Strategic Directions of Intensive Care for Subcompensated Gastrointestinal Dysfunction in Patients with Severe Traumatic Brain Injury, Combined with the Trauma of Skeletal Bones

O.R. Yayechnyk

Abstract


Today the question of intensive care in patients with traumatic brain injury, combined with the trauma of skeletal bones, is relevant because of the high mortality rate of patients with this pathology. The objective of this article is to show the outcomes of intensive therapy for gastrointestinal dysfunction syndrome (GIDS) under subcompensation in patients with traumatic brain injury, combined with the trauma of skeletal bones. We have proposed the use of selective decontamination of the gut and enterosorption in patients with traumatic brain injury, combined with the trauma of skeletal bones, with signs of subcompensated GIDS. These methods of intensive care are proposed on the basis of pathogenesis in view of literature data, according to which inhibition of motor function present in subcompensated GIDS is associated with malabsorption of first gas and then water, electrolytes. Hyperextension of intestine loops and accumulation in the lumen of large volumes of gas and liquid occur. Patients were divided into two groups, which did not differ by such parameters as patient age, sex, severity of the condition, the severity of multiple organ dysfunction symptoms and its component — GIDS. Patients in group 1 received basic therapy: active volemic, inotropic and vascular support, respiratory therapy, antibiotics, anticytokine therapy. Patients in group 2, except the above mentioned therapy, used selective decontamination of the gut (SDG) and enterosorption (ES). In SDG we used: polymyxins, antifungals, aminoglycosides. ES has been carried out by introducing enterosorbent via probe. All patients underwent general clinical and biochemical blood tests. To diagnose signs of systemic inflammatory response syndrome (SIRS) we defined parameters that characterize the presence and dynamics of systemic response against inflammation. Integral assessment of the severity of patients was carried out on a scale of APACHE II, severity of multiple organ dysfunction — on a scale of SOFA. Considering that triggers of SIRS development are molecular inflammatory mediators, tumor necrosis factor and interleukin-8 were isolated from the proinflammatory cytokines. In order to control and correction of central hemodynamics, except such indicators as blood pressure, mean arterial pressure, heart rate, central venous pressure, we have measured cardiac index. We have determined the parameters of supply and consumption of oxygen — DO2 and VO2, the ratio of PaO2/FiO2. The energy balance of the cell was determined by the level of glucose, adenosine triphosphate, lactate. The level of endotoxemia was evaluated by level of the average weight molecules, the sorption capacity of erythrocytes and erythrocyte membranes permeability. Destructive changes in the cell membranes are characterized by the level of lipid peroxidation. Activity of lipid peroxidation was assessed by the level of their primary products — diene conjugates and secondary — malondialdehyde. Investigations were carried out on the 1st (H1) (stage 1), 3rd (H3) (stage 2), 5th (H5) (stage 3), 7th (H7) (stage 4), 10th (H10) (stage 5) days of the disease. In the results of the research attention is drawn to a lower mortality rate, more rapid regression of the severity of the patient’s state, reducing the manifestations of multiple organ dysfunction syndrome and GIDS in patients who underwent selective decontamination of the gut and enterosorption. Thus, as can be seen from the results of the study, selective decontamination of the gut and enterosorption have positive effect on state of patients with traumatic brain injury, combined with the trauma of skeletal bones, who have signs of subcompensated GIDS, and provide an opportunity to reduce mortality and complications, to shorten treatment time.


Keywords


traumatic brain injury; trauma of skeletal bones; subcompensated gastrointestinal dysfunction

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DOI: https://doi.org/10.22141/2224-0586.6.61.2014.83636

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