Use of intestinal lavage in the treatment of wound sepsis in intensive care unit conditions

BACKGROUND: In sepsis of any etiology, multiple organ dysfunction develops against the background of an infectious focus. Intestinal failure syndrome, as a link in the pathogenesis, leads to impairment of the motor and barrier functions of the intestine, growth of pathogenic flora, and translocation of toxins into the systemic circulation, exacerbating tissue energy deficiency. Intestinal detoxification using a domestic saline enteral solution (SES) with enteroprotective properties allows for the removal of toxic substances through the enterohematic and enterohepatic circulatory pathways. Further study of the effectiveness of this technique is required. AIM: To evaluate the role of the intestinal lavage technique (using a saline enteral solution) in the comprehensive treatment of wound sepsis in the intensive care unit setting. METHODS: A randomized controlled trial was conducted in male patients with wound sepsis. Patients were divided into a main group, which received intestinal lavage with a saline enteral solution at a volume of 2–4 L/day on days 1 and 3 of hospitalization, and a control group receiving standard therapy. Clinical and laboratory status, as well as the dynamics of integral parameters, were assessed on days 1, 3, 5, and 10 of treatment. RESULTS: The use of intestinal lavage with a saline enteral solution contributed to a more rapid decrease in body temperature, heart rate, and respiratory rate, as well as improvement in hemodynamics and oxygen status. In the main group (n = 23), a more pronounced regression of signs of intestinal insufficiency and accelerated normalization of laboratory inflammatory markers were observed compared to the control group (n = 27). Patients receiving the saline enteral solution were transferred from the intensive care unit earlier: by day 5 — 50% vs. 22% in the control group, by day 10 — 79% vs. 55%. CONCLUSION: Analysis of the experience of using a saline enteral solution in the comprehensive treatment of wound sepsis as an additional detoxification method showed a positive accelerated dynamics of resolution of systemic inflammation with the use of intestinal lavage and, as a result, earlier transfer of patients from the intensive care unit.