Severe combined trauma is one of the main causes of mortality in intensive care units. Treatment of these pathological states is accompanied by the development of oxidative stress, which indicates an unfavorable prognosis, since oxidative stress often leads to multiple organ dysfunction [1]. In addition, patients in this group have a high risk of developing purulent-septic complications.
Thus, assessing the condition of patients with multiple and combined trauma as well as predicting the development of complications in patients in the early period is a very important task. Previously for this purpose open-circuit potential of platinum electrode (OCP), measured in blood plasma or serum, was successfully used for transplant patients. The effectiveness of using this electrochemical parameter in living biological media is based on the fact that it reflects the state of equilibrium in the antioxidant/pro-oxidant system. Analysis of monitoring the values of OCP in the treatment of patients with grafted organs led to the development of criteria for assessing the severity of the patient's condition and predicting the effectiveness of treatment [2].
In the present work 28 patients with severe combined trauma were investigated. OCP measurements in blood plasma samples were carried out according [2] on a platinum electrode against saturated Ag/AgCl electrode. The potentiostat IPC-Compact ("Kronas", Russia) was used.
The obtained data showed that the changes in the OCP values of the Pt electrode measured in the blood plasma in above patients had significant differences with respect to values obtained earlier in patients with grafted organs [3]. Unusually high values of potential shifts of the platinum electrode in the blood plasma (ΔOCP) were observed during 1 day. The absolute values of OCP shifts were significantly higher compared with data obtained earlier from patients with grafted organs.
For example, the value of the OCP in blood plasma in patient B. shifted on 39 mV to the positive potential region for the first day and for 7 days in the early period on 86 mV (Fig. 1a). At the same time it was obtained that dependence potential on time contained wavelike sections (Fig. 2b). According to [3], like data indicates to inflammatory processes occurring in organism. Indeed, by the clinical examination of the patient it was revealed the development of purulent tracheobronchitis, and later (only on the 13th day) - secondary purulent meningitis accompanied by the development of intoxication, systemic inflammatory response syndrome and multiple organ dysfunction syndrome.
It is important that the average values of OCP measured in blood plasma of investigated patients in critical condition was into the potential range distinguishing for apparently healthy people. However during the monitoring abnormal shifts of the OCP were detected both to the positive and to the negative potential region. At the same time it was shown earlier [3] that the change of the OCP value for 1 day more than 25 mV and the output of their numerical values beyond the limits typical for apparently healthy people indicates the development of pathological conditions. The maximum change of OCP in absolute value in patients in critical condition reached 158 mV for one day, while the maximum effects observed earlier in patients with grafted organs were no more than 60 mV.
Anomalously high absolute values and shifts of OCP obtained in patients with severe trauma, can be explained not by the extreme severity of their condition, but by the specificity of the development of this disease. Organism of the patient was full of strength before injury, therefore organism responded to a severe organs and tissues injuries very actively, whereas patients after organ transplantation were for a long time chronic patients. Organism of such patients was in a weakened state, thus organism can give weak response.
Thus, OCP monitoring in the blood plasma in patients with severe combined trauma in critical conditions can be used to predict the development of inflammatory processes and evaluate the effectiveness of the therapy.
References
- Keel M., Trentz O. Pathophysiology of Polytrauma // Injury. 2005; 36(6): 691-709.
- Goldin M.M., Khubutia M.Sh., Evseev A.K. et al. Noninvasive Diagnosis of Dysfunctions in Patients After Organ Transplantation by Monitoring the Redox Potential of Blood Serum // Transplantation. 2015; 99(6): 1288-92.
- Evseev A.K., Levina O.A., Petrikov S.S. et al. An Electrochemical Apparatus for Determination of the Redox Potential of Blood Plasma and Serum // Biomed. Eng. 2016; 50(1): 50-3.
