Effect of total volume replenishment of massive obstetric blood loss on the frequency and severity of multiple organ dysfunction syndrome
Vladyslav Sedinkin, Olena Klygunenko
State Establishment ‘Dnipropetrovsk Medical Academy of Health Ministry of Ukraine’. Department of Anaesthesiology, Intensive Care and Emergency Medicine of Postgraduate Faculty. Dnipropetrovsk, Ukraine.
Background and Goal of Study: The Aim to evaluate the effect of total replenishment of massive obstetric blood loss in the frequency and severity of clinical manifestations of MODS.
Materials and Methods: Having agreed with the local Ethics Committee and obtained the informed consents, 68 women (whose delivery or early postpartum period was complicated by acute severe hemorrhage with blood volume (BV) deficit of 44-52%) were examined. Patients were randomized into 2 groups depending on the characteristics of the BV replenishment. Both groups were similar in relation to age, height, gestation term, blood loss volume (2621±613 ml). In 1 group (n=30) BV replenishment performed according to Ukrainian national protocol (relation between erythrocytes, FFP, and platelet (if necessary) is 1:1:1). In 2 group (n=38) 1500 IU of Prothrombin Complex Concentrate (PCC) (Octaplex) was added to therapy. Were assessed: the number of red blood cells, hemoglobin, hematocrit, standard coagulation, SaO2, liver-kidney complex. Clinical signs of MODS are accounted for myocardial insufficiency (frequency and duration of vasopressor support); respiratory dysfunction (frequency and duration of mechanical ventilation); acute kidney injury (frequency and duration of renal replacement therapy), gastrointestinal dysfunction (frequency and duration of the enteroparesis). The time points: 1, 3, 5, 7, 10, 14 and 28 days after delivery.
Results and Discussion: Analysis showed that use of PCC reduced total infusion-transfusion volume by 24.5% (1300 ml). Comparative analysis of the frequency and severity of clinical manifestations of MODS is presented in Table 1. Patients 2 group had decreased frequency and duration of vasopressor support, frequency and duration of mechanical ventilation, had reduced the number of patients requiring renal replacement therapy, and it duration. The frequency gastrointestinal dysfunction reduced more than twice. This provided a significant reduction in the duration of stay in the ICU from 14.1±1.7 (1 group) to 7.8±2.1 days (2 group).
Conclusion(s): Reducing the total volume of infusion-transfusion therapy provides a significant decrease in frequency of clinical signs of MODS and reduces the duration of stay in the ICU.