SOVREMENNAYA PEDIATRIYA.2016.7(79):20-25; doi 10.15574/SP.2016.79.20 

A case of successful treatment of severe catheter-related gram-negative sepsis in the young child 

Semkovych M., Semkovych Ya., Synoverska O.

State higher educational institution «The Ivano-Frankivsk National Medical University», Ukraine

The child having serious catheter-related gram-negative sepsis has been treated in the Department of anesthesiology and intensive therapy (DAIT) of the regional children's clinical hospital (RCCH) of Ivano-Frankivsk. From the anamnesis, it is known that infusion therapy through peripheral venous catheter in the projection of the left crook of the arm had been being conducted for three days. At admission, the child's condition is severe due to endogenous intoxication, type II respiratory distress by lower obstructive_constrictive type on the background of pneumonia, anemic, hypoproteinemic and dyselectrolytemic syndroms, and coagulopathy. Given the signs of increasing respiratory distress, hemorrhagic, anemic syndromes, and cerebral deficit, indurative edema of upper-left extremity with the transition to the neck tracheal intubation with respiratory support using artificial lung ventilation was carried out. Because of progression of upper extremity edema, interference with blood flow, we had to do a fasciotomy and necrectomy. Due to the development of organ dysfunction, two sessions of hyperbaric oxygenation were initiated on the seventh day. On the tenth day because of the progression of purulent endobronchitis an intermediate tracheostomy was held. To regress purulent expectorative component therapeutic bronchoscopy was performed six times. Correction of anemic, hypoalbuminemic syndromes and coagulopathy were provided by the transfusion of washed red blood cells, fresh frozen plasma, 10% solution of albumin. With immunosupportive purpose, intravenous human immunoglobulin was administered (three times 5 ml/kg). On the 17th day of treatment at DAIT the respirator was removed. Tracheostomy decannulation was held on the 24th day. On the 26th day the child was transferred for further treatment to Combustiology Department of regional clinical hospital in Ivano-Frankivsk, where the child was discharged due to satisfactory condition on the 38th day of total stay in hospital.

Key words: sepsis, pneumonia, children.

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