RU2556611C1 - Method for detecting cumulative liquid overload in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method is implemented by measuring the patient's weight on admission to hospital and on the day the liquid overload is detected. A percentage of the cumulative liquid overload (CLO) is calculated by formula: CLO= (M1-M2)/M2 x 100%. Herewith: CLO is the cumulative liquid overload; M1 is the patient's weight on the day the liquid overload is detected, kg; M2 is the patient's weight on admission to hospital, kg.

EFFECT: simplifying and reducing labour intensity the method possesses high sensitivity and specificity and increases the detection accuracy.

2 ex

Description

The present invention relates to medicine, namely to anesthesiology and intensive care.

A known method for determining excess fluid in children with renal failure by identifying clinical indicators of fluid overload - cavity edema and edema of the skin, taking into account the age of the patient. The volume of excess fluid relative to the ideal body weight, in percent, is determined by the formulas:

- for children aged from one day to one year:

V = 6.10509 + (15.10323 × X ₁ ) - (0.45023 × X ₂ ) + (2.89610 × X ₃ );

- for children from one year to seventeen years old:

V = 4,05933 + (9.786627 × X ₁ ) - (0.233923 × X ₂ ) + (1.459055 × X ₃ ),

where X ₁ - abdominal edema: 0 - absence, 1 - moderate, 2 - pronounced;

X ₂ - patient's age: up to a year - months, older than one year - years;

X ₃ - skin edema: set according to the depth of the fossa, which is formed after pressure, mm (Method for determining excess fluid in children with renal failure: RF patent 2336015, IPC A61B 5/00 / Dats A.V., Gorbachev V.I .-- No. 2007116656; claimed 02.05.2007; published 20.10.2008).

The disadvantages of this method include its restriction of use - only in children with renal failure, as well as the complexity and complexity of its implementation.

The closest in technical essence to the proposed one is a method for determining cumulative (accumulated) fluid overload (CSF), including measuring the patient’s weight upon admission to the hospital and calculating the percentage of CSF by the formula:

where KPZh - cumulative liquid overload;

V ₁ - the volume of injected fluid, l, from the moment of admission to the hospital;

V ₂ - the volume of the allocated fluid, l, from the moment of admission to the hospital;

M - patient weight upon admission to the hospital, kg

When implementing the known method, the sum of the volumes of all injected fluids is measured daily: intravenous solutions, food and drink, including the probe, fluid for flushing catheters and drains, as well as the sum of all volumes of the fluids excreted: urine excreted, fluid loss with vomit and liquid stool, fluid loss through the gastric tube and drainage. Before starting renal replacement therapy, the patient defines cumulative fluid overload as the difference between these amounts relative to body weight at the time of hospitalization, in percent ((Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury (Program to Improve Care in Acute Renal Disease (PICARD) Study Group) / J. Bouchard, SB Soroko, GM Chertow [et al.] // Kidney Int. - 2009. - Vol.76. - P.422-427)).

The disadvantages of this method, as well as similar, should include the complexity and complexity, as well as the fact that when calculating the CSL do not take into account the imperceptible loss of fluid through the skin and lungs.

The task of the invention is the determination of cumulative fluid overload in a child on a particular day of its determination.

The technical result of the proposed method is to increase its accuracy by taking into account the imperceptible loss of fluid, as well as reducing the complexity and complexity of the method.

The technical result of the proposed method for determining fluid overload in children includes measuring the patient’s weight upon admission to the hospital and calculating the percentage of cumulative fluid overload (CSF) by the formula.

Distinctive techniques of the proposed method are that the patient measures the weight on the day of determination of CSL, which is determined by the formula:

where KPZh - cumulative liquid overload;

M ₁ - patient weight on the day of determination of fluid overload, kg;

M ₂ - patient weight upon admission to the hospital, kg

A comparative analysis with the prototype showed that the proposed method differs from the known above methods and, therefore, meets the criteria of the invention of "novelty."

From the analysis of special and patent literature, the authors found that the proposed method has features that distinguish it not only from the prototype, but also from other technical solutions in this and related fields of medicine. In the available literature, the authors have not identified a method for determining cumulative fluid overload in children by the distinguishing features of the proposed method.

Clinical observations of the authors of the proposed method indicate that the use of the proposed technical solution allows you to set the percentage of cumulative fluid overload in a child on any day of its determination to obtain its specific value, relative to the weight of the child registered upon admission to the hospital.

Compared with the known technical solutions, the proposed method can significantly simplify and reduce the complexity of the determination of cumulative fluid overload in children due to a single measurement of weight instead of daily measurement of all volumes of injected and output fluids.

The above allows us to conclude that the claimed technical solution meets the criterion of "inventive step".

A method for determining cumulative fluid overload in children, comprising the claimed invention, is intended for use in healthcare. The implementation of its capabilities is confirmed by the methods and means described in the application, therefore, the claimed invention meets the patentability condition “industrial applicability”.

The proposed method is as follows.

The patient is measured weight both on admission and on the day of determining fluid overload while he is in the hospital.

Then, the cumulative fluid overload, expressed as a percentage of body weight upon admission, is determined by the above formula.

The obtained value of cumulative liquid overload is compared with its critical value.

It is known that fluid overload is associated with impaired oxygenation and morbidity in critically ill children / AA Arikan, M. Zappitelli, SL Goldstein [et al.] // Pediatr Cri. Care Med. - 2012 .-- Vol.13. - P.255).

If cumulative fluid overload exceeds a critical value, then, depending on the clinical situation, either reduce the volume of injected fluid and prescribe furosemide, or conduct renal replacement therapy.

The proposed method for determining cumulative fluid overload in children is illustrated by examples of specific performance.

Example 1. Patient T., 1 year 3 months., DS: Hospital pneumonia, bilateral pneumothorax. Severe sepsis. Multiple organ failure syndrome: acute respiratory failure, hepatorenal syndrome. Upon admission to the hospital, the weight is 10 kg; on day 5, the maximum weight value is 12 kg. At the same time, the calculated fluid overload according to the proposed formula for the 5th day of hospital stay was 20%:

Since the fluid overload exceeded the critical level of 15%, the patient was given indications for renal replacement therapy, which was carried out for 3 days. On the 25th day after the child was admitted to the hospital, he was discharged in satisfactory condition.

Example 2. Patient E., 17 days, DS: Ulcerative necrotic enterocolitis, peritonitis, Severe sepsis. Multiple organ failure: acute heart failure, acute respiratory and acute renal failure. The weight of the patient upon admission to the hospital was 1.969 kg; on the 3rd day of hospitalization, the weight was 2.276 kg. The percentage of cumulative fluid overload on the 3rd day of hospital stay, calculated by the proposed formula, was:

Given that the fluid overload exceeded the critical level, the patient was given indications for renal replacement therapy, which was carried out for 4 days - until the water balance normalized. On day 35, the child was discharged from the hospital in satisfactory condition.

Clinical studies of the proposed method are conducted from 2007 to the present on the basis of the City of Ivano-Matreninsky Children's Clinical Hospital in Irkutsk. A total of 105 children were examined, of which with lung disease 40%, sepsis 22%, combined trauma 15%, kidney disease 13%, cardiovascular diseases 8% and other diseases 2%.

Within seven days from the moment of admission to the hospital, in 84 children (80%), fluid overload reached its maximum value and ranged from 2.5 to 20%. By the 14th day of hospital stay, fluid overload persisted in 5% of patients. The accuracy of determining fluid overload in treated children was 91%, specificity - 80%.

Thus, the proposed method makes it possible to determine the cumulative fluid overload in children as a percentage of body weight upon admission to the hospital, which allows timely correction.

Claims (1)

A method for determining cumulative fluid overload (CSF) in children, including measuring the patient’s weight upon admission to the hospital and calculating the percentage of CSF according to the formula, characterized in that the patient’s weight is measured on the day CSF is determined, which is determined by the formula:
$$\mathrm{TO}PF=\frac{M\mathrm{one}-M2}{M2}\times \mathrm{one\; hundred}\%,$$

where: KPZh - cumulative liquid overload;
M ₁ - patient weight on the day of determination of fluid overload, kg;
M ₂ - patient weight upon admission to the hospital, kg