Differential Use of Different Colloids During Plazmaferesis in Abdominal Sepsis Patients with Acute Lung Injury

Abstract


Relevance Sevre sepsis and septic shock continue to remain one of the most significant problems of modern medicine. The leading cfuse of a high mortality of this category of patients is formation and progressing of a multiple organ failure syndrom. The acute lung injury is leading component in structure of multiple organ failure syndrom at patients with abdominal sepsis. In development of acute lung injury in patients with abdominal sepsis the leading role is played by a syndrome of the system inflammatory responce. Therefore in intensive therapy of abdominal sepsis methods of extracorporal haemocorrection are applied. One of methods is the plasma exchange. The most serious problem when carrying out a plasma exchange is adequate replacement of remote plasma and a choice of infusional solutions taking into account the minimum negative action on gas exchange in lungs and system haemodynamics.
The purpose of the study The purpose of our research was studying of influence of a plasma exchange on gas exchange in lungs at patients with abdominal sepsis at various severity of acute lung injury.
Materials and methods We investigated 34 patients with a syndrome of acute lung injury. All patients, according to classification of J.F. Murray (1988), were divided into 2 groups. In the first group (n = 16) were included patients with moderate pulmonary damage, in the second (n = 18) – with severe acute lung injury. Plasma exchange carried out by a standard technique with removal 30-40% of volume of total plasma volume. Completion of volume of circulating plasma carried out colloidal solutions on a basis hydroxyaetylstarch (HAES 130/0,42) and cristalloids. At all patients defined: РаО2, РаСО2, SaO2, alveolar ventilation (VA), a pulmonary circulation (QT) ventilation-perfusion ratio (VA/QT), the total shunt (QVA/QT), the alveolar shunt (QS/QT).
Results and their discussion Results of research showed that at all patients before to the beginning of an extracorporal detoxication the severe hypoxemiya took place. At patients in both groups decrease in alveolar ventilation is noted. Reduction of VA and increase in QT led to decrease in an indicator of VA/QT. The main role in genesis of a hypoxia was played by alveolar shunting of blood in lungs.
At patients of the first group statistically РаО2 and SaO2 authentically exceeded values to a plasma exchange and in 24 hours after it. The average sizes VA/QT , QVA/QT and QS/QT at this group of patients in 72 hours after the first plasma exchange was normal. At patients of the second group of value of the specified indicators significantly (р<0,05) differed from normal levels.
Conclusion 1. Effectivity of a plasma exchange at patients with abdominal sepsis depends on severity of acute lung injury.
2. At moderate acute lung injury carrying out 3 sessions of a plasma exchange with an interval provides at 24 hours permanent decrease in endogenous intoxication and normalize gas exchange in lungs. 3. At severe acute lung injury more overdue and unstable improvement of respiratory function of lungs is observed. It dictates need of continuation of carrying out sessions of a plasma exchange taking into account severity of a a multiple organ failure syndrom.

Smolensk State Medical Academy, 28 Krupskoi Str., Smolensk, 214019, Russian Federation

Author for correspondence.
Email: petrov-oar@yandex.ru
MD, assistant prof. of anesthesiology and Reanimatology with postgraduate course Smolensk State Medical Academy

N.N. Burdenko Voronezh State Medical Academy, 10 Studencheskaia Str., Voronezh, 394036,
Russian Federation

Email: mail@vestnik-surgery.com
MD, Prof., Head of Anesthesiology and Intensive Care department N.N. Burdenko Voronezh State Medical Academy

Smolensk State Medical Academy, 28 Krupskoi Str., Smolensk, 214019, Russian Federation

Email: mail@vestnik-surgery.com
MD, Prof., Head of Anesthesiology and Reanimatology department with postgraduate course Smolensk State Medical Academy

Smolensk State Medical Academy, 28 Krupskoi Str., Smolensk, 214019, Russian Federation

Email: mail@vestnik-surgery.com
MD, assistant prof. of Anesthesiology and Reanimatology department with postgraduate course Smolensk State Medical Academy

Smolensk State Medical Academy, 28 Krupskoi Str., Smolensk, 214019, Russian Federation

Email: serg-aro@yandex.ru
MD, assistant prof. of anesthesiology and Reanimatology department with a postgraduate course Smolensk State Medical Academy

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