What are the symptoms of sepsis. How does sepsis progress to septic shock. What infections commonly lead to sepsis. Who is at higher risk for developing sepsis. How can sepsis complications affect the body.

Unveiling the Complexities of Sepsis: A Serious Medical Emergency

Sepsis is a potentially life-threatening condition that arises when the body’s response to infection spirals out of control. Instead of fighting off the invading pathogens, the immune system turns against the body itself, causing widespread inflammation and organ dysfunction. This critical medical emergency can rapidly progress to septic shock, a severe state characterized by a dramatic drop in blood pressure that can lead to multiple organ failure and death if not treated promptly.

The gravity of sepsis cannot be overstated. While early detection and treatment significantly improve survival rates, the condition remains a leading cause of death in hospitals worldwide. Understanding the symptoms, causes, and risk factors associated with sepsis is crucial for timely intervention and improved outcomes.

Recognizing the Warning Signs: Symptoms of Sepsis

Identifying sepsis can be challenging due to its nonspecific symptoms, which may vary from person to person. However, certain key indicators should raise immediate concern:

• Altered mental status or confusion
• Rapid, shallow breathing
• Unexplained sweating
• Dizziness or lightheadedness
• Shivering or fever
• Symptoms specific to the underlying infection (e.g., painful urination in urinary tract infections or worsening cough in pneumonia)

Are there differences in sepsis symptoms between adults and children? Indeed, sepsis may manifest differently in pediatric patients compared to adults. Parents and caregivers should be particularly vigilant for signs of lethargy, decreased appetite, or changes in behavior in infants and young children.

The Progression to Septic Shock: A Critical Turn

As sepsis advances, it may evolve into septic shock, a severe condition marked by a significant drop in blood pressure. This progression substantially increases the risk of mortality. Symptoms of septic shock include:

• Inability to stand or maintain balance
• Extreme drowsiness or difficulty staying awake
• Severe alterations in mental status, including profound confusion

When should you seek medical attention for suspected sepsis? Any signs of infection that are not improving or are accompanied by sepsis symptoms warrant immediate medical evaluation. Symptoms such as confusion or rapid breathing require emergency care without delay.

The Origins of Sepsis: Understanding the Underlying Causes

Sepsis can result from any type of infection, whether bacterial, viral, or fungal in nature. However, certain infections are more commonly associated with the development of sepsis:

1. Pneumonia and other lung infections
2. Urinary tract infections affecting the kidneys, bladder, or other parts of the urinary system
3. Infections of the digestive system
4. Bloodstream infections (bacteremia)
5. Infections at catheter sites
6. Wound or burn infections

Can sepsis develop from minor infections? While it’s less common, even seemingly minor infections can potentially lead to sepsis, especially in individuals with compromised immune systems or other risk factors.

Identifying High-Risk Groups: Who is More Susceptible to Sepsis?

Certain populations are at an increased risk of developing sepsis following an infection. Understanding these risk factors can help in early identification and prevention efforts:

• Older adults (over 65 years of age)
• Infants and young children
• Individuals with weakened immune systems (e.g., cancer patients, HIV-positive individuals)
• People with chronic medical conditions (diabetes, kidney disease, COPD)
• Patients in intensive care units or those with prolonged hospital stays
• Individuals with invasive medical devices (intravenous catheters, breathing tubes)
• Recent antibiotic use (within the last 90 days)
• Patients on corticosteroid treatments

How does a weakened immune system increase sepsis risk? A compromised immune system may struggle to contain and eliminate infections effectively, allowing them to spread more easily and potentially trigger the dysregulated immune response characteristic of sepsis.

The Devastating Impact: Complications of Sepsis

As sepsis progresses, it can lead to severe complications affecting multiple organ systems:

• Reduced blood flow to vital organs (brain, heart, kidneys)
• Abnormal blood clotting
• Tissue damage or destruction due to clots or ruptured blood vessels
• Increased risk of future infections

What is the mortality rate associated with septic shock? The mortality rate for septic shock remains alarmingly high, ranging from 30% to 40% even with advanced medical care. This underscores the critical importance of early detection and intervention.

Navigating the Aftermath: Long-Term Effects of Sepsis

While many individuals recover from mild sepsis without lasting effects, severe cases can have long-term consequences:

• Increased susceptibility to future infections
• Cognitive impairments or memory problems
• Chronic pain or fatigue
• Post-traumatic stress disorder (PTSD)
• Organ dysfunction or failure

Can sepsis survivors regain full health? Many sepsis survivors do recover fully, but others may experience persistent physical or psychological effects. Comprehensive follow-up care and rehabilitation can significantly improve long-term outcomes.

Empowering Prevention: Strategies to Reduce Sepsis Risk

While it’s not always possible to prevent sepsis, certain measures can help reduce the risk:

• Practicing good hygiene and handwashing
• Keeping vaccinations up to date
• Properly managing chronic health conditions
• Seeking prompt medical attention for infections
• Following prescribed antibiotic regimens completely
• Taking extra precautions if you fall into a high-risk category

How effective are these preventive measures? While no strategy can eliminate the risk of sepsis entirely, these practices can significantly reduce the likelihood of developing severe infections that may lead to sepsis.

The Critical Role of Timely Intervention: Sepsis Treatment Approaches

Early diagnosis and aggressive treatment are paramount in managing sepsis effectively. The primary goals of sepsis treatment include:

1. Controlling the underlying infection
2. Supporting organ function
3. Maintaining blood pressure
4. Preventing complications

Treatment typically involves a combination of interventions:

• Broad-spectrum antibiotics
• Intravenous fluids
• Vasopressors to support blood pressure
• Oxygen therapy or mechanical ventilation if needed
• Dialysis for kidney support
• Surgical removal of infected tissue, if necessary

Why is rapid treatment so crucial in sepsis cases? The progression of sepsis can be incredibly swift, with organ damage occurring within hours. Prompt intervention can halt this progression, potentially preventing septic shock and improving survival rates.

As our understanding of sepsis continues to evolve, so do the strategies for its prevention, diagnosis, and treatment. Ongoing research into biomarkers, novel therapies, and improved risk assessment tools holds promise for further reducing the burden of this life-threatening condition. By staying informed and vigilant, we can work towards better outcomes for those affected by sepsis and ultimately save more lives.

Sepsis – Symptoms & causes

Overview

Sepsis is a serious condition in which the body responds improperly to an infection. The infection-fighting processes turn on the body, causing the organs to work poorly.

Sepsis may progress to septic shock. This is a dramatic drop in blood pressure that can damage the lungs, kidneys, liver and other organs. When the damage is severe, it can lead to death.

Early treatment of sepsis improves chances for survival.

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Symptoms

Symptoms of sepsis

Symptoms of sepsis may include:

• Change in mental status.
• Fast, shallow breathing.
• Sweating for no clear reason.
• Feeling lightheaded.
• Shivering.
• Symptoms specific to the type of infection, such as painful urination from a urinary tract infection or worsening cough from pneumonia.

Symptoms of sepsis are not specific. They can vary from person to person, and sepsis may appear differently in children than in adults.

Symptoms of septic shock

Sepsis may progress to septic shock. Septic shock is a severe drop in blood pressure. Progression to septic shock raises the risk of death. Symptoms of septic shock include:

• Not being able to stand up.
• Strong sleepiness or hard time staying awake.
• Major change in mental status, such as extreme confusion.

When to see a doctor

Any infection could lead to sepsis. Go to a health care provider if you have symptoms of sepsis or an infection or wound that isn’t getting better.

Symptoms such as confusion or fast breathing need emergency care.

Causes

Any type of infection can lead to sepsis. This includes bacterial, viral or fungal infections. Those that more commonly cause sepsis include infections of:

• Lungs, such as pneumonia.
• Kidney, bladder and other parts of the urinary system.
• Digestive system.
• Bloodstream.
• Catheter sites.
• Wounds or burns.

Risk factors

Some factors that increase the risk infection will lead to sepsis include:

• People over age 65.
• Infancy.
• People with lower immune response, such as those being treated for cancer or people with human immunodeficiency virus (HIV).
• People with chronic diseases, such as diabetes, kidney disease or chronic obstructive pulmonary disease (COPD).
• Admission to intensive care unit or longer hospital stays.
• Devices that go in the body, such as catheters in the vein, called intravenous, or breathing tubes.
• Treatment with antibiotics in the last 90 days.
• A condition that requires treatment with corticosteroids, which can lower immune response.

Complications

As sepsis worsens, vital organs, such as the brain, heart and kidneys, don’t get as much blood as they should. Sepsis may cause atypical blood clotting. The resulting small clots or burst blood vessels may damage or destroy tissues.

Most people recover from mild sepsis, but the mortality rate for septic shock is about 30% to 40%. Also, an episode of severe sepsis raises the risk for future infections.

Sepsis – Symptoms & causes

Overview

Sepsis is a serious condition in which the body responds improperly to an infection. The infection-fighting processes turn on the body, causing the organs to work poorly.

Sepsis may progress to septic shock. This is a dramatic drop in blood pressure that can damage the lungs, kidneys, liver and other organs. When the damage is severe, it can lead to death.

Early treatment of sepsis improves chances for survival.

Products & Services

Symptoms

Symptoms of sepsis

Symptoms of sepsis may include:

• Change in mental status.
• Fast, shallow breathing.
• Sweating for no clear reason.
• Feeling lightheaded.
• Shivering.
• Symptoms specific to the type of infection, such as painful urination from a urinary tract infection or worsening cough from pneumonia.

Symptoms of sepsis are not specific. They can vary from person to person, and sepsis may appear differently in children than in adults.

Symptoms of septic shock

Sepsis may progress to septic shock. Septic shock is a severe drop in blood pressure. Progression to septic shock raises the risk of death. Symptoms of septic shock include:

• Not being able to stand up.
• Strong sleepiness or hard time staying awake.
• Major change in mental status, such as extreme confusion.

When to see a doctor

Any infection could lead to sepsis. Go to a health care provider if you have symptoms of sepsis or an infection or wound that isn’t getting better.

Symptoms such as confusion or fast breathing need emergency care.

Causes

Any type of infection can lead to sepsis. This includes bacterial, viral or fungal infections. Those that more commonly cause sepsis include infections of:

• Lungs, such as pneumonia.
• Kidney, bladder and other parts of the urinary system.
• Digestive system.
• Bloodstream.
• Catheter sites.
• Wounds or burns.

Risk factors

Some factors that increase the risk infection will lead to sepsis include:

• People over age 65.
• Infancy.
• People with lower immune response, such as those being treated for cancer or people with human immunodeficiency virus (HIV).
• People with chronic diseases, such as diabetes, kidney disease or chronic obstructive pulmonary disease (COPD).
• Admission to intensive care unit or longer hospital stays.
• Devices that go in the body, such as catheters in the vein, called intravenous, or breathing tubes.
• Treatment with antibiotics in the last 90 days.
• A condition that requires treatment with corticosteroids, which can lower immune response.

Complications

As sepsis worsens, vital organs, such as the brain, heart and kidneys, don’t get as much blood as they should. Sepsis may cause atypical blood clotting. The resulting small clots or burst blood vessels may damage or destroy tissues.

Most people recover from mild sepsis, but the mortality rate for septic shock is about 30% to 40%. Also, an episode of severe sepsis raises the risk for future infections.

Sepsis

Sepsis

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• Sepsis

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Key Facts

• Sepsis occurs when the body’s response to an infection causes damage to its own tissues and organs, and can lead to death or serious deterioration.
• The global epidemiological burden of sepsis cannot be accurately estimated. It is estimated that it develops in more than 30 million people each year and possibly kills 6 million people(1). The problem of sepsis is likely to be most prevalent in low- and middle-income countries.
• An estimated 3 million newborns and 1.2 million children suffer from sepsis each year (2). Three out of ten deaths due to neonatal sepsis are suspected to be due to drug-resistant pathogens.
• One in ten deaths due to pregnancy and childbirth are due to maternal sepsis, with 95% of maternal sepsis deaths occurring in low- and middle-income countries (4). Each year, one million newborns die due to maternal infections, in particular maternal sepsis (5).
• Sepsis may be a clinical manifestation of infections acquired both outside and inside healthcare facilities. Healthcare-associated infection is one of the most common, if not the most common, type of adverse events occurring in the course of healthcare, affecting millions of patients worldwide each year (6). Because these infections are often resistant to antibiotics, they can cause rapid clinical deterioration.

General information

Sepsis is a life-threatening organ dysfunction caused by dysregulation of the body’s response to infection (7). If sepsis is not recognized early and treated promptly, it can cause septic shock, multiple organ failure, and death. Sepsis can be caused by any type of infectious pathogen. Antimicrobial resistance is a leading factor in the lack of clinical response to treatment and the rapid development of sepsis and septic shock. Among patients with sepsis caused by drug-resistant pathogens, there is an increased risk of hospital mortality.

Who is at risk?

Anyone with an infection can develop sepsis, but vulnerable populations such as the elderly, pregnant women, newborns, hospitalized patients, and those with HIV/AIDS, cirrhosis, cancer, kidney disease, autoimmune disease, and spleen (8).

Signs and symptoms

Sepsis is an emergency. However, the signs and symptoms of sepsis in patients may be different at different points in time, since such a clinical condition as sepsis can be caused by many pathogens and change its character at different stages. Warning signs and symptoms include a rise or fall in body temperature and chills, changes in mental status, shortness/rapid breathing, rapid heartbeat, weak pulse/low blood pressure, oliguria, blue or marbling of the skin, cold extremities, and severe pain or discomfort in the body ( 9-eleven). Suspicion of sepsis is the first step towards its early recognition and diagnosis.

Prevention

There are two main ways to prevent sepsis:
1. Prevention of microbial transmission and infection;
2. Prevention of complications of infection to the state of sepsis.

Infection prevention in the community includes good hygiene practices such as handwashing and safe food preparation, improving the quality and availability of water and sanitation, ensuring access to vaccines, especially for those at high risk of developing sepsis, and proper nutrition including breastfeeding newborns.
Prevention of nosocomial infections is generally ensured by having functioning infection prevention and control programs and appropriate teams of staff, good hygiene practices, including hand hygiene, along with cleanliness of the premises and proper operation of equipment.

Prevention of sepsis in both the community and in health care settings involves appropriate antibiotic treatment of infections, including regular assessment of patients for the rational use of antibiotics, prompt medical attention, and early detection of signs and symptoms of sepsis.
The effectiveness of infection prevention is clearly supported by scientific evidence. For example, with strict hand hygiene practices in health care settings, infections can be reduced by up to 50% (12), and in public places, these interventions can reduce the risk of diarrhea by at least 40% (13). Measures to improve water supply, sanitation and hygiene (WASH) can reduce the overall burden of disease worldwide by 10% ¹⁴ . Every year, vaccinations help prevent 2–3 million infection-related deaths (15).

Diagnosis and clinical management

In order to detect sepsis early and manage it appropriately in a timely manner, it is essential to recognize and not ignore the signs and symptoms listed above, and to identify certain biomarkers (particularly procalcitonin). Post-early detection, diagnostic procedures are important to help identify the causative agent of the infection that caused sepsis, since this determines the choice of targeted antimicrobial treatment. Antimicrobial resistance (AMR) can hinder the clinical management of sepsis, as it often requires empirical antibiotic selection. Therefore, it is necessary to understand the epidemiological parameters of the spread of AMR in these settings. Once the source of the infection has been identified, the most important task is to eliminate it, for example, by draining the abscess.
Fluid therapy is also important in the early management of sepsis to normalize circulating fluid volume. In addition, vasoconstrictor drugs may be required to improve and maintain tissue perfusion. Further measures for the correct management of sepsis are selected based on the data of repeated examinations and diagnostic measures, including monitoring of the patient’s vital signs.

Sepsis and the Sustainable Development Goals

Sepsis is a major cause of maternal death, as well as death of newborns and children under five years of age. For this reason, the control of sepsis will clearly contribute to the achievement of targets 3.1 and 3.2 of the Sustainable Development Goals (SDGs).

Sepsis is a highly relevant cause of maternal death, as well as death of newborns and children under five years of age. For this reason, the control of sepsis will clearly contribute to the achievement of targets 3.1 and 3.2 of the Sustainable Development Goals (SDGs).
The indicators for achieving these two SDG targets are maternal, newborn and under-five mortality rates. Sepsis occupies an important place among the causes of these preventable deaths. It is often the clinical condition that ultimately causes death in patients with HIV, tuberculosis, malaria and other infectious diseases mentioned in task 3.3, but it is usually not recorded as a cause of death in such patients and is not is included in the statistics on the indicators of the achievement of SDG target 3.3.
Sepsis is also important, though more indirectly, to other health-related targets under SDG 3. For example, prevention and/or proper diagnosis and management of sepsis is also relevant to adequate vaccine coverage, universal coverage of quality health services, compliance with the International Health Regulations, preparedness and provision of water and sanitation services. However, achieving universal prevention, diagnosis and management of sepsis remains a challenge.

WHO activities

In May 2017, the Seventieth World Health Assembly, based on a report by the WHO Secretariat, adopted a resolution on sepsis.

Resolution WHA70.7. Improving the prevention, diagnosis and clinical management of sepsis
Report of the WHO Secretariat A70/13. Improving the prevention, diagnosis and clinical management of sepsis
Several WHO headquarters-level programmes, in collaboration and coordination with WHO regional offices, are currently studying the public health impact of sepsis and providing guidance and support at country level on prevention, early and correct diagnosis, as well as timely and effective clinical management of sepsis in the interests of a comprehensive solution to this problem. The Global Infection Prevention and Control Team, located at WHO Headquarters in the Department of Service Delivery and Safety, coordinates sepsis activities and leads prevention efforts.

Bibliography

(1) Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med 2016; 193(3): 259-72.

(2) Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of pediatric and neonatal sepsis: a systematic review. The Lancet Respiratory medicine 2018; 6(3): 223-30.

(3) Laxminarayan R, Matsoso P, Pant S, et al. Access to effective antimicrobials: a worldwide challenge. Lancet 2016; 387(10014): 168-75.

(4) Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health 2014; 2(6): e323-33.

(5) Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). In: Black RE, Laxminarayan R, Temmerman M, Walker N, eds. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank(c) 2016 International Bank for Reconstruction and Development / The World Bank.; 2016.

(6) World Health Organization. WHO Report on the burden of endemic health care-associated infection worldwide. 2017-11-21 15:11:22 2011.

http://apps.who.int/iris/bitstream/handle/10665/80135/9789241501507_eng.pdf?sequence=1 (accessed April 10 2018).

(7) Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315(8): 801-10.

(8) Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. British Medical Journal 2016.

(9) United States Centers for Disease Control and Prevention. Healthcare Professional (HCP) Resources : Sepsis. 2018-02-01T06:23:15Z.

https://www.cdc.gov/sepsis/get-ahead-of-sepsis/hcp-resources.html (accessed April 10 2018).

(10) Global Sepsis Alliance. Toolkits. https://www.world-sepsis-day.org/toolkits/ (accessed April 10 2018).

(11) UK SepsisTrust. education. 2018. https://sepsistrust.org/education/ (accessed April 10 2018).

(12) Luangasanatip N, Hongsuwan M, Limmathurotsakul D, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. british medical journal. 2015;351:h4728.

(13) UNICEF. UNICEF Data : Monitoring the Situation of Children and Women – Diarrhoeal Disease. https://data.unicef.org/topic/child-health/diarrhoeal-disease/ (accessed April 10 2018).

(14) Pruss-Ustun A, Bartram J, Clasen T, et al. Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Tropical medicine & international health : TM & IH 2014; 19(8): 894-905.

(15) World Health Organization. Fact sheet: Immunization coverage. 2018-04-10 14:55:37.

Septic shock – Vascular Innovation Center article

Septic shock is a systemic pathological reaction to severe infection. It is characterized by fever, tachycardia, tachypnea, leukocytosis when identifying the focus of the primary infection. At the same time, microbiological examination of blood often reveals bacteremia. In some patients with sepsis syndrome, bacteremia is not detected. When arterial hypotension and multiple systemic insufficiency become components of the sepsis syndrome, the development of septic shock is ascertained.

Causes and pathogenesis of septic shock:

The frequency of sepsis and septic shock has been steadily increasing since the thirties of the last century and, apparently, will continue to increase.
The reasons for this are:

1. Increasing use of invasive devices for intensive care, i.e. intravascular catheters, etc.

2. Widespread use of cytotoxic and immunosuppressive agents (in malignant diseases and transplants), which cause acquired immunodeficiency.

3. Life expectancy increase in patients with diabetes mellitus and malignant tumors, who have a high level of predisposition to sepsis.

Bacterial infection is the most common cause of septic shock. In sepsis, the primary foci of infection are more often localized in the lungs, abdominal organs, peritoneum, and also in the urinary tract. Bacteremia is detected in 40-60% of patients in a state of septic shock. In 10-30% of patients in a state of septic shock, it is impossible to isolate a culture of bacteria whose action causes septic shock. It can be assumed that septic shock without bacteremia is the result of an abnormal immune reaction in response to stimulation with antigens of bacterial origin. Apparently, this reaction persists after the elimination of pathogenic bacteria from the body by the action of antibiotics and other elements of therapy, that is, it is endogenized.
Endogenization of sepsis can be based on numerous, mutually reinforcing and realized through the release and action of cytokines, interactions of cells and molecules of innate immunity systems and, accordingly, immunocompetent cells.

Sepsis, systemic inflammatory response, and septic shock are consequences of an overreaction to stimulation by bacterial antigens of cells that carry out innate immune responses. The overreaction of the cells of the innate immune systems and the reaction of T-lymphocytes and B-cells secondary to it cause hypercytokinemia. Hypercytokinemia is a pathological increase in the blood levels of agents of auto-paracrine regulation of cells that carry out innate immunity reactions and acquired immune reactions.

With hypercytokinemia, the content of primary pro-inflammatory cytokines, tumor necrosis factor-alpha and interleukin-1 abnormally increases in the blood serum. As a result of hypercytokinemia and systemic transformation of neutrophils, endothelial cells, mononuclear phagocytes, and mast cells into cellular effectors of inflammation, an inflammatory process devoid of protective significance occurs in many organs and tissues. Inflammation is accompanied by alteration of the structural and functional elements of the effector organs.

A critical deficiency of effectors causes multiple systemic insufficiency.

Symptoms and signs of septic shock:

The presence of two or more of the following signs indicates the development of a systemic inflammatory response:

• Body temperature higher than 38 ^o C or below 36 ^o C.

• Respiratory rate above 20/minute. Respiratory alkalosis with carbon dioxide in the arterial blood below 32 mm Hg. Art.

• Tachycardia with heart rate greater than 90/minute.

• Neutrophilia with an increase in the content of polymorphonuclear leukocytes in the blood to a level above 12×10 ⁹ /l, or neutropenia when the content of neutrophils in the blood is below 4×10 ^9/ l.

• A shift in the leukocyte formula, in which stab neutrophils make up more than 10% of the total number of polymorphonuclear leukocytes.

Sepsis is evidenced by two or more signs of a systemic inflammatory response in the presence of pathogenic microorganisms in the internal environment, confirmed by bacteriological and other studies.

Course of septic shock

In septic shock, hypercytokinemia increases the activity of nitric oxide synthetase in endothelial and other cells. As a result, the resistance of resistive vessels and venules decreases. A decrease in the tone of these microvessels reduces the total peripheral vascular resistance. Part of the cells of the body in septic shock suffers from ischemia due to disorders of the peripheral circulation. Peripheral circulation disorders in sepsis and septic shock are consequences of systemic activation of endotheliocytes, polymorphonuclear neutrophils, and mononuclear phagocytes.

Inflammation of this genesis is purely pathological in nature, occurs in all organs and tissues. A critical drop in the number of structural and functional elements of most effector organs is the main link in the pathogenesis of the so-called multiple systemic failure.

According to traditional and correct ideas, sepsis and a systemic inflammatory reaction are caused by the pathogenic action of gram-negative microorganisms.

In the occurrence of a systemic pathological reaction to invasion into the internal environment and blood of gram-negative microorganisms, the determining role is played by:

• Endotoxin (lipid A, lipopolysaccharide, LPS). This thermostable lipopolysaccharide makes up the outer coating of Gram-negative bacteria. Endotoxin, acting on neutrophils, causes the release of endogenous pyrogens by polymorphonuclear leukocytes.

• LPS-binding protein (LPBP), traces of which are determined in plasma under physiological conditions. This protein forms a molecular complex with endotoxin that circulates with the blood.

• Cell surface receptor of mononuclear phagocytes and endothelial cells. Its specific element is a molecular complex consisting of LPS and LPSBP (LPS-LPSSB).

Currently, the frequency of sepsis due to invasion of the internal environment of gram-positive bacteria is increasing. The induction of sepsis by gram-positive bacteria is usually not associated with the release of endotoxin by them. It is known that peptidoglycan precursors and other components of the walls of gram-positive bacteria cause the release of tumor necrosis factor-alpha and interleukin-1 by cells of the immune system. Peptidoglycan and other components of the walls of Gram-positive bacteria activate the complement system through an alternative pathway. Whole-body activation of the complement system causes systemic pathogenic inflammation and contributes to endotoxicosis in sepsis and the systemic inflammatory response.

It was previously thought that septic shock was always caused by endotoxin (lipopolysaccharide of bacterial origin) released by gram-negative bacteria. It is now generally accepted that less than 50% of cases of septic shock are caused by Gram-positive pathogens.

Disorders of the peripheral circulation in septic shock, adhesion of activated polymorphonuclear leukocytes to activated endotheliocytes – all this leads to the release of neutrophils into the interstitium and inflammatory alteration of cells and tissues. At the same time, endotoxin, tumor necrosis factor-alpha, and interleukin-1 increase the formation and release of tissue coagulation factor by endothelial cells. As a result, the mechanisms of external hemostasis are activated, which causes the deposition of fibrin and disseminated intravascular coagulation.

Arterial hypotension in septic shock is mainly a consequence of a decrease in total peripheral vascular resistance. Hypercytokinemia and an increase in the concentration of nitric oxide in the blood during septic shock causes the expansion of arterioles. At the same time, by means of tachycardia, the minute volume of blood circulation increases compensatory. Arterial hypotension in septic shock occurs despite a compensatory increase in cardiac output. Total pulmonary vascular resistance increases in septic shock, which can be partly attributed to the adhesion of activated neutrophils to activated pulmonary microvascular endotheliocytes.

The following main links in the pathogenesis of peripheral circulatory disorders in septic shock are distinguished:

1) an increase in the permeability of the microvascular wall;

2) an increase in the resistance of microvessels, which is enhanced by cell adhesion in their lumen;

3) low response of microvessels to vasodilating influences;

4) arteriolo-venular shunting;

5) drop in blood fluidity.

Hypovolemia is one of the factors of arterial hypotension in septic shock.

The following causes of hypovolemia (falling preload of the heart) in patients in a state of septic shock are distinguished:

1) dilatation of capacitive vessels;

2) loss of the liquid part of the blood plasma in the interstitium due to a pathological increase in capillary permeability.

It can be assumed that in the majority of patients in a state of septic shock, the drop in oxygen consumption by the body is mainly due to primary disorders of tissue respiration. In septic shock, mild lactic acidosis develops with normal oxygen tension in mixed venous blood.

Lactic acidosis in septic shock is thought to result from decreased pyruvate dehydrogenase activity and secondary accumulation of lactate, rather than a drop in peripheral blood flow.

Peripheral circulatory disorders in sepsis are systemic and develop with arterial normotension, which is supported by an increase in cardiac output. Systemic microcirculation disorders manifest themselves as a decrease in pH in the gastric mucosa and a drop in blood hemoglobin oxygen saturation in the hepatic veins. Hypoergosis of the cells of the intestinal barrier, the action of immunosuppressive links in the pathogenesis of septic shock – all this reduces the protective potential of the intestinal wall, which is another cause of endotoxemia in septic shock.

Diagnosis of septic shock

• Septic shock – sepsis (systemic inflammatory response syndrome plus bacteremia) in combination with a decrease in blood pressure syst. less than 90 mm Hg. Art. in the absence of visible reasons for arterial hypotension (dehydration, bleeding). The presence of signs of tissue hypoperfusion despite infusion therapy. Perfusion disorders include acidosis, oliguria, acute impairment of consciousness. In patients receiving inotropic drugs, perfusion disorders may persist in the absence of arterial hypotension.
• Refractory septic shock – septic shock lasting more than one hour, refractory to fluid therapy.

Treatment of septic shock:

1. Infusion therapy

• Catheterization of two veins.
• 300-500 ml of crystalloid solution IV as a bolus followed by 500 ml of crystalloid solution IV by drip over 15 minutes. Assess for venous hypertension and the presence of cardiac decompensation.
• In the presence of heart failure, catheterization is reasonable a. pulmonalis with a Swan-Ganz catheter to assess the volemic status: optimal PCWP = 12 mm Hg. Art. in the absence of AMI and 14-18 mm Hg. Art. in the presence of AMI;
• if after an infusion bolus the PCWP value exceeds 22 mmHg. Art., then progression of heart failure should be assumed and active infusion of crystalloids should be stopped.
• If, despite high left ventricular filling pressure values, arterial hypotension persists – dopamine 1-3-5 or more mcg/kg/min, dobutamine 5-20 mcg/kg/min.
• Calculated sodium bicarbonate to correct metabolic acidosis.

2.