Analysis of early risk factors for the lethal outcome of abdominal sepsis as indications for the start of invasive monitoring of central hemodynamics: a retrospective observational study

Kozlov, I. A.; Ovezov, A.М.; Раутбарт, С. А.; Tyurin, I.N.; Aleksandrovskiy, A.A.; Skripkin, Yu.V.

doi:10.21320/1818-474x-2022-2-70-79

Annals of Critical Care

2022

DOI: 10.21320/1818-474x-2022-2-70-79

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Analysis of early risk factors for the lethal outcome of abdominal sepsis as indications for the start of invasive monitoring of central hemodynamics: a retrospective observational study

I. A. Kozlov

A.М. Ovezov

С. А. Раутбарт

et al.

Abstract: ЦЕЛЬ ИССЛЕДОВАНИЯ. Проанализировать предикторную значимость в отношении риска летальности клинико-лабораторных показателей, оценка которых доступна в первые 24 ч нахождения больных с сепсисом в отделении реанимации и интенсивной терапии (ОРИТ), и оценить целесообразность начала инвазивного мониторинга центральной гемодинамики (ЦГД) у больных с предикторами неблагоприятного исхода. МАТЕРИАЛЫ И МЕТОДЫ. Проанализированы результаты обследования 134 больных в возрасте 58,5 (43–71) года с абдоминальным сепсисом. Оце… Show more

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Cited by 3 publications

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“…Прямое действие цитокинов на миокард хорошо изучено при сепсисе, и, хотя нельзя полностью перенести результаты этих исследований на острый панкреатит, патогенез последнего имеет много общих звеньев с патогенезом сепсиса, а значит, можно предположить сходное влияние. Опосредованное действие связано с непосредственной выработкой цитокинов в миокарде в ответ на системную воспалительную реакцию и действием цитокинов на эндотелий сосудов, что приводит к диффузному нарушению микроциркуляции и оказывает кардиодепрессивный эффект [10,[14][15][16].…”

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Modern Ideas on the Role of Hemodynamic Disorders in the Pathogenesis of Acute Pancreatitis

Midlenko,

Chavga

et al. 2023

Ulyanovsk Medico-biological Journal

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Acute pancreatitis remains one of the most common abdominal diseases, causing a large number of both local and systemic complications. Acute pancreatitis has a high death rate. The pathogenesis of acute pancreatitis is complex and needs careful examination. Many authors suppose, that hemodynamic disorders lead to the development of complications, often fatal. Thus, such disorders need be studied separately. The review is based on the analysis of articles included in such databases as elibrary.ru, cyberleninka.ru, and e-versions of specialized open access journals. All the articles outline modern views on the role of hemodynamic disorders in the pathogenesis of acute pancreatitis. The causes and mechanisms of development of hemodynamic disorders are considered in terms of central and regional hemodynamics, and microcirculation. The authors describe their mutual influence and role in the development of both local and systemic complications of acute pancreatitis. Contractility disorders can be observed in the pathogenesis of central hemodynamics. They can be caused by a highly active myocardial depressant factor. These disorders are supported and aggravated by other organs and systems with the development of multiple organ failure. Violations of regional hemodynamics are associated mainly with an increase in intra-abdominal pressure. A direct dependence of intestinal wall perfusion on intra-abdominal pressure is established. Intestinal barrier dysfunction contributes to the infection of necrosis foci. Microcirculation disorders are the most important element in the pathogenesis of acute pancreatitis, often defining its outcome. Microcirculation disorders include angiospasm, venous stasis, microthrombi formation, and interstitial edema. A decrease in local perfusion due to impaired gland microcirculation can cause tissue ischemia and pancreonecrosis.

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Modern Ideas on the Role of Hemodynamic Disorders in the Pathogenesis of Acute Pancreatitis

Midlenko,

Chavga

et al. 2023

Ulyanovsk Medico-biological Journal

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Assessing a potential to improve data quality for accelerated identification of microorganisms derived from positive blood cultures

Khaliulin

Lyamin

Gusyakova

et al. 2023

Russian Journal of Infection and Immunity

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Diagnostics of blood-borne infections is still an urgent problem of modern medicine. The main causative agents of septic conditions are gram-positive microorganisms particularly Staphylococcus aureus, enterococci, etc., whereas clinical significance of isolated coagulase-negative staphylococci is ambiguous. Escherichia coli, Klebsiella pneumonia and other enterobacteria, as well as Acinetobacter baumannii prevail among the gram-negative flora. Modern possibilities of accelerated identification of microorganisms derived from positive blood cultures based on mass-spectrometry consist of two approaches. Firstly, the manufacturers' developed consumables for mass spectrometry are proposed, and secondly, there are domestic developments of accelerated sample preparation protocols developed by microbiological laboratories. The approaches used have a number of advantages and disadvantages, but to summarize, the use of the proposed methods in routine practice is quite limited. At the same time, the need to accelerate the issuing a microbiological conclusion related to nosology is great being associated with improved outcomes. In this regard, the aim of the study was to evaluate convergence and accuracy of results for accelerated identification of microorganisms derived from positive blood cultures in blood-borne infections. The study included 87 positive blood cultures, the identification of pathogens from them occurred in four ways: the classical microbiological analysis of blood for sterility, pathogen identification directly from the vial without isolating a pure culture, as well as two sample preparation methods based on ethylenediaminetetraacetic acid (EDTA) and potassium ethylenediaminetetraacetate disubstituted (EDTA-K2) as wash additives. It was found that gram-positive and gram-negative flora were isolated from the blood almost evenly often. When evaluating an influence of biomaterial used for mass spectrometry, it turned out that use of wash additives increases chances of successful identification of bacteria from a blood sample. The influence of tinctorial properties on the results of determining the species assignment of isolates was also evaluated. Identification of gram-positive flora is more accurate, since some pathogens were not identified without washing additives, and when using EDTA-K2 and the corresponding acid, assignment to the genus was obtained in the same samples. A similar pattern was also characteristic of gram-negative flora. At the same time, modern manufacturers of laboratory equipment and reagents allow to standardize sample preparation procedures in the protocols used. The effects of EDTA-K2, which allowing to use it as a washing component, are associated with the binding of calcium and magnesium ions in solution, which reduces the adhesion of bacterial cells to blood cells, thereby contributing to better mass spectrometry of microbial sediments with accelerated identification of microorganisms from positive blood cultures. Thus, use of the described additives can provide high quality, timely and adequate diagnostics of serious and life-threatening conditions such as blood-borne infections.

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Role of invasive hemodynamics monitoring in sepsis intensive care

Kozlov,

Ovezov,

Rautbart

2024

Medicinskij alfavit

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The objective was to study the effect of early planned use of transpulmonary thermodilution (TPTD) and therapeutic measures to stabilize blood circulation on the clinical outcome of sepsis.Materials and methods. The cohort study involved 132 patients with abdominal sepsis with SOFA >7 and blood lactate >1.6 mmol/L. Septic shock was diagnosed in 56 % of patients. TPTD in the early periods of intensive care was began in 53.8 % of patients. Logistic regression and ROC-analysis were used to process the data.Results. Early use of invasive monitoring (OR 2,3715, 95 % CI 1,1107–5,0635, p=0,026, AUC 0.655) and infusion volume >43 ml/kg per day (OR 1.0313, 95 % CI 1.0073–1.0558, p=0.01, AUC 0.677) were predictors of survival in patients with abdominal sepsis. The use of TPTD compared to patients of group II was accompanied by an increase in the daily infusion volume (53.7 [38.1–63.5] vs 38.2 [29.9–47.2], ml/kg per day, p = 0.0001), more frequent use of inotropic drugs (39.4 vs 16.4 %, p = 0.004), and higher level of the inotropic scale (0 [0–4.7] vs 0 [0–0], p = 0.01). There were no differences in the frequency of prescription (57.7 vs 65.5 %, p = 0.376) and dosages (0.2 [0.1–0.4] vs 0.3 [0.2–0.4] μg/kg/min, p = 0.554) of norepinephrine. Twenty-eight-day mortality in groups I and II was 31 and 50.8 % (p = 0.022), hospital mortality was 32.9 and 54.0 % (p = 0.014).Conclusion. When assessed by SOFA > 7 points and lactatemia > 1.6 mmol/L, the onset of TPTD and infusion volume > 43 mL/kg/day increase the likelihood of survival of patients with abdominal sepsis, as a result, 28-day and hospital mortality decrease by 1.6 times. The use of invasive monitoring of central hemodynamics in this clinical situation is accompanied by an increase in the prescription of inotropes by 2.4 times with an unchanged intensity of norepinephrine use.

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Analysis of early risk factors for the lethal outcome of abdominal sepsis as indications for the start of invasive monitoring of central hemodynamics: a retrospective observational study

Cited by 3 publications

References 30 publications

Modern Ideas on the Role of Hemodynamic Disorders in the Pathogenesis of Acute Pancreatitis

Modern Ideas on the Role of Hemodynamic Disorders in the Pathogenesis of Acute Pancreatitis

Assessing a potential to improve data quality for accelerated identification of microorganisms derived from positive blood cultures

Role of invasive hemodynamics monitoring in sepsis intensive care

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