What is sepsis and how does it develop. Who is at risk of sepsis. What are the symptoms of sepsis. How is sepsis diagnosed. What are the treatment options for sepsis. How can sepsis be prevented. What is the prognosis for sepsis patients.

Understanding Sepsis: A Life-Threatening Condition

Sepsis is a severe and potentially fatal condition that occurs when the body’s response to an infection spirals out of control. It begins with a simple infection, such as a cut on the arm, which allows bacteria or other microbes to enter the body. While the immune system typically fights off these invaders, in some cases, the defense mechanism goes awry, leading to a cascade of events that can result in organ damage and even death.

The gravity of sepsis cannot be overstated. Each year, approximately 1.7 million U.S. adults develop sepsis, with nearly 270,000 succumbing to the condition. Dr. John Sather, an emergency physician at Yale Medicine, emphasizes its significance: “It is one of the leading causes of death in the United States, on par with cancer and heart disease.”

The Pathophysiology of Sepsis: From Infection to Systemic Crisis

To understand sepsis, it’s crucial to grasp how a localized infection can escalate into a systemic crisis. When an infection occurs, the immune system releases chemicals to combat the invading pathogens. In sepsis, this response becomes exaggerated, leading to widespread inflammation throughout the body.

This overactive immune response can cause:

• Leaky or clotted blood vessels
• Loss of circulating blood volume
• Low blood pressure
• Organ failure

In severe cases, sepsis can progress to septic shock, a condition characterized by dangerously low blood pressure, compromised oxygen delivery to vital organs, and an imminent threat of death.

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

While sepsis can affect anyone, certain groups are more vulnerable to its development. These include:

• Infants under 12 months
• Pregnant women
• Older adults
• People with chronic health conditions (e.g., diabetes)
• Individuals with weakened immune systems

Are certain types of infections more likely to lead to sepsis? Indeed, some infections are more commonly associated with sepsis development:

1. Lung infections (pneumonia)
2. Urinary tract infections
3. Skin infections (particularly burns)
4. Infections of the digestive system

Recognizing the Signs: Early Symptoms of Sepsis

Early detection of sepsis is crucial for effective treatment. Dr. Sather emphasizes the importance of patient awareness: “Patients can play an important role in their care by recognizing early symptoms that might be associated with sepsis.” The most common signs include:

• Source of infection (cough, sore throat, abdominal pain, pain with urination) accompanied by fever
• Elevated heart rate
• Shortness of breath
• Confusion or disorientation
• Lightheadedness and/or low blood pressure
• Decreased urine output

Is it possible to distinguish sepsis symptoms from those of other conditions? While some symptoms overlap with other illnesses, the combination of an infection source, fever, and systemic symptoms (like rapid heart rate and confusion) should raise suspicion for sepsis.

Diagnostic Challenges: How Medical Professionals Identify Sepsis

Diagnosing sepsis can be challenging due to the lack of a single definitive test. Instead, healthcare professionals rely on a combination of clinical signs, symptoms, and laboratory tests to make a diagnosis. The diagnostic process typically involves:

1. Assessing for the presence of an infection
2. Monitoring vital signs (blood pressure, heart rate, breathing rate)
3. Conducting blood tests to check for:
   • Elevated or low white blood cell count
   • Increased lactic acid levels
   • Markers of organ dysfunction (e.g., creatinine for kidney function, liver enzymes)
4. Urine tests to check for urinary tract infections or kidney problems
5. Imaging studies (e.g., chest X-rays for suspected pneumonia)

Why is early diagnosis of sepsis crucial? Early detection allows for prompt initiation of treatment, which significantly improves patient outcomes and reduces the risk of progression to septic shock.

Treatment Approaches: Combating Sepsis and Saving Lives

The treatment of sepsis requires a multi-faceted approach aimed at controlling the infection, supporting organ function, and preventing complications. Key components of sepsis treatment include:

• Prompt administration of broad-spectrum antibiotics
• Intravenous fluid resuscitation to maintain blood pressure and organ perfusion
• Vasopressor medications to support blood pressure if fluids alone are insufficient
• Oxygen therapy or mechanical ventilation if respiratory function is compromised
• Continuous monitoring and support of organ function

In some cases, additional interventions may be necessary, such as dialysis for kidney failure or surgery to remove infected tissue.

How quickly should treatment be initiated for sepsis patients? The Surviving Sepsis Campaign guidelines recommend initiating antibiotic therapy within one hour of recognizing sepsis or septic shock, highlighting the time-sensitive nature of treatment.

Emerging Therapies and Research

Research in sepsis treatment is ongoing, with scientists exploring new approaches to improve outcomes. Some areas of investigation include:

• Immunomodulatory therapies to regulate the immune response
• Targeted therapies based on individual patient characteristics
• Novel biomarkers for earlier and more accurate diagnosis
• Machine learning algorithms to predict sepsis development in hospitalized patients

Prevention Strategies: Reducing the Risk of Sepsis

While not all cases of sepsis can be prevented, certain measures can reduce the risk of developing this life-threatening condition:

1. Practicing good hygiene, including regular handwashing
2. Keeping wounds clean and protected
3. Staying up-to-date with vaccinations, particularly for pneumonia and influenza
4. Managing chronic health conditions effectively
5. Seeking prompt medical attention for infections, especially if you’re in a high-risk group

Can lifestyle changes impact sepsis risk? Indeed, maintaining a healthy lifestyle, including a balanced diet, regular exercise, and adequate sleep, can strengthen the immune system and potentially reduce the risk of infections that could lead to sepsis.

Long-Term Outlook: Prognosis and Recovery from Sepsis

The prognosis for sepsis patients varies widely depending on factors such as the severity of the condition, the timeliness of treatment, and the patient’s overall health. While sepsis can be fatal, many patients can make a complete recovery with early diagnosis and appropriate treatment.

However, some sepsis survivors may experience long-term effects, including:

• Chronic fatigue
• Cognitive impairment
• Muscle weakness
• Increased risk of recurrent infections
• Post-traumatic stress disorder (PTSD)

What is the typical recovery timeline for sepsis survivors? Recovery time can vary significantly, ranging from weeks to months or even years. Some patients may require ongoing medical care and rehabilitation to address lingering health issues.

The Importance of Follow-up Care

For sepsis survivors, comprehensive follow-up care is crucial. This may include:

• Regular check-ups with healthcare providers
• Physical therapy to address muscle weakness
• Cognitive rehabilitation for those experiencing mental fog or memory issues
• Psychological support to manage emotional trauma
• Nutritional counseling to support overall health and recovery

Raising Awareness: The Role of Education in Combating Sepsis

Given the challenges in diagnosing sepsis and its potentially rapid progression, public awareness is crucial. Healthcare organizations, medical professionals, and patient advocacy groups play a vital role in educating the public about sepsis. Key areas of focus include:

• Recognizing early signs and symptoms
• Understanding risk factors
• Promoting preventive measures
• Emphasizing the importance of seeking prompt medical attention

How can healthcare systems improve sepsis outcomes on a broader scale? Implementing standardized protocols for sepsis recognition and treatment, continuous staff training, and leveraging technology for early detection can significantly improve sepsis outcomes across healthcare settings.

Global Initiatives and Sepsis Awareness

Several global initiatives are working to combat sepsis, including:

• World Sepsis Day (September 13th) to raise awareness
• The Global Sepsis Alliance, which promotes education and research
• WHO resolutions recognizing sepsis as a global health priority

These efforts aim to reduce the global burden of sepsis through improved prevention, recognition, and management strategies.

The Future of Sepsis Care: Innovations and Challenges

As our understanding of sepsis evolves, so too do the approaches to its diagnosis and treatment. Emerging areas of research and innovation include:

• Precision medicine approaches tailored to individual patient characteristics
• Advanced biomarker panels for rapid and accurate diagnosis
• Artificial intelligence algorithms for early sepsis prediction in hospital settings
• Novel therapies targeting specific aspects of the sepsis cascade
• Improved strategies for long-term sepsis survivor care

What challenges remain in sepsis research and treatment? Despite advancements, significant challenges persist, including the need for more accurate diagnostic tools, effective treatments for septic shock, and strategies to address the long-term consequences of sepsis.

The Role of Collaboration in Advancing Sepsis Care

Addressing the complex challenges of sepsis requires a collaborative approach involving:

• Multidisciplinary research teams
• Partnerships between academic institutions and pharmaceutical companies
• International cooperation to share data and best practices
• Engagement with patient advocacy groups to ensure research aligns with patient needs

By fostering such collaborations, the medical community can accelerate progress in sepsis prevention, diagnosis, and treatment, ultimately improving outcomes for patients worldwide.

Sepsis > Fact Sheets > Yale Medicine

Overview

An infection can start with a simple injury—like a shallow cut on the arm—that allows bacteria and other microbes to slip into your body’s tissue or circulation. Your immune system is designed to detect these foreign invaders, launch an attack, and kill the infectious microbes—but sometimes the defense doesn’t work as planned. 

When this happens, the infection progresses and the immune system battles even harder by releasing more infection-fighting chemicals. In rare cases, rather than being helpful, these extra chemicals begin to overwhelm the body. As in a game of dominoes, this can then lead to further failures of the body’s processes. 

Sepsis occurs when an already-present infection spirals out of control and begins to cause organ damage, and even death. The term “septic shock” is used to describe what’s happening when a person’s blood pressure is low, oxygen delivery to vital organs is compromised, and the threat of death is imminent.  

About 1.7 million U.S. adult cases of sepsis occur each year, and nearly 270,000 die from the condition. Sepsis can be difficult to diagnose immediately, which makes general awareness about it all the more important. “It is one of the leading causes of death in the United States, on par with cancer and heart disease,” says Yale Medicine emergency physician John Sather, MD. “Sepsis is challenging because often the inciting event is a common infection. Patients often don’t think of common infections as potentially deadly ones.” 

While septic shock can be fatal, many patients can make a complete recovery if they are diagnosed and treated early with antibiotics, intravenous fluids, and blood pressure support. At Yale Medicine, our physicians are involved in research to find ways to detect sepsis earlier and potential new treatment options.

What is sepsis?

Sepsis is a life-threatening condition that is caused by any type of infection a person already has—it can be bacterial, fungal, or viral—and the complex immune response that attempts to fight it. The immune system itself, while an important component of the body’s defense against infection, produces chemicals that can inadvertently cause leaky or clotted blood vessels, loss of circulating blood volume, low blood pressure, organ failure and/or death.    

Who is at risk of getting sepsis?

Sepsis can affect anyone at any age, but especially susceptible are infants (under 12 months), pregnant women, older adults, and people with chronic health conditions like diabetes and/or weakened immune systems.

Sepsis is most commonly associated with the following types of infections:

• Lung infections (like pneumonia)
• Urinary tract infections
• Skin infections (especially burns)
• Infections of the digestive system 

What are symptoms of sepsis?

Because sepsis can happen quickly, it is important to be alert for early signs. The most common signs include the following:

• Source of infection (cough, sore throat, abdominal pain, pain with urination) and fevers
• High heart rate
• Shortness of breath
• Confusion or disorientation
• Lightheadedness and/or low blood pressure
• Decreased urine output

“Patients can play an important role in their care by recognizing early symptoms that might be associated with sepsis,” Dr. Sather says. 

How is sepsis diagnosed?

A single diagnostic test for sepsis does not yet exist, and so doctors and healthcare professionals use a combination of tests and immediate and worrisome clinical signs, which include the following:

• The presence of an infection
• Very low blood pressure and high heart rate
• Increased breathing rate

Doctors will also do tests to try to confirm the presence—and possibly type—of infection. A urine sample can provide information about urinary tract infections (UTI) or kidney problems. Markers found in the blood can show that the immune system has gone into an over-reactive mode.

 Blood tests may reveal the following signs suggestive of sepsis:

• Elevated or low white blood cells – Higher than usual levels of leukocytes, known as white blood cells (WBCs), are a sign of a current infection, while too few WBCs indicate that a person is at higher risk of developing one.
• Lactic acid – When organs and muscles do not receive enough oxygen, they can release lactic acid. A high level of this in the blood can indicate that an infection is present.
• Markers of organ dysfunction – Creatinine levels (which test kidney function), enzymes (to check liver function), and cardiac biomarkers. 

Researchers now believe that the development of sepsis depends not only on the initial infection type, but also on a person’s age, sex, previous chronic health conditions, and genetic factors. As a result, current sepsis research is focused on gathering additional background data, like those mentioned above, on patients who are labeled “at risk” of sepsis due to their initial diagnosis or reason for hospitalization.        

What treatment options are available for sepsis?

The earlier sepsis is detected and treated, the better odds a person with the condition has for full recovery. People who have developed sepsis—and most especially those who have progressed into septic shock—are usually transferred to a hospital’s intensive care unit for supportive care and close monitoring. Septic shock is treated with intravenous fluids, antibiotics, medications to maintain blood pressure, and mechanical ventilation, as needed. Additional treatments such as steroids, vitamins, and surgery to control the source of infection are sometimes required.

Why is Yale Medicine unique in its treatment of sepsis?

Yale Medicine strives to provide patients with sepsis swift access to a high quality of care. It maintains a quality assurance program focused on sepsis detection, compliance with best practice recommendations, and optimal patient experience.

“At Yale Medicine, we have a multidisciplinary team that can recognize sepsis early and implement evidence-based strategies to prevent related complications,” Dr. Sather says. 

Testing for Sepsis | Sepsis Alliance

Unlike diseases or conditions like diabetes or kidney stones, there is no one test for sepsis testing. However, your doctor makes the diagnosis by evaluating your symptoms, your history, and other tests. This can then lead your doctor to suspect you have sepsis.

Here are some of the tests that help determine if you do have sepsis.

Blood tests

Blood tests show healthcare providers many things about your body, from the possibility of an infection to how well your body’s organs work. These are some of the more common blood tests for patients who present with possible signs and symptoms of sepsis. None of these tests can diagnose sepsis, but when the test results are combined with information about your illness and a physical examination, they can help your doctor determine if you have sepsis:

Complete blood count (CBC): A CBC is a common blood test. It measures how many white blood cells are circulating in your blood, among other things. White blood cells (also called leukocytes) fight bacteria, viruses, and other organisms your body identifies as a danger. A higher than normal amount of WBCs in your blood could mean that you have an infection. But too few WBCs can indicate you’re at risk of developing an infection.

Monocyte distribution width (MDW): Monocytes are a type of white blood cell that increases in variability when an infection is present. MDW can be measured as part of the CBC.

Lactate: Your organs may produce lactic acid when they don’t receive enough oxygen. Intense exercise, heart failure, or serious infection, among other conditions can cause this. A high level of lactic acid caused by infection can be an important clue that you have sepsis.

C-reactive protein (CRP): Your body produces C-reactive protein is produced when there is inflammation. Several conditions can cause inflammation, including infections.

Blood culture: A blood culture test tries to identify what type of bacteria or fungi caused infection in the blood. Blood cultures are collected separately from other blood tests. They are usually taken more than once from different veins. It can take several days to get the results of a blood culture.

Prothrombin time and partial thromboplastin time (PT and PTT), platelet count, and d-dimer: Sepsis can have serious effects on blood clotting inside your body. If the PT and PTT are too high, it can indicate your blood is not clotting well. Platelets are tiny cells in your blood that help to form blood clots. If your platelet count is too low, it can mean your body is forming many unseen clots in tiny vessels all over your body. This can be an important sign of sepsis. The d-dimer test also indicates that blood clotting is happening in your body. The level of d-dimer can be high if you have one large clot, or it can be high if your body is making many tiny clots, as happens in sepsis.

Confirmatory/Diagnostic Tests

The following tests are what doctors call confirmatory or diagnostic tests. The test results give the medical team more information when they suspect sepsis. Patients and their doctors need to first recognize the clinical signs and symptoms for the tests to be ordered, however. If your doctor suspects sepsis, treatment (with fluids and antibiotics) should begin right away, while waiting for these confirmatory test results.

Endotoxin is a component of certain bacteria, released when the bacteria cell disintegrates. It should not be in your blood, so its presence confirms there are gram negative bacteria in your bloodstream, although this test cannot identify which type. This test is not a replacement for blood cultures.

Procalcitonin (PCT): Procalcitonin is a protein in your blood that rises if you have a bacterial infection. It cannot tell what type of bacterial infection you may have. If you have low levels of PCT, your doctor may rule out a bacterial infection. The infection may be caused by a viral infection or an illness not related to an infection.

More testing: urine tests

Urinalysis: Like the CBC, this simple urine test can tell your doctor a lot about your health, including if you have a urinary tract infection (UTI) or problems with your kidneys, such as a kidney stones. There is no special preparation to provide a urine sample for a urinalysis.

Urine culture: A urine culture can determine what bacteria or fungi causes a UTI. Urine for a culture must be obtained midstream. You need a special cleanser to wipe your genitals before you start urinating. Once the area is cleaned as instructed, urinate for a few seconds into the toilet and then place the container under the flow and collect the sample.

Testing for specific infections

In addition to blood and urine tests, your doctor may want you to undergo other tests to identify where the infection may be. Here are some examples:

Pneumonia

Chest x-ray: A chest x-ray may show if you have pneumonia or damage around the lungs. A chest x-ray can’t tell your doctor what type of infection you have.

Pulse oximetry. A pulse oximeter measures the oxygen saturation level of your blood. This tells your doctor how well your lungs are taking oxygen from the air and putting it into your bloodstream. The device is clipped on your finger or ear lobe. A light measure sthe oxygen levels as your blood flows past.

Sputum test. A sputum (phlegm) sample can show if there is an infection in your throat or lungs.

Meningitis

Computerized tomography (CT) scan: A CT scan of your head may show swelling or inflammation .

Magnetic resonance imaging (MRI): MRIs of your head check for swelling or inflammation.

Lumbar puncture: A lumbar puncture is also called a spinal tap. Your doctor uses a lumbar puncture for a sample of cerebral spinal fluid (CSF), fluid that circulates around your spine and brain. Your doctor inserts a needle into your spinal cord, in your lower back, to remove a small amount of fluid to send for testing.

Strep throat

There are two tests for strep throat, the rapid antigen test and the throat culture. For the rapid antigen test, your doctor or nurse uses a swab to get a sample from the back of your throat. This test takes only minutes. A throat culture is done the same way, but with a special swab. This goes to a lab, similar to a blood culture or urine culture.

Influenza

Doctors usually diagnose influenza by your symptoms. Rapid influenza diagnostic tests may indicate what type of influenza you have, but they are not always accurate. A cotton swab takes a sample from inside your nose or the back of your throat.

Skin infections

If your doctor suspects you have an infection on your skin, such as cellulitis or MRSA, a culture will help determine what type of infection is present. A small amount of saline solution is injected under your skin, then withdrawn.

The symptoms of early sepsis are vague and often easily dismissed. Any invasive procedures (such as a surgery) or an invasive devices (such as an IV), or any type of break in your skin (such as a bug bite or cut), should be mentioned if you experience any of the symptoms,. Testing can be frustrating when nothing specific turns up, but it’s the only way your team can decide how best to treat you.

Updated April 24, 2023.

Septic shock. What is septic shock?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Septic shock is a serious pathological condition that occurs when a massive intake of bacterial endotoxins into the blood. Accompanied by tissue hypoperfusion, a critical decrease in blood pressure and symptoms of multiple organ failure. The diagnosis is made on the basis of the general clinical picture, which combines signs of damage to the lungs, cardiovascular system (CVS), liver and kidneys, and centralization of blood circulation. Treatment: massive antibiotic therapy, infusion of colloid and crystalloid solutions, maintenance of CCC activity by introducing vasopressors, correction of respiratory disorders by mechanical ventilation.

ICD-10

R57.2

• Causes
• Pathogenesis
• Classification
• Symptoms of septic shock
• Complications
• Diagnostics
• Treatment of septic shock
• Prognosis and prevention
• Prices for treatment

General

Septic shock (SS) is also called infectious-toxic shock (ITS). As an independent nosological unit, pathology was first described in the 19th century, however, a full-fledged study with the development of specific anti-shock measures began no more than 25 years ago. It can occur with any infectious process. Most often occurs in patients of surgical departments, with meningococcal septicemia, typhoid fever, salmonellosis and plague. It is common in countries where the largest number of bacterial and parasitic diseases is diagnosed (Africa, Afghanistan, Indonesia). More than 500,000 people around the world die each year from TSS.

Septic shock

Causes

In the vast majority of cases, pathology develops against the background of weakened immune responses. It occurs in patients suffering from chronic severe diseases, as well as in the elderly. Due to physiological characteristics, sepsis is more often diagnosed in men. The list of the most common diseases in which TTS events can occur includes:

• Foci of purulent infection. Signs of a systemic inflammatory reaction and associated disorders in the functioning of internal organs are noted in the presence of volumetric abscesses or phlegmon of soft tissues. The risk of a generalized toxic response increases with a long course of the disease, the absence of adequate antibiotic therapy, and the patient’s age over 60 years.
• Prolonged stay in the ICU. Hospitalization in the intensive care unit is always associated with the risk of sepsis and infectious shock. This is due to constant contact with microflora resistant to antibacterial drugs, weakening of the body’s defenses as a result of a serious illness, the presence of multiple gates of infection: catheters, gastric tubes, drainage tubes.
• Wounds. Violations of the integrity of the skin, including those that occurred during surgery, significantly increase the risk of infection with a highly contagious flora. TSS begins in patients with contaminated wounds who have not received timely care. Tissue trauma during surgery becomes the cause of a generalized infection only if the rules of asepsis and antisepsis are not followed. In most cases, septic shock occurs in patients who have undergone manipulations on the stomach and pancreas. Another common cause is diffuse peritonitis.
• Taking immunosuppressants. Immune depressant drugs (mercaptopurine, krizanol) are used to suppress the rejection reaction after organ transplantation. To a lesser extent, the level of self-protection decreases with the use of chemotherapeutic agents – cytostatics intended for the treatment of oncological diseases (doxorubicin, fluorouracil).
• AIDS. HIV infection in the AIDS stage leads to the development of atypical sepsis, provoked not by a bacterial culture, but by a fungus of the genus Candida. Clinical manifestations of the disease are characterized by a low degree of severity. The lack of an adequate immune response allows the pathogenic flora to multiply freely.

The causative agent of sepsis is gram-positive (streptococci, staphylococci, enterococci) and gram-negative (Enterobacter cloacae, Clostridium pneumoniae) bacteria. In many cases, cultures are insensitive to antibiotics, making it difficult to treat patients. Septic shock of viral origin is currently controversial among specialists. Some representatives of the scientific world argue that viruses are unable to cause pathology, others that an extracellular life form can provoke a systemic inflammatory response, which is the pathogenetic basis of TSS.

Pathogenesis

The symptoms are based on the uncontrolled spread of inflammatory mediators from the pathological focus. In this case, activation of macrophages, lymphocytes and neutrophils occurs. A systemic inflammatory response syndrome occurs. Against this background, peripheral vascular tone decreases, the volume of circulating blood decreases due to increased vascular permeability and fluid stagnation in the microvasculature. Further changes are due to a sharp decrease in perfusion. Insufficient blood supply causes hypoxia, ischemia of internal organs and disruption of their function. The most sensitive is the brain. In addition, the functional activity of the lungs, kidneys and liver worsens.

In addition to SVR, endogenous intoxication plays an important role in the formation of septic shock. In connection with a decrease in the efficiency of excretory systems, products of normal metabolism accumulate in the blood: creatinine, urea, lactate, guanine and pyruvate. In internal environments, the concentration of intermediate results of lipid oxidation (skatol, aldehydes, ketones) and bacterial endotoxins increases. All this causes severe changes in homeostasis, acid-base balance disorders, disturbances in the functioning of receptor systems.

Classification

The state of shock is classified according to pathogenetic and clinical principles. Pathogenetically, the disease can be “warm” and “cold”. Warm shock is characterized by an increase in cardiac output against the background of a decrease in overall vascular tone, endogenous hypercatecholaminemia, and dilation of intradermal vessels. The phenomena of organ failure are expressed moderately. The cold variety is manifested by a decrease in cardiac output, a sharp decrease in tissue perfusion, centralization of blood circulation, and severe MOF. According to the clinical course, septic shock is divided into the following varieties:

• Compensated. Consciousness is clear, safe, the patient is inhibited, but fully contactable. Arterial pressure is slightly reduced, the level of SBP is not less than 90 mm Hg. Tachycardia is detected (PS <100 bpm). Subjectively, the patient feels weakness, dizziness, headache and decreased muscle tone.
• Subcompensated. The skin is pale, the heart sounds are deaf, the heart rate reaches 140 beats per minute. SBP <90 mm. rt. Art., Respiration is rapid, shortness of breath up to 25 movements / min. Consciousness is confused, the patient answers questions with a delay, poorly understands what is happening around, where he is. Speech is quiet, slow, unintelligible.
• Decompensated. Marked depression of consciousness. The patient answers in monosyllables, in a whisper, often after 2-3 attempts. Motor activity is practically absent, the reaction to pain is weak. The skin is cyanotic, covered with sticky cold sweat. The heart sounds are deaf, the pulse on the peripheral arteries is not determined or is sharply weakened. Heart rate up to 180 beats / min, respiratory rate 25-30, shallow breathing. BP below 70/40, anuria.
• Terminal (irreversible). Consciousness is absent, the skin is marbled or gray, covered with bluish spots. Pathological breathing according to the type of Biot or Kussmaul, the respiratory rate decreases to 8-10 times / minute, sometimes breathing stops completely. SBP less than 50 mm Hg. pillar. There is no urination. The pulse is hardly palpable even on the central vessels.

Symptoms of septic shock

One of the defining signs of TSS is arterial hypotension. It is not possible to restore the level of blood pressure even with an adequate infusion volume (20-40 ml / kg). To maintain hemodynamics, it is necessary to use pressor amines (dopamine). Acute oliguria is noted, diuresis does not exceed 0.5 ml/kg/hour. Body temperature reaches febrile values ​​- 38-39 ° C, it is poorly reduced with the help of antipyretics. To prevent convulsions caused by hyperthermia, it is necessary to use physical methods of cooling.

90% of cases of SS are accompanied by respiratory failure of varying severity. Patients with decompensated and terminal course of the disease need hardware respiratory support. The liver and spleen are enlarged, compacted, their function is impaired. There may be intestinal atony, flatulence, stools mixed with mucus, blood and pus. In the later stages, symptoms of disseminated intravascular coagulation occur: petechial rash, internal and external bleeding.

Complications

Septic shock leads to a number of severe complications. The most common of these is multiple organ failure, in which the function of two or more systems is impaired. First of all, the central nervous system, lungs, kidneys and heart suffer. Somewhat less common damage to the liver, intestines and spleen. Mortality among patients with MOF reaches 60%. Some of them die 3-5 days after being removed from a critical state. This is due to organic changes in internal structures.

Another common consequence of TSS is bleeding. With the formation of intracerebral hematomas, the patient develops a clinic of acute hemorrhagic stroke. The accumulation of extravasate in other organs can lead to their compression. A decrease in blood volume in the vascular bed potentiates a more significant decrease in blood pressure. DIC against the background of infectious-toxic shock causes the death of the patient in 40-45% of cases. Secondary organ damage, provoked by microthromboses that occur at the initial stage of coagulopathy formation, is observed in almost 100% of patients.

Diagnostics

The diagnosis is established by an anesthesiologist-resuscitator. The assumption is based on clinical data, however, it is possible to accurately determine the existing condition only if there are results of hardware and laboratory studies. If septic shock is suspected, all tests are done in an emergency mode, “according to cito”. Resuscitation activities should begin without waiting for the end of the support services. A comprehensive examination necessary to determine and confirm TTS includes:

• Examination and physical examination. Implemented directly by the attending physician. The specialist detects the characteristic clinical signs of a shock state. For this, tonometry, a visual assessment of the color of the skin, features of respiratory movements, counting the pulse and respiratory rate, auscultation of the heart and lungs are performed. If complications are suspected, an assessment of the neurological status is necessary for symptoms of cerebral hemorrhage.
• Hardware research. Has an auxiliary value. The patient is shown to control the condition using an anesthetic monitor. The screen of the device displays information about the value of blood pressure, heart rate, degree of blood oxygen saturation (with lung failure SpO2<90%) and coronary rhythm. Against the background of respiratory disorders and toxic damage to the myocardium, tachycardia, arrhythmia and blockade of intracardiac conduction may occur.
• Laboratory research. Allows you to identify existing violations of homeostasis, failures in the work of internal organs. In patients with shock of septic origin, elevated levels of creatinine (> 0.177 mmol / l), bilirubin (> 34.2 μmol / l), lactate (> 2 mmol / l) are found. Thrombocytopenia (<100 × 10⁹/l) indicates a violation of coagulation. With progressive anemia, erythrocytes are 1.5-2.5 million per 1 mm3, hemoglobin is below 90 g/l. venous blood pH <7.3 (metabolic acidosis).

Treatment of septic shock

Patients are given intensive care. Treatment is carried out in intensive care units using the methods of hardware and drug support. The attending physician is a resuscitator. Consultation with an infectious disease specialist, cardiologist, gastroenterologist and other specialists may be required. It is required to transfer the patient to artificial lung ventilation, round-the-clock supervision of nurses, parenteral feeding. Mixtures and products intended for introduction into the stomach are not used. All methods of exposure are conditionally divided into pathogenetic and symptomatic:

• Pathogenetic treatment. If sepsis is suspected, the patient is prescribed antibiotics. The scheme should include 2-3 drugs of various groups with a wide spectrum of action. The selection of the drug at the initial stage is carried out empirically, in accordance with the expected sensitivity of the pathogen. At the same time, blood is taken for sterility and susceptibility to antibiotics. The result of the analysis is prepared within 10 days. If by this time it was not possible to select an effective drug regimen, the study data should be used.
• Symptomatic treatment. It is selected taking into account the existing clinical picture. Usually patients receive massive infusion therapy, glucocorticosteroids, inotropic agents, antiplatelet agents or hemostatics (depending on the state of the blood coagulation system). In severe cases of the disease, blood products are used: fresh frozen plasma, albumin, immunoglobulins. If the patient is conscious, the introduction of analgesic and sedative drugs is indicated.

Prognosis and prevention

Septic shock has a poor prognosis for life. With a subcompensated course, about 40% of patients die. Decompensated and terminal varieties end in the death of 60% of patients. In the absence of timely medical care, mortality reaches 95-100%. Some patients die a few days after the elimination of the pathological condition. Prevention of TSS consists in the timely relief of foci of infection, the competent selection of antibiotic therapy in surgical patients, compliance with antiseptic requirements in departments involved in invasive manipulations, and the maintenance of an adequate immune status in representatives of the HIV-infected stratum of the population.

Sources

1. Resuscitation and intensive care// Zhdanov G.G., Zilber A.P. – 2007.
2. Management of patients with sepsis and septic shock in a multidisciplinary hospital / Sapicheva Yu.Yu., Likhvantsev VV. – 2015.
3. Sepsis and septic shock / Kuzkov V.V. – 2015.
4. This article was prepared based on the materials of the site: https://www.krasotaimedicina.ru/

IMPORTANT
Information from this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Biomarkers for septic acute kidney injury

Biomarkers for septic acute kidney injury

Septic acute kidney injury: early comprehensive diagnosis of sepsis, glomerular and tubular dysfunction

Presentation

PDF, 91 pages, 7.7 MB

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Cystatin C is a biomarker for the differential diagnosis of glomerular and tubular dysfunction: implications for resuscitation and surgery

Presentation

PDF, 70 pages, 6.5 MB

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Biomarkers for critical illness: sepsis, acute kidney injury, septic acute kidney injury

Presentation

PDF, 74 pages, 6. 3 MB

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Sepsis and Acute Kidney Injury—A Two-Way Road: Biomarker Value

Scientific review

PDF, 17 pages, 1 MB

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Septic acute kidney injury: early comprehensive diagnosis of sepsis, glomerular and tubular dysfunction

Scientific review

PDF, 48 pages, 761 KB

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