ABSTRACT
Medical technologies development and recent approaches in management of patients with septic complications during the early postoperative period present new obstacles to the laboratory service. Endotoxin is a main agent in the systemic inflammatory cascade and plays important role in sepsis pathogenesis. Recent express methods of diagnostics allow determining blood activity of endotoxin during 30-50 min. 55 ICU patients with clinical and laboratory signs of systemic inflammatory response syndrome (SIRS) after cardiac surgery were studied in the single-center prospective research. Endotoxaemia was diagnosed by express tests. Level of endotoxaemia was assessed before and after sorption in 15 patients receiving complex intensive care with selective lipopolysaccharide (LPS) adsorption. Endotoxaemia level assessment allows to define indications for different programs of intensive care in time and to assess its efficiency. Test systems for assessment endotoxin level based on the principle of interaction antigen - antibody (EAA and MACH-endotox spp.) is a most efficient for express diagnostics of endotoxaemia.
Subject(s)
Cardiac Surgical Procedures , Endotoxemia/blood , Endotoxins/blood , Monitoring, Physiologic/methods , Postoperative Complications/blood , Sorption Detoxification , Adult , Aged , Clinical Chemistry Tests/methods , Early Diagnosis , Endotoxemia/microbiology , Endotoxemia/therapy , Female , Humans , Limulus Test , Male , Middle Aged , Postoperative Complications/microbiology , Postoperative Complications/therapy , Predictive Value of Tests , Prognosis , Prospective Studies , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/microbiology , Systemic Inflammatory Response Syndrome/therapy , Time Factors , Young AdultABSTRACT
The study deals with assessment of LPS-adsorption and haemodialysis with EMiC2-filters use in the complex treatment in cardio-surgery patients with heavy sepsis. 64 adult patients included in the study were divided into two groups. 26 patients of the main group with heavy sepsis (EEA > 0.6; procalcitonin level higher than 2 ng/ml) received LPS-adsorption and haemodialysis with EMiC2-filters. 38 patients of control group with heavy sepsis developed after surgeries on heart and vessels did not receive extracorporeal methods of treatment. Positive effect of combined extracorporeal treatment on haemodynamics, oxygenation, endotoxin activity decreasing, procalcitonin level, inflammatory and antiphlogistic cytokines level was identified Trend of 28-day survival increasing was indentified in the main group.
