S 368 10. Multi-Organ Failure - Poster Discussions 030 PLASMA EXCHANGE AS AN ADDITIONAL THERAPY IN SEPTIC SHOCK WITH MULTIPLE ORGAN FAILURE D. Siebenlist, R. Klobe, W. Gattenlohner OBJECTIVES: The therapeutic goal in the treatment of septic patients is to eliminate or block mediators of inflammation in order to prevent multiple organ failure (MOF). Plasma exchange (PE) seems to be an effective me- thod of eliminating mediators. DESIGN, SUBJECTS AND METHODS: 19 patients with septic shock and MOF, who were resistant to the usual treatment of septic shock (substitution of volume, antibiotics, catecholamines) were treated by PE as an additional the- rapy. PE was performed as a membrane plasmaseparation, three litres of plasma were exchanged and substituted by human albumin or fresh-frozen-plasma during each PE. The therapeutic effect of PE was evaluated by scoring systems (APACHE II, ELEBUTE), clinical and hemodynamic parameters. RESULTS: 52 % of our patients had a grampositive sepsis, 26 % had a gramnegative sepsis. A three organ failure was seen in 58 %, a four organ failure in 37 %. After PE, 11 patients showed a significant clinical improvement (responder group), 8 patients showed no improvement (nonresponder group). The mortality of the responder group after PE was 45,5 % ( statistically exspected mortality 96 %), the mortality of the nonresponder group 87,5 % ( significant by Fischer/Yates-Test). No complica- tion of the PE was seen, the surviving patients recovered without sequelae. CONCLUSION: In our observational study we could demon- strate that PE in septic patients seems to be an effec- tive additional treatment to reduce the high mortality of these patients. Intensive Care Unit, Department of Internal Medicine, Leopoldina-Hospital Schweinfurt, Germany 061 PLASMAPHERESIS AS METHOD OF MOF-SYNDROME PROPHYLACTICE IN MASSIVE OBSTETRIC BLEEDINGS. A.N. Diugehev, V.F.Kovalev, M.D.Fomin, V.A.Sokolov The MOF-syndrome is one of the main causes of mortality in puerperas with massive obstetric bleedings in Russia. According to different authors the incidence of MOF-syndrome varies in interval 25- 77%. Mortality rate in such situation mounts to 80% and more. The late works demonstrate that MOF-syndrome is a result of "damage factors" persistence in circulation. The discrete plasmapheresis (PP) was carried out for prophylactice of MOF-syndrome in puerperas with massive obstetric bleedings in early 12 hours after performing of surgical hemostasis. 70% of CPV (circulating plasma volume) exfusion was substituted by equivalent volumes of donors' FFP and 10% VAES-sterile solution. The discrete PP was performed in 45 puerperas with massive (1800,0- 5000,0 ml; mean = 3450,0 ml) bleedings. Critical hypotension during the period 15-60 min developed in 14 females. In 17 females the hemodinamic stability was achieved by vasopressors. All patients had artificial ventilation. The basic functional hemodinamic tests, chronometric hemostasis parameters, DIC-syndrome markers, oxygen saturation and biochemical blood tests were controled before and after each plasmapheresis procedure. At the end of the PP procedure the system hemodinamic without cardiotrope vasopressor therapy and chronometric hemostasis parameters in coagulogramm normalised. The microcirculation improvement and liquidation of hypoxia has been observed, confirmed by ABC tests and normalisation of the saturation. Not a single case of MOF-syndrome has been registrated. 2 of 45 females died (mortality rate = 4,4 %). The discrete PP is one of the effective methods of MOF-syndrome prophylactice in massive obstetric bleedings. Urgent Hematological Aid Department Hematological Scientific Center, Moscow, Russia 114 METHOD OF SYSTEMIC INFLAMMATORY RESPONSE RESTRICTION IN NEUROSURGERY EI Vereschagin OBJECTIVES: Systemic inflammatory response (SIR) due to phagocytes activation is an universal reaction to trauma and blood loss. The most dangerous complications of surgery, such as circulatory shock and multiorgan failure (MOF), are connected with SIR. Previously it was shown that different immunomodulators injected several times make the macrophages tolerant to ischemia and trauma. DESIGN: The aim of study was to investigate the method of SIR restriction in neurosurgery by immunomodulators. SUBJECTS AND METHODS: "Pyrogenal" (Russia) was injected preoperatively twice to 14 patients, 2-8 years of age, suffering from brain tumors. In the control group I l patients with the same pathology and age were prepared to surgery by the common method. Neopterin determination and zumosan-induced chemiluminescence (ZIC) were used for estimation of activity of macrophages and blood granulocytes respectively. RESULTS AND STATISTICAL ANALYSES: In the control group 7 patients were registered to have perioperative disturbances of blood circulation, dangerous for life, in spite of adequate anesthesia and correction of blood loss. After surgery the following complications were noted: unstable arterial preasure and heart failure(6 patients), respiratory infections(3) and MOF(2); one patient died. In the control group macrophage activity increased by 270% by the 3rd day after the operation, and was enhanced for 7 days postoperatively. The rate of macrophage activity postoperatively had a positive correlation with the nitrogen excretion with urine (P<0.01). On the contrary among "Pyrogenal"-pretreated patients activity of macrophages did not change after the operation, and ZIC was 2-times less when compared with the control group for the first 3 days after operation. The "Pyrogenal'- pretreated patients were noted to have no complications perioperatively and after surgery. CONCLUSION: The restriction of SIR in the neurosurgery decrease the risk of peni- and postoperative complications significantly. Dept. of Anaesthesiology, Medical Institute, Novosibirsk 630083, P.B. 26, Russia 136 NITRITE/NITRATE(NOx)AND sFas ANTIGEN LEVELS WITH MULTIPLE ORGAN FAILURE T Kasai, S Endo 1 , K Inada2 , T Takakuwal, Y Yamadal, T Suzukil, S Taniguchi' It is well known that microcirculatory disorders after various kinds of shock cause organ disorders, progressing to multiple organ failure (MOF). In particular, nitric oxide (NO) plays an important role in damaging the vascular endothelium during septic shock. When the human Fas antigen was inoculated on murine cells, the cells were immediately killed by the anti-human Fas antibody. However, it has a also been reported that NO is associated with Fas antigen production. In this study, nitrite/nitrate (NOx), instead of NO, as well as soluble Fas antigen (sFas) were examined in 44 patients with multiple organ failure. Goris' diagnostic criteria were used to diagnose MOF. Of 44 patients with MOF, sepsis complicated 33 patients, while there was no infection detected in 11 patients. There was no significant difference in the mean age between the two groups. Nitrite/nitrate (NOx) was measured using an autoanalyzer (TLC- NOX 1000, Tokyo Kasei Kogyo Co., Ltd., Tokyo, Japan) according to Griess' method. The normal range of NOx is 38.3 ± 19.1 smol/l. sFas was measured by enzymed-linked immunosorbent assay (MBL, Nagoya, Japan). The detection limit is 01. ng/ml, and normal values in healthy adults are below the detection limit. In the MOF group with sepsis, the mean sFas level was 8.7 ± 5.2 ng/ml, being slightly, but not significantly, higher than that in the MOF group without infection (5.7 ± 3.9 ng/ml) (p=0.526). There was a significant correlation between NOx and sFas levels. Both sFas and NOx levels were high during MOF, and rapidly decreased when MOF was relieved. However, in patients with MOF, both both sFas and NOx remained high. These findings suggested that sFas and NOx contribute to the development of MOF. Cells may play an important role by activating their own apoptosis programs causing cell death in response to various stimuli. t Critical Care and Emergency Center, Iwate Medical University, 2 Department of Bacteriology, Iwate Medical University, 19-1 Uchimaru, Morioka 020, Japan.