RHABDOMYOLYSIS: HOW MUCH DO WE KNOW ABOUT IT? MODERN CLINICAL CONSENSUS (Literature review)

Abstract

The article presents a review of the world data on modern approaches to the treatment of patients with rhabdomyolysis according to the principles of evidence-based medicine. Rhabdomyolysis is a condition occurring in critically ill and injured patients. But only 20 % of all cases of rhabdomyolysis are usually related to direct trauma. Diagnosis is made based on a combination of clinical and laboratory findings, determining the need for surgical intervention to stop any processes causing muscle damage and to prevent or treat known complications of the disease. Careful examination of patients and identification of potential risk factors associated with myocyte damage and release of breakdown products (myoglobin, creatinine, potassium, phosphorus) into the systemic bloodstream, which can lead both to asymptomatic elevations of muscle enzymes in the blood and to life-threatening acute renal damage and severe electrolyte disturbances. Although early volume resuscitation for rhabdomyolysis is a well-established principle for improving renal tubular function, diluting nephrotoxins such as myoglobin, and providing adequate renal perfusion to prevent acute kidney injury (AKI), choosing the best type of crystalloid for this purpose. Existing protocols and benefits of infusion therapy, rate of administration, target recommendations, and diuresis rate to prevent ARF in rhabdomyolysis are analyzed. The appropriateness of diuretics and/or bicarbonate administration for the prevention of AKI is considered. Whether extracorporeal removal of myoglobin can be an effective preventive strategy and taking into account the molecular weight of myoglobin or effective use of different dialysis regimens, filters and flow types to treat and prevent AKI.