RESUMO
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.
Assuntos
Procedimentos Cirúrgicos Cardiovasculares , Cuidados Críticos/métodos , Hemoperfusão/métodos , Plasmaferese/métodos , Complicações Pós-Operatórias/terapia , Sepse/terapia , Adsorção , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimixina B/administração & dosagem , Polimixina B/uso terapêutico , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Sepse/sangue , Sepse/etiologia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
The article deals with the safety and efficiency of recombinant activated factor VII (Coagil VII, Russia) and prothrombin complex concentrate (protromplex-600, Baxter Austria) in the neonatal and pediatric cardiac surgery. The study included 56 children aged from 7 days to 5.5 years underwent surgery with cardiopulmonary bypass for congenital heart defects repair. Clinical and laboratory evidences suggest that Coagil VII and protromplex-600 effective for bleeding stop. The drugs have no negative impact on hemodynamics. We did not identify allergic reactions and thrombosis associated with the introduction of drugs in the pen operative period.
