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The effect of extracorporeal efferent detoxication (EED) methods inclusion in the severe community-acquired pneumonia (CAP) treatment.

PURPOSE
To assess the clinical efficacy including of EED methods in the treatment of severe CAP with endogenic intoxication syndrome.


MATERIAL AND METHODS
Severe CAP in patients (n = 103, aged 18-60 years, male 89%) were randomly subdivided into the 4 comparable groups. The 1st group (n = 30) was standard treated with antibiotics. The 2nd group (n = 27) underwent additionally 3 courses of extracorporeal ultraviolet light-exposure (UVLE). The 3rd group (n = 25) was co-treated with 3 courses of biospecific hemosorption (BSS). The 4th group (n = 21) underwent 2 additional courses of BSS plus 3 courses of UVLE. The effectiveness of these schemes therapy was assessed by clinical and laboratory data.


RESULTS
The additional application of EED methods led to faster disappearance of clinical symptoms, focal chest signs and the infiltrate resolution in chest X-ray (CXR) as compared with standard treatment. Mean time of the disappearance of fever and sweating was 2.2; 2.5; 2.0 days and 4.8; 5.0; 4.6 days in the 2nd, 3rd and 4th group respectively after EED courses vs 6.1 and 8.0 days in 1st group (P < 0.05). The baseline elastase activity was elevated by 5 times in the 1st-4th groups vs the control (healthy) group and was decreased by 1.5; 2.1; 4.1; 6.6 times respectively (P < 0.05) after treatment in these groups. The initial trypsin-like activity was increased about 5.5 times in all groups vs control and decreased after therapy by 2.1; 3.8; 6.4; 6.0 times (P < 0.05) in the 1st-4th groups respectively. Small CXR residual changes persisted in 7, 4 and 5 patients from the 2nd, 3rd and 4th groups vs 12 patients in the 1st group. The spirometry data were normalized faster in the patients who underwent EED methods (by the 14th day) vs the 1st group.


CONCLUSIONS
Additional using of EED methods in severe CAP therapy is more effective (as compared with traditional management with antibiotics only) in term of faster improvement of patients general condition, reduced time of inflammatory infiltrate resolution and hospitalization by 3-4 days. It has been shown that EED methods correct the main pathogenic mechanisms of severe CAP. Our results indicated on the EED methods as an attractive supportive therapy for the empiric antibiotics treatment of this disease.