Fluid resuscitation patients with burn sepsis

Abstract

Objective. The purpose the of the study is to improve the fluid therapy regimens for burn sepsis patient.
 Materials and methods. The study is based on the observation 52 patients with burn sepsis aged 23 to 65 years, with a total body surface area more than 35 % at the Kyiv City Clinical Hospital № 2 during 2016-2019. Patients were divided into two groups: the main group – 30 patients were treated with crystalloids, plasma, albumin and Rheosorbilact (RSL); control group – 16 patients received treatment without using of RSL. Clinical and biochemical parameters of endogenous intoxication (tissue destruction products, medium weight molecules (MWM), concentrations of lipid oxidation products (LOP) – by diene conjugate content and oxidatively modified proteins (OMP) – by carbonyl groups) were studied.
 Results and discussion. Syndrome of endogenous intoxication was an increase in burn sepsis patients, which correlated with an increase in the number of LOP, OMP, MWM, namely an increase in the hydrophobic (most toxic) fraction of MWM, which is 2-3 times higher than in healthy, sick and both groups. MWM and hydrophobic fraction remained high during the observation period in patients of the comparison group. MWM decreased by 1.35 times in patients of the main group relative to the group of crystalloids. The level of carbonyl groups of serum OMP in patients of the comparison group was 50 % higher than in the main group. The indicators of LOP exceeded 1.45 times in the comparison group, which testified to the continuation of oxidative stress and the continuation of systemic inflammation. Acute respiratory distress syndrome (ARDS) was characterized by the appearance of bilateral infiltrates in the lungs, according to radiography. This common organ dysfunction was detected in 75 % of patients in the comparison group and in 63 % of patients in the RSL-group. The duration of mechanical ventilation in the main group decreased by 1,6 days.
 Conclusions. The use of Rheosorbylact for patients with burn sepsis at a dose of 15 ml/kg has led to a decrease in the manifestations of intoxication syndrome, reduction of MWM, LOP, OMP, clinical manifestations of systemic inflammatory response, septic complications by 1.3 times, septic shock from 16 to 12 %, and the incidence of ARDS from 75 to 63 %.