Multiple Organ Failure Syndrome Research Articles

Вплив модифікованої інфузійної терапії та адреноміметичної корекції на показники транспорту та споживання кисню, показники периферичного кровообігу при розвитку синдрому поліорганної недостатності внаслідок тяжкої політравми

Стаття присвячена впливу різних спосібів інфузійної терапії та адреноміметичної корекції на показники транспорту та споживання кисню, показники периферичного кровообігу в постраждалих із розвитком синдрому поліорганної недостатності (СПОН) унаслідок тяжкої політравми. Використання протоколу модифікованої інфузійної терапії з урахуванням стадії травматичної хвороби при розвитку СПОН дозволяє підтримувати рівень транспорту кисню понад 550 мл/хв/м2, його споживання понад 150 мл/хв/м2; відновити певний рівень рН артеріальної крові; нормалізувати показники лактату в артеріальній крові; досягти референтних рівней градієнтів PvCO2-PaCO2, Tperif-Tatm, Tcentr-Tperif, Tskin diff, підтримувати темп діурезу понад 1 мл/кг/год. Використання модифікованої інфузійної терапії та адреноміметичної корекції з урахуванням стадій травматичної хвороби в умовах ранньої та пізньої СПОН дозволяє досягти транспорту кисню понад 600 мл/хв/м2; рівня сатурації у верхній порожнистій вені понад 70 % поряд зі зниженням показників екстракції кисню, що поєднувалось зі зменшенням рівня лактату артеріальної крові та зростанням рівня ВЕ. Отримані результати свідчать про те, що застосування протоколу модифікованої інфузійної терапії та адреноміметичної корекції з урахуванням стадії травматичної хвороби в умовах СПОН дозволяє покращити периферичний кровообіг, про що свідчить зростання градієнтів Tperif-Tatm і темпу діурезу, а також зниження градієнтів Tperif-Tatm, Tcentr-Tperif, Tskin diff.

Стан систолічної та діастолічної функції міокарда при сепсисі в дітей: клінічні та прогностичні аспекти

У статті обговорюється проблема гемодинамічних розладів при сепсисі та септичному шоку в дітей. Наведено результати досліджень серцевого викиду, систолічної, діастолічної функції лівого шлуночка серця при сепсисі та септичному шоку в дітей. Продемонстровано розвиток різних типів діастолічної дисфункції та зниження серцевого викиду при септичному шоку в дітей. Надано докази негативного впливу діастолічної дисфункції на перебіг та прогноз при сепсисі й синдромі поліорганної недостатності в дітей.

Machine learning model for predicting acute kidney injury progression in critically ill patients

BackgroundAcute kidney injury (AKI) is a serve and harmful syndrome in the intensive care unit. Comparing to the patients with AKI stage 1/2, the patients with AKI stage 3 have higher in-hospital mortality and risk of progression to chronic kidney disease. The purpose of this study is to develop a prediction model that predict whether patients with AKI stage 1/2 will progress to AKI stage 3.MethodsPatients with AKI stage 1/2, when they were first diagnosed with AKI in the Medical Information Mart for Intensive Care, were included. We used the Logistic regression and machine learning extreme gradient boosting (XGBoost) to build two models which can predict patients who will progress to AKI stage 3. Established models were evaluated by cross-validation, receiver operating characteristic curve, and precision–recall curves.ResultsWe included 25,711 patients, of whom 2130 (8.3%) progressed to AKI stage 3. Creatinine, multiple organ failure syndromes were the most important in AKI progression prediction. The XGBoost model has a better performance than the Logistic regression model on predicting AKI stage 3 progression. Thus, we build a software based on our data which can predict AKI progression in real time.ConclusionsThe XGboost model can better identify patients with AKI progression than Logistic regression model. Machine learning techniques may improve predictive modeling in medical research.

Критерии диагностики дыхательной недостаточности при синдроме полиорганной недостаточности у детей

We examined 26 children aged 4 to 14 years with multiple organ failure syndrome (MODS). The mainorgan systems involved in MODS were the respiratory, cardiovascular, and central nervous systems.Acute respiratory failure in combination with acute heart failure of the 2nd degree was observed in all26 (100%) children, respiratory, cardiovascular failure in combination with cerebral insufficiency in19 (73%) children, respiratory, cardiovascular failure in combination with toxic damage to the liver,kidneys and intestinal failure syndrome in 7 (27%) cases. The main criteria for respiratory failure are asignificant increase in respiratory rate and a decrease in saturation.

How COVID-19 affects children: a review article

Coronavirus disease 2019 (COVID-19) has affected 550,369 confirmed cases, with 8,856 fatalities. COVID-19 was more common in adults over 15 during the early outbreak, and the proportion of confirmed cases among youngsters was relatively low. In addition, children with COVID-19 are asymptomatic or have mild clinical symptoms compared to adults. The present study reviewed the clinical features, signs, symptoms, and effect of COVID-19 in children. This review was performed through an electronic literature search for relevant studies identified using keywords on the MEDLINE database between 2020 and 2021, inclusive: COVID-19, COVID-19 in children, coronavirus, novel coronavirus in children, COVID-19 symptoms in children, COVID-19 effect in children. Similar keywords were used to peruse and identify relevant articles on Google Scholar. The articles were chosen based on defined inclusion criteria. The current review included papers published between 2020 and 2021. The review was written under specific titles in the discussion part. This review concluded that children of all ages are susceptible to getting COVID-19 due to human-to-human transmission. COVID-19 has a milder clinical course, quicker recovery, and a better prognosis in children than adults. Infants less than 1 year and children with underlying chronic disorders were at higher risk of having severe forms of COVID-19. Septic shock, toxic encephalopathy, multiple organ failure syndromes, disseminated intravascular coagulation, and status epilepticus were the most common consequences identified in children with severe forms of COVID-19. Infection prevention by isolation of diseased children is critical, as is thorough surveillance, early diagnosis of illness complications, and the ability to treat patients on time while preventing secondary dissemination.

Non-occlusive mesenteric ischemia in reconstructive digestive tract surgery

To analyze the mechanisms of non-occlusive mesenteric ischemia (NOMI) after digestive tract surgery. NOMI occurred in 10 (0.4%) patients after reconstructive digestive tract surgery between 2015 and 2021. There were 4 women and 6 men aged 29-92 years (67 [60; 71]). Patients differed from each other in the nature of baseline disease and surgical approach. All patients underwent standardized surgical interventions. There were no intraoperative complications. Median of surgery time was 372.5 (246.25; 548.75) min, blood loss - 450 (200; 725) ml. These parameters conformed to the type of surgery. There were no specific clinical signs of NOMI. Lactic acidosis (>4 mmol/L) occurred in 7 patients after 1-3 postoperative days. In 6 patients, fulminant NOMI developed after 1-2 postoperative days with subsequent multiple organ failure syndrome and septic shock. All patients underwent emergency redo surgery. Multivisceral gastrointestinal necrosis occurred in 5 patients, gastric conduit necrosis - 3, colon necrosis - 1, gastric stump necrosis - 1 patient. Mortality rate was 80%. Two patients survived. NOMI manifested as a septic shock in 60% of patients that was due to fulminant development of multivisceral necrosis after 1-2 postoperative days. Timely diagnosis of reversible NOMI in these cases was impossible. Extensive visceral necrosis in early postoperative period is probably associated with intraoperative critical ischemia of digestive organs.

Incidence and effects of deep vein thrombosis on the outcome of patients with coronavirus disease 2019 infection

BackgroundDeep vein thrombosis (DVT) has been reported to occur at different rates in patients with coronavirus disease 2019 (COVID-19). Limited data exist regarding comparisons with non–COVID-19 patients with similar characteristics. Our objective was to compare the rates of DVT in patients with and without COVID-19 and to determine the effect of DVT on the outcomes. MethodsWe performed a retrospective, observational cohort study at a single-institution, level 1 trauma center comparing patients with and without COVID-19. The 573 non–COVID-19 patients (age, 61 ± 17 years; 44.9% male) had been treated from March 20, 2019 to June 30, 2019, and the 213 COVID-19 patients (age, 61 ± 16 years; 61.0% male) had been treated during the same interval in 2020. Standard prophylactic anticoagulation therapy consisted of 5000 U of heparin three times daily for the medical patients without COVID-19 who were not in the intensive care unit (ICU). The ICU, surgical, and trauma patients without COVID-19 had received 40 mg of enoxaparin daily (not adjusted to weight). The patients with COVID-19 had also received enoxaparin 40 mg daily (also not adjusted to weight), regardless of whether treated in the ICU. The two primary outcomes were the rate of deep vein thrombosis (DVT) in the COVID-19 group vs that in the historic control and the effect of DVT on mortality. The subgroup analyses included patients with adult respiratory distress syndrome (ARDS), pulmonary embolism (PE), and intensive care unit patients (ICU). ResultsThe rate of DVT and PE for the non–COVID-19 patients was 12.4% (71 of 573) and 3.3% (19 of 573) compared with 33.8% (72 of 213) and 7.0% (15 of 213) for the COVID-19 patients, respectively. Unprovoked PE had developed in 10 of 15 COVID-19 patients (66.7%) compared with 8 of 497 non–COVID-19 patients (1.6%). The 60 COVID-19 patients with ARDS had had an incidence of DVT of 46.7% (n = 28). In contrast, the incidence of DVT for the 153 non–COVID-19 patients with ARDS was 28.8% (n = 44; P = .01). The COVID-19 patients requiring the ICU had had an increased rate of DVT (39 of 90; 43.3%) compared with the non–COVID-19 patients (33 of 123; 33.3%; P = .01). The risk factors for mortality included age, DVT, multiple organ failure syndrome, and prolonged ventilatory support with the following odd ratios: 1.030 (95% confidence interval [CI], 1.002-1.058), 2.847 (95% CI, 1.356-5.5979), 4.438 (95% CI, 1.973-9.985), and 5.321 (95% CI, 1.973-14.082), respectively. ConclusionsThe incidence of DVT for COVID-19 patients receiving standard-dose prophylactic anticoagulation that was not weight adjusted was high, especially for ICU patients. DVT is one of the factors contributing to increased mortality. These results suggest a reevaluation is necessary of the present standard-dose thromboprophylaxis for patients with COVID-19.

Зміна мікробіому кишечника пацієнтів з коронавірусною інфекцією

The purpose of the study was to analyze modern literature on the problems of dysbiosis in patients with COVID-19, to study the main mechanisms of systemic interaction between the intestine and lungs, as well as changes in the microbiota that occur under the influence of coronavirus infection. Materials and methods. A comprehensive selection of research methods was used for the work: systematization of the material, the method of generalization, methods of analysis and synthesis. Scientific works in the field of microbiology, epidemiology and infectious diseases were studied. Literature data for the last 2 years (2019-2021) were considered. The results of bacteriological studies from patients with COVID infection were described. The data obtained were processed using information-analytical and statistical-analytical methods. Results and discussion. As a result of this work, a complex of connections between intestine and lungs, which is called the "intestinal-lung axis", was considered. It is known that the interaction between these two biotopes occurs with the participation of microflora and its metabolites. Dysfunction of the intestinal barrier is accompanied by bacterial translocation. Bacteria from the intestinal lumen enter the liver through the portal vein system. The lymphatic pathway of bacterial translocation from the intestine to the lungs is also possible, which causes multiple organ failure syndrome in coronavirus infection. The COVID-19 virus is able to reduce the number of ACE2 receptors in the gastrointestinal tract, which leads to an imbalance in the intestines. At the same time, the infection process in the lungs promotes the growth of bacteria of the Enterobacteriacae family in the intestine, which also leads to dysbiotic disorders. The use of probiotics is an effective tool in the complex treatment of this infection, which facilitates the general condition of patients. In the course of treatment, it is important not only to eliminate the virus from the body, but also to restore normal intestinal microbiota after an infection. Conclusion. Thus, the use of probiotic drugs for the treatment of patients with coronavirus infection can significantly reduce the risk of developing dysbiosis and improve the condition of patients. A perspective direction is the development of new treatment regimens for dysbiotic conditions using probiotics, eubiotics, synbiotics and postbiotics to prevent the development of severe complications in COVID infection

Microbiological characteristics of patients with severe burns caused by blast and application of meta- genomics next-generation sequencing in the detection of pathogenic microorganisms

Microbiological characteristics of patients with severe burns caused by blast and application of meta- genomics next-generation sequencing in the detection of pathogenic microorganisms

Kidney damage in COVID-19 patients

The results of the analysis of case histories of 100 deceased patients (55 women and 45 men), whose cause of death was the syndrome of multiple organ failure due to COVID-19, are presented. The case histories of patients who had no previous renal dysfunction were selected for the analysis. The average age of the patients was 76 years. At the terminal stage of the disease, microhematuria was detected in 27 patients, hypercreatininemia was noted in 17 patients, while the creatinine content in the blood did not exceed 437 mol / L in any of 100 patients. Oliguria was observed in 9 patients, polyuria in 43 patients. A possible cause of kidney damage is the damaging effect of SARS-CoV-2 on the proximal convoluted tubules of the nephron. At the same time, in no patient with a severe course of COVID-19, kidney damage did not determine the severity of the condition and was not the cause of death.

Интенсивная терапия синдрома полиорганной недостаточности при политравме: место экстракорпоральной гемокоррекции

В статье рассмотрен вопрос целесообразности и эффективности использования экстракорпоральных методов гемокоррекции в интенсивной терапии полиорганной недостаточности. Представлен клинический случай интенсивной терапии синдрома полиорганной недостаточности у пациента с политравмой с использованием продленной вено-венозной гемодиафильтрации.

Possibilities of prognosis and improvement of treatment results in children with congenital malformations of the gastrointestinal tract

The category of newborns with congenital malformations is considered the most difficult to treat. The influence of “stress”factors on the body in a short period of time triggers a pathogenetically determined chain reaction that leads to the development of multiple organ failure syndrome. The forecasting methodology determines the timeliness and directions of intensive care to approach and achieve positive results in this group of patients.The aim of the study: is to show the diagnostic and practical value of metabolic markers and functional indicators of homeokinesis in newborns with congenital malformations of the gastrointestinal tract.Materials and methods. An observational study of 81 patients in the neonatal period. The prognostic assessment of functional parameters and biochemical markers was performed by ROC analysis.Results. In newborns with malformations of the gastrointestinal tract, the course of the pre-and early postoperative period is associated with cardiopulmonary maladaptation, which requires the protection of vital functions. By the end of the first week, priority is given to therapy aimed at restoring the motility of the gastrointestinal tract. The prognostic value of the adverse outcome was determined: stress index greater than 3503 Sp = 98.36% (95%CI 86.3–99.2) and Se = 99.2% (95%CI 87.3–100), lactatemia level greater than 3.3 mmol/L Sp = 73.7% (95% CI 59.6–84.7) and Se = 93.6% (95% CI 78.9–100). The control of the infectious process and the selection of antibacterial therapy is important, since the risks of developing septic shock are high. Prolonged epidural analgesia is the optimal method of analgesia and is indicated in suspected cases of failure to achieve 75% of the volume of enteral nutrition by the week of the postoperative period Sp 85.42% (95%CI 48.2–97.7), Se 46.8% (95% CI 62.0–84.2).Conclusions. Prognostic models allow predicting the outcome of critical conditions and timely adjusting the volume of therapy.

Multiple Organ Dysfunction Syndrome: literature review

Dainius Misevičius1, Ignas Floreskul1, Jokūbas Vitkus1 1 Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania Abstract Sepsis is one of the leading causes of death in the world. According to some authors, about 11 million people worldwide die from sepsis each year, which is about 20% of all deaths. There has long been no consensus on the exact definition of sepsis. According to recent recommendations, sepsis is defined as a life-threatening condition that develops due to an inadequate response to the infection. Usually, several organ systems are involved. The last stage of sepsis is multiple organ dysfunction syndrome. Aim: to summarize and provide up-to-date information on the relevance of multiple organ failure syndrome peculiarities of the clinic, diagnostics, treatment of patients, and future prospects. Method: literature search in scientific electronic databases PubMed, ScienceDirect, UpToDate. Full-text articles were used for analysis. Publications were selected by keywords: “sepsis”, “multiple organ dysfunction”, “multiple organ failure”. Results of the study revealed that no specific treatment has yet been discovered, and mortality from sepsis remains high. It has also been established that the aim is to elucidate a more precise pathogenetic mechanism and to create new therapeutic prevention and treatment options. Conclusions: 1. The assessment of damage to different organ systems is individual, so rating scales help in the classification of damage. The principles of diagnosis of the relevant organ system shall be followed in the examination of organ damage. Biological markers to better predict the course of sepsis are being investigated, but they are not yet used in clinical practice. 2. The treatment applied in MODS is based on the general principles: correction of fluid balance, inhibition of inflammation, artificial ventilation, hemodialysis, and other methods aimed at the correction and compensation of impaired function. New therapies directly targeting the pathogenesis of sepsis are still under investigation. 3. The main and most commonly used are SOFA, MODS, and LODS scales. The SOFA scale is most commonly used in clinical work to assess and determine the risk of patient mortality. Keywords: multiple organ dysfunction syndrome, multiple organ failure, sepsis, sepsis diagnostic, sepsis treatment.

Improving the therapy of generalized forms of Meningococcal infection in children using extracorporeal hemocorrection

Invasive meningococcal infection is a significant cause of death, reaching 80% in septic shock. The Pediatric Research and Clinical Center for Infectious Diseases (PRCCID) has developed an algorithm for the treatment of children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome, which includes basic drug therapy with polymyxin hemoperfusion in combination with extended methods of extracorporeal hemocorrection.Purpose: to evaluate the effectiveness of extracorporeal hemocorrection operations in children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome.Materials and research methods: to the intensive care unit of the PRCCID for the analyzed period 2006—2020 34 children were hospitalized with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome. Two groups were formed: Group 1 — children admitted to the PRCCID in the period 2014—2020 (n = 23), who underwent polymyxin hemoperfusion simultaneously with extended methods of extracorporeal hemocorrection, group 2 — children hospitalized in 2006—201 3 (n = 1 1), methods of extracorporeal hemocorrection were not performed. The Mann-Whitney U-test and ANOVA were used to evaluate the results.Results and discussion: the use of extracorporeal hemocorrection operations in the complex therapy of invasive forms of meningococcal infection with refractory septic shock and multiple organ failure syndrome in children provides stabilization of central hemodynamics, reduces clinical and laboratory inflammatory reactions, helps to reduce the dose of vasopressor drugs and parameters of respiratory support, and also increases patient survival rate by 82.6%.

Interaction of aviation medical teams with ambulance, emergency medical care teams and hospitals in the management of mechanically ventilated patients

Relevance. Acute respiratory failure (ARF) and acute cardiopulmonary failure (ACPF) are unavoidable, and often – the leading syndromes in any critical condition, especially in case of multiple organ failure syndrome as a regular stage in the course of previously incurable conditions. Even a full range of intensive care measures in this category of patients does not always give the desired result. According to various authors, with the development of acute respiratory distress syndrome, the mortality rate reaches 80 %.Intention is to determine the role of the aviation medical teams of the emergency medical service-disaster medicine in ensuring the timely availability of high-tech methods for patients who need them, regardless of the patient’s location.Methodology. Activities of the aviation medical teams of the Scientific and Practical Center for Emergency Medical Care of the Moscow City Health Department for the medical evacuation of patients and victims in emergency situations with ARF and ACPF were analyzed.Results and Discussion. There were analyzed interactions of aviation medical teams with the emergency medical response units of the territorial center for disaster medicine and with medical organizations during the medical evacuation of patients with ARF and ACPF. An algorithm and a scheme of interaction between air medical teams are proposed to optimize medical evacuation of these patients.Conclusion. An analysis of the activities of air medical teams revealed their advantages in providing care for patients with ARF and ACPF.

Carboxyhemoglobin, Methemoglobin and Lactate Levels in Patients with Systemic Inflammatory Response Syndrome

Background: Systemic inflammatory response syndrome (SIRS) is a common, severe inflammatory condition. This condition forms the basis of the definitions of sepsis, severe sepsis, septic shock, and multiple organ failure syndromes. The diagnosis can be made earlier with arterial blood gas analysis, which can provide a lot of information within minutes. This study aimed to determine the value of carboxyhemoglobin (COHb), methemoglobin (metHb), and lactate levels in the prognosis and mortality of patients with SIRS. Methods: Patients who met the SIRS criteria with the first vital signs and laboratory values and who had arterial blood gas analysis according to the clinician’s decision were included in the study. The demographic characteristics, prognosis and correlation of 1-month mortality rates of patients with baseline COHb, metHb and lactate levels were investigated. Results: Among non-smoker patients, no significant difference was found between fCOHb values and age, gender, presence of infection, blood pressure, department of hospitalization, and 1-month mortality rates (p>0.05). Also, the relationship between fCOHb values and length of stay in the hospital was not statistically significant (r = -0.013, p = 0.883). Among the patients included in the study; there was no significant difference in metHb values between age groups (p = 0.9941), gender (p = 0.6422), presence of infection (p = 0.1311), blood pressure (p = 0.7711), length of stay in hospital (p = 0.737), inpatient clinics (p = 0.6722) and 1-month mortality (p = 0.8752). Lactate values were found to be correlated with the 1-month mortality of the patients (p = 0.005). Lactate levels were significantly higher in patients who died within 1-month compared to those who survived. Conclusions: In patients with SIRS, initial COHb and metHb values cannot be considered a predictor for prognosis and mortality. However, lactate values may be useful to predict SIRS mortality even during hospital admission.

Opportunities for early diagnostics of contemporary obstetric sepsis

Aim: to objectively assess potential for early generalized postpartum infection diagnostics prior to the onset of irreversible organ changes based on a retrospective analysis.Materials and Methods. Сlinical and laboratory forensic medical data were examined by analysing 29 cases of severe maternal outcomes coupled to sepsis: including 17 «near miss» and 12 deceased patients (maternal mortality). The control group consisted of 30 patients who had chorioamnionitis in labor and successfully completed pregnancy. Statistical data analysis was carried out by using nonparametric statistics by creating conjugacy tables and assessing a relationship between parameters with Pearson χ2 distribution.Results. There were found significant differences in rate of some symptoms in both groups. Patients with severe maternal outcomes vs. control group were significantly more likely to develop hyperthermia ≥ 38.0 °C or hypothermia ≤ 36.0 °C, hectic fever, leukocytosis ≥ 12×109/L or leukopenia ≤ 4×109/L before the end of pregnancy; after pregnancy, persistent subfebrility, febrility or hypothermia, hectic fever, multiple-organ failure syndrome (PON), as well as uterine subinvolution and abnormal discharge from the genital tract were observed.Conclusion. Early identification of recognized symptoms of systemic inflammatory response syndrome and PON allows to properly assess severity of patient condition, taking into account the risk of generalized infection, contributes to making correct diagnosis and timely implementation of adequate organizational and therapeutic measures.

Clinical efficiency of antioxidant therapy in patients with liver cirrhosis and acute blood loss

Objective:to determine the clinical efficiency of antioxidant therapy in patients with liver cirrhosis and acute blood loss.Material and methods.The study included 286 patients with liver cirrhosis and acute blood loss of varying degrees of severity. The patients were divided into two series of studies. In the first series, the patients received the therapy according to the clinical diagnostic and treatment protocols, in the second series 1 according to the same protocols in combination with an intravenous administration of the antioxidant complexes “Reamberin” and “Fluimucil”. After 48 hours from admission, the antioxidant status of blood serum, the blebbing index of lymphocytes, the concentration of uric acid, and the level of hemoglobin were analyzed. The indicators of the clinical efficiency of the treatment were determined: risk of absolute mortality, risk of relative mortality, the number needed to treat.Results.The blood serum of the patients from the first series of studies was characterized by pronounced prooxidant activity, high values of the lymphocyte blebbing index, and a small amount of uric acid, which was indicative of the development of oxidative stress. The mortality rate in this series of studies was 26.0 %. The patients of the second series of studies were characterized by pronounced antioxidant activity of blood serum, low values of the lymphocyte blebbing index, and high concentrations of uric acid, which indicated a decrease in the activity of systemic oxidation processes. The mortality rate in this series of studies was 18.2 %. The duration of the treatment decreased from 16.5 days (first series) to 13.0 days (second series).Conclusion.The combined use of the “Reamberin” and “Fluimucil” complexes as part of the therapy according to the clinical diagnostic and treatment protocols leads to a relief of oxidative stress in patients with liver cirrhosis complicated by acute blood loss. The blood serum of these patients is characterized by pronounced antioxidant activity, low values of the lymphocyte blebbing index, and a high concentration of uric acid, which reduces the risk for the development of multiple organ failure syndrome. This therapy decreases the mortality rate to 18.2 % and the duration of the treatment to 13.0 days.

Вплив додаткової нейропротекції Гліатиліном на перебіг септичного процесу і вираженість енцефалопатії в структурі синдрому поліорганної недостатності

Актуальність. Сепсис, як реакція організму на інфекцію, включає такий етап розвитку, як синдром поліорганної недостатності (СПОН). Мозкова дисфункція в 70 % випадків є одним з перших симптомів сепсис-асоційованого СПОН, ще до клінічних проявів в інших системах життєзабезпечення. Сепсис-асоційована енцефалопатія — мультифокальне порушення функцій головного мозку за умови наявності інфекції, що супроводжується проявами системного запалення, але без клінічних і лабораторних доказів прямої причетності інфекції до пошкодження головного мозку. Залежно від критеріїв, покладених в основу діагностики, церебральна дисфункція-недостатність може бути виявлена в усіх хворих із сепсисом. Ступінь її вираженості корелює зі зростанням тяжкості септичного процесу. Сепсис-асоційована дисфункція-недостатність може бути незалежним предиктором летального кінця. Тяжкість церебральної дисфункції-недостатності коливається від летаргії і/або дезорієнтації до коми. Мета: вивчення впливу терапії відповідно до головних положень «Міжнародного керівництва з інтенсивної терапії сепсису та септичного шоку: 2016» із додатковою нейропротекцією Гліатиліном на перебіг септичного процесу й вираженість енцефалопатії в структурі синдрому поліорганної недостатності. Матеріали та методи. За період 2010–2015 рр. нами проведено контрольоване проспективне рандомізоване когортне дослідження на клінічній базі кафедри анестезіології та інтенсивної терапії ДЗ «Дніпропетровська медична академія МОЗ України» і на базі відділення інтенсивної терапії сепсису КП «Дніпропетровська обласна клінічна лікарня ім. І.І. Мечникова» ДОР». У дослідження було включено 22 пацієнти. У всіх хворих було проведено рутинні лабораторні дослідження для визначення рівня клінічних і біохімічних маркерів системного запалення й органних дисфункцій за шкалами SOFA і LIFE. Для оцінки стану свідомості використовували шкалу коми Глазго. Концентрацію цитокінів (фактор некрозу пухлини α, інтерлейкін-1, інтерлейкін-4, інтерферон α) у сироватці крові вивчали імуноферментним методом. Базисна інтенсивна терапія здійснювалася відповідно до основних положень «Міжнародного керівництва з інтенсивної терапії сепсису та септичного шоку: 2016» з додатковим використанням нейропротекторного препарату Гліатиліну (холіну альфосцерат) 1000–3000 мг на добу внутрішньовенно, розчиненого в 0,9% розчині натрію хлориду, протягом 5–10 днів. Дослідження показників проводилося в чотири етапи: на 1-шу, 3-тю, 5-ту, 7-му добу. Результати. Узагальнюючи результати дослідження, можливо сказати, що на п’яту й сьому добу були відсутні клінічні прояви синдрому системної запальної відповіді в понад 75 % хворих; зменшилася тяжкість стану за APACHE II на 72,5 і 74,5 % (p < 0,001) і ступінь вираженості синдрому поліорганної недостатності за SOFA в 9 разів (p < 0,001) відповідно до етапів дослідження. Церебральна недостатність, оцінена за шкалою коми Глазго, становила 15 балів на п’яту й сьому добу дослідження, що відповідало стану ясної свідомості в понад 75 % хворих. Зазначене спостерігалося на тлі тенденції до збалансованості активності прозапальних і протизапальних ланок цитокінової системи, про що свідчили максимальні значення фактора некрозу пухлини α та інтерферону α на п’яту добу спостереження при зниженні концентрації інтерлейкіну-1 на 55,8 % щодо фону. Прогнозована летальність у пацієнтів другої групи становила 51 %, фактична летальність — 7,5 %. Отже, шляхом проведення даного варіанта інтенсивної терапії вдалося знизити передбачувану летальність на 43,5 %.

ROLE OF ANTIOXIDANT THERAPY IN PREVENTION OF LIPOPEROXIDATION AND PROCOAGULANT ACTIVITY OF PLATELETS IN SARS-COV-2 VIRAL INFECTIONS

Based on a metanalysis of clinical observations in different countries with practical experience in the treatment of pneumonia complicated by the syndrome of multiple organ failure caused by the COVID-19 coronavirus, it is impossible to draw an unambiguous conclusion about the effectiveness of various therapies in patients. viruses modify the apparatus of biosynthesis of cells in the body as a whole. Therefore, finding drugs that have an exceptional effect on viruses without infecting the body is a difficult task. Various antiviral drugs (ribaverin, interferons and glucocorticosteroids, antiparasitic, antimalarials (Chloroquine, Hydroxychloroquine) are effective at certain stages of the infectious process, however, they are toxic and therapy with these drugs has risks of developing severe cytopenia, hepatotoxicity, neuropsychiatric disorders and severe ischemia Interleukin antagonists (Tocilizumab, Anakindra, Levilimab) are effective in severe cases with an increase in IL-6, as they limit the cascade of activation of cells of the immune system, reduce the effect of "cytokine storm" in the formation of acute respiratory distress syndrome and endothelial dysfunction of the pulmonary vessels.
 Discussion. In an experimental study R.G. Alborov, in the framework of the dissertation for the degree of candidate of medical sciences (2001), in which nonlinear white rats were used, it was demonstrated that: activators of lipid peroxidation (LPO), different in nature and biological activity, inhibition of the transformation of arachidonic acid in platelets reduces, along with proaggregant activity, the intensity of LPO processes in them. Based on the experimental data obtained, it can be considered appropriate to study the effect of antioxidants as agents that enhance the effects of antiplatelet inhibitors of the transformation of arachidonate and platelets. It can be expected that antioxidants, by reducing the procoagulant activity of platelets, due to inhibition of LPO, can enhance the effect of antiplatelet agents.
 Findings. 1. The effectiveness of antioxidant therapy for infection with SAPS-COV-2 viruses, including COVID-19, is beyond doubt. It is important that antioxidant therapy was prescribed before the development of lipid peroxidation and "cytokine storm" and an increase in the procoagulant activity of platelets, that is, at the initial stage of infection.
 
 Antioxidant therapy presupposes adequate dosages according to the type of "saturating phase of treatment" with subsequent transfer to maintenance doses.
 
 Currently, no drugs have been found that have an exceptional effect on viruses without affecting the body. Antioxidants are protective at the cellular level. In addition, they practically do not cause side effects. It is advisable to prescribe antioxidant drugs in large doses in the complex therapy of viral infections.