Septic means medically. Septic Shock: Causes, Symptoms, and Treatment of This Life-Threatening Condition

14.09.202324.06.2023 by alexxlab

What is septic shock. How does septic shock occur. Who is at risk for developing septic shock. What are the symptoms of septic shock. How is septic shock diagnosed. What treatments are available for septic shock. Can septic shock be prevented.

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Understanding Septic Shock: A Serious Medical Emergency

Septic shock is a severe and potentially life-threatening condition that occurs when a widespread infection in the body leads to dangerously low blood pressure. This medical emergency requires immediate attention and intensive care treatment. To fully grasp the gravity of septic shock, it’s crucial to understand its underlying causes, risk factors, and impact on the body.

The Pathophysiology of Septic Shock

Septic shock develops as a complication of sepsis, a systemic inflammatory response to infection. The condition is characterized by a cascade of events that can rapidly lead to organ failure and death if not addressed promptly. But how exactly does septic shock occur?

Infection spreads throughout the body
Toxins released by bacteria or fungi cause tissue damage
Blood pressure drops to dangerously low levels
Organ function deteriorates due to poor blood flow
Inflammatory response further contributes to organ damage

Some researchers propose that blood clots forming in small arteries contribute to the lack of blood flow and subsequent organ dysfunction. This complex interplay of factors makes septic shock a challenging condition to treat effectively.

Who is at Risk? Identifying Vulnerable Populations

While septic shock can affect anyone, certain groups are more susceptible to developing this life-threatening condition. Understanding these risk factors can help in early identification and prevention of septic shock.

Age-Related Vulnerability

The very young and the very old are particularly susceptible to septic shock. Their immune systems may not be as robust, making it more difficult to fight off infections effectively.

Compromised Immune Systems

Individuals with weakened immune systems face a higher risk of developing septic shock. This includes people with:

HIV/AIDS
Ongoing cancer treatments
Recent organ or bone marrow transplants
Long-term use of immunosuppressive medications

Pre-existing Medical Conditions

Certain medical conditions can increase the likelihood of developing septic shock:

Diabetes
Genitourinary system diseases
Biliary system disorders
Intestinal conditions
Leukemia and lymphoma

Medical Procedures and Treatments

Various medical interventions can inadvertently increase the risk of septic shock:

Indwelling catheters (e.g., intravenous lines, urinary catheters)
Plastic and metal stents used for drainage
Recent surgeries or medical procedures
Prolonged antibiotic use
Current or recent use of steroid medications

Recognizing the Signs: Symptoms of Septic Shock

Early recognition of septic shock symptoms is crucial for timely intervention and improved outcomes. The symptoms can vary but often include:

Cool, pale arms and legs
Extreme body temperature (high or low) with chills
Lightheadedness
Reduced urine output
Low blood pressure, especially when standing
Rapid heartbeat and palpitations
Restlessness, agitation, or lethargy
Confusion or decreased mental status
Shortness of breath
Skin rash or discoloration

Is it possible for septic shock to affect multiple organs simultaneously? Indeed, septic shock can impact various parts of the body, including the heart, brain, kidneys, liver, and intestines. This widespread effect on multiple organ systems contributes to the severity and complexity of the condition.

Diagnosing Septic Shock: A Multi-Faceted Approach

Accurate and prompt diagnosis of septic shock is essential for initiating appropriate treatment. Healthcare providers employ a combination of clinical assessment, laboratory tests, and imaging studies to confirm the diagnosis and assess the extent of organ involvement.

Blood Tests

Various blood tests are conducted to evaluate the presence and severity of infection, as well as to assess organ function:

Complete blood count (CBC)
Blood chemistry panel
Blood cultures to identify the causative organism
Arterial blood gas analysis to check oxygen levels and acid-base balance
Lactate levels to assess tissue perfusion

Imaging Studies

Imaging techniques may be employed to identify the source of infection or assess organ involvement:

Chest X-ray to check for pneumonia or pulmonary edema
CT scans to identify potential infection sites
Ultrasound to evaluate organ function and fluid status

Urine Analysis

A urine sample may be collected to check for urinary tract infections, which can sometimes lead to sepsis and septic shock.

Are blood cultures always immediately positive in cases of septic shock? It’s important to note that blood cultures may not become positive for several days after the blood has been taken or after the shock has developed. This delay underscores the importance of initiating treatment based on clinical suspicion rather than waiting for definitive culture results.

Treatment Strategies: Combating Septic Shock

Septic shock is a medical emergency that requires immediate and aggressive treatment. The primary goals of treatment are to:

Stabilize blood pressure and improve organ perfusion
Eradicate the underlying infection
Support failing organs
Prevent complications

Intensive Care Management

Patients with septic shock are typically admitted to the intensive care unit (ICU) for close monitoring and advanced supportive care. Treatment may include:

Mechanical ventilation to support breathing
Hemodynamic monitoring to assess heart and lung function
Intravenous fluid resuscitation
Vasopressor medications to improve blood pressure
Continuous renal replacement therapy (CRRT) or dialysis for kidney support

Antimicrobial Therapy

Identifying and treating the underlying infection is crucial in managing septic shock:

Broad-spectrum antibiotics are initiated immediately
Antifungal or antiviral medications may be used if indicated
Antibiotic therapy is adjusted based on culture results and clinical response

Source Control

In some cases, surgical intervention may be necessary to control the source of infection:

Drainage of abscesses
Debridement of necrotic tissue
Removal of infected medical devices

Adjunctive Therapies

Additional treatments may be employed to support organ function and mitigate complications:

Corticosteroids in select cases
Glucose control
Nutritional support
Deep vein thrombosis prophylaxis

How quickly should treatment be initiated in cases of suspected septic shock? Time is of the essence in treating septic shock. The Surviving Sepsis Campaign guidelines recommend initiating appropriate antibiotic therapy within one hour of recognizing sepsis or septic shock. Early, aggressive treatment is associated with improved outcomes and reduced mortality.

Prognosis and Complications: Understanding the Outlook

Septic shock carries a high mortality rate, with outcomes depending on various factors:

Patient’s age and overall health
Cause and severity of the infection
Number of organs affected
Timeliness and appropriateness of medical intervention

Even with prompt and appropriate treatment, septic shock can lead to severe complications:

Respiratory failure
Cardiac failure
Acute kidney injury
Liver dysfunction
Disseminated intravascular coagulation (DIC)
Gangrene, potentially leading to amputation

Does septic shock always result in long-term health consequences? While many patients who survive septic shock recover fully, some may experience long-term effects such as cognitive impairment, physical disabilities, or an increased risk of future infections. Ongoing research aims to better understand and address these long-term consequences.

Prevention Strategies: Reducing the Risk of Septic Shock

While not all cases of septic shock can be prevented, certain measures can help reduce the risk:

Infection Control

Practice good hygiene, especially handwashing
Ensure proper wound care
Seek prompt medical attention for infections
Adhere to prescribed antibiotic regimens

Vaccination

Staying up-to-date with recommended vaccinations can help prevent certain infections that may lead to sepsis and septic shock:

Influenza vaccine
Pneumococcal vaccine
Meningococcal vaccine

Management of Chronic Conditions

Proper management of chronic health conditions can reduce the risk of infections and subsequent complications:

Diabetes management
Regular check-ups for those with compromised immune systems
Proper care of indwelling medical devices

Healthcare-Associated Infection Prevention

Healthcare facilities play a crucial role in preventing infections that can lead to septic shock:

Proper sterilization of medical equipment
Adherence to infection control protocols
Judicious use of antibiotics to prevent resistance

Can septic shock be completely eliminated through preventive measures? While prevention strategies can significantly reduce the incidence of septic shock, it’s important to recognize that some cases may still occur despite best efforts. Ongoing research and advances in medical care continue to improve our ability to prevent and manage this life-threatening condition.

Emerging Research and Future Directions in Septic Shock Management

The field of septic shock research is continuously evolving, with scientists and clinicians working tirelessly to improve diagnosis, treatment, and outcomes for patients. Several promising areas of research are currently being explored:

Biomarkers for Early Detection

Researchers are investigating novel biomarkers that could allow for earlier and more accurate diagnosis of sepsis and septic shock. These include:

Procalcitonin
C-reactive protein (CRP)
Interleukin-6 (IL-6)
Presepsin

Early detection could lead to more timely interventions and improved patient outcomes.

Immunomodulation Therapies

The complex immune response in septic shock has led to research into therapies that can modulate the immune system:

Monoclonal antibodies targeting specific inflammatory mediators
Therapies to boost the immune response in later stages of sepsis
Extracorporeal blood purification techniques

Personalized Medicine Approaches

Recognizing the heterogeneity of septic shock, researchers are exploring ways to tailor treatments to individual patients:

Genetic profiling to predict response to specific therapies
Machine learning algorithms for risk stratification and treatment selection
Precision antibiotic therapy based on rapid pathogen identification

Novel Antimicrobial Strategies

With the growing threat of antibiotic resistance, new approaches to combating infections are being investigated:

Bacteriophage therapy
Antimicrobial peptides
Nanoparticle-based drug delivery systems

How might these emerging research areas transform the management of septic shock in the future? As these areas of research progress, we may see significant improvements in our ability to rapidly diagnose, effectively treat, and ultimately prevent septic shock. The integration of advanced technologies, such as artificial intelligence and precision medicine, could lead to more targeted and personalized approaches to managing this complex condition.

While septic shock remains a formidable challenge in modern medicine, ongoing research and clinical advancements offer hope for improved outcomes. As our understanding of the underlying mechanisms deepens and new therapeutic strategies emerge, we move closer to more effective management of this life-threatening condition. Healthcare providers, researchers, and patients alike must remain vigilant and proactive in the fight against septic shock, working together to implement best practices in prevention, early detection, and treatment.

Septic shock: MedlinePlus Medical Encyclopedia

Septic shock is a serious condition that occurs when a body-wide infection leads to dangerously low blood pressure.

Septic shock occurs most often in the very old and the very young. It may also occur in people with weakened immune systems.

Any type of bacteria can cause septic shock. Fungi and (rarely) viruses may also cause the condition. Toxins released by the bacteria or fungi may cause tissue damage. This may lead to low blood pressure and poor organ function. Some researchers think that blood clots in small arteries cause the lack of blood flow and poor organ function.

The body has a strong inflammatory response to the toxins that may contribute to organ damage.

Risk factors for septic shock include:

Diabetes
Diseases of the genitourinary system, biliary system, or intestinal system
Diseases that weaken the immune system, such as AIDS
Indwelling catheters (those that remain in place for extended periods, especially intravenous lines and urinary catheters, and plastic and metal stents used for drainage)
Leukemia
Long-term use of antibiotics
Lymphoma
Recent infection
Recent surgery or medical procedure
Recent or current use of steroid medicines
Solid organ or bone marrow transplantation

Septic shock can affect any part of the body, including the heart, brain, kidneys, liver, and intestines. Symptoms may include:

Cool, pale arms and legs
High or very low temperature, chills
Lightheadedness
Little or no urine
Low blood pressure, especially when standing
Palpitations
Rapid heart rate
Restlessness, agitation, lethargy, or confusion
Shortness of breath
Skin rash or discoloration
Decreased mental status and confusion

Blood tests may be done to check for:

Infection around the body
Complete blood count (CBC) and blood chemistry
Presence of bacteria or other organisms
Low blood oxygen level
Disturbances in the body’s acid-base balance
Poor organ function or organ failure

Other tests may include:

A chest x-ray to look for pneumonia or fluid in the lungs (pulmonary edema)
A urine sample to look for infection

Additional studies, such as blood cultures, may not become positive for several days after the blood has been taken, or for several days after the shock has developed.

Septic shock is a medical emergency. In most cases, people are admitted to the intensive care unit of the hospital.

Treatment may include:

Breathing machine (mechanical ventilation)
Dialysis
Drugs to treat low blood pressure, infection, or blood clotting
High volume of fluids given directly into a vein (intravenously)
Oxygen
Sedatives
Surgery to drain infected areas, if needed
Antibiotics or other agents to treat viral or fungal infections

The pressure in the heart and lungs may be checked. This is called hemodynamic monitoring. This can only be done with special equipment and intensive care nursing.

Septic shock has a high death rate. The death rate depends on the person’s age and overall health, the cause of the infection, how many organs have failed, and how quickly and aggressively medical therapy is started.

Respiratory failure, cardiac failure, or any other organ failure can occur. Gangrene may occur, possibly leading to amputation.

Go directly to an emergency department if you develop symptoms of septic shock.

Prompt treatment of bacterial infections is helpful. Vaccination could help prevent some infections. However, many cases of septic shock cannot be prevented.

Bacteremic shock; Endotoxic shock; Septicemic shock; Warm shock

Russell JA. Shock syndromes related to sepsis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 100.

van der Poll T, Wiersinga WJ. Sepsis and septic shock. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 73.

Updated by: Denis Hadjiliadis, MD, MHS, Paul F. Harron Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A. D.A.M. Editorial team.

Septic Definition & Meaning – Merriam-Webster

sep·tic

ˈsep-tik

: of, relating to, or causing putrefaction

: relating to, involving, caused by, or affected with sepsis

septic patients

: used for sewage treatment and disposal

a septic system

also

: of or relating to a septic system

septic effluents

Example Sentences

Recent Examples on the Web

To minimize water use and eliminate the need for a septic system, the home has a vault-style composting toilet by Clivus Multram.

—Kimberley Mok, Treehugger, 12 June 2023

Some may be connected to nearby sewer systems, some may get new septic systems, or join hybrid systems being developed by researchers from the University of Alabama, Auburn University and the University of South Alabama.

—Dennis Pillion | [email protected], al, 9 June 2023

To prevent inputs from human waste, have your septic system inspected and tank pumped out at least every two years.

—Sarah Bowman, The Indianapolis Star, 30 May 2023

Legislation rolling back wetlands protections may have been dealt a fatal blow Thursday after Indiana lawmakers stripped the language out of a sewage and septic system bill for irrelevance.

—The Indianapolis Star, 20 Apr. 2023

This advanced dishwashing solution helps break down stubborn food particles, offers superior cleaning performance, and even works with septic systems.

—Amber Smith, Discover Magazine, 3 Apr. 2023

Some symptoms of a septic miscarriage include fever, chills and tenderness in the lower abdomen, and surgery is needed to remove the cause of the infection.

—Kimberlee Speakman, Peoplemag, 1 Apr. 2023

There are no water or sewer hookups, but those looking for a septic dump can find one nearby for $1.

—Evie Carrick, Travel + Leisure, 26 Mar. 2023

The bill sets aside another $5 million for septic systems that can be used in the state’s Black Belt, where some communities lack sanitary sewage systems.

—Mike Cason | [email protected], al, 14 Mar. 2023

These examples are programmatically compiled from various online sources to illustrate current usage of the word ‘septic.’ Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

Etymology

Latin septicus, from Greek sēptikos, from sēpein to putrefy

First Known Use

1597, in the meaning defined at sense 1

Time Traveler

The first known use of septic was
in 1597

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Septibranchiata

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septicemia

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“Septic. ” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/septic. Accessed 23 Jun. 2023.

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Medical Definition

septic

adjective

sep·tic

ˈsep-tik

: putrefactive

: relating to, involving, caused by, or affected with sepsis

septic complications

septic arthritis

septic patients

Topical issues of pharmacotherapy of sepsis and septic shock | #08/04

Over the past decades, the treatment of sepsis has been one of the most pressing problems. The annual incidence of sepsis continues to grow, reaching over 700,000 cases in the United States alone. First of all, this is associated with a change in the qualitative composition of sepsis pathogens, an increase in multi-resistant hospital strains, as well as with the emergence of a contingent of more severe patients, formed as a result of significant progress in the treatment of previously incurable diseases (optimization of surgical and resuscitation techniques, progress in transplantation, modern chemotherapeutic approaches in hematology and oncology, treatment of HIV infection). Despite the emergence of a large number of highly effective antibiotics, mortality associated with sepsis has decreased by only 20% over the past 50 years and today is about 40%, reaching 80–90% for multiple organ dysfunction syndrome and septic shock.

Classical concepts of bacteremia and distant pyemic foci do not reflect the full development of a generalized infectious process and are only possible clinical variants of the course of sepsis with a certain localization of the primary lesion. The clinical interpretation of the modern view on the pathogenesis of sepsis was the diagnostic criteria and classification proposed at the conciliation conference of the American College of Pulmonologists and the Society of Critical Medicine Specialists – ACCP / SCCM (R. Bone et. al., 1992). According to ACCP/SCCM, sepsis is defined as a systemic response of the body to an infection characterized by a well-established infectious cause of the disease and two or more features of a systemic inflammatory response syndrome (SIRS). SIRS is a pathological condition due to both infectious and non-infectious causes and characterized by the presence of two or more signs: 1) temperature > 38°C or < 36°C; 2) heart rate > 90/min; 3) RR > 20/min, PaCO2 < 32 mm Hg. Art.; leukocytes > 12,000 or < 4,000 per ml and/or stab > 10%. Sepsis is considered severe with organ dysfunction, hypoperfusion, and/or hypotension. Septic shock is defined as sepsis-induced hypotension that persists despite adequate fluid infusion; may be combined with a violation of perfusion, which manifests itself in the form of lactic acidosis, oliguria, acute impairment of consciousness, but is not limited to these signs.

Pharmacological approaches to the treatment of sepsis

Numerous immune disorders that occur as a result of exposure to an infectious agent and are manifested by a systemic inflammatory response are characterized by activation of the complement system, increased synthesis of cytokines, metabolites of arachidonic acid and other vasoactive substances. With systemic inflammation, multistage cascades of immune responses are triggered, dysregulation of the coagulation-anticoagulation systems occurs, dysfunction of the cardiovascular system occurs, and various variants of metabolic disorders are formed, including those predetermining the development of shock [1].

The difficulty in determining pharmacological approaches in severe sepsis and septic shock lies in the complexity of this syndrome, which makes it difficult to choose treatment tactics. The need for combination therapy is dictated by the manifestation of the infectious nosology itself, which led to the development of septic shock, as well as the formation of numerous syndromes associated with severe sepsis.

Drugs (drugs) prescribed for sepsis and pathogenetically associated syndromes can be divided into three groups:

drugs with a high degree of evidence that affect the prognosis of the disease;
drugs that demonstrate a positive symptomatic effect without affecting survival;
experimental funds.

The only group of drugs that significantly affect the prognosis of the disease are antibacterial drugs. From non-pharmacological approaches, surgical interventions aimed at fighting infection can be included in the same category. From a practical point of view, with the exception of the use of the above groups of drugs, sepsis therapy involves the use of drugs aimed at combating individual symptoms and maintaining the function of vital organs and systems (as, for example, in septic shock, adequate infusion therapy and the appointment of vasopressors or mechanical ventilation of the lungs with respiratory failure). In turn, the experimental group can include drugs whose effectiveness in sepsis requires further study, for example, glucocorticosteroids, as well as drugs undergoing clinical trials, but have already demonstrated some clinical efficacy (C1-esterase inhibitor, activated protein C, antibodies to tumor necrosis factor alpha, etc. ).

Antibacterial agents

The effectiveness of antibacterial agents observed in uncomplicated bacterial infection is significantly limited in severe sepsis. Therefore, the task of the earliest and most adequate prescription of antimicrobial drugs is relevant. The rules for the empirical choice of antibiotics are based on the localization of the primary focus, determining the severity of the condition, concomitant diseases, clarifying the allergic history.

Identification of the primary localization of the process with a high degree of probability suggests a possible pathogen. At the same time, the correct and timely sampling of biological material (blood, urine, pleural fluid, biopsy, etc.) should be an indispensable attribute of diagnostic measures for sepsis. It is possible to increase the effectiveness of treatment by prescribing antimicrobial agents as soon as possible after the verification of the bacterial process, which seems possible only with a quick and complete clinical and laboratory-instrumental analysis of the patient’s condition. Taking into account the pharmacokinetic and pharmacodynamic characteristics of the assigned group of antibiotics ensures the creation of the required concentration of the drug in the primary focus of infection with minimal adverse reactions, especially in patients with severe disease and multiple organ dysfunction syndrome ( tab. 1 ).

Drugs affecting the blood coagulation system

Multidirectional changes and various variants of dysfunctions in the hemostasis system in sepsis make it difficult to create unified algorithmic recommendations and require the most complete clinical, laboratory and instrumental assessment of the patient’s condition. With the progression of the pathology, along with disturbances in the synthesis and consumption of coagulation factors, thrombocytopenia and signs of disseminated intravascular coagulation (DIC) occur. Suspicion of the development of DIC requires the urgent initiation of therapeutic measures ( tab. 2).

Encouraging results have been obtained in the study of the effectiveness of activated protein C (drotrecogin alfa), used to treat severe sepsis and septic shock. Synthetic activated protein C, as well as its endogenous counterpart, demonstrates antithrombotic, profibrinolytic and anti-inflammatory effects. The PROWESS study showed a significant reduction in the absolute risk of mortality by 6.1% over a 28-day follow-up period in the group of patients with severe sepsis [2].

Drugs affecting the severity of the systemic inflammatory response

Data indicating the ability of glucocorticosteroids (GCS), on the one hand, to improve the function of the cardiovascular system by increasing the synthesis of β-adrenergic receptors and catecholamines, on the other hand, to modulate the immune response by inhibiting aggregation and adhesion of leukocytes, as well as reducing the activation of the complement system, create theoretical prerequisites for their use in sepsis [3]. In addition, any severe stress for the body (surgery, trauma, severe infectious disease) activates the hypothalamic-pituitary system, thereby increasing the synthesis of cortisol. Therefore, in the case of even relative adrenal insufficiency, corticosteroids are considered as a possible option for replacement therapy. Based on the results of clinical studies, the use of corticosteroids can be recommended for septic shock only in patients with signs of adrenal insufficiency according to the results of a corticotropin test (blood cortisol concentration> 9mg/dL after administration of corticotropin). The positive effect of the appointment of GCS has been described with the use of 50 mg of hydrocortisone every 6 hours in combination with fludrocortisone at a dose of 50 mg / day for 7 days [4].

One of the most promising directions in the treatment of severe sepsis and septic shock today is the effect on the complement system, since its excessive activation leads to severe systemic inflammation, increased capillary permeability and tissue destruction [5]. The classic activation method is through C ₁ factor of the complement system. The C ₁ esterase inhibitor is the only known inhibitor of C ₁ s and C ₁ r, components of the classical complement activation pathway and an inactivator of coagulation factors XII, XIa, and kallikrein. Despite the fact that the C ₁ -esterase inhibitor is an acute phase protein, in patients with severe sepsis or septic shock, there is an absolute and functional deficiency of the C ₁ -esterase inhibitor in sepsis, associated with its increased breakdown and consumption both in the systemic circulation , and in the focus of inflammation [6]. Appointment of high doses of exogenous C ₁ -esterase inhibitor involves inhibition of both local and systemic inflammation, as well as stabilization of hemodynamics due to a decrease in capillary permeability [7]. The results of several blind placebo-controlled clinical trials confirmed the safety of early administration of high doses of C ₁ -esterase inhibitor (up to 12,000 IU for 2 days), and also revealed a positive effect of the drug on the rate of recovery of renal function in patients with sepsis or septic shock , a decrease in multiple organ manifestations, expressed in a decrease in the severity indices of a number of scales (LOD, SOFA). In addition, in the course of observational studies, a positive trend was noted, expressed in a decrease in the mortality of patients treated with C ₁ is an esterase inhibitor. Thus, early administration of the C ₁ -inhibitor avoids the undesirable consequences of systemic inflammation [8] and improves the prognosis in patients with sepsis or septic shock in whom conventional therapy has been ineffective [9, 10, 11].

Correction of hemodynamic disorders in sepsis and septic shock

Timely correction of arterial hypotension makes it possible to restore tissue perfusion, maintain homeostasis and improve the prognosis for shock of any origin. The therapy, carried out using the principles of the strategy, called EGRT (early-goal related therapy), demonstrated that effective correction of perfusion disorders in severe sepsis is possible only with the early use of invasive hemodynamic monitoring (measurement of central venous pressure, pulmonary artery wedge pressure, saturation of the central venous blood). Central venous blood saturation and hematocrit level are considered among the key targets of therapy, the value of which already in the early stages of severe sepsis makes it possible to identify individuals with myocardial dysfunction and a high risk of perfusion disorders. The need to maintain a central venous saturation of more than 70% requires inotropic dobutamine therapy (dobutrex, dobutamine Solvay, dobutamine Lahema 250) and large infusion volumes in patients at risk. This tactic contributes to the early withdrawal of vasopressors, shortening the time of mechanical ventilation, optimizes pre- and afterload, improves cardiac contractility and significantly reduces mortality in patients with severe sepsis and septic shock [12].

The basis for the traditional intensive pharmacotherapy of septic shock are infusion solutions, drugs with inotropic and vasopressor activity. According to various recommendations, the initially required dosing regimen of crystalloids for patients with septic shock is 6-10 L for the first 24 hours, and for colloids it ranges from 2-4 L for the first day [13]. The increase in cardiac index (CI) at a given rate of infusion reaches 25–40% [14]. If the previous infusion did not lead to an increase in the contractile function of the left ventricle and SI is still less than 2.5 l/min/m2, it is advisable to use inotropic agents. The drug of choice in this situation is dobutamine ( tab. 3 ) [15]. When using dobutamine in patients with septic shock, it is necessary to take into account its β ₂ -agonistic properties, while the combination with vasopressors, in particular with norepinephrine, avoids vasodilation.

The complexity of pathological reactions greatly complicates the treatment of sepsis. Undoubtedly, active study of the pathogenesis of the disease will contribute to the formation of a new strategy in modern pharmacotherapy of sepsis.

I. B. Lazareva , PhD
A. A. Igonin , PhD I. M. Sechenov, Moscow

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