Changes in visceral proteins pool in children with different types of respiratory failure
Authors:   The Danylo Halytsky National Medical University in Lviv, Filyk O.V. 
Published: December 2020

Malnutrition has substantial clinical and socioeconomic significance. Early nutritional disturbances may adversely affect the course of existing lung diseases in early childhood and increase the risk of lung disease in adults. Early diagnosis with combination of clinical examination, anthropometric and laboratory methods in children with acute respiratory failure help to improve results of treatment, and laboratory markers which quickly respond to changes in nutrition will provide optimal monitoring for patients and conditions for immediate correction of these disorders by physicians. The aim of the study was to determine the features of visceral proteins pool (albumin and transthyretin) in children with different types of respiratory failure and duration of their stay in the intensive care unit depending on the plan of nutritional disorders monitoring and correction. Material and Methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children's Clinical Hospital "OHMATDYT". We included 237 patients aged from 1 month to 18 years and distributed them into a control group, Group I, and Group II. In Groups I and II patients with acute respiratory failure were included who were mechanically ventilated for more than 2 days. Group I included patients who received lung-protective ventilation strategy and assessment of nutritional status; Group II included patients who received diaphragm-protective in addition to lung-protective ventilation strategy; the results of nutritional status assessment were taken into account as well. The atients were divided into age subgroups: 1st subgroup - children from1 month to 1 year of age; 2nd subgroup - children of 1 - 3 years; 3rd subgroup - children of 3 - 6 years; 4th subgroup - children of 6 - 13 years; 5th subgroup - children of 13 - 18 years. The stages of the study were the following: 1st day (d1), 3rd day (d3), 5th day (d5), 7th day (d7), 9th day (d9), 14th day (d14), 28th day (d28). The primary endpoint was the duration of stay in the intensive care department. The additional assessment criteria included serum albumin and transthyretin levels, the frequency of transfusions of albumin solution, and the frequency of changes in nutritional therapy procedure. The statistical analysis of the study results was performed using MS Excel 2017 with the calculation of the median [IQR - interquartile range], and p-values calculations. Results and Discussion. As a result of the analysis of data on the visceral pool of proteins, it should be noted that the most common disorders were found in patients of the 1st, 2nd and 5th age subgroups: in 1st age subgroup there were disorders related to albumin and transthyretin level; in 2nd age subgroup -to transthyretin level, in 5th age subgroup -to albumin. This might be explained in terms of malnutrition impact on development of body weight deficit and lower body mass index in children of 1st and 2nd age subgroups. On the other hand, in 5th age subgroup nutritional deficiency might be the basis for the emergence of serious diseases that are directly related to nutritional status (severe bacterial infections) and lead to their severe course. The analysis of the frequency of transfusions of albumin solution found that it was performed: in the 1st age subgroup - in 50% of patients of Group I and 0% patients of Group II; in the 2nd age subgroup there were no patient received albumin solution; in the 3rd age subgroup - in 30% of patients of I group and in 0% of patients of II group; in the 4th group - in 20% of patients in Group I and in 0% patients in Group II; in 5th age subgroup - in 0% patients of Group I and in 50% of patients in Group II. The change in the procedure of the nutritional therapy was carried out: in 1st age subgroup - 18% in Group I, 0% in Group II; in 2nd age subgroup - 0% patients in Group I and 30% patients of Group II; in 3rd age subgroup - 0% patients in Group I and 33% patients of Group II; in 4th age subgroup - 40% in Group I and 50% in GroupII; in 5th age subgroup - 0% in Group I and 43% in Group II. Conclusions. It was found that the duration of stay in the intensive care unit depends on principles of monitoring and correction of nutritional disorders in children with respiratory failure. A reliable twofold decrease of the time spent in the intensive care unit was achieved in Group II in comparison with Group I and in the 2nd age subgroup; the time of ICU stay also decreased 2.3 times in 5th age subgroup (p<0.05). Keywords: visceral proteins, children, acute respiratory failure