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Published on: April 9, 2013

[Early application of plasmapheresis for complex treatment of purulent mediastinitis]

M M Abakumov, I V Aleksandrova, S I Reĭ

    Khirurgiia
    |April 23, 2008
    PubMed

    Insights

    Early plasmapheresis significantly reduces mortality in acute purulent mediastinitis (APM). This treatment improves hemostasis, microcirculation, and immune function, decreasing intoxication and systemic inflammation.

    Area of Science:

    • Surgical Infections
    • Critical Care Medicine
    • Immunology

    Context:

    • Acute purulent mediastinitis (APM) presents a severe clinical challenge with high mortality rates (17-80%).
    • Prognostic indicators for APM include advanced age, elevated APACHE-2, SAPS-2, SOFA scores, and specific biochemical markers like creatinine, urea, and glucose.
    • Traditional management of APM necessitates effective interventions to mitigate its severe course.

    Purpose:

    • To evaluate the efficacy of plasmapheresis as an adjunctive therapy in managing acute purulent mediastinitis.
    • To determine the impact of early versus late initiation of plasmapheresis on patient outcomes.
    • To investigate the mechanisms by which plasmapheresis influences physiological parameters in APM patients.

    Summary:

    • A study involving 80 patients with APM assessed the effectiveness of plasmapheresis, particularly in the postoperative period for 66 patients.
    • Early plasmapheresis application demonstrated a significantly lower lethality rate (12.5%) compared to late application (35.3%) and a control group (36.2%).
    • Plasmapheresis was observed to normalize hemostasis, improve microcirculation, restore immune parameters, and reduce systemic inflammation and intoxication.

    Impact:

    • Early plasmapheresis is a critical intervention for improving survival rates in acute purulent mediastinitis.
    • The findings support the integration of plasmapheresis into the standard treatment protocols for severe surgical infections like APM.
    • Understanding plasmapheresis's role in modulating key physiological systems offers new therapeutic avenues for critical surgical conditions.

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