Hale BORAZAN, Çiğdem SİZER, Alper YOSUNKAYA

Şiddetli sepsiste çifte olazmafiltrasyon adsorpsiyon uygulanması

Amaç: Şiddetli sepsis ve septik sokun mortalitesi oldukça yüksektir. Şiddetli sepsis ve akut akciğer hasan tedavisi için çifte plazmafiltrasyon adsorpsiyon uygulanan olguyu sunmayı amaçladık. Olgu Sunumu: Elektif sol femur osteokondritis dissekans (OCD) için genel anestezi altında öpere olan otuz bir yaşında kadın hasta ortopedi servisinde değerlendirildiğinde, şuuru uykuya meyilli, Glasgow koma skoru (GKS) 12, pupiller izokorik ve ışık refleksi ++, solunumu sayısı 40 dk1, kalp atım hızı 115 dk', kan basıncı 180/100 mmHg, vücut sıcaklığı 38,5°C olarak saptandı. Hastaya postoperatif solunum yetmezliği tanısı konularak yoğun bakım ünitesinde mekanik ventilasyon destek tedavisi başlandı. İlk gün APACHE II skoru 29 olarak belirlendi. Antibakteriyel ve destek tedavilerine rağmen 5. günde şiddetli sepsis gelişti. Hastaya toplam 5 seans her biri yaklaşık 13 saat süren çifte plazmafiltrasyon adsorpsiyon uygulandı. Hasta yatışının 33. günü sekelsiz olarak taburcu edildi. Sonuç: Aspirasyon pnömonisine sekonder akut sıkıntılı solunum sendromu (ARDS) ve sepsis gelişen hastada standart bakım tedavilerine ek olarak çifte plazmafiltrasyon adsorpsiyon uygulamasının hayat kurtarıcı olabileceği kanısına varıldı.

Aplication of coupled plazmafiltration in severe sepsis

Objective: The mortality of severe sepsis and septic shock is extremely high. We aimed to present a case to which we applicated coupled plasmafiltration adsorption for treatment of severe sepsis and acute lung injury. Case Report: Assessment of the 31 year-old female operated for elective osteochondritis dissecans (OCD) under general anesthesia in the orthopedia service revealed that Glasgow Coma Scale 12, isochoric pupils, bilateral positive light reflex, spontan ventilation rate (40 min1), heart rate (115 miri1), blood pressure 180/100 mmHg, body temperature (38.5°C). It was diagnosed as postoperative respiratory failure and she was mechanically ventilated in intensive care unit. In first day, APACHE II score was determined as 29. In the 5th day severe sepsis developed in spite of antibacterial and supportive treatments. Coupled plasmafiltration adsorption was started in the 7th day and applicated total 5 sessions each was going on approximately 13 hours. She was discharged without sequel in the 33th day. Conclusion: In a case with severe sepsis and acute lung injury due to aspiration, in addition to standart care therapies, the application of coupled plasmafiltration adsorption may be life-saving.

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