Effects of Main Positions of «International Guidelines for Management of Severe Sepsis and Septic Shock — 2012» during Local Intraluminal Reoxygenation by Perftoran on the Course Sepsis and Severity of Encephalopathy in the Structure of Multiple Organ Fai

L.O. Maltseva, M.F. Mosentsev, R.K. Karas, L.V. Kovalenko

Abstract


The paper analyzes the results of the impact of the key issues of diagnosis and intensive care for sepsis based on the provisions of the «International Guidelines for Management of Severe Sepsis and Septic Shock: 2012» supplemented by local intraluminal reoxygenation with perftoran on the course of sepsis and severity of encephalopathy in the structure of multiple organ failure. The conclusions were based on the dynamics of the quantitative characteristics of the physiological pattern CI-DO2-VO2; intramucousal pH; GCS, APACHE II, SOFA scores; indicators of systemic inflammatory response syndrome, the concentration of cytokines (TNFα, IL-1, IL-4, IFNα), immunoglobulins (IgA, IgM, IgG). Restoration of the parameters of physiological pattern DO2-VO2 to the supernormal values by the 3rd day contributed to the improvement of general and regional oxygenation; rapid regression of cerebral insufficiency: score was 13.83 and ranged clinically between mild obtundation and clear consciousness; no manifestations of SIRS were recorded; a significant reduction in the concentrations of proinflammatory cytokines and restoration of their ba­lance with antiinflammatory IL-4. Lack of redeterioration phase of patients’ state has been associated with limitation of acute mediatosis, further regression of gastrointestinal failure manifestations. Prevention of gastrointestinal bleeding indicates the acceleration of reparative regeneration of enterocytes under the influence of perftoran. Mortality rate estimated initially on the total score of APACHE II scale was 51 %, the true mortality rate — 25 %, local reoxygenation by perftoran has reduced the mortality by 26 %.


Keywords


septic process; encephalopathy; multiple organ failure; perftoran



DOI: https://doi.org/10.22141/2224-0586.4.75.2016.75825

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