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DOI: https://doi.org/10.22263/2312-4156.2017.4.48

Zhylinski Y.V.1,2
The complex method of medical sepsis prophylaxis in severely burnt patients
1Belarusian State Medical University, Minsk, Republic of Belarus
2Minsk City Clinical Emergency Hospital, Minsk, Republic of Belarus

Vestnik VGMU. 2017;16(4):48-57.

Abstract.
The hypermetabolic syndrome in severely burnt patients leads to secondary immunodeficiency, the decrease in wounds epithelialization, and translocation of microorganisms in the intestine, thereby contributing to the development of sepsis. Despite many approaches to the correction of hypermetabolism the goals of treatment remain unreached.
Objectives. To develop a method for the prevention of sepsis in a burn disease by correcting the hypermetabolic syndrome and to evaluate its efficacy.
Material and methods. A cohort study of severely burnt patients with a high probability of sepsis was conducted. The complex method of preventing sepsis by correcting the hypermetabolic syndrome of a burn disease included the temporary closure of wounds with the cadaveric skin, with the technique of preventing early rejection of an allograft, enteral feeding with the preparations of protected glutamine and β-blockers.
Results. The complex method of preventing sepsis 2,14 times (p<0,001) increased the lifetime of the skin allograft without rejection. The applied method 1,25 time (p<0,001) contributed to  the increase of albumin, serum protein – 1,15 time (p=0,001) and IgG – 1,48 time (p=0,020), 1,26 time (p = 0,001) reduced the proportion of neutrophils, the value of C-reactive protein – 2,26 times (p=0,021) and the level of procalcitonin – 6,55 times (p=0,005). The use of the method of preventing early rejection of the skin allograft, enteral feeding with glutamine, β-blockers led to 1,97 time (p=0,004) decrease in the proportion of patients with sepsis, lethality – 2,17 times (p=0,044).
Conclusions. The complex method of preventing sepsis in case of a burn disease, including the prevention of early skin allograft rejection, enteral feeding with the preparations of protected glutamine, beta-blockers, resulted in 1,97-fold reduction in the proportion of patients with sepsis, and 1,31 time increased the effectiveness of treatment of severely burnt patients.
Key words: burn disease, sepsis, prophylaxis, skin alloplasty, enteral feeding, β-blockers.

References

1. Zhilinskiy EV, Chasnoyt' ACh, Alekseev SA, Doroshenko GV. The analysis of lethality, the major prognostic factors and complications among patients with a burn trauma. Med Novosti. 2014;(11):87-91. (In Russ.)
2. Mann EA, Baun MM, Meininger JC, Wade CE. Comparison of mortality associated with sepsis in the burn, trauma, and general intensive care unit patient: a systematic review of the literature. Shock. 2012 Jan;37(1):4-16. doi: http://dx.doi.org/10.1097/SHK.0b013e318237d6bf
3. Zhilinskiy EV, Chasnoyt' ACh, Alekseev SA, Tsvetkova NV. Diagnostics of a sepsis and other infectious complications at patients with a burn disease. Ekstren Meditsina. 2015;(3):100-11. (In Russ.)
4. Zhilinskiy EV, Mazolevskiy LM, Kustinskaya NA. Dermal plasty of an autodermograftama and allodermograftama in treatment of hard burned patients. Vestn Soveta Molodykh Uchenykh Spetsialistov Cheliab Obl. 2014;(3):15-20. (In Russ.)
5. Jeschke MG, Chinkes DL, Finnerty CC, Kulp G, Suman OE, Norbury WB, et al. Pathophysiologic response to severe burn injury. Ann Surg. 2008 Sep;248(3):387-401. doi: http://dx.doi.org/10.1097/SLA.0b013e3181856241
6. McCowen KC, Malhotra A, Bistrian BR. Stress-induced hyperglycemia. Crit Care Clin. 2001 Jan;17(1):107-24.
7. Cree MG, Wolfe RR. Postburn trauma insulin resistance and fat metabolism. Am J Physiol Endocrinol Metab. 2008 Jan;294(1):E1-9. doi: http://dx.doi.org/10.1152/ajpendo.00562.2007
8. Hart DW, Wolf SE, Mlcak R, Chinkes DL, Ramzy PI, Obeng MK, et al. Persistence of muscle catabolism after severe burn. Surgery. 2000 Aug;128(2):312-9.
9. Petri A, Sebin K. Evident medical statistics. Moscow, RF: GEOTAR-Media; 2009. 165 р. (In Russ.)
10. Zhilinskiy EV. Forecasting of a sepsis at a burn disease taking into account specific indicators. Vestn VGMU. 2017;16(2):79-84. (In Russ.)
11. Hunt DG, Ivy JL. Epinephrine inhibits insulin-stimulated muscle glucose transport. J Appl Physiol. 2002 Nov;93(5):1638-43. doi: http://dx.doi.org/10.1152/japplphysiol.00445.2002
12. Mochizuki H, Trocki O, Dominioni L, Brackett KA, Joffe SN, Alexander JW. Mechanism of prevention of postburn hypermetabolism and catabolism by early enteral feeding. Ann Surg. 1984 Sep;200(3):297-310.
13. Peng X, Chen RC, Wang P, You ZY, Wang SL. Effects of enteral supplementation with glutamine on mitochondria respiratory function of intestinal epithelium in burned rats. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2004 Feb;16(2):93-6.
14. Wischmeyer PE. The glutamine story: where are we now? Curr Opin Crit Care. 2006 Apr;12(2):142-8. doi: http://dx.doi.org/10.1097/01.ccx.0000216582.87674.a4
15. Herndon DN, Hart DW, Wolf SE, Chinkes DL, Wolfe RR. Reversal of catabolism by beta-blockade after severe burns. N Engl J Med. 2001 Oct;345(17):1223-9. doi: http://dx.doi.org/10.1056/NEJMoa010342
16. Orgill DP. Excision and skin grafting of thermal burns. N Engl J Med. 2009 Feb;360(9):893-901. doi: http://dx.doi.org/10.1056/NEJMct0804451
17. Stella M, Risso D, Bollero D, Capocelli R, Primiceri C, Castagnoli C. Treatment of extensive burns by means of skin allografts. Burns. 2007 Feb;33(1):S152.
18. Cheglakov EV, Soloshenko VV, Nosenko VM, Mikhaylichenko VYu. Experimental studying of influence of the ozonized solution on a current of a wound process at deep combustions. Kombustiologiia. 2005;(22-23):63-6. (In Russ.)

Information about authors:
Zhylinski Y.V. – surgeon of the burns department, Minsk City Clinical Emergency Hospital, post-graduate of the Chair of General Surgery, Belarusian State Medical University.

Correspondence address: Republic of Belarus, 220024, Minsk, 58 Kizhevatogo str., Minsk City Clinical Emergency Hospital. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Yauhen V. Zhylinski.

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