Pidhirnyy Y. TExtracorporeal Detoxication in Management of Organ Failure Syndrome

The Dissertation focuses on selected steps of pathogenesis, clinical features and diagnosis of dysfunction of the main natural detoxication systems (renal, hepatic and gastrointestinal) viewed as a component of multiple organ dysfunction syndrome.Based on improved criteria of dysfunction of natural detoxication systems three grades of severity are distinguished: compensation, decompensation and failure. The thesis studies detoxifying effect of various efferent therapy techniques and effect on homeostasis of critical patients. For patients with compensated acute renal failure early directed intensive care supplemented by nutritive supports enhances regression symptoms of multiple organ failure syndrome.This resulted in improved filtration and concentration capacity of the kidneys and decreased severity of MODS. For patients with kidney failure slow continuous hemodiafiltration is reasonable uptake thus significantly reducing severity of the critical condition. In patients with compensated acute liver failure early infusion therapy with nutritive support including early enteral feeding and enterosorbtion with selective gut decontamination increases pigment function and cytolytic enzyme levels. For patients with decompensated form of hepatic failure the above therapeutic comlex supplemented with plasmapheresis lead to faster regression of hypocoagulation, detoxifying dysfunction and encephalopathy. For patients with liver albumin dialysis caused faster regression of sign of systemic inflammatory response syndrome normalization of pigment, synthetic and detoxifying function of the liver. In patients with compensated GIT dusfunction early enterl nutrition leads to faster reduction of gastrointestinal dysfunction symptoms, overall improvement and MODS regression. In patients with decompensated gastrointestinal dysfunction selective GIT decontamination, intestinal oxygenation and enterosorbtion caused faster regression of systemic inflammatory response signs, MODSsigns overall severity and gastrointestinal dysfunction syndrome.