[Methods of Molecular Transfusion in the Intensive Therapy of Critical States].

Development of extracorporeal blood purification acquires greater significance in the intensive care of multiple organ failures (MOF) with all the pathophysiological aspects of its constituent parts. MOF are the main cause of mortality among critically ill patients and treatment of these patients require significant investment. The purpose of the implementation of extracorporeal blood correction techniques today is multiple organ support therapy (MOST). Early extracorporeal therapy is used only in the treatment of renal failure. Today extracorporeal techniques are increasingly being used to replace the functions of various organs and systems. MOST includes diffusion, convection, filtration, sorption, apheresis methodic. They affect the molecular and electrolyte composition of blood, allow to correct, repair, replace, and maintain homeostasis in severe multiorgan dysfunction. Extracorporeal new molecular technologies have been successfully applied in the intensive care of severe heart and respiratory failure, acute kidney injury and acute hepatic dysfunction, in the treatment of severe sepsis, metabolic disorders, the correction of immune imbalance.

[THE NEW CONCEPT OF COMBINED USE OF EXTRACORPOREAL BLOOD CORRECTION IN COMPLEX INTENSIVE THERAPY OF SEVERE SEPSIS IN PATIENTS AFTER CARDIAC SURGERY].

OBJECTIVE: Clinical and laboratory evaluation of the safety and efficacy of combined application of LPS selective adsorption (using cartridges with immobilized polymyxin B on fibers) and plasma filtration and adsorption (CPFA) in patients with severe sepsis after surgery on the heart and blood vessels. MATERIAL AND METHODS: The study involved 40 adult patients with severe sepsis after cardiac surgery. Group I included 20 patients who received the combined therapy with LPS-selective adsorption and CPFA in a single circuit. The control group 2 consisted of 20 patients who received the standard complex intensive therapy of sepsis. Inclusion criteria were clinical and laboratory indices of sepsis (FAA endotoxin activity level above 0.6; procalcitonin 2 ng/ml). RESULTS: Patients in Group I had an increase in mean aerial pressure by 12% (p = 0.001), the oxygenation index of 36% (p = 0.004), leukocytosis reduction (p = 0.01) and a significant decrease in body temperature (p = 0.0001). We also registered declines of FAA endotoxin activity by 35% (p = 0.0003) and Procalcitonin by 55% (p = 0.005). Patients of the control group had no significant change in the level of white blood cells, procalcitonin, and temperature. 28-day survival rate was 65 and 35% in the 1st and 2nd groups, respectively (p = 0.11). CONCLUSION: Combination of LPS adsorption and CPFA in a single extracorporeal circuit in the complex intensive therapy is a safe and effective treatment of severe sepsis.

[Experience of using endotoxin selective adsorption in patients with severe sepsis after open-heart surgery].

PURPOSE OF THE STUDY: To evaluate the safety and effectiveness of selective lipopolysaccharide (LPS)-adsorption therapy using polymyxin B immobilised fibre cartridges in adult patients complicated with severe sepsis after cardiac surgery. METHODS: 105 patients received extracorporeal LPS-adsorption procedures using Toraymyxin columns--PMX (Toray, Japan) in addition to the standard treatment according to the Surviving Sepsis Campaign guideline study group. For control group we selected 40 patients, comparable by PMX group in age, body weight, severity of illness, and the duration of cardiopulmonary bypass, received only standard therapy. All patients received significant doses of vasoactive drugs for hemodynamic support, mechanical ventilation and broad-spectrum antibiotics. Mean APACHE II and SOFA scores were comparable for both groups. Inclusion criteria were: clinical signs of severe sepsis, endotoxin activity assay (EAA) > or = 0.6, elevated blood plasma procalcitonin (PCT) > 2 ng ml(-1). The inclusion criteria were clinical signs of severe sepsis, endotoxin activity assay (EAA) > or = 0.6, and blood plasma procalcitonin (PCT) > 2 ng ml(-1). RESULTS: Extracorporeal treatment was administered within 24 h of a severe sepsis diagnosis. Each patient in PMX group received 2 LPS-adsorption procedures and each session of hemoperfusion lasted for 120 minutes. After the LPS-adsorption course, we noted any indices of haemodynamic improvements, including an increase in mean arterial pressure on 22% (p < 0.001), mean oxygenation index (on 24.5%, p < 0.001), normalisation of leukocytosis and a decrease in mean body temperature. After the procedures of LPS-adsorption we found the statistically significant decreasing of LPS concentrations according to LAL-test and EAA. In the control group, there were no significant changes in any of the studied parameters except body temperature. Moreover, the 28-day mortality was 42% in the study group and 65% in the control group (p = 0.032). The endotoxin adsorption procedures were not associated with any adverse reactions, and specifically no extracorporeal circuit thrombosis cases were noted. CONCLUSION: Selective LPS-adsorption is a safe and effective additional treatment method for severe sepsis patients.

[Extracorporeal methods of hematological correction in patients with acute liver insufficiency after cardiac surgery].

BACKGROUND & AIMS: Acute liver failure (ALF) usually develops in multiple organ dysfunction syndrome (MODS) and carries a high mortality risk in patients after cardiac surgery. Artificial liver support devices aim to remove albumin-bound and water-soluble toxins arising as a result of liver failure. The currently most used devices combine haemodialysis with albumin dialysis (MARS) or plasma separation and adsorption (Prometheus). The aim of this study was to assess safety and efficacy of use MARS or Prometheus in elderly patients with ALF have been operated for heart diseases. METHOD: We studied 26 elder patients with ALF and MODS as postoperative complication after cardiac surgery. Patients were assigned to groups, given a combination of MARS and standard medical therapy (SMT) (MARS-group, n=9) or Prometheus and SMT (Prometheus-group, n=17). Inclusion criteria were clinical and laboratory signs of ALF: serum total bilirubin level>180 mkmol/L, 2-fold increasing serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT), low serum cholinesterase and high serum ammonia levels. A variety of clinical and biochemical parameters were assessed. Primary endpoint was survival probabilities at day 28. RESULTS: MARS was used to provide 1 to 2 rounds (minimum of 6 hours each) and Prometheus was used to provide 2 to 14 rounds (minimum of 6 hours each). There were amelioration of haemodinamic instability, especially in MARS-group (increase in ADmean was 17% in MARS (p=0.005) and 10% in Prometheus-group (p=0.001)), increase in P/F ratio (12% in Prometheus-group (p=0.07)), decrease in serum total bilirubin (8.6% in MARS-group (p=0.028) and 33% in Prometheus-group (p<0.001)) and unconjugated bilirubin levels (29% in Prometheus-group (p=0.003)), also we had decreasing in serum aminotransferase levels and trend to increasing in serum cholinesterase level (12% in MARS-group (p=0.87) and 8% in Prometheus-group (p=0.86)). There were no side effects of extracorporeal liver support in both patients groups. Survival of patients with ALF, treated with MARS was 22%, in Prometheus group--35%. CONCLUSIONS: MARS and Prometheus are found to be safe and effective in patients with ALF after cardiac surgery. Further studies are needed to assess whether therapy might be beneficial in specific sublets of patients.

[Express diagnostics of endotoxaemia during postoperative period in cardiac surgical patients].

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.

[Etiopathogenetic extracorporeal treatment of severe sepsis in patients after cardiac surgery].

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.