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1 7 , 1 3 ; 2 40 w w w . r e a n i m a t o l o g y . c o mТенденция к развитию и генерализации инфекции у пациентов с тяжелой термической травмой реали зуется за счет комплексного влияния термической травмы на иммунную систему. Особенно страдает фаго цитарная система, представленная, в первую очередь, нейтрофильными гранулоцитами.Цель исследования: определение динамики изменения функциональной активности нейтрофилов у па циентов с термической травмой, а также ее прогностической значимости при развитии гнойно септических осложнений ожоговой болезни.Материалы и методы. Функциональную активность нейтрофилов оценивали на основе спонтанного и ин дуцированного хемилюминесцентного ответа цельной крови при последовательной стимуляции форбол 12 миристат 13 ацетатом (ФМА) и N формил метионил лейцил фенилаланином (фМЛФ). Было обследовано 34 пациента с ожоговой болезнью при разной тяжести течения ожоговой болезни и в динамике наблюдения.Результаты. Разработанная новая методика была использована для исследования цельной крови паци ентов с ожоговой болезнью, получены данные о функциональной активности нейтрофилов при разной тя жести течения болезни и в динамике. В результате анализа хемилюминесцентных кривых развития респи раторного взрыва нейтрофилов выявлены показатели, характеризующие состояние иммунной системы, а именно: одно-или двухфазный ответ на стимул, удельная активность нейтрофила «быстрой фазы», удель ная активность нейтрофила «медленной фазы».Заключение. Результаты позволили выделить тенденции изменения функциональной активности ней трофилов при ожоговой болезни. Предложены диагностические и прогностические показатели функцио нальной активности нейтрофилов для оценки тяжести болезни и прогноза септического процесса. Ключевые слова: хемилюминесценция; функциональная активность нейтрофилов; ожоговая травма; сепсисA complex effect of thermal trauma on the immune system triggers the tendency to develop and generalize infection in patients with severe thermal trauma. The phagocytic system, which is represented, first of all, by neu trophilic granulocytes, is significantly altered.Objective: to determine the dynamics of changes in the functional activity of neutrophils in patients with thermal trauma, as well as its prognostic significance in the development of purulent septic complications of a burn disease.Materials and methods. The functional activity of neutrophils was assessed by spontaneous and induced chemiluminescence responses of whole blood sequentially stimulated with phorbol 12 myristate 13 acetate ВведениеПроблема лечения ожоговой болезни и ее осложнений не теряет актуальности до настоя щего времени [1]. В структуре летальности тя желообожженных ведущее место занимает ин фекция, приводящая к развитию пневмонии и сепсиса [2]. Развитие и генерализация инфекции у тяжелообожженных реализуется за счет влия ния термической травмы на иммунную систему; в особенности страдает фагоцитарное звено им мунитета [3][4][5]. Дисфункция фагоцитов прояв ляется в нарушении уничтожения бактерий, из менении уровня секреции ин...

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In order to describe the outcomes of patients hospitalized with an acute exacerbation of severe chronic obstructive pulmonary disease (COPD) and determine the relationship between patient characteristics and length of survival, we studied a prospective cohort of 1,016 adult patients from five hospitals who were admitted with an exacerbation of COPD and a PaCO2 of 50 mm Hg or more. Patient characteristics and acute physiology were determined. Outcomes were evaluated over a 6 mo period. Although only 11% of the patients died during the index hospital stay, the 60-d, 180-d, 1-yr, and 2-yr mortality was high (20%, 33%, 43%, and 49%, respectively). The median cost of the index hospital stay was $7,100 ($4,100 to $16,000; interquartile range). The median length of the index hospital stay was 9 d (5 to 15 d). After discharge, 446 patients were readmitted 754 times in the next 6 mo. At 6 mo, only 26% of the cohort were both alive and able to report a good, very good, or excellent quality of life. Survival time was independently related to severity of illness, body mass index (BMI), age, prior functional status, PaO2/FI(O2), congestive heart failure, serum albumin, and the presence of cor pulmonale. Patients and caregivers should be aware of the likelihood of poor outcomes following hospitalization for exacerbation of COPD associated with hypercarbia.

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We prospectively studied treatment and outcome in 5030 patients in intensive care units at 13 tertiary care hospitals. We stratified each hospital's patients by individual risk of death using diagnosis, indication for treatment, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. We then compared actual and predicted death rates using group results as the standard. One hospital had significantly better results with 69 predicted but 41 observed deaths (p less than 0.0001). Another hospital had significantly inferior results with 58% more deaths than expected (p less than 0.0001). These differences occurred within specific diagnostic categories, for medical patients alone and for medical and surgical patients combined, and were related more to the interaction and coordination of each hospital's intensive care unit staff than to the unit's administrative structure, amount of specialized treatment used, or the hospital's teaching status. Our findings support the hypothesis that the degree of coordination of intensive care significantly influences its effectiveness.

This prospective study describes the current prognosis of patients in acute Organ System Failure (OSF). Objective definitions were developed for five OSFs, and then 5677 ICU admissions from 13 hospitals were monitored. The number and duration of OSF were linked to outcome at hospital discharge for each of the 2719 ICU patients (48%) who developed OSF. For all medical and most surgical admissions, a single OSF lasting more than 1 day resulted in a mortality rate approaching 40%. Among both medical and surgical patients, two OSFs for more than 1 day increased death rates to 60%. Advanced chronologic age increased both the probability of developing OSF and the probability of death once OSF occurred. Mortality for 99 patients with three or more OSFs persisting after 3 days was 98%. The two patients who survived were both young, in prior excellent health, and had severe but limited primary diseases. These results emphasize the high death rates associated with acute OSF and the rapidity with which mortality increases over time. The prognostic estimates provide reference data for physicians treating similar patients.