2004, Number 5
hanges of the oxygen saturation during the intrahospital transport of patients assisted with mechanical ventilation
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ABSTRACTIntroduction: Sepsis and septic shock are the main complications in the burned ill patient and are associated with a high morbi-mortality despite the new antibiotics and the organic support. Sepsis is the result of imbalance between coagulation and inflammation in which protein C activated plays a main role. Recombinant Human Protein C Activated (Drotrecogin Alfa Activated) increases survival in severe sepsis. There is few experience in the management of severe sepsis in the burned ill patient with Recombinant Human Protein C Activated. Patients and methods: Two patients with severe burns, severe sepsis and multiple organ dysfunction (MOD) were included. They were followed up with APACHE II, SOFA and oxygenation index (OI) before, during and after the treatment with Recombinant Human Protein C Activated. The dose employed was 24 mg/kg/h for 96 hours as a continuous infusion. Results: The first patient had 60% of total surface area burned and he was infected with Klebsiella pneumoniae and Enterococcus faecalis. The second patient has 40% of total surface area burned and he was infected with Candida spp. Both of them developed severe sepsis with progression to MOD. As the treatment with Drotrecogin alfa activated was initiated the scores of APACHE II and SOFA decreased and the OI increased significantly. The pulmonary dysfunction and infiltrates improved rapidly. There were no bleeding complications, and both patients survived. Conclusion: Recombinant Human Protein C Activated is safe and contributes to revert severe sepsis and MOD in critically ill burned patients. More clinical trials are needed to validate this results.
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