнения у детей в отделении реанимации и интенсивной терапии
https://doi.org/10.55308/1560-9510-2021-25-6-386-391Аннотация
Введение. В публикации освещено состояние проблемы тромбообразования в педиатрических ОРИТ, в частности вопросы профилактики и лечения тромбоэмболии лёгочной артерии (ТЭЛА) у детей. В настоящее время отмечается тенденция к увеличению случаев ТЭЛА у детей, так же в мировой литературе отсутствуют чёткие рекомендации по дозированию препаратов для тромболитической терапии у детей с ТЭЛА и острым коронарным синдромом (ОКС) при болезни Кавасаки.
Клинические наблюдения. Представлены два клинических наблюдения из реальной клинической практики, когда успешное лечение детей с жизнеугрожающими тромботическими осложнениями стало возможным благодаря проведению системной тромболитической терапии.
Заключение. В описании клинических наблюдений представлен результат большой аналитической работы с позиций «рискпольза» и «эффективность-безопасность», но на сегодняшний день можно заключить, что необходимы дальнейшие исследования.
Список литературы
1. Nidhya Navanandan, Jill Stein, Rakesh D. Mistry. Pulmonary Embolism in Children. Pediatric Emergency Care. 2019; 2: 143–51. https://doi.org/10.1097/PEC.0000000000001730
2. ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) 2019.
3. Румянцев А.Г., Масчан А.А., Жарков П.А., Свирин П.В. Федеральные клинические рекомендации по диагностике, профилактике и лечению тромбозов у детей и подростков. М.: 2015.
4. Rajpurkar M., Warrier I., Chitlur M., et al. Pulmonary embolism – experience at a single children’s hospital. Thromb Res. 2007; 119: 699–703. https://doi.org/10.1016/j.thromres.2006.05.016
5. Sigrun A. Johannesdottir, Erzsébet Horváth-Puhó, Olaf M. Dekkers, Suzanne C. Cannegieter, Jens Otto L. Jørgensen, Vera Ehrenstein, Jan P. Vandenbroucke, Lars Pedersen, Henrik Toft Sørensen. Use of glucocorticoids and risk of venous thromboembolism: a nationwide populationbased case-control study. JAMA Intern Med. 2013; 173(9): 743–52. https://doi.org/10.1001/jamainternmed.2013.122
6. Damien G. Noone, KazumotoIijima, Rulan Parekh. Idiopathic nephrotic syndrome in children. Lancet. 2018 Jul 7; 392(10141): 61–74. https://doi.org/10.1016/S0140-6736(18)30536-1
7. Sheila J. Hanson, MD, MS, E. Vincent S. Faustino, MD, MHS, Arash Mahajerin, MD, MSCr, Sarah H. O’Brien, MD, Christian J. Streck, MD, A. Jill Thompson, Pharm D., Toni M. Petrillo, MD, John K. Petty, MD, Winston-Salem, North Carolina Recommendations for venous thromboembolism prophylaxis in pediatric trauma patients. J Trauma Acute Care Surg. 2016 May; 80(5): 695–701.
8. Horton D.B., Xie F., Chen L., Mannion M.L., Curtis J.R., Strom B.L., Beukelman T. Oral Glucocorticoids and Incident Treatment of Diabetes Mellitus, Hypertension, and Venous Thromboembolism in Children. Am J Epidemiol. 2021 Feb 1; 190(3): 403–12. https://doi.org/10.1093/aje/kwaa197. PMID:32902632
9. Lee E.Y., Tse S.K., Zurakowski D., et al. Children suspected of having pulmonary embolism: multidetector CT pulmonary angiography – thromboembolic risk factors and implications for appropriate use. Radiology. 2012; 262: 242–51. https://doi.org/10.1148/radiol.11111056
10. Goudie A., Dynan L., Brady P.W., Fieldston E., Brilli R.J., Walsh K.E. Costs of venous thromboembolism, catheter-associated urinary tract infection, and pressure ulcer. Pediatrics. 2015; 136(3): 432Y9. https://doi.org/10.542/peds.2015-1386
11. Albisetti M., Andrew M. Low molecular weight heparin in children. Eur J Pediatr. 2002; 161(2): 71. https://doi.org/10.007/s00431-001-0873-9
12. Monagle P., Cuello C.A., Augustine C., Bonduel M., Brandão L.R., Capman T., Chan A.K.C., Hanson S., Male C., Meerpohl J., Newall F., O’Brien S.H., Raffini L., van Ommen H., Wiernikowski J., Williams S., Bhatt M., Riva J.J., Roldan Y., Schwab N., Mustafa R.A., Vesely S.K. American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv. 2018 Nov 27; 2(22): 3292–316. https://doi.org/10.1182/bloodadvances.2018024786
13. Gupta A.A., Leaker M., Andrew M., et al. Safety and outcomes of thrombolysis with tissue plasminogen activator for treatment of intravascular thrombosis in children. J Pediatr. 2001 Nov; 139(5): 682–8. https://doi.org/10.1067/mpd.2001.118428
14. Patocka C., Nemeth J. Pulmonary embolism in pediatrics. J Emerg Med. 2012; 42: 105–16. https://doi.org/10.1016/j.jemermed.2011.03.006
15. Yee D.L., Chan A.K., Williams S., et al. Varied opinions on thrombolysis forvenous thromboembolism in infants and children: findings from a survey of pediatric hematology-oncology specialists. Pediatr Blood Cancer. 2009; 53: 960–6. https://doi.org/10.1002/pbc.22146
16. Corrigan J.J., Sleeth J.J., Jeter M., et al. Newborn’s fibrinolytic mechanism: components and plasmin generation. Am J Hematol. 1989; 32: 273–8. https//doi.org/10.1002/ajh.2830320407
17. Williams M.D. Thrombolysis in children. Br J Haematol. 2010; 148: 26–36. https://doi.org/10.1111/j.1365-2141.2009.07914.x
18. P. Monagle, A.K. Chan, N.A. Goldenberg, R.N. Ichord, J.M. Journeycake, U. NowakGottl, S.K. Vesely, P. American College of Chest, Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-based Clinical Practice Guidelines. Chest. 2012; 141: e737S–801S. https://doi.org/10.1378/chest.11-2308
19. Щедеркина И.О., Ларина Л.Е., Власова А.В., Лившиц М.И., Кузнецова А.А., Горбунов А.В., Харькин А.В., Селиверстова Е.В., Петряйкина Е.Е., Анжель А.Е. Возможности реперфузионной терапии при ишемическом инсульте в педиатрии: протокол тромболизиса у детей в первичном центре детского инсульта. Московская медицина. 2020; 3(37): 35Z.
20. Branchford B.R., Betensky M., Goldenberg N.A. Thromb Res. Pediatric issues in thrombosis and hemostasis: The how and why of venous thromboembolism risk stratification in hospitalized children. Thromb Res. 2018 Dec; 172: 190–3. https://doi.org/10.1016/j.thromres.2018.02.010
Russian Journal of Pediatric Surgery. 2021; 25: 386-391
Life-threatening thrombotic complications in a pediatric in the intensive care unit
https://doi.org/10.55308/1560-9510-2021-25-6-386-391Abstract
Introduction. This article highlights the problem of thrombus formation in pediatric patients staying in ICU, namely, the problem of prevention and management of pulmonary embolism in children. Currently, there is a tendency to increasing pulmonary embolism occurrence in children, though there are no clear guidelines on the medicine dosage for the systemic thrombolytic therapy of pulmonary embolism in children and for the acute coronary syndrome in children with Kawasaki disease.
Clinical observations. The authors present two clinical cases from their practice when a successful management was obtained in children with life threatening thrombotic complications due to the applied systemic thrombolytic therapy.
Conclusion. The obtained success in the described clinical cases have resulted from a thorough analysis of ratios “risk-benefit” and “efficiency-safety”. But the authors conclude that further research work in this direction is still needed.
References
1. Nidhya Navanandan, Jill Stein, Rakesh D. Mistry. Pulmonary Embolism in Children. Pediatric Emergency Care. 2019; 2: 143–51. https://doi.org/10.1097/PEC.0000000000001730
2. ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) 2019.
3. Rumyantsev A.G., Maschan A.A., Zharkov P.A., Svirin P.V. Federal'nye klinicheskie rekomendatsii po diagnostike, profilaktike i lecheniyu trombozov u detei i podrostkov. M.: 2015.
4. Rajpurkar M., Warrier I., Chitlur M., et al. Pulmonary embolism – experience at a single children’s hospital. Thromb Res. 2007; 119: 699–703. https://doi.org/10.1016/j.thromres.2006.05.016
5. Sigrun A. Johannesdottir, Erzsébet Horváth-Puhó, Olaf M. Dekkers, Suzanne C. Cannegieter, Jens Otto L. Jørgensen, Vera Ehrenstein, Jan P. Vandenbroucke, Lars Pedersen, Henrik Toft Sørensen. Use of glucocorticoids and risk of venous thromboembolism: a nationwide populationbased case-control study. JAMA Intern Med. 2013; 173(9): 743–52. https://doi.org/10.1001/jamainternmed.2013.122
6. Damien G. Noone, KazumotoIijima, Rulan Parekh. Idiopathic nephrotic syndrome in children. Lancet. 2018 Jul 7; 392(10141): 61–74. https://doi.org/10.1016/S0140-6736(18)30536-1
7. Sheila J. Hanson, MD, MS, E. Vincent S. Faustino, MD, MHS, Arash Mahajerin, MD, MSCr, Sarah H. O’Brien, MD, Christian J. Streck, MD, A. Jill Thompson, Pharm D., Toni M. Petrillo, MD, John K. Petty, MD, Winston-Salem, North Carolina Recommendations for venous thromboembolism prophylaxis in pediatric trauma patients. J Trauma Acute Care Surg. 2016 May; 80(5): 695–701.
8. Horton D.B., Xie F., Chen L., Mannion M.L., Curtis J.R., Strom B.L., Beukelman T. Oral Glucocorticoids and Incident Treatment of Diabetes Mellitus, Hypertension, and Venous Thromboembolism in Children. Am J Epidemiol. 2021 Feb 1; 190(3): 403–12. https://doi.org/10.1093/aje/kwaa197. PMID:32902632
9. Lee E.Y., Tse S.K., Zurakowski D., et al. Children suspected of having pulmonary embolism: multidetector CT pulmonary angiography – thromboembolic risk factors and implications for appropriate use. Radiology. 2012; 262: 242–51. https://doi.org/10.1148/radiol.11111056
10. Goudie A., Dynan L., Brady P.W., Fieldston E., Brilli R.J., Walsh K.E. Costs of venous thromboembolism, catheter-associated urinary tract infection, and pressure ulcer. Pediatrics. 2015; 136(3): 432Y9. https://doi.org/10.542/peds.2015-1386
11. Albisetti M., Andrew M. Low molecular weight heparin in children. Eur J Pediatr. 2002; 161(2): 71. https://doi.org/10.007/s00431-001-0873-9
12. Monagle P., Cuello C.A., Augustine C., Bonduel M., Brandão L.R., Capman T., Chan A.K.C., Hanson S., Male C., Meerpohl J., Newall F., O’Brien S.H., Raffini L., van Ommen H., Wiernikowski J., Williams S., Bhatt M., Riva J.J., Roldan Y., Schwab N., Mustafa R.A., Vesely S.K. American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv. 2018 Nov 27; 2(22): 3292–316. https://doi.org/10.1182/bloodadvances.2018024786
13. Gupta A.A., Leaker M., Andrew M., et al. Safety and outcomes of thrombolysis with tissue plasminogen activator for treatment of intravascular thrombosis in children. J Pediatr. 2001 Nov; 139(5): 682–8. https://doi.org/10.1067/mpd.2001.118428
14. Patocka C., Nemeth J. Pulmonary embolism in pediatrics. J Emerg Med. 2012; 42: 105–16. https://doi.org/10.1016/j.jemermed.2011.03.006
15. Yee D.L., Chan A.K., Williams S., et al. Varied opinions on thrombolysis forvenous thromboembolism in infants and children: findings from a survey of pediatric hematology-oncology specialists. Pediatr Blood Cancer. 2009; 53: 960–6. https://doi.org/10.1002/pbc.22146
16. Corrigan J.J., Sleeth J.J., Jeter M., et al. Newborn’s fibrinolytic mechanism: components and plasmin generation. Am J Hematol. 1989; 32: 273–8. https//doi.org/10.1002/ajh.2830320407
17. Williams M.D. Thrombolysis in children. Br J Haematol. 2010; 148: 26–36. https://doi.org/10.1111/j.1365-2141.2009.07914.x
18. P. Monagle, A.K. Chan, N.A. Goldenberg, R.N. Ichord, J.M. Journeycake, U. NowakGottl, S.K. Vesely, P. American College of Chest, Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-based Clinical Practice Guidelines. Chest. 2012; 141: e737S–801S. https://doi.org/10.1378/chest.11-2308
19. Shchederkina I.O., Larina L.E., Vlasova A.V., Livshits M.I., Kuznetsova A.A., Gorbunov A.V., Khar'kin A.V., Seliverstova E.V., Petryaikina E.E., Anzhel' A.E. Vozmozhnosti reperfuzionnoi terapii pri ishemicheskom insul'te v pediatrii: protokol trombolizisa u detei v pervichnom tsentre detskogo insul'ta. Moskovskaya meditsina. 2020; 3(37): 35Z.
20. Branchford B.R., Betensky M., Goldenberg N.A. Thromb Res. Pediatric issues in thrombosis and hemostasis: The how and why of venous thromboembolism risk stratification in hospitalized children. Thromb Res. 2018 Dec; 172: 190–3. https://doi.org/10.1016/j.thromres.2018.02.010
