Septic shock in a patient with severe cranio-brain injury during a car crash in the department of neuroreanimation of RNCEMPA AF

The presented clinical observation illustrates the role of screening for inflammatory markers and advanced hemodynamic monitoring in optimizing the intensive care of a patient in the acute period of severe traumatic brain injury. The patient was admitted to the intensive care unit with a diagnosis of acute severe closed concomitant craniocerebral injury. At admission, the level of consciousness was assessed by GCS 5 points. From the first day of stay in the intensive care unit, the victim had hyperthermia up to 39oC, an increase in C-reactive protein, leukocytosis, radiological signs of aspiration pneumonia. On the 2nd day to maintain blood pressure cf. not lower than 80 mm Hg. Art. required an infusion of norepinephrine. On the 10th day the patient's condition deteriorated sharply. Hyperthermia developed up to 40.2oC, cardiovascular insufficiency developed (against the background of vasopressor support, there was a sharp decrease in blood pressure to 49/20 mm Hg). PiCCO (transpulmonary thermodilution) advanced hemodynamic monitoring has been started. There was a need for early diagnosis of sepsis. Laboratory tests routinely used in the work of the department did not meet the criteria for septic shock. There was a slight increase in CRP, and procalcitonin was within normal limits. The diagnostic search was supplemented by the study of interleukins (IL-6 and IL-2R) in blood plasma. A significant increase in their values was revealed, which could be regarded as the initial manifestations of a systemic inflammatory response. As a result, the patient's condition was regarded as septic. Antibacterial therapy was expanded, prolonged veno-venous hemofiltration was started. Against the background of the therapy, the patient's condition stabilized, the patient regained consciousness in the form of opening his eyes, following simple instructions. By the time of discharge, the patient's condition on the Glasgow Outcome Scale was estimated at 4 points.