SEPSIS-ASSOCIATED ENCEPHALOPATHY IN FORMING A SYNDROME OF POLYORGANIC INSUFFICIENCY OF PATIENS WITH SEVERE SEPSIS AND SEPTIC SHOCK
Keywords:
sepsis, Sepsis Severity Score, sepsis-associated encephalopathyAbstract
The purpose of study is to assess the severity of the condition and outcome prognosis in severe sepsis and septic shock by using scale Sepsis Severity Score (SSS). Materials and methods. It was performed a retrospective analysis of 50 case histories of patients with severe sepsis and septic shock who were treated in the intensive care unit in 2013–2014. Assessment of the status and outcome of the disease addition to the classic criteria included the use of scales SSS. Results. Indications for hospitalization of patients in the intensive care unit for sepsis are manifestations of systemic inflammatory response syndrome plus septic focus, available or perceived. At admission manifestations of systemic inflammatory response syndrome (two or more symptoms) occurred in 86.94% of cases. Septic pathology character can be represented as follows: necrotic pancreatitis — 22.5%, gangrene of the lower extremities — 15%, nosocomial pneumonia — 10%, peritonitis — 10%, mandible osteomyelitis — 10%, boil perineum — 7.5% paraproctitis — 5%, phlegmon of the floor of the mouth — 5%, over — and subhepatic abscesses — 5%, other lesions — 12%. In accordance with the scale of SSS, cardio-vascular failure in admission was registered in 74% of cases, in 68% there was no reaction to the liquid resuscitation. In our study, cardiovascular failure with elevated lactate, despite the record liquid resuscitation crystalloid, colloid, vasopressor therapy, corticosteroids was not accompanied by adequate physiological response to the intensive care. Respiratory insufficiency at baseline occurred in 76% of cases, on MLV were 41% of all patients and 54% of patients admitted to hospital with acute respiratory failure (ARF); SaO2 <95% occurred in 18% of the total patients and 23% of cases of ARF; FiO2 of 1.0 was required in 12% of the total patients and 15% of patients with ARF. Renal failure at admission occurred in 65% of cases, the concentration of creatinine above the upper normal values at 203.15%. Hepatic failure occurred initially in 35% of cases, the concentration of total bilirubin was higher by 112.4%. In the analysis of glycemia found that blood glucose <2.2 mmol/l observed in 12%, >10 mmol/L in 41% of patients, of which 89% of patients had diabetes mellitus type II. Wherein hyperglycemia may indicate a normal reaction to stress. Chills or shivering initially occurred in 6% of cases, medication sleep in 12% of cases. Initially GCS score 15 (clear conscience) were in 29%, GCS score 13 (light stun) — 18%, GCS score 8 (moderate coma) — 12% and GCSscore 4 (deep coma) — 6% of patients. Conclusions. In this way on admission to the intensive care unit for sepsis patients studied were in multiple organ dysfunction syndrome. The most characteristic of its components were cardiovascular, respiratory, renal and hepatic insufficiency. The situation was aggravated by severe concomitant diseases and the fact that the average age — over 60 years, 54% of patients had some degree of impaired consciousness. Consequently, in all cases, initially occurred failure are four systems that SSS scale predicted probability of death and the final result was confirmed. It was found the place of sepsis-associated encephalopathy in forming a syndrome of multiorgan insufficiency in patients with severe sepsis and septic shock.
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