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SEPSIS (general festering infection)

SEPSIS (general festering infection). m.d. Shydlovscky O.V. Actuality of sepsis as disease In the USA – annually near 750 thousand cases from them near 200 thousands die - treatment of one patient with a sepsis makes near 22-23 thouthant dollars. Europe

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SEPSIS (general festering infection)

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  1. SEPSIS(general festering infection) m.d. Shydlovscky O.V.

  2. Actuality of sepsis as disease In the USA – annually near 750 thousand cases from them near 200 thousands die - treatment of one patient with a sepsis makes near 22-23 thouthant dollars. Europe annually near 500 thousand patients or 1:1000 hospitalized or > 21 % from hospitalized in the departments of intensive therapy - daily dies near 1400 patients from a sepsis Germany - annually from a sepsis morbidity dies near 75 thousand patients Reason of death – poliorganic insufficiency grows constantly

  3. Determination (terminology) • Sepsis – rotting • Schottmuller (1914) – About a sepsis it is possible to talk then, when in an organism there is a hearth of infection, from which constantly and periodically blood bacteria enter, as a result and there are subjective and objective symptoms of disease.

  4. Determination of concept Sepsis is an infectious disease which is predefined different exciters, develops for persons with sharply mionectic protective forces of organism and characterized the presence of primary hearth, heavy making progress motion and absence of tendency, to spontaneous healing.

  5. Determination (terminology) • Modern information: Sepsis it is not possible to consider the result of direct action microorganisms on a macroorganism, but is investigation of substantial violations in the immune system, which in the development prokhodyat' a way from hyperactivating (phase of hyperinflammation) to imunoparalichu (phase of imunoparalichu). Sepsis is a syndrome of system answer for inflammation (SIRS) is the heavy reaction of organism on inflammation, which is predefined an infection, heavy trauma, burns, sharp destructive pancreatitis, and second poshkodzhuyuchimi fabrics by factors.

  6. A gate of infection is at a sepsis Thru skin obstetric-gynaecological Oral (odontogenne, tonsilar) Otogenne As a result of surgical interferences and manipulations Cryptogenic Most frequent thru skin, obstetric – gynaecological and cryptogenic

  7. Terms of sepsis development • Presence of primary hearth which is constantly or periodically related to the blood or lymphatic vessel • Permanent or periodic (multiple) penetration of exciter is from a primary hearth in blood • Hematogen dissemination of infection and forming of the second septic hearths from which an exciter periodically enters blood • Acyclic motion, predefined inability of organism to localization of infection in the hearths of inflammation and effective immunoreactions

  8. Assisted development of sepsis : • Haematological, onko-illnesses, metabolic diseases • AIS infection, tuberculosis, innate defects of the immune system • Of long duration application of cytostatics, chemical drags, immunodepressants, corticosteroids preparations • Radial therapy

  9. Classification of sepsis On character of microflora: A gramme positive: • staphylococcuss (anreus, epidermidis) • streptococci (pyogenes, pneomonic) • anaerobes (bacteroids, peptococci) A gramme is negative: • collibacillus • protey • enterobacter • klebsiela • mycotic

  10. Signs of sepsis • temperature of body > 38 or < 360 graduse of Celcius • frequency of heart-throbs > 90 per min • number of respiratory motions > 20 per min, or PaCO2 < 32 mm. • leucocytes > 12000/ml; or < 4000/mlandmore than 10 % immature neytrophiles.

  11. Classification of sepsis is on weight of clinical motion • 2 signs – easy degree; • 3 signs – middle weight; • 4 signs – heavy;

  12. Markers of sepsis 1. Cytocins (grow).- TNF, IL-6; 8; 10 2. С – reactive albumen (grows). 3. High temperature (for the persons of senior age is a hypothermia). 4. Bacteriemia (a fence of blood is 3 times on a day, on height of temperature) 5. Arterial LP 6. Oliguria. 7. Disorders of consciousness.

  13. Markers of sepsis 8. Hyperleycocitosis (leycopenia). 9. Anemia. 10. Thrombocytopenia. 11. Acidosis. 12. Low BP, tachicardia. 13. Disseminate intravascular rolling upsyndrome. 14. Hypoprotein, - albuminaemia. 15. Hypertransaminaseaemia. 16. Encephalopathy. 17. State of wound and it’s process.

  14. Clinical motion of sepsis • Quick as lightning. Runs across with development of septic shock and leads to death during 1 – 2 days • Acute sepsis. Lasts to 4 weeks • Subacute. Lasts 3 – 4 months • Recidivate. Runs across with sharpening and remission, lasts to 6 months • Cronic sepsis. Can last to year and even anymore

  15. Clinical picture Consists of symptoms : - general intoxication - basic disease which is a primary focus - metastatic defeats of other organs

  16. Clinical symptoms • Beginning is acute, or from a pre-sepsis (subfebril temperature from shortly protracted gettings up of temperature) • Expressed intoxication • Intermittent type of fever (breach exciter in blood) • Severe general condition • Anaemia, tachicardia, shortbreathing, is not predefined the state of pulmonary tissue

  17. Clinical symptoms • Decline of arteriotony • Expansion of heart limits • Metastatic abscesses of lights, buds, liver, marrow, cerebrum and his shells • Hemorragic syndrome with the septic skiddings

  18. Laboratory information • Anaemia, speed-up BSR • Neutrophilic leycocitosis, toxic grittiness of neytrophils • Growth of levels of bilirubin, remaining nitrogen, kreatinine • Hypoproteinaemia (albumin), factors of hemopexis • In urine pathological changes

  19. Clinical features depending on an exciter • Staphylococcus sepsis : - frequent quick as lightning forms, run across exceptionally hardness, without a septicopyemia, death to 90% during 1 – 2 days - sharp forms : a skin and oral gate of infection, prevail, pustule pouring out - frequent metastatic festerings hearths are in buds, bones, endocardium - recidivate duration with acutening - large probability of chronic motion (during years)

  20. Clinical features depending on an exciter • Blue puss sepsis -the clinic of the expressed general intoxication predominates - without metastatic defeats - a liquid pus is in a far with a strong putrid smell - bandage dark blue - green color

  21. Clinical features depending on an exciter • Anaerobic sepsis - acute beginning, heavy motion - high temperature, gectic temperature curve - frequent development of septic shock - a septicopyemia is with the defeat of brain, liver, lights

  22. The stages of system answer syndrome for inflammation Stage A - the physiology reaction of organism on inflammation, operating trauma. • tachycardia • hyperthermia Stage В– surplus stress answer • diminishing of arterio-venouse difference is on oxygen • increase of lactat concentration • the satiation of arterial blood goes down by oxygen • increase of bilirubin level • stress ulcers and erosions of stomach develop • the level of kreatinine grows

  23. The stages of system answer syndrome for inflammation Stage C– decompensate answer for stress (state of shock) • decline of arteriotony and cardiac extrass • a heavy lactat is acidosis • an arterio-venouse difference diminishes • polyorganic insufficiency develops Stage D– pre-terminal stage ofSIRS • decline of arteriotony and cardiac extrass • cardiac insufficiency is expressed • the consumption of oxygen is sharply mionectic • lactoacidosis • heavy system disfunction of all organs and systems

  24. Treatment of sepsis Place of treatment - reanimation Success of treatment is determined: • timely diagnostics; • adequate (in obedience to an exciter) antibacterial therapy; • scalene supporting therapy; • removal of contributory infringement moments

  25. Directions of treatment - influence on the organism of patient (nutritive support, passive imunotherapy, extracorporal detoxication) - influence on microorganism (adequate, timely, of long duration, by courses, antibacterial therapy) - treatment of infection focus (sanation of festering hearth, opening of metastatic abscesses)

  26. Surgery of festering focus • early and radical sanation of festerings focusses • wide access • necretomy • draining of festering focus • application of sorbents • ointments are on vatersolubable basis • running draining • immobilization of area • Secondary guy-sutures on a wound • in relation to an abdominal region are programmable laparotomia (laparopertion)

  27. Influence on microorganism (antibacterial therapy of sepsis) Empiric antibacterial therapy Appoint at an infectious process without the exact results of bacteriologic examinations, antibiotics of wide spectrum of action taking into account localization of festering focus. Purposeful antibacterial therapy Appointed after authentication of exciter

  28. Algorithm of antibacterial therapysetting • Clinical grounds: hyperthermia, heating, suspicion on the focus of inflammation. 2. Choice of antibiotic: - on toxicness and pharmakokinetics of preparation - sensitiveness of exciter - possibility of combination 3. Advantage preparations of bactericidal action(penicilini, cefalosporini, phtorchinolones, aminoglycosides, carbopenems).

  29. Algorithm of antibacterial therapysetting 4. Advantage of not combination of antibacterial preparations, but monotherapy. 5. Optimum dose – maximally possible for age of patient. 6. Ways of antibiotics introduction: into the cavities, intravenous, intramuscular 7. Correction of antibiotics - at unefficiency of treatment - at the low sensitiveness of microflora

  30. Duration of antibacterial therapy 1. Conducted to achievement of proof positive dynamics 2. Criteria of sepsis antibacterial therapy sufficientness - proof normalization of temperature - positive dynamics of infectious process - absence of system inflammatory answer signs - normalization of gastro-enteric tract function - normalization of white blood indexes - subzero hemoculture

  31. Influence on the organism of patient 1. Primary reanimation - providing of BCV - normalization of arteriotony - proceeding in a diuresis - providing of saturation of oxygen in venous blood scope not less than 70 %. 2. Infusion therapy (crystalloids, synthetic colloids, squirrel of blood, vitamins, hormones) Volume of liquid: 50 ml/kg/day + loss on drainages + 500 ml on a 1 degree of temperature higher norms

  32. Influence on the organism of patient 3. Vasopresors :at arterial LP which is irresponsive on infusion therapy. 4. Isotropic therapy:(cardiac preparations) – for the increase of cardiac extrass is Dobutaminum; vasopressors is adrenalin, dophamin. 5. Steroids– for support BP - hydrocortizon is from 200 mg to 1 gr on days. 6. Preparations of blood: - washed erythrocites - hyperimmune plasma - freeze plasma - leucothromboconcentrate

  33. Influence on the organism of patient 7.Treatment of pulmonary distress syndrome (artificial ventilation of lights is for liquidation of hypoxia). 8. Analgesia and neuro-muscle blockade (ALV+analgetics) on a background miorelaxants. 9. Stimulation and substituting for the function of kidneys(venous hemophiltration, intermitanthemodialisis). 10. Correction water-electrolyte balance and PH of blood. 11. Prophylaxis of venous thromboses (deep veins of lower extremities). 12. Prophylaxis of stress ulcers (Н2-blocators).

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