Infusion therapy for sepsis
Background. Sepsis is a life-threatening organ dysfunction syndrome caused by the dysregulatory response of the organism to infection. Treatment of septic shock (SS) requires massive infusion therapy (IT), as it is necessary to restore volemia as quickly as possible. Other goals of IT are the restoration of electrolyte balance, normalization of acid-base state and organ perfusion.
Objective. To describe IT in sepsis.
Materials and methods. Analysis of literature sources on this topic; own multicenter prospective open research. 68 patients with abdominal SS source (intestinal obstruction, perforation of hollow organs, infected pancreatitis, etc.) who underwent IT were involved.
Results and discussion. In case of SS it is obligatory to start infusion of crystalloid solutions in a dose of 30 ml/kg during the first 3 hours of resuscitation. Current treatment guidelines suggest early aggressive fluid recovery within 6 hours of onset of shock. Delaying an increase in volemia cannot be allowed. If stabilization of the clinical condition cannot be achieved by initial fluid resuscitation, close monitoring should be initiated to avoid fluid overload, as both hypovolemia and hypervolemia increase mortality. Indicators such as blood pressure, heart rate, central venous pressure, dynamic parameters (lower extremity lifting test (LELT), volume load bolus test), lactate content, daily fluid balance should be monitored. Achieving a negative fluid balance during at least one of the first 3 days of SS treatment is a predictor of the favorable prognosis. According to the own study, LELT showed a weak correlation with the results of the infusion probe. This may be related to the increase in intra-abdominal pressure in the studied patients. Despite a number of disadvantages, crystalloids are the basis of SS treatment. The use of hydroxyethyl starch solutions in sepsis is not recommended; they can be used only in limited groups of patients. Albumin is the only safe colloid solution that can be used in patients with SS and hypoalbuminemia, but there is no evidence of the benefits of its routine use in sepsis. Analysis of patient data divided into Reosorbilact, Volutenz, Ringer malate and 0.9 % NaCl (all solutions – “Yuria-Pharm”) found that the most effective solutions for cardiac output were Reosorbilact and Volutenz.
Conclusions. 1. Treatment of sepsis and SS requires massive IT. 2. The goals of IT include the restoration of volemia, normalization of electrolyte balance and acid-base status, normalization of organ perfusion. 3. During the first 3 hours of resuscitation in SS, it is advisable to restore the fluid volume within 6 hours from the onset of shock. 4. If stabilization of the clinical condition has not been achieved, close monitoring should be initiated to avoid fluid overload. 5. The most effective solutions for the increase of cardiac output are Reosorbilact and Volutenz.
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