Septicism is a clinical syndrome with high mortality rates, and its incidence has remained high in recent years and is the leading cause of global mortality and crisis. New septic shock is defined as a sepsis, with a higher risk of death than simple sepsis. So, how do you diagnose and treat sepsis? This paper is an important compilation for your information.
I. Diagnostic criteria for septic shock
It means that the infection continues to deteriorate on the basis of sepsis, and even after full capacity recovery, low blood pressure occurs. Low blood pressure means a reduction in the pressure below 90 mmhg or 40 mmHg without other reasons for low blood pressure. Therefore, the use of an booster drug is required to maintain the average artery pressure of 65 mmhg, based on sufficient blood capacity, and the level of serum lactation >2 mml/L (18 mg/dL). According to this criterion, the hospital mortality rate for septic shock exceeds 40 per cent.
II. Treatment of septic shock
Liquid resuscitation
Liquid recovery for septic shock patients should begin as soon as possible. Patients with a hemodynamic instability may have higher concentrations of low blood pressure or lactate, and it is recommended that 30 mL/kg crystal fluid be applied quickly and that the delivery of the drug commences within the first hour. In the case of pediatric sepsis, it is recommended to use 20 mL/kg of initial crystall or protein fluids and repeat up to 60 mL/kg. After the initial recovery is completed, the hemodynamic state is assessed and the next liquid use is directed.
Anti-infection treatment
Observation data from some septic shock studies suggest that the timely commencement of appropriate antibiotics treatment can improve patient prognosis. Antibacterial drugs are recommended as soon as possible after hospitalization or after diagnosis of sepsis, preferably within 1h or 3h. For septic shock patients, antibacterial drugs that may cover all pathogens are recommended and can be used as soon as a septic shock patient is identified. For the early treatment of septic shock, it is recommended that antibacterial drugs be used together empirically and that, once a specific pathogens are identified, antibacterial treatment be adjusted accordingly. Co-use of conventional antibacterial drugs is not recommended for patients with no septic shock or moderate particle cell reduction. In addition, a daily reduction in the intensity of antibacterial drugs is considered, as clinical conditions permit.
3. Further blood flow mechanics stabilization and assessment of body fluid response
When the blood flow mechanics of patients remain unstable after the first liquid recovery, the fluid reaction should be assessed. Various methods for assessing and predicting body fluid response have been examined in clinical terms. For example, there are limitations to the current method of assessing fluid reaction, such as heart rate, pulse pressure change, etc. Accurate predictions and dynamic measurements are required. The Guide recommends that liquid recovery continue after initial recovery of patients who continue to lose low-input, if static or dynamic treatment improves blood flow mechanics. After the stabilization phase, it is important to realize when the patient is ready for downgrade treatment. At this stage, negative liquid balance targets are set and frequent urea is introduced.
4. Angiogenesis
In septic shock patients, angiogenesis is usually needed to maintain the pressure of the infusion. Adrenalin is recommended as the first option for vascular pressure. Dopamine can be used as an alternative to drugs for patients at lower risk of heart disorders and for patients with slow pulses. In the case of sepsis patients, in addition to an vascularly active drug, it is also recommended to use nuclei ejection, which increases blood pressure, stabilizes blood pressure and reduces the use of vascularly active drugs. An average arterial pressure of 65 mm/Hg is the ideal initial target for most pustic shock patients requiring a booster drug.
5. Sugar cortex hormones
For sepsis patients, even with sufficient liquid resuscitation and vascular activity treatment, if hemodynamics remain unstable, it is recommended to inject hydride pine at 200 mg of intravenous dose per day. RRT, CRRT and intermittent RRT are required for patients with acute kidney damage associated with sepsis.
6. Mechanical ventilation
The application of mechanical ventilation is recommended for patients with sepsis-induced acute respiratory distress syndrome (ARDS), with a 6 ml/kg fluency and a ceiling of 30 cm H2O for platform pressure. The use of a higher PEP is recommended for patients with moderate to severe ARDS (PaO2/FiO2≤200mmHg) caused by sepsis.
7. Stress ulcer prevention
In cases of septic shock, it is recommended to prevent stressor ulcer if there is a risk factor for digestive haemorrhage.
Summary
The treatment of septic shock should be treated as an emergency. Screening of signs and symptoms of sepsis and septosis contributes to early detection and intervention. Effective treatment, in turn, should focus on timely interventions, including reducing mortality through the removal of sources of infection and access to rapid liquid resuscitation and antibiotics.
