No abstract

Endotoxemia is a common cause of shock and poor outcomes in sepsis. This paper describes a case of recovery of a young patient from sepsis caused by pan-resistant bacterial flora after a car injury with aortic rupture. Multiple adsorption of lipopolysaccharide was used as part of complex therapy to treat endotoxemia. Material and methods. A17-year old patient K., diagnosed with a condition after polytrauma, accompanied by aortic rupture, complicated by multiple organ dysfunction and sepsis (SOFA score up to 14 points): coma I-II; paresis of the gastrointestinal tract; respiratory failure due to pneumonia; acute kidney injury with anuria; acute liver failure; thrombocytopenia. The sources of infection were: translocation of bacteria; sinusitis, meningoencephalitis. In bacterial blood cultures, the presence of both gram-positive and gram-negative multi-resistant flora was identified. The level of procalcitonin, depending on the activity of the infectious process, ranged from 35 to 336 ng/ml. Surgical interventions to drain and sanitize the focus of infection as well as repeated changes in antibiotic therapy were performed in order to control the infectious process. The level of endotoxemia was assessed by endotoxin activity assay (EAA from 0.7 to 1). 60 hours of polymyxin B (PMX) hemoperfusion (5 sessions) were performed in conjunction with continuous use of the Oxiris universal set. Results. In 100 days after hospitalization, the patient had no signs of infection, was conscious, breathing spontaneously, had partially restored motor and speech functions and was transferred to a rehabilitation center. After each PMX hemoperfusion [a 12-hour (h) session followed by a 12-h break before the next 12-h session], EAA value reduced or didn't increase above 0.7. After the first 12 hours of use, it was possible to withdraw vasopressors, oxygenation index significantly increased, signs of shock were no longer observed; after 2 sessions peristalsis was restored. According to the literature, repeated PMX hemoperfusion sessions have been used in the treatment of patients with septic shock associated with endotoxemia caused by translocation of the intestinal flora, and in patients with an infectious focus in the lungs or other organs, after transplantation of parenchymal organs and as a replacement for antibiotic therapy. The indications for the procedure were: an increase of EAA over 0.6; high SOFA values; the presence of gram-negative microorganisms. Conclusion.The heterogeneity of the course of sepsis requires a multidisciplinary, complex and targeted treatment. Patients with severe multiple organ dysfunction and severe endotoxemia represent the most unfavorable cohort of patients with sepsis and can be identified using a blood женной эндотоксемией представляют наиболее неблагоприятную когорту больных с сепсисом и могут быть идентифицированы с помощью теста на активность липополисахарида в крови. Тест на активность эндотоксина в крови также позволяет судить о природе бактериальной флоры, отслеживать наличие очага инфекции, аде...