[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.

[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.

[SCD14-ST (presepsin) level monitoring in cardiac surgical patients during perioperative period].

UNLABELLED: Purpose of the study was to define prognostic ability of presepsin (sCD14-ST) as a predictor of complications in cardiac surgical patients during perioperative period. METHODS: Patients operated for acquired heart valvular diseases with cardiopulmonary bypass were involved in the study (n = 51, age 58 +/- 11 years). Following parameters were studied; demographic data, duration of cardiopulmonary bypass, time of aorta clamping, severity-of-disease by APACHE II scale before surgery, on 1st, 2nd, 3rd and 6th day after surgery, routine clinical laboratory data and sCD14-ST. RESULTS: there were no clinical laboratory evidences of inflammation before surgery in all patients. There was no difference between biomarkers in patients who had normal condition during postoperative period and in patients who had complications and/or untoward outcomes during postoperative period. Presepsin level in 6 patients (11.8%) was 543 (519-602) ng/ml, maximal 1597 ng/ml. Infection complications accrued in 19 patients (37%). Hospital mortality was 13.7% (7 patients), all cases of death was in group of patients with infection complications. Statistically significant differences in the level of presepsin and severity-of-disease by APACHE II in groups of patients with infection complications and without accrued on 1st and 2nd days of postoperative period. Optimal split point were 702 ng/ml, 8.5 points and 3.3 ng/ml. Increased postoperative level of presepsin is associated with a risk of infection complications and untoward outcomes. CONCLUSION: sCD14-ST monitoring with the use of severity-of-disease scales and recent biomarkers allow to identify patients with high risk of infection complications and untoward outcomes.

[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.

[Selective hemoperfusion in gram-negative severe sepsis of patients after cardiac surgery: a prospective randomized study].

Early in the new millennium, sepsis remains one of the most urgent problems of modern reanimatology. Endotoxin, a component of the cell wall of gram-negative bacteria is of paramount importance in the pathogenesis of sepsis. Complex intensive care for severe sepsis involves selective endotoxin hemoperfusion with Polymyxin B and Alteco LPS adsorber, which has been performed in 2 patients. This study will enable specialists to formulate their opinion as to whether it is expedient to incorporate selective endotoxin hemoperfusion into complex intensive care for severe sepsis.

[The first experience in using selective sorbents in complex intensive care of patients with infectious and septic complications after cardiac surgery].

Early in the new millennium, sepsis remains one of the most urgent problems of modern medicine as before in view of a steady tendency for a rise of morbidity rates and for stably high mortality rates in patients (from 30 to 70%). The endotoxin lipopolysaccharide (LPS) of the cell wall of gram-negative bacteria plays the most important role in the pathogenesis of sepsis. This paper assesses the first experience in using endotoxin-selective sorption technologies within complex intensive care of critically ill patients with infectious and septic complications after cardiac surgery. Group 1 comprised 6 patients undergoing Alteco LPS adsorption procedures. Group 2 included 5 patients having hemoperfusion using Polymixin B-based Toraymyxin columns. The authors'first experience in clinically using LPS adsorption suggests that it is absolutely expedient to include extracorporeal selective hemoperfusion into the complex intensive care for infectious and septic complications in patients after operations on the heart and vessels.

[Hemorheology and morphofunctional characteristics of blood cells in children with congenital heart defects]. / Gemoreologiia i morfofunktsional'nye osobennosti kletok krovi u detei s vrozhdennymi porokami serdtsa.

Patients with congenital heart diseases (CHD) aged 4 months to 12 years, hospitalized for surgical treatment, were examined. Complex viscosity of the blood and the constituents of this parameter (dynamic viscosity and elastic component) were evaluated in the range of shift strain corresponding to the range of shift velocities 0.37-500 s-1 at a frequency of 2 Hz. The threshold blood fluidity was estimated for evaluating the conditions under which erythrocyte disaggregation begins. The relationship between blood rheology and morphofunctional characteristics of blood cells was evaluated. In accordance with the findings, the patients were divided into 3 groups with different suspension stability of the blood. In group 1 the threshold fluidity approximated the norm. In group 2 with normal blood rheology the shifts were compensated and regulation of rheology was in general intact. In group 3 the hematocrit values, mean erythrocyte volume, mean concentration of hemoglobin in erythrocyte, leukocyte counts, and complex viscosity of the blood were the highest, while the suspension stability was the lowest, which indicates depletion of the adaptive potential of the organism. Hence, blood rheology in patients with CHD differs by the type of regulation, mechanisms and compensation of changes, and depend largely on the mean erythrocyte volume, mean hemoglobin concentration in erythrocytes, and leukocyte counts.