Abstract
Objective. To analyse the results of treatment of patients with septic shock, which was carried out in accordance with the decisions of the International Conference on Conciliation and the protocols of the Sepsis–3 guideline.
Materials and methods. We observed 283 patients with sepsis who were treated in the purulent–septic centre of Zaporizhzhia City Hospital No. 3 during 1991–2024: Group 1 – 193 (68.2%) patients with sepsis treated according to the decisions of the International Conference on Sepsis and Septic Shock (2012, 2004) in 1991–2015, and Group 2 – 90 (31.8%) patients treated according to the protocols of the Sepsis–3 guideline adopted in 2016 in 2016–2024. In group 1, there were 118 (61.1%) patients with sepsis and 75 (38.9%) with septic shock, and in group 2, there were 56 (62.2%) patients with sepsis and 34 (37.8%) with septic shock. In other words, there were 109 patients with septic shock in both groups.
Results. Of 75 patients with septic shock of group 1, 56 died, with a mortality rate of 74.7%. Of 34 patients with septic shock in group 2, 23 died, with a mortality rate of 67.6%. In group 1, 17 (30.4%) patients died unoperated in the first hours or day of septic shock, whereas in group 2, there were only 4 (17.4%) such patients. The mortality rate of patients with septic shock who were not operated on was 13.0% lower in group 2 (х2 = 5.63; p<0.0177). Also, the average length of stay of patients with septic shock in group 2 in the hospital was shorter by (4.7 ± 0.24) days (t=4.36; p<0.001).
Conclusions. Intensive care in septic shock should be continued until hemodynamic parameters continue to improve, and primary infusion therapy should be limited and guided by an assessment of the body's response to the administration of solutions. Norepinephrine increases preload, systemic vascular resistance and cardiac output, so its use in patients with persistent hypotension is required in the early stages of septic shock. In patients with adequate control of the source of infection, shorter rather than longer antibiotic therapy should be used. The optimal regimen for antibiotic therapy is the use of carbapenems in the highest dosage in combination with linezolid.