akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2024.509akusherstvo-2115Research ArticleОRIGINAL ARTICLESОРИГИНАЛЬНЫЕ СТАТЬИSeptic shock in obstetrics: the role of efferent techniques for endotoxin removal in Gram-negative sepsisСептический шок в акушерстве: роль эфферентных методик в удалении эндотоксина при грамотрицательном сепсисеhttps://orcid.org/0000-0001-7577-3284БаялиеваА. Ж.BayalievaA. Zh.

Баялиева Айнагуль Жолдошевна - д.м.н., профессор.

420012 Казань, ул. Бутлерова, д. 49; 420064 Казань, ул. Оренбургский тракт, д. 138

Ainagul Zh. Bayalieva - MD, Dr Sci Med, Professor.

49 Butlerova Str., Kazan 420012; 138 Str. Orenburgsky Tract, Kazan 420064

bayalieva1@yandex.ruhttps://orcid.org/0000-0003-4718-5076ДавыдоваВ. Р.DavydovaV. R.

Давыдова Вероника Рустэмовна - к.м.н.

420012 Казань, ул. Бутлерова, д. 49; 420064 Казань, ул. Оренбургский тракт, д. 138

Veronika R. Davydova - MD, PhD.

49 Butlerova Str., Kazan 420012; 138 Str. Orenburgsky Tract, Kazan 420064

ФГБОУ ВО «Казанский государственный медицинский университет» Министерства здравоохранения Российской Федерации; ГАУЗ «Республиканская клиническая больница» Министерства здравоохранения Республики ТатарстанРоссияKazan State Medical University, Health Ministry of Russian Federation; Republican Clinical Hospital, Ministry of Health of the Republic of TatarstanRussian Federation202423072024184504513Copyright © Bayalieva A.Z., Davydova V.R., 20242024Баялиева А.Ж., Давыдова В.Р.Bayalieva A.Z., Davydova V.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/2115Aim

Aim: to assess the sorption capacity of various devices for endotoxin removal modelled in in vitro patient with septic shock experiment.

Materials and Methods

Materials and Methods. Endotoxin adsorption was evaluated in vitro by using circulating endotoxin solution in bovine serum in a closed circuit. The following columns were chosen for the experiment: Toraymyxin PMX-20R (РМ Х), Alteco® LPS Adsorber, Efferon LPS, Toray Filtryzer BK-2.1U. Lipopolysaccharide (LPS) doses corresponding to severity of the septic process were sequentially added to a column pre-washed with physiological solution. The first LPS dose of 12.5 µg was added to a flask containing 1500 ml (1.5 L) of fetal bovine serum, a second LPS dose of 37.5 µg was added at 120 minute; the serum samples were collected before the onset of experiment, as well as 30, 60, 120 (before the second dose), 120 (after the second dose), 150 and 240 minutes after the start of circulation. LPS measurement was carried out by mixing the prepared serum sample with LAL reagent at 1:1 ratio in a measuring tube.

Results

Results. All columns can reduce endotoxin levels below the 12.5 µg and even 50 µg levels, although none of devices were able to reduce the LPS level from “supercritical” 50 µg to “critical” 12.5 µg. However, at the same time, the capacity of the Toraymyxin PMX-20R column turned out to be 5-13 times greater than that of other products. This result suggests that while removing endotoxin under similar conditions, the Toraymyx in PMX-20R column will have a much higher reserve of sorption capacity and, therefore, greater opportunities for lowering a risk of septic shock progression.

Conclusion

Conclusion. The study we presented provides insights into whether sorption capacity of the tested cartridges is sufficient to remove endotoxin at initial (12.5 µg) load that corresponds to the onset of systemic inflammatory response syndrome in a typical patient. Additionally, it elucidates to what extent a cartridge can reduce the endotoxin load in severe septic shock with a total LPS load of up to 50 µg.

Цель

Цель: оценка сорбционной способности различных устройств по удалению эндотоксина в модели пациента с септическим шоком в эксперименте in vitro.

Материалы и методы

Материалы и методы. Для оценки адсорбции эндотоксина был проведен эксперимент in vitro методом циркуляции раствора эндотоксина в бычьей сыворотке в замкнутом контуре. Для эксперимента были выбраны следующие колонки: Toraymyxin PMX-20R (РМ Х), Alteco® LPS Adsorber, Эфферон ЛПС, Toray Filtryzer BK-2.1U. В предварительно промытую физиологическим раствором колонку последовательно вносили дозы липополисахарида (ЛПС), соответствующие тяжести септического процесса. Первую дозу ЛПС в количестве 12,5 мкг вносили в колбу, содержащую 1500 мл (1,5 л) фетальной бычьей сыворотки, на 120-й минуте в сыворотку добавляли вторую дозу ЛПС в количестве 37,5 мкг. Образцы сыворотки собирали до начала эксперимента, а также через 30, 60, 120 (перед внесением второй дозы) мин, на 120-й (после внесения второй дозы), 150-й и 240-й минуте после начала циркуляции. Измерение ЛПС проводили путем смешивания подготовленного образца сыворотки с ЛАЛ-реагентом в соотношении 1:1 в измерительной пробирке.

Результаты

Результаты. Все колонки могут снизить уровень эндотоксина ниже значений 12,5 мкг и даже 50 мкг, хотя ни одно устройство не показало способности снизить содержание ЛПС с «закритических» 50 мкг до «критических» 12,5 мкг. Но при этом способность колонки Toraymyxin PMX-20R оказалась в 5-13 раз больше, чем у остальных изделий. Этот результат позволяет утверждать, что при удалении эндотоксина в сходных условиях колонка Toraymyxin PMX-20R будет иметь более существенный запас сорбционной емкости и, следовательно, большие возможности для снижения риска прогрессирования септического шока.

Заключение

Заключение. Выполненное исследование дает представление о том, достаточно ли сорбционной емкости для удаления эндотоксина у протестированных картриджей при начальной (12,5 мкг) нагрузке, соответствующей началу синдрома системного воспалительного ответа у типичного пациента, а также насколько картридж может снизить нагрузку эндотоксином при тяжёлом септическом шоке с общей нагрузкой ЛПС до 50 мкг.

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The authors declare that there are no conflicts of interest present.