Critical care advisory support and telemedicine technologies for in-hospital medical care in children

The foundations of telemedicine consulting were laid in the 70s of the 20th century. However, development of this direction was significantly accelerated at the beginning of the 21st century. A significant accelerator was the pandemic of a new coronavirus infection (COVID-19). The Russian Federation has federal and regional systems that often develop in isolation from each other. At the beginning of the new coronavirus infection pandemic in the Russian Federation, a vertically integrated model for counseling intensive care patients with COVID-19 and pneumonia was created. Various national and foreign studies confirmed high efficiency of telemedicine counseling for in-hospital patients. This is evidenced by less mortality rates and ICU-stay, as well as introduction of modern clinical practice in regional hospitals. Integration of critical care for children is carried out through critical care advisory support centers based on large regional and federal hospitals. The objective of regional centers is decision-making on the need for hospitalization of patients in level III hospitals, while the task of federal centers is management of patients in accordance with modern clinical practice. © 2023, Media Sphera Publishing Group. All rights reserved.

Efficacy of clinical guidelines in the treatment of severe forms of a novel coronavirus infection in children

Intensive therapy of severe COVID-19 is one of the most difficult problems of modern intensive care. Objective. To assess the effectiveness of clinical guidelines in the treatment of severe forms of a new coronavirus infection in children. Material and methods. A retrospective controlled non-randomized multiple-center study enrolled 111 ICU children from 40 hospitals. Specialists of the Federal Remote Intensive Care Counselling Centre counseled all patients. Children were divided into 2 groups («recovery» and «death») depending on the outcome. Results. pSOFA score 2 (1—5) at admission was associated with 19.5-fold increase of mortality risk (OR 19.5, 95% Cl 2.3—165.7). We found higher score «respiratory distress» item in all patients regardless the outcome. Antibacterial, corticosteroid therapy and vasopressor support significantly affected the outcome of disease (X2=18.202;df=3, p=0.000), while infusion, respiratory, anticoagulant therapy and enteral nutrition were less significant, especially in pSOFA score ≤4 points (X2=15.521;df=5, p=0.008). Mortality risk decreased in no need for increase of initial doses of catecholamines (OR 0.2, 95% 0=0.1—0.7). Less compliance with recommendations for correction of antibacterial and corticosteroid therapy was followed by higher mortality (OR 5.2, 95% Cl 1.4—18.9 and OR 3.4, 95% Cl 1.1—10.8, respectively). Conclusion. Timely strict implementation of clinical guidelines, adequate catecholamine support, antibacterial and corticosteroid therapy in children with COVID-19 significantly reduce the likelihood of mortality. © 2022, Media Sphera Publishing Group. All rights reserved.

Predictors of death in severe new coronavirus infection in children

Currently, in pandemic settings, the new coronavirus infection is the leading cause of adult fatalities and may cause death of children with comorbidities. The objective of the study is to identify predictors of the fatality of the new coronavirus infection in children. Subjects and Methods. 230 patients with the new coronavirus infections were examined. The main group of 94 patients with severe COVID-19, the fatal outcome occurred in 25 (26.6%) children. The comparison group consisted of 126 children with a moderate degree of severity, and there were no lethal outcomes. Results. Children older than 10 years of age (43%) prevailed in the study cohort. Every fifth patient in the main group suffered from shock, and 79 (84%) children had failure of two or more systems/organs. The presence of pronounced manifestations of the disease was associated with a 20-fold increase in the probability of a severe course of COVID-19 (OR = 0.04). Involvement of two organs and systems doubled the risk of death. An acceptable discriminatory ability of the pSOFA score for predicting COVID-19 outcomes in children was identified: sensitivity 83%, specificity 61%, cut-off point 5.6 points. Conclusion. Predictors of death in severe new coronavirus infection in children include failure of two or more organs and systems, acute renal injury and the pSOFA score above 5. © 2021 Tomsk Polytechnic University, Publishing House. All rights reserved.