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Elimination of Intestinal Hypoxia in Complex Treatment of Intestinal Failure (Case Report)
- Authors: Bykov M.V.1,2,3,4, Lazarev V.V.1, Mayorov A.D.2, Tsesareva M.S.2, Nafikov V.S.2, Koroleva A.S.2, Sytkov V.V.2,5,6, Severinov D.A.7, Smirnov D.A.3, Frolov N.S.3, Chernyshev D.V.8
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Affiliations:
- N. I. Pirogov Russian National Research Medical University
- Moscow Regional Center for the Protection of Maternity and Childhood
- Podolsk Children's Hospital
- Central Research Institute of Epidemiology
- Russian University of Medicine
- Morozovskaya Children's City Clinical Hospital of the Moscow City Health Department
- Kursk State Medical University
- Infectious Diseases Clinical Hospital No. 2 of the Moscow City Health Department
- Issue: Vol 32, No 2 (2024)
- Pages: 287-295
- Section: Clinical reports
- Submitted: 04.04.2023
- Accepted: 06.10.2023
- Published: 10.07.2024
- URL: https://journals.eco-vector.com/pavlovj/article/view/321911
- DOI: https://doi.org/10.17816/PAVLOVJ321911
- ID: 321911
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Abstract
INTRODUCTION: Currently, various approaches to the treatment of intestinal failure (IF) are considered. In search for pathogenetically justified therapy, it is possible to use oxygenated saline enteral solution (OSES).
АIM: To demonstrate, by gas analysis of the introduced oxygenated saline enteral solution and the excreted intestinal fluid, the possibility of gas exchange in the intestine with increased oxygen extraction under hypoxic conditions.
An 8-year-old child with burdened premorbid history and severe community–acquired bilateral pleuropneumonia kept on mechanical ventilation, had signs of IF (disorder in passage, absence of independent defecation for more than two days). During treatment and observation of the child, enteral feeding was attempted with pharmacological stimulation with prokinetics, and introduction of laxative sorbent with prebiotic effect (lactulose). Because of non-effectiveness of these measures, it was decided to perform intestinal lavage with OSES introduced through the nasogastral tube. In 30 minites after start of OSES introduction, the gastrointestinal tract motility notably enhanced, in 1.5 hour from the beginning of the procedure, fractional passage of a significant amount of thick fecal masses was noted, after which intestinate — liquid stool stained yellow with bile, was obtained. During the procedure, a comparative analysis of the gas composition of the introduced OSES and excreted intestinate was done. In the excreted solution, 97-fold decrease of рО2 from 659 to 6.8 mm Hg, and 3.6-fold increase in CO2 tension from 23 to 85.7 mm Hg, were noted.
CONCLUSION: Oxygenation of the enteral environment by barbotage of a saline enteral solution introduced through a tube is an effective component of intensive therapy for intestinal failure syndrome, taking into account the ability of the gastrointestinal tract tissues to actively participate in gas exchange: extract oxygen and release carbon dioxide.
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About the authors
Mikhail V. Bykov
N. I. Pirogov Russian National Research Medical University; Moscow Regional Center for the Protection of Maternity and Childhood; Podolsk Children's Hospital; Central Research Institute of Epidemiology
Email: mikhail_v_bykov@mail.ru
ORCID iD: 0000-0003-4537-2548
SPIN-code: 1485-9284
MD, Cand. Sci. (Med.), Associate Professor
Russian Federation, Moscow; Lyubertsy; Podolsk; MoscowVladimir V. Lazarev
N. I. Pirogov Russian National Research Medical University
Email: lazarev_vv@inbox.ru
ORCID iD: 0000-0001-8417-3555
SPIN-code: 4414-0677
MD, Dr. Sci. (Med.), Professor
Russian Federation, MoscowAleksey D. Mayorov
Moscow Regional Center for the Protection of Maternity and Childhood
Email: ximyra07@yandex.ru
ORCID iD: 0000-0003-3245-603X
Russian Federation, Lyubertsy
Mariya S. Tsesareva
Moscow Regional Center for the Protection of Maternity and Childhood
Email: ximyra07@yandex.ru
ORCID iD: 0000-0003-2699-7550
Russian Federation, Lyubertsy
Vyacheslav S. Nafikov
Moscow Regional Center for the Protection of Maternity and Childhood
Email: salavatovi486@mail.ru
ORCID iD: 0000-0002-7722-8324
Russian Federation, Lyubertsy
Anna S. Koroleva
Moscow Regional Center for the Protection of Maternity and Childhood
Email: anna-doctor79@rambler.ru
ORCID iD: 0009-0006-8477-3669
Russian Federation, Lyubertsy
Valentin V. Sytkov
Moscow Regional Center for the Protection of Maternity and Childhood; Russian University of Medicine; Morozovskaya Children's City Clinical Hospital of the Moscow City Health Department
Email: val-sytkov@yandex.ru
ORCID iD: 0000-0001-6152-5693
SPIN-code: 2792-6214
MD, Cand. Sci. (Med.)
Russian Federation, Lyubertsy; Moscow; MoscowDmitriy A. Severinov
Kursk State Medical University
Author for correspondence.
Email: dmitriy.severinov.93@mail.ru
ORCID iD: 0000-0003-4460-1353
SPIN-code: 1966-0239
MD, Cand. Sci. (Med.)
Russian Federation, KurskDmitriy A. Smirnov
Podolsk Children's Hospital
Email: smirnov-med@mail.ru
ORCID iD: 0000-0002-8065-1940
Russian Federation, Podolsk
Nikolay S. Frolov
Podolsk Children's Hospital
Email: niksf-med88@mail.ru
ORCID iD: 0000-0002-7540-1365
Russian Federation, Podolsk
Dmitriy V. Chernyshev
Infectious Diseases Clinical Hospital No. 2 of the Moscow City Health Department
Email: saracin007@yandex.ru
ORCID iD: 0000-0003-0439-4812
Russian Federation, Moscow
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