Značaj hemodinamske stabilizacije i adjuvantne terapije u lečenju pacijenata sa sepsom i septičnim šokom

Abstract

Sepsis represents a life-threatening condition that requires prompt recognition, detailed initial assessment and energetic administration of therapy. Guidelines published in 2016 emphasized the importance of early fluids replacement and infection control together with assessment based on laboratory parameters and precise monitoring of hemodynamic status of septic patients within the first 3-6 hours after diagnosis. Revision that followed in 2018 stressed that all therapeutic actions should be initiated within the first hour after diagnosis. Urgent administration of isotonic saline and balanced crystalloids in a dose of 30ml/kg should provide adequate hemodynamic stability of septic patients. If the fluid replacement fails to achieve hemodynamic stability and mean arterial pressure >65 mmHg, addition of vasopressors is mandatory. The vasopressor of choice for septic patients is norepinephrine. It may be used alone or in combination with other vasopressors such as epinephrine, vasopressin, terlipresine or phenylephrine. Septic patients with inadequate cardiac output after fluid replacement, and cardiomyopathy induced by sepsis or those with combined shock may need treatment with inotropic medication such as epinephrine or dobutamine. Adjuvant therapy with steroids, immunoglobulins, anticoagulants, statins, vitamin C and Bl, may be useful, but no benefit regarding the overall outcome was observed. In conclusion, early detection of sepsis and septic shock within the first hour and immediate adequate fluid administration with vasoactive medications to maintain hemodynamic stability, are crucial for achievement of better outcome of these patients.