Infusion therapy for sepsis in patients with burns
Background. Sepsis develops in 8-42.5 % of patients with burns and is the leading cause of death among them. The criteria for sepsis are suspected or documented infection and the presence of two or more criteria on the SOFA scale. The involvement of remote from the primary pathological focus organs or systems in the generalized pathological process is the key sign of sepsis.
Objective. To describe infusion therapy (IT) for sepsis in patients with burns.
Materials and methods. Analysis of literature data on this topic; own research. The study involved 52 patients with sepsis due to severe burns, who were prescribed individually selected comprehensive treatment. Patients in group 1 received IT according to the following scheme: Ringera lactate (“Yuria-Pharm”) + glucose + isoosmolar crystalloids, group 2 – Ringera lactate + glucose + Reosorbilact (“Yuria-Pharm”) at a dose of 10 ml/kg, group 3 – Ringera lactate + glucose + Reosorbilact at a dose of 15 ml/kg.
Results and discussion. Sepsis in patients with burns differs from sepsis in general surgery patients, as the former lose the main protective barrier – their skin. Due to the hypermetabolic response patients with burns for several months may have tachycardia, tachypnea, leukocytosis, shift of the leukocyte formula to the left, fever, signs of multiorgan dysfunction. The development of sepsis in patients with burn disease depends on the area and depth of the injury, as well as on the condition of the patient’s immune system. Treatment of sepsis may include antibiotic therapy, surgery (removal of non-viable tissues, closure of skin defects), IT, vasopressor therapy, heparin, inotropic support, glucocorticoid therapy, administration of blood products, mechanical lung ventilation. Despite the leading role of IT in the treatment of sepsis in patients with burns, the question of the optimal solution and its dose is still unclear. The goals of IT in this case are to ensure the delivery of oxygen to tissues in conditions of increased consumption and detoxification. According to the results of our own study, patients in groups 2 and 3 had a significantly lower heart rate (HR) and higher systolic blood pressure (SBP) than in group 1 (HR: 1st group – 119.5±5.4 bpm, 2nd group – 108.2±4.3 bpm, 3rd group – 104.5±5.3 bpm; SBP: 1st group – 82.6±5.3 mm Hg, 2nd group – 82.5±4.6 mm Hg, 3rd group – 92.4±3.2 mm Hg). The increase in SBP was accompanied by an increase in glomerular filtration rate and rate of diuresis. The use of Reosorbilact at a dose of 10 ml/kg/day reduced the total volume of infusions by 7.8 %, and at a dose of 15 ml/kg/day – by 19.5 % compared with group 1. Patients in both groups of Reosorbilact had a lower frequency of septic shock (11.8 and 12.5 % vs. 15.7 % in group 1) and shorter duration of treatment with vasopressors. The use of Reosorbilact in both doses helped to reduce the level of leukocytes, urea, creatinine, C-reactive protein. Hemodynamic, osmodiuretic and detoxifying effects of Reosorbilact justify its use in patients with severe burns and sepsis.
Conclusions. 1. Sepsis develops in 8-42.5 % of patients with burns and is the leading cause of death among them. 2. Sepsis in patients with burns is different from sepsis in general surgery patients. 3. Despite the leading role of IT in the treatment of burn sepsis, the question of the optimal solution and its dose still remains unclear. 4. The use of Reosorbilact helps to reduce heart rate, increase SBP, reduce the total volume of infusions, reduce the frequency of septic shock and reduce treatment with vasopressors.
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