Relevance:  Destructive pneumonia is one of the most severe forms of pneumonia in children, which is characterized by the development of inflammation with possible destruction of lung tissue and other complications. The disease requires a comprehensive approach to treatment, and effective diagnosis and timely intervention play a key role in reducing mortality. One of the most important physiological reactions of the body to infection and inflammation is the stress response, which initiates the activation of various biological mechanisms, including stress-limiting systems. These systems regulate and limit the undesirable effects of stress, such as overloading the body, inflammation, and tissue damage.

The Purpose of the Study: To investigate the mechanisms of stress-limiting in children with destructive pneumonia and their impact on the clinical outcomes of the disease, with an emphasis on the development and therapeutic correction of stress reactions during treatment, as well as the optimization of anesthetic approaches in conditions of severe infection.

1. To identify changes in key biomarkers of the stress-limiting system (levels of cortisol, adrenaline, norepinephrine, antioxidant enzymes, anti-inflammatory and anti-inflammatory cytokines), immune parameters to optimize the diagnosis of the severity of destructive forms of pneumonia.

2. To evaluate the effect of pain syndrome measured by VAS on the overall clinical picture of the disease and the restoration of respiratory function in children with destructive forms of

pneumonia in the postoperative period, operated by thoracoscopic method.

3. To study the role of central hemodynamics with direct involvement in the regulation of blood circulation, in adequate blood perfusion

4. Based on the results of the study, to conduct a comparative analysis of the stress-limiting system of children with destructive forms of pneumonia.

5. To assess the severity of the condition of sick children with destructive forms of pneumonia on the APACHE-II, SOFA scale in the postoperative period

6. To develop methods for correcting disorders of the stress-limiting system aimed at reducing systemic inflammation, oxidative stress and maintaining homeostasis.

7. To determine the most optimal respiratory support option based on the results of a comparative assessment of changes in ventilation parameters in various study options and an assessment of related complications in children in the postoperative period.

8. To evaluate the effectiveness of the protocol of accelerated rehabilitation of children after video thoracoscopic operations.

Research Design: It is planned to conduct a randomized prospective comprehensive study of sick children with destructive forms of pneumonia, aged 1 to 14 years in the intensive care unit of the TashPMI clinic.  The study will interpret the results such as: assessment of the severity of the condition, clinical, laboratory, instrumental and statistical methods.

Scientific Novelty: For the first time, an in-depth study of the activation of the hypathalamic-pituitary adrenocortical axis, the sympatho-adrenal system and other components of the stress-limiting  system has been conducted, which will reveal new mechanisms influencing the development of complications in destructive forms of pneumonia in children. The study will propose new methods for monitoring the state of the stress-limiting system, including biomarkers and their dynamic tracking, which can improve the effectiveness of diagnosis and intensive care. Research of the novelty in the use of antioxidant therapy and correction of disorders of the stress-limiting system in the framework of standard intensive care, which can lead to an improved prognosis and a reduction in the duration of hospitalization of patients with severe obstructive forms of pneumonia. The development of prognostic models based on the indicators of the stress-limiting system will make it possible to identify patients with a high risk of complications at the early stages of the disease and conduct more personalized treatment.

 1.Optimization of approaches to the treatment of pneumonia: The study will reveal effective therapeutic interventions aimed at normalizing the stress-limiting system (antioxidant activity and inflammatory mediators), which can increase the overall effectiveness of treatment of patients with destructive forms of pneumonia.

 2. Development of individualized treatment regimens, taking into account the state of stress response and inflammation in each patient, to optimize the use of drugs and reduce the likelihood of complications.

 3. Predicting the severity and outcomes of the disease: Identification of markers of stress and inflammation, such as cortisol levels, antioxidant activity, and inflammatory mediators (IL-6, TNF-a), (ELISA, and PCR), can predict the severity of the disease and the likelihood of complications. 

4. Reducing the frequency of complications

 5. Development of new drugs and therapeutic strategies. The results of the study can serve as the basis for the development of new pharmacological drugs aimed at correcting stress-limiting 

mechanisms in the body.

 6. Support of the scientific and practical base. The study contributes to the expansion of the scientific base on the problem of destructive forms of pneumonia, as well as on the mechanisms of oxidative stress, inflammation and stress response, which will open up new horizons for further research in the field of pulmonology and intensive care.

Expected Results: It is expected that more accurate diagnostic approaches will be developed, including the analysis of stress biomarkers (for example, cortisol and catocholamine levels), which will allow timely identification of the risk of complications. As a result of the use of new methods for monitoring and correcting stress reactions, it is expected to improve clinical outcomes in children, reduce the number of patients with severe complications, as well as reduce mortality and duration of treatment. It is assumed that the inclusion of stress response correction methods (antioxidant therapy, neurohumoral drugs) in the standard treatment practice will improve outcomes, shorten the duration of hospitalization, and reduce the incidence of complications