Aim: To study the effect of the antiproteinasehemosorbent “Hemo-proteasesorb” on the dynamics of the main markers of inflammation in the complex intensive care of children with generalized peritonitis. Material and methods: A prospective randomized study of 60 children with generalizedperitonitis was conducted. Group I included 30 patients who underwent hemoperfusion through the sorbent “Hemo-proteazsorb”. Group II included 30 patients who underwent traditional treatment. The examined groups were comparable in the nature of pathology and severity of the condition. Results: After hemoperfusion, a significant decrease in the main markers of inflammation was found: C-reactive protein decreased from 83.7 (72.2; 131.3) to 12.9 (10.0;22.0) (p=0,0003) mg/l, procalcitonin level normalized from 4.65 (2.1;7.4) to 0.21 (0.07;0.4) (p=0,00002) ng/ml, presepsin level decreased from 5.7 (2.5; 8.8) to 0.4 (0.3; 0.8) (p=0,25) ng/ml, the level of IL-6 decreased from 25.3 (6.0; 68.8) to 4.6 (0.9; 8.3) (p=0.000001) pg/ml. When compared in the second group, the studied indicators changed much more slowly. Conclusions: The data obtained as a result of the study indicate a decrease in the severity of the inflammatory process, a decrease in the risk of sepsis in the group of patients who underwent hemoperfusion, and thereby prove the effectiveness of this method.

Background. Despite the undoubted success of modern medicine, peritonitis in children remains not only a surgical, but also a general pathological problem, the relevance of which is not decreasing. The use of efferent therapy methods, in particular hemosorption, imitating the natural mechanisms of detoxification of the body, are promising in the complex therapy of children with peritonitis. The aim of the study was to establish the effectiveness of the antiproteinase hemosorbent "Hemo-proteazsorb" in the complex intensive care of children with generalized peritonitis. Material and methods. A prospective randomized study of 60 children with generalized peritonitis was conducted. In the main group, there were 30 patients who underwent hemosorption in complex intensive therapy. The comparison group also included 30 patients who underwent traditional treatment. The examined groups were comparable in terms of the nature of the pathology and the severity of the condition. Results. During hemoperfusion, a significant increase in blood saturation was established – from 95.1 (93.2; 97.1)% to 97.3 (95.5; 98.7)%, with an improvement in oxygen transport (ctO2, mmol/l) from 6.9 (6.4; 7.9) to 8.8 (1.5; 9.7) and a decrease in lactate level (mmol/l) from 1.7 (1.5;2.1) to 1.1 (0.9;1.3), which indicated normalization of blood oxygenation and improvement of microcirculation. After 24 hours, there was a significant decrease in the sum of points on the pSOFA scale, from 4.5 (3.0; 6.0) to 0.5 (0; 2.0), p<0.001. Normalization of body temperature and restoration of intestinal function in 15 (50.0% СI 32.1-67.9) children were also noted, which indicated a decrease in multiple organ dysfunction and improvement of the condition. In the comparison group, the studied indicators changed much more slowly. Conclusions. The data on the positive dynamics of clinical and laboratory parameters, obtained as a result of the study, prove the high effectiveness of the Belarusian hemosorbent "Hemo-proteazsorb" in the complex intensive care for generalized peritonitis.

Introduction. Despite the undoubted success of modern medicine, peritonitis in children remains not only a surgical, but also a general pathological problem, the relevance of which does not decrease. The use of efferent therapy methods, in particular hemosorption, imitating the natural mechanisms of detoxification of the body, are promising in the complex therapy of children with peritonitis. Aim. The aim of the study was to establish the effectiveness of the antiproteinase hemosorbent „Hemo-proteazsorb” in the complex intensive care of children with generalized peritonitis. Material and methods. A prospective randomized study of 60 children with generalized peritonitis was conducted. In the main group, there were 30 patients who underwent hemosorption in complex intensive care, and the comparison group also included 30 patients who underwent traditional treatment. The examined groups were comparable in terms of the nature of the pathology and the severity of the condition. Results. During hemoperfusion, a significant increase in blood saturation was established from 95.1 (93.2; 97.1)% to 97.3 (95.5; 98.7)%, with an improvement in oxygen transport (ctO2, mmol/l) from 6.9 (6.4; 7.9) to 8.8 (1.5; 9.7) and a decrease in lactate level (mmol/l) from 1.7 (1.5;2.1) to 1.1 (0.9;1.3), which indicates normalization of blood oxygenation and improvement of microcirculation. After 24 hours, there was a significant decrease in the amount of points on the pSOFA scale, from 4.5 (3.0; 6.0) to 0.5 (0; 2.0), p < 0.001, normalization of body temperature, restoration of intestinal function was noted in 15 (50.0% CI: 32.1-67.9) children, which indicates a decrease in multiple organ dysfunction and improvement of the condition. When compared in the second group, the studied indicators changed much more slowly. Conclusions. The data obtained as a result of the study on the positive dynamics of clinical and laboratory parameters prove the high effectiveness of the use of the Belarusian hemosorbent ?Hemo-proteazsorb? in the complex of intensive care of generalized peritonitis.

Sepsis in children is still accompanied by high mortality, especially in developing countries, and the annual cost of treatment amounts to billions of dollars. Currently, various methods and combinations of extracorporeal blood purification depending on the characteristics of the clinical course of sepsis, its type and severity are being actively and successfully developed and put into practice. However, not all methods of extracorporeal hemocorrection in children and adults with regard to a particular critical situation have been fully studied. This literature review provides up-to-date data on extracorporeal methods of hemocorrection in children. Special attention is paid to innovative technologies in intensive care of acute renal injury induced by sepsis and methods of hemosorption of endotoxin and cytokines in adults and children.

Peritonitis treatment in children remains one of the most complicated and urgent problem of modern surgery and intensive care. Particular attention is paid to therapy aimed to remove proinflammatory mediators and toxic substances. Hemoperfusion (HP) is a method based on elimination of toxic substances of an endogenous or exogenous nature from the patient’s blood by extracorporeal perfusion of whole blood through a special sorbent. However, to date, there are no clear clinical and laboratory criteria for the initiation, prolongation or completion of the HP procedure. Purpose – to objectify the stratification criteria in children with appendicular peritonitis for the selective HP using the hemosorbent «Hemo-proteazsorb». Materials and methods. The retrospective analysis of data from 60 patients with appendicular peritonitis was provided. Discriminant analysis was used. Results. Stratification criteria based on clinical and laboratory parameters of patients have been developed for HF procedure. Conclusions. The proposed scheme allows to stratify patients with appendicular peritonitis for the HP procedure. It makes possible to control the results of HP manipulation and allows to make decision whether to continue or complete treatment using the HP. Considering different capabilities of medical institutions, we recommend using the proposed method after validation of the results in these institutions. The study was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee. The informed consent of the parents for the research was obtained. No conflict of interest was declared by the authors. Key words: acute appendicitis, peritonitis, children, extracorporeal hemocorrection, hemoperfusion.