The toxic-resorbtive state in children with polytrauma (a literature review)

Abstract

Introduction. Polytrauma (PT) in children is an important medical and social issue because it leads to a high percentage of disability and mortality in pediatric population. Destruction of the muscle mass in patients with PT causes traumatic rhabdomyolysis (TR) in 85% of cases. Such patients develop endogenous intoxication called “toxic-resorbtive state” (TRS) which is caused by the absorption of tissue degradation products into the systemic circulation.Purpose. The aim of the present study was to analyze publications on the diagnostics and treatment of “toxic-resorbtive state”, including extracorporeal techniques.Material and methods. We searched PubMed, Web of Science, Scopus, MEDLINE, eLibrary, and RSCI databases and found about 1800 references and 268 articles. We selected 38 articles for reviewing in traumatology, intensive care and extracorporeal methods.Results. In the acute period of injury, TRS is complicated by the acute kidney injury (AKI) in 5–25% of cases. Mortality in TRS is up to 20%; the leading cause of death is multiple organ failure. TRS markers are myoglobin, creatine phosphokinase lactate, LDH, AST and others. TRS therapy is aimed to prevent and to treat AKI. Continous renal replacement therapy (CRRT) for treating TRS allows to remove myoglobin, CPK and LDH from the circulation and to reduce mortality by half.Conclusion. In TRS management, there are no unified approaches to CRRT indications, regimens, session duration, and choice of optimal filters. In the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, a trial is planned aiming to assess CRRT effectiveness and safety of TRS treatment in children with polytrauma injuries.