Sepsis: traditions and innovations in the terminology, pathogenesis, diagnosis, intensive care — to save and to preserve the life of the patient

L.A. Maltseva, N.F. Mosentsev, V.N. Lisnichaya, D.V. Bazilenko, E.A. Mishchenko

Abstract


The article deals with a new position regarding the definition of sepsis, septic shock, life-threatening organ dysfunction; SOFA system is presented. It is shown that the new definition of sepsis does not exclude a systemic inflammatory response syndrome. The main priorities in the diagnosis and intensive therapy of sepsis are marked. The strategy of the septic shock phases is outlined: SOSD. Risk factors are presented, as well as their treatment in scales of SRS and SSRS. There are outlined the basic positions of the new paradigm of sepsis pathogenesis, based on the sequential inclusion of certain biomarkers into the pathophysiological mechanisms. The characteristic of the phases of shock is provided depending on the principle, goals, time of onset, infusion therap, typical scenario of the outcome, monitoring results. Principles of the diagnosis of hypovolemia, overhydratation are justified. The analysis of the influence of the central venous pressure values on the cardiac output, acute kidney injury, microcirculation is performed. We have evaluated risk and outcome factors in terms of the time of resolution of septic shock in different strategies of fluid therapy. Advantages and disadvantages of liberal and conservative oxygenation were detected. The advisability of immune correction is established. It is proved that the high ratio of P(v-a) CO2 / C(a-v)O2 is an indicator of anaerobic metabolism, and intramucosal acidosis reflects the splanchnic hypoperfusion. The options of metabolic resuscitation are presented.

Keywords


sepsis; life-threatening organ dysfunction; diagnosis; intensive care; review

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DOI: https://doi.org/10.22141/2224-0586.3.82.2017.102330

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