Liver dysfunction in pathogenesis of burn disease and its correction with succinate-containing drugs

2016 ◽  
Vol 7 (4) ◽  
pp. 132-141
Author(s):  
Tatiana V Brus ◽  
Nikolay V Khaytsev ◽  
Aleftina A Kravtsova
Keyword(s):  
Succinic Acid ◽  
Intensive Therapy ◽  
Multiple Organ ◽  
Burn Injuries ◽  
Cellular Respiration ◽  
Circulating Blood Volume ◽  
Liver Functions ◽  
Burn Disease ◽  
Cholestatic Syndrome ◽  
Extensive Burn

Current information on the effects of extensive and deep burns upon the liver functions as well as some novel methods of its correction with succinic acid derivates are reviewed. The liver is the main target organ for extensive burn injuries. Manifestations of cytolytic and cholestatic syndrome were observed already on the first days of the disease. To correct these conditions a comprehensive layout of the infusion of intensive therapy is needed. In burn disease it is impossible to restore the circulating blood volume only by infusion of plasma-substituting solutions. Thus, these cocktails must contain drugs, stabilizing metabolic disorders and reducing the concentration of proinflammatory cytokines. Complex intensive therapy in case of burns should also include correction of energy production within the cells without increasing oxygen transport. Substrate antihypoxic drugs are used in order to reduce the need of tissues for oxygen, stabilization of cell membranes and reduction of lipid peroxidation. Succinic acid is a substrate antihypoxic drug capable of detoxification, antihypoxic, antioxidant and hepatoprotective effects. Its derivates modify cellular respiration, compensate for metabolic acidosis, reducing lactate, pyruvate and citrate concentration, normalize histamine and serotonin concentration, improve microcirculation without affecting systemic hemodynamics. All of these effects are pathogenetically substantiated in the treatment of patients with burns. Data regarding the use of drugs on the basis of succinic acid in the treatment of patients with extensive deep burns, critical and supercritical burns during various periods of burn disease, their influence on the severity of multiple organ dysfunction in these patients, the presence of hepatoprotective effect are reported in a few of publications and their conclusions are so far ambiguous enough.

Skin grafts

2021 ◽  
pp. 35-38
Author(s):  
Siobhan O’Ceallaigh ◽  
Mamta Shah
Keyword(s):  
Immune System ◽  
Blood Supply ◽  
Skin Graft ◽  
Burn Injuries ◽  
Skin Grafts ◽  
Skin Defects ◽  
Extensive Burn

Skin grafts are an option for closing skin defects that cannot be closed primarily. A skin graft consists of epidermis and a portion of the underlying dermis that is detached from its blood supply and transferred to another location, usually on the same individual (an autograft). Skin grafts can also be used from cadaver donors (allografts) in extensive burn injuries, but as the recipient’s immune system will eventually reject this foreign tissue, this is only a temporary measure.

scholarly journals Antibiotic therapy and infection complications in paediatric burn injuries

2019 ◽  
Vol 73 ◽  
pp. 1-8
Author(s):  
Jakub Noskiewicz ◽  
Paweł Juszczak ◽  
Małgorzata Rzanny- Owczarzak ◽  
Przemysław Mańkowski
Keyword(s):  
Antibiotic Therapy ◽  
Thermal Injury ◽  
Treatment Time ◽  
Burn Injuries ◽  
Wound Infections ◽  
Risk Of Infection ◽  
Negative Effects ◽  
Burn Wound ◽  
Prophylactic Measure ◽  
Burn Disease

Background: Each year, nearly 1% of population suffers from burn injuries. The main cause of complications and death after thermal injury is infections. Excessive use of antibiotics affects however the children treated for burns and can have negative effects. Therefore, specifying the recommendations for antibiotic therapy in patients after thermal injury seems to be of importance. Materials and methods: An evaluation of 310 paediatric patients hospitalised for burn injuries was performed. In the first part of evaluation, a retrospective analysis of treatment with particular focus on infection complications and administered antibiotics was performed. This was followed by a prospective evaluation of effectiveness of the principles of antibiotic therapy specified at the earlier stage. Results: In 2010-2016, an antibiotic was systemically administered to 53.4% of children treated for thermal injury, provided that in 87.1% of cases it was introduced as a prophylactic measure. Infection of a burn wound was recorded in 4.7% of cases. The most frequently isolated bacterium (57.1%) was Staphylococcus aureus MSSA. Supply of antibiotics failed to reduce the number of infection complications or burn wound infections. The studies formed the basis for specification of the internal antibiotic therapy criteria, effectiveness of which was then evaluated. In 2017, an antibiotic was administered to 37.1% of patients. Reducing antibiotic therapy did not increase the risk of infection complications or frequency of wound infections. Conclusion: Routine antibiotic prophylaxis in burn injuries has no effect on the risk of infection complications and does not reduce the treatment time. It should be limited to perioperative prophylaxis in the case of skin grafts and to the patients with progressing symptoms of burn disease or with concomitant infections.

scholarly journals Current laboratory biomarkers of burn sepsis

2019 ◽  
pp. 59-67
Author(s):  
G. S. Golobokov ◽  
E. V. Zinoviev ◽  
D. V. Kostyakov ◽  
D. A. Lioznov
Keyword(s):  
Burn Injury ◽  
Current Method ◽  
Interleukin 10 ◽  
Diagnostic Value ◽  
Multiple Organ ◽  
Burn Injuries ◽  
Laboratory Diagnostics ◽  
Necrosis Factor Alpha ◽  
Clinical Scales ◽  
Trigger Receptor

Relevance.Currently, there is no universally recognized standard method for diagnosis of sepsis in patients with burn injury, which causes many variations when recording septic conditions and also high mortality of such patients. Traditionally, patients in intensive care units are assessed using the clinical scales SOFA, APACHE II-IV or SAPS II-III. However, most of the known clinical scales cannot always be used to assess the severity of burn injuries. Therefore, unrecognized sepsis can lead to the multiple organ dysfunction syndrome that is the main cause of death in burn patients. The definition, systematization and standardization of new criteria for sepsis and predictors of its development can significantly improve the medical care for patients in this category and reduce the level of mortality.Intention.To review the studies of burn sepsis biomarkers using publications from the National Center for Biotechnological Information and the Scientific Electronic Library (eLIBRARY) over 2003–2017.Methodology.This article provides an overview of the most promising clinical and laboratory markers of sepsis with high predictive and diagnostic value that can be used to predict and assess the severity of burn injuries.Results and their analysis.Over the past 15 years, many potential biomarkers of burn sepsis have been studied. The most promising of them are: tumor necrosis factor-alpha, interleukin-6, interleukin-8, interleukin-10, interleukin-27, presepsin, endotoxin of gram-positive bacteria, lipopolysaccharide-binding protein, soluble receptor of urokinase-type plasminogen activator, trigger receptor expressed on myeloid cells, and myeloperoxidase. The most topical current method for laboratory diagnostics of these biomarkers can be the enzyme-linked immunoassay in the biochip format.Сonclusion.Integrated and simultaneous measurements of the sepsis markers reviewed in this article within one study can be useful for diagnosing sepsis in severely burned patients in the future.

scholarly journals Correction of hepatic dysfunction in an extensive deep burn model

2017 ◽  
Vol 8 (2) ◽  
pp. 62-67
Author(s):  
Tatiana V Brus ◽  
Maria A Pahomova ◽  
Andrey G Vasiliev
Keyword(s):  
Biochemical Analysis ◽  
Hepatic Dysfunction ◽  
Intensive Therapy ◽  
Subsequent Development ◽  
Albino Rats ◽  
Gamma Glutamyl Transpeptidase ◽  
Internal Organs ◽  
Bilirubin Concentration ◽  
Burn Disease ◽  
Glutamyl Transpeptidase

The ongoing increase of burn trauma rates urges elaboration of valid and effective methods of medical aid with actualization of pathogenetically-based intensive therapy. Burn disease is a peculiar nosologic form characteristic of local manifestations as well as critical systemic state with involvement of internal organs and systems with subsequent development of polyorganic insufficiency. Liver lesions in case of burn disease are multiform and often combine with disturbances of other organs yielding polyorganic insufficiency. Desintoxicating, hepatoprotector and organoprotector effects of succine acid - containing medicines used for prevention of hepatic failure were assessed in the present study in a model of extensive deep burn in comparison with standard therapy. The experiments involved 60 mature albino rats (180-200 g). Deep burns involving 20% of body surface caused hepatic dysfunction. Remaxol and Reamberin infusions’ effects were comparatively assessed. To evaluate desintoxicating and hepatoprotector effects of these medicines biochemical analysis of these rats’ blood serum was carried out on the 7th day after infliction of extensive deep burns. Alanine-aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase activity and bilirubin concentration were assessed. Analyzing desintoxicating and hepatoprotector effects of Remaxol and Reamberin upon the morphologic structure of the liver in case of extensive deep burn one must admit these medicines are capable of moderate desintoxicating and hepatoprotector effects.

Intensive therapy of multiple fatty embolism of the microvascular bed of vital organs

2021 ◽  
Vol 87 (1) ◽  
pp. 59-62
Author(s):  
M.V. Chepelyanskaya ◽  
◽  
V. V. Unzhakov ◽  
A.S. Doloka ◽  
S.N. Berezutsky ◽  
...  
Keyword(s):  
Intensive Therapy ◽  
Interdisciplinary Approach ◽  
Lung Ventilation ◽  
Fat Embolism ◽  
Multiple Organ ◽  
Acid Base Balance ◽  
Artificial Lung Ventilation ◽  
Base Balance ◽  
Cardiovascular Medications ◽  
Complications And Mortality

The article presents a clinical case of successful treatment of a patient with polytrauma complicated by multiple fatty embolism. Complications were manifested in the form of a syndrome of multiple organ failure: cerebral, cardiovascular and respiratory failure. According to the protocols and recommendations for providing assistance to patients with polytrauma, the tactics of management and intensive therapy were determined, with the obligatory consideration of recommendations for the treatment of patients with fat embolism. The patient underwent neuroprotection, which included one of the modern drugs, such as celex, artificial lung ventilation, maintenance of hemodynamics by cardiovascular medications, correction of the water, electrolyte and acid-base balance with positive dynamics. Despite the difficulties of diagnosis and treatment, a high percentage of disability, complications and mortality, the difficulty of preventing complications, a favorable outcome for patients with associated trauma is possible. An interdisciplinary approach ensures the success of the treatment and rehabilitation of these patients.

scholarly journals The Pitfalls of Febrile Jaundice. A Case Report

2016 ◽  
Vol 2 (2) ◽  
pp. 93-95
Author(s):  
Maria Obreja ◽  
Andra Teodor ◽  
Daniela Leca ◽  
Alexandr Ceasovschih ◽  
Egidia Miftode
Keyword(s):  
Clinical Manifestations ◽  
Multiple Organ ◽  
Low Back ◽  
Mri Findings ◽  
Paravertebral Abscess ◽  
Biliary Sepsis ◽  
Inflammatory Processes ◽  
Magnetic Resonance Imaging Mri ◽  
Cholestatic Syndrome ◽  
Febrile Jaundice

Abstract Jaundice in sepsis is usually caused by cholestasis, and its onset can precede other manifestations of the infection. Inflammation-induced cholestasis is a common complication in patients with an extrahepatic infection or those with inflammatory processes. We describe the case of a 47 years old female who presented with low back pain and paravertebral muscular contracture. She subsequently developed a cholestatic syndrome with clinical manifestations such as jaundice, followed by fever and sepsis with multiple organ dysfunction. Initially labeled as biliary sepsis, the diagnosis was crucially reoriented as the blood cultures were positive for Streptococcus pyogenes and the magnetic resonance imaging (MRI) findings suggested spondylodiscitis as well as a paravertebral abscess.

scholarly journals Significance of the determination of proinflammatory cytokines in the serum of polytraumatized patients with sepsis

2004 ◽  
Vol 61 (2) ◽  
pp. 137-143 ◽  
Author(s):  
Maja Surbatovic ◽  
Krsta Jovanovic ◽  
Danilo Vojvodic ◽  
Nikola Filipovic ◽  
Dragan Babic
Keyword(s):  
Inflammatory Response ◽  
Inflammatory Cytokines ◽  
Clinical Investigation ◽  
Intensive Therapy ◽  
Multiple Organ ◽  
Mean Values ◽  
Reliable Predictor ◽  
Necrosis Factor ◽  
Pro Inflammatory Cytokines

Severe sepsis and trauma complicated with multiple organ dysfunction syndrome (MODS) are among the leading causes of death in intensive therapy units with mortality rate exceeding 50%. The outcome is not determined only by infection or trauma, but also by the intensity of immuno-inflammatory response, which is essential for host defence, but if uncontrolled leads to MODS. Pro-inflammatory cytokines (tumor necrosis factor-a -TNF-a, IL-1 IL-8, IL-12, IFN-g, etc) represent a part of this immuno-inflammatory response to an insult. The results of the clinical investigation of correlation between pro-inflammatory cytokines (IL-8, IL-12, TNF-a, IFN-g) the outcome (survivors, non-survivors), and the severity (systemic inflammatory response syndrome - SIRS - less severe, and MODS - more severe) in polytraumatised patients with sepsis are presented in this paper. Mean values of IL-8 were 1.3-fold higher in non-survivors (p<0.05), and 60-fold higher in MODS group (p<0.01). Mean values of IL-12 were 1.6-fold higher in survivors (p<0.01), while the values between SIRS and MODS group did not differ significantly; mean values of TNF-a were 3-fold higher in survivors (p<0.05), and 46-fold higher in MODS group (p<0.01). Mean values of IFN-g did not differ significantly between the two groups regarding the outcome and severity. The obtained results indicated that IL-8 was a reliable predictor of lethal outcome and MODS (p<0.01), IL-12 a reliable predictor of survival (p<0.05), and TNF-a a reliable predictor of survival (p<0.05) and MODS (p<0.01).

scholarly journals INSULIN AND CERTAIN STEROIDS SECRETION IN PATIENTSWITH VARYING SEVERITY OF BURN DISEASE

2014 ◽  
Vol 6 (4) ◽  
pp. 26-31 ◽  
Author(s):  
M I Pugachev ◽  
L M Dobrovolskaya ◽  
V V Ivanov ◽  
S B Shustov
Keyword(s):  
Insulin Resistance ◽  
Burn Injury ◽  
Burn Injuries ◽  
Cortisol Secretion ◽  
Severe Burn ◽  
Testosterone Secretion ◽  
Burn Disease ◽  
Severe Burn Injury

The results levels of insulin, testosterone and cortisol in patients with burn disease are presented. The analysis of the secretion hormones in groups with varying severity of the injury are provided. It was shown that in male burned patients was accompanied with prolonged decrease in testosterone secretion. Degree of inhibition testosterone secretion depends on the severity of burn injuries. Also there were revealed that burn disease was accompanied with prolonged increase in cortisol secretion. It was shown that increase IRI-activity on the 6 th and 14 th day of hospitalization, which may indicate emerging insulin resistance in this period disease. Severe burn injury were observed to hormonal failure, which may reduce the chances of survival of the injured.

scholarly journals Features of infusion therapy with gastrointestinal bleeding

2020 ◽  
pp. 23-24
Author(s):  
F.J. Hasanov ◽  
N.F. Muradov ◽  
M.T. Abbasova ◽  
G.A. Askarova
Keyword(s):  
Intensive Care ◽  
Gastrointestinal Bleeding ◽  
Venous Pressure ◽  
Intensive Therapy ◽  
Antiplatelet Agents ◽  
Fresh Frozen Plasma ◽  
Infusion Therapy ◽  
Colloidal Solutions ◽  
Acid Base Balance ◽  
Circulating Blood Volume

Background. Ulcers of the stomach and 12-duodenal ulcers, complicated by gastrointestinal bleeding (GIB), become more life threatening, especially in patients with concomitant coronary heart disease (CHD). The composition of infusion therapy can significantly affect the coagulation potential of blood and the prognosis of treatment. Objective. The aim of this work is to identify the features of the infusion therapy performed in patients with GIB. Materials and methods. We analyzed the composition of infusion therapy in 457 patients who received intensive therapy for GIB in the period 2015-2019. The study protocol included a general and biochemical blood test, coagulogram, acid base balance, endoscopic and/or X-ray contrast examination of the gastrointestinal tract, ultrasound and, if necessary, CT or MRI of the abdominal organs, ECG, EchoCG. Results and discussion. Upon admission to the intensive care unit, all patients underwent catheterization of one of the central veins and continuous monitoring of the main indicators: pulse, blood pressure, ECG, pulse oximetry (SpO2), Hb level, coagulogram indicators. The main principles of intensive care were to stop all previously taken anticoagulants and antiplatelet agents, the appointment of H2-blockers – histamine receptors and proton pump inhibitors, Almagel or Maalox for 3-4 days, continuous infusion of nitroglycerin under hemodynamic control, transfusion of a polarizing mixture. The composition of the infusion given to these patients is one of the important factors that can affect the prognosis of treatment. To replenish the circulating blood volume, erythrocyte mass, fresh frozen plasma (FFP) and, if necessary, colloidal solutions under the control of central venous pressure and diuresis were given preference. At the same time, they tried to maintain the Hb level not lower than 8 g/dL, hematocrit 25 %, and FFP was used in large (15-20 ml/kg) doses. Conclusions. Considering the danger of thrombosis of the coronary arteries of the heart, shunts or stands on these vessels, in patients with GIB and concomitant CHD, the use of hemostatics is inappropriate. Resuming the use of anticoagulants can only be after the bleeding has stopped.

RESULTS OF THE IMPACT OF ANTIPROTEINASE HEMOSORBENT ON THE DYNAMICS OF CLINICAL AND LABORATORY INDICATORS IN CHILDREN WITH GENERALIZED PERITONITIS

2021 ◽  
Vol 19 (4) ◽  
pp. 410-417
Author(s):  
U. K. Serhiyenka ◽  
◽  
R. E. Yakubtsevich ◽  
V. G. Vakulchik ◽  
V. A. Kazhina ◽  
...  
Keyword(s):  
Intensive Care ◽  
Comparison Group ◽  
Intensive Therapy ◽  
Randomized Study ◽  
Modern Medicine ◽  
Multiple Organ ◽  
Blood Oxygenation ◽  
The Body ◽  
Generalized Peritonitis ◽  
The Impact

Background. Despite the undoubted success of modern medicine, peritonitis in children remains not only a surgical, but also a general pathological problem, the relevance of which is not decreasing. The use of efferent therapy methods, in particular hemosorption, imitating the natural mechanisms of detoxification of the body, are promising in the complex therapy of children with peritonitis. The aim of the study was to establish the effectiveness of the antiproteinase hemosorbent "Hemo-proteazsorb" in the complex intensive care of children with generalized peritonitis. Material and methods. A prospective randomized study of 60 children with generalized peritonitis was conducted. In the main group, there were 30 patients who underwent hemosorption in complex intensive therapy. The comparison group also included 30 patients who underwent traditional treatment. The examined groups were comparable in terms of the nature of the pathology and the severity of the condition. Results. During hemoperfusion, a significant increase in blood saturation was established – from 95.1 (93.2; 97.1)% to 97.3 (95.5; 98.7)%, with an improvement in oxygen transport (ctO2, mmol/l) from 6.9 (6.4; 7.9) to 8.8 (1.5; 9.7) and a decrease in lactate level (mmol/l) from 1.7 (1.5;2.1) to 1.1 (0.9;1.3), which indicated normalization of blood oxygenation and improvement of microcirculation. After 24 hours, there was a significant decrease in the sum of points on the pSOFA scale, from 4.5 (3.0; 6.0) to 0.5 (0; 2.0), p<0.001. Normalization of body temperature and restoration of intestinal function in 15 (50.0% СI 32.1-67.9) children were also noted, which indicated a decrease in multiple organ dysfunction and improvement of the condition. In the comparison group, the studied indicators changed much more slowly. Conclusions. The data on the positive dynamics of clinical and laboratory parameters, obtained as a result of the study, prove the high effectiveness of the Belarusian hemosorbent "Hemo-proteazsorb" in the complex intensive care for generalized peritonitis.

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