Pathogenetic Substantiation of the Algorithm of Emergency Organoprotective Targeted Therapy of Surgical Sepsis

A.N. Nesterenko, T.I. Vorobyova, Ye.D. Yakubenko, T.I. Kolesnikova

Abstract


Introduction: sepsis is in the top ten of the most expensive nosologies, but also in the top ten of the leading causes of death, even in highly developed countries. The surgical sepsis is dominated in the structure of all types of sepsis. Delayed correction of the microcirculatory and mitochondrial distresses, metabolic and immune distresses leads to the development of bioenergetical failure of cells and, at last, to the formation of multiple organ disorders in surgical sepsis with a poor outcome. That is why it is difficult to overestimate the importance of early and adequate to clinical situation pathogenetically oriented organoprotective intensive care of sepsis.
Materials and Methods: for pathogenetic substantiation of the tactical algorithm of emergency organoprotective targeted therapy (EOTT) of surgical sepsis a prospective non-randomized observational cohort-controlled clinical trial in 208 patients aged 19 to 74 years with severe surgical sepsis (SSS, n = 167) and septic shock (SS, n = 41) had been performed. The study (main) group consisted of 103 patients with severe surgical sepsis (n = 82) and septic shock (n = 21) treated by the algorithm of EOTT. The EOTT algorithm included early goal-directed (fluid/infusion — transfusion) therapy, antimicrobial therapy, including the antibiotic treatment with extracorporeal donor washed erythrocytes by the author’s method, the metabolic therapy, the early replacement immunocorrection. We developed the EOTT algorithm on the base of ideology of MUST — the Multiple Urgent Sepsis Therapies Protocol. 105 patients of control group with SSS (n = 85) and SS (n = 20) were treated with some inconsistencies of principles of intensive care of sepsis, which set out in the Guidelines SSC, that is, those patients whose treatment is not carried out by the algorithm ETSOT, and were comparable in severity degree of state, sex and age with main group.
Results: the clinical efficacy of the developed by us the algorithm of EOTT was confirmed by statistically significant reduction of the chances and risks of death in the intervention group compared with controls. In the SSS groups risk ratio (RR) was 1.76 [95% CI 1.06–2.92], p = 0.038; odds ratio (OR) = 0.46 [95% CI 0.23–0.91], p = 0.038; χ2 = 5.28; with a reduction of the absolute risk of death (ARD) by 15.74 % [95% CI 2.0–28.7 %], p = 0.038. In patients with SS, RR was 2.28 [95% CI 1.08–4.81], p = 0.046; OR = 0.23 [95% CI 0.06–0.81], p = 0.043; χ2 = 4.1; with a decrease ARD = 36.43 % [95% CI 6.0–58.9 %], p = 0.046.
Conclusions: the sequence of measures of complex intensive therapy of severe surgical sepsis and septic shock, outlined in the algorithm of emergency organoprotective targeted therapy of surgical sepsis is pathogenetically substantiated as demonstrated statistically significant clinical benefits.


Keywords


surgical sepsis; septic shock; early etiotropic treatment; early infusion therapy; early transfusion therapy; early metabolic therapy; early replacement immune correction; algorithm for emergency organoprotective targeted therapy of sepsis

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DOI: https://doi.org/10.22141/1997-2938.1.20.2013.87571

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