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Aim of the study to improve the results of treatment of children with intracranial hypertension in the acute period of severe mechanical trauma by virtue of the use of the “Protocol of step-by-step therapy” Material and methods. The article is devoted to the problem of intracranial hypertension in children with severe mechanical trauma. An analysis of 148 case histories of children with severe mechanical trauma, including brain trauma hospitalized in an intensive care unit. 27 patients out of 148 were excluded from the inclusion criteria: 6 patients (22.2%) due to the “late” admission (more than 72 hours from the time of injury); 21 patients - (77,8%) due to the persistent condition of atonic coma from the moment of trauma. 121 patients, according to indications, monitored intracranial pressure and intensive therapy of intracranial hypertension. All patients were divided into two groups: one group (the main one - 84 patients), in which the treatment was carried out according to the “Protocol of step-by-step therapy of intracranial hypertension” and approved in the Scientific Research Institute of Emergency Children’s Surgery and Traumatology, characterized by a strict sequence of treatment measures (“steps”), with clear indications for prescribing each subsequent “step” and the time frame for the duration of the “steps” taken; 2 group (control group - 37 patients), in which the treatment was carried out according to existing international guidelines for the management of patients with severe head injury. Conclusion. Comparative evaluation of treatment results showed outcomes of trauma in the main group to be better, including a statistically significantly less mortality rate (p = 0.0002, p < 0.05).

Introduction. In modern literature, there is a limited information on the techniques of extracorporeal detoxification in children with severe concomitant injuries. Moreover, in fact there are no data on their application in children with severe concomitant traumatic brain injuries. It has defined the relevance of this research.Purpose. To improve outcomes of treatment in children with severe concomitant traumatic brain injuries who have manifestations of toxic-resorptive syndrome (TRS), septic complications, acute renal failure of mixed genesis using a combined application of extracorporeal detoxification techniques.Material and methods. The article describes authors’ experience in a combined application of extracorporeal detoxification techniques, including continuous veno-venous hemodiafiltration (CVVHDF) and membrane plasma separation (MPS) in ICU patients with severe concomitant traumatic brain injuries complicated by toxic-resorptive syndrome, sepsis and septic shock.Results. The combined application of extracorporeal detoxification techniques promoted the regression of toxic-resorptive syndrome, shock reversal, stabilization of hemodynamic parameters, parameters of internal homeostasis as well as the regression of multiple organ failure.Conclusion. Early extracorporeal detoxification improves clinical course at the acute stage of trauma. The authors underline that the key requirement for safety in extracorporeal detoxification in patients with severe concomitant traumatic brain injury is the invasive monitoring of intracranial pressure.

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