Reamberin within the complex for optimization and differentiation of the strategy of intensive therapy of secondary purulent meningoencephalitis

L.A. Maltseva, V.G. Chernenko, E.A. Mishchenko

Abstract


A range of algorithms of the intensive therapy of secondary meningoencephalitis are applied in the clinical practice. However, they do not provide such treatment strate­gies as prophylaxis and treatment of secondary brain injuries by providing the well-ordered process of mitochondrial function that is the key factor for life-support systems disfunction/insufficiency correction. In this respect, reamberin attracts our attention. Research objective: to study the indicators dynamics in systemic inflammatory response syndrome, APACHE ІІ and SOFA scores, cerebral perfusions, metabolism and functional status of blood-brain barrier in patients with secondary purulent meningoencephalitis at the research stage using the protocol that adheres Surviving Sepsis Campaign International Guidelines: International guidelines for management of severe sepsis and septic shock: 2008, supplemented with dexamethasone inclusion basing on Management of bacterial meningitis and meningococcal septicemia in children and young people younger than 16 years in primary and secondary care. Full guideline: to include 2010 (I group) to the basic reamberin protocol (II group). General scheme of selection of patients and their randomization, included in the research and analysis, may be represented as follows. Patients with secondary purulent meningoencephalitis approved by randomization method were classified into 2 groups on the basis of their emergency state and intensive therapy (IT) option. Group I included 22 patients treated with basis IT from the position of evidence-based medicine meeting Surviving Sepsis Campaign International Guidelines: International guidelines for management of severe sepsis and septic shock: 2012, supplemented with dexamethasone inclusion. Group II included 21 patients treated with IT equal to group I and supplemented with intravenous injection of reamberin solution. Patients were examined according to 2001 SCCM/ESISM/ACCP/ATS/SIS International Sepsis Definition Conference guidelines, being primary steps or points for efficiency assessment, while mortality/recovery within 28 days of disease was considered as endpoints. The following diagnostic algorithm of secondary purulent meningoencephalitis inclu­ded: medical history; related professionals’ consultations; chest and paranasal sinuses roentgenograms; CT scan, MRI, and brain spiral computed tomography; cerebral vessels Doppler sonography; clinical picture; lumbar puncture; initial cerebrospinal fluid pressure; clinical and bacteriological cerebrospinal fluid testing. The following criteria were applied for bacterial and viral meningoencephalitis differential diagnostics: septic focus; previous viral infections; immunodeficiency; the number of cells > 1000 × 106/liter during CSF examination; prevalence of granulocytes; obtaining bacteriological confirmation; PCR in cerebrospinal fluid: DNA of herpes types I and II viruses, Epstein — Barr virus, cytomegalovirus, etc.; procalcitonin (PCT) in blood plasma. Criteria for hospitalization of patients with secondary purulent meningoencephalitis sepsis to ICU were the following: two or more SIRS clinical signs; infection, contemplated or documented according to SCCM/ESISM/ACCP/ATS/SIS International Sepsis Definition Conference; patient’s emergency state assessment and prediction of morta­lity probability at sepsis (Mortality in Emergency Department Sepsis Score — MEDS, 1998). The descriptive statistics results were used to describe primary dataset. During the research no significant differences between groups in terms of gender, age, septic focus localization, registration frequency of four SIRS signs, positive results of the cerebrospinal fluid and primary focus materials bacteriological tests were determined initially, i.e. samples were compared according to these features. Meanwhile, there were 2.8 times more patients with the sopor or coma I level in group II (76.2 % vs. 27.2 %; p < 0.001). 22.7 % of patients from group I and 28.6 % of patients from group II (p > 0.60) had a poor prognosis (CPP < 50 mm Hg) at hospitalization. Despite the initially more emergent state of patients with secondary purulent meningoencephalitis in group II, implementation of intravenous injection of reamberin solution to the basic therapy helped smooth sanitation of cerebrospinal fluid in group II without secondary splash of cytosis, specific for group I on the 5th day of research. It was determined that CRP in cerebrospinal fluid in group I disappeared to the 3rd day of research, occurred on the 5th day and was absent to the 7th day of the research. In group II, CRP was found only initially on the 1st day of the research that proves more stable character of the restoration of BBB functional state in group II, without its secondary duplicative breakthrough. IT efficiency assessment on the 28th day of the research showed the decrease of cognitive dysfunctions by 28.4 % in group I, and by 37.7 % in group II; organ dysfunctions — from 76.3 % to 43.8 % in group I, and from 88.7 % to 36.9 % in group II. Genuine lethality indicators constituted 27.27 and 23.81 % (р > 0.90) in groups, respectively. Decrease of the estimated lethality in group I was 4.73 %, while in group II 16.19 %.

Keywords


severe sepsis; secondary purulent meningoencephalitis; intensive therapy; reamberin

References


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DOI: https://doi.org/10.22141/2224-0586.3.82.2017.102325

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