Sorokina O. Organ-protective intensive care therapy during surgery in severely burned

This thesis is dedicated to the issues of treatment improvement in patients with different degree of thermal injury in acute burn disease. Different techniques and methods of perioperative organ-protective care therapy were grounded. The correlation of acute burn disease manifestation and dynamics of clinical and laboratory inflammatory/anti-inflammatory markers, cortisol levels in acute burn disease was revealed. Changes in serum IL-1?, TNF? and IL-18 proved to be dependent on total burned area, degree of burns and characteristics of adaptation. Relative suprarenal glands failure on the 3-5 day of burn disease was detected in patients with severe burns and early surgical treatment. For the first time has it been revealed on the basis of cluster analysis that the necessity of fluid resuscitation with crystalloids is reduced at 1,5-2,5 times when the surface area of the burns is extensive and the combination of fluids is used for the resuscitation in patients with severe acute burn disease. This helps reduce 2,5 times of the fluids volume in 1 day of burn disease, calculated by Parkland’s formula. Based on differential approach, the most current and appropriate pathways of organ-protective and hemodynamic support in burn shock were elaborated which allows to reduce preoperative preparation period in patients with severe thermal injury. It has been shown that the “step by step” management algorithm of the burned patient helps reduce duration and severity of the burn shock and gives an opportunity for early surgery in the burned.