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Sepsis: Modern Paradigm
- Authors: 1,2, 3, 2
-
Affiliations:
- North-Ossetian State Medical Academy, 40 Pushkinskaya Str., Vladikavkaz, 362019, Russian Federation
- Non-state operated “Passenger Terminal Hospital at the Vladikavkaz Station of the JST “Russian Railways”, 16 Chkalov Str., Vladikavkaz, 362002, Russian Federation
- Volgograd State Medical University, 1 Pavshikh Bortsov Sq., Volgograd, 400131, Russian Federation
- Issue: Vol 8, No 3 (2015)
- Pages: 301-309
- Section: Original articles
- URL: https://vestnik-surgery.com/journal/article/view/47
- DOI: https://doi.org/10.18499/2070-478X-2015-8-3-301-309
- ID: 47
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Abstract
The article presents the current guidelines for the diagnosis and treatment guidelines for severe sepsis (SS) and septic shock (SSh), reflecting the interdisciplinary experience of experts in more than 30 associations, united in the movement «Surviving Sepsis Campaign».
For the diagnosis of sepsis is recommended to focus on advanced clinical and laboratory criteria and is not recommended to use a higher level of procalcitonin or other biomarkers as a diagnostic tool for the verification of the vehicle.
With regard to the treatment program accented allocated an initial and subsequent stages of treatment. The purpose of the initial phase is to achieve the target parameters of hemodynamics and oxygen status, which is implemented by hemodynamic and respiratory support, adequate surgical control of the focus of infection and the choice of the optimal mode of antibacterial therapy.The highest level of reliability has a number of provisions of the treatment program at SS and SSh: crystalloid infusion solutions are the choice; hydroxyethyl starches should not be used for infusion therapy; norepinephrine is the vasopressor of choice; dobutamine is regarded as the drug of choice to increase cardiac output; restrictive strategy in relation to the use of corticosteroids, blood products, and muscle relaxants; expansion of recommendations for respiratory support; the need for hypo- and normokaloric combined with enteral nutritional support regime; glycemic control should start at the level of blood glucose above 180 mg / dL, in order to achieve the target level of ≤110 mg / dL; continuous renal replacement therapy and intermittent hemodialysis are equivalent in patients with acute renal failure; obligatory daily pharmacoprophylaxis venous thromboembolic complications with the preferred use of low molecular weight heparins and stress gastric ulcer proton pump inhibitors.
About the authors
North-Ossetian State Medical Academy, 40 Pushkinskaya Str., Vladikavkaz, 362019, Russian Federation;
Non-state operated “Passenger Terminal Hospital at the Vladikavkaz Station of the JST “Russian Railways”,
16 Chkalov Str., Vladikavkaz, 362002, Russian Federation
Author for correspondence.
Email: karsan@inbox.ru
Ph.D., Assistant of the Department ofthe Surgical Diseases №3 NOSMA; Oncologist Nonstate operated “Passenger Terminal Hospital at theVladikavkaz Station of the JST “Russian Railways”
Volgograd State Medical University, 1 Pavshikh Bortsov Sq., Volgograd, 400131, Russian Federation
Email: maskins@bk.ru
MD., Prof., Chief of the Department ofthe Hospital Surgery VSMU
Non-state operated “Passenger Terminal Hospital at the Vladikavkaz Station of the JST “Russian Railways”,
16 Chkalov Str., Vladikavkaz, 362002, Russian Federation
Email: z.karsanova@mail.ru
Ph.D., Surgeon Non-state operated“Passenger Terminal Hospital at the Vladikavkaz Station of the JST “Russian Railways”
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