SEPTIC SHOCK: TREATMENT ACCORDING TO THE «SЕPSIS – 3» GUIDELINE

Summary. Introduction. Septic shock (SSH) is a type of sepsis with a significantly increased mortality rate due to severe disturbances in blood circulation and/or cellular metabolism. The overall mortality of patients with HF today averages from 30 to 40% (in the range from 10 to 90%, depending on the characteristics of the patient). Unsatisfactory results are often associated with refusal to start intensive therapy (for example, within 6 hours after the assumption of the diagnosis). However, many issues of the methodical approach and interpretation of certain aspects of the higher education system need to be studied and clarified. Objective. To analyze the results of treatment of patients with sepsis, which was carried out according to the decisions of the “Sepsis-3” guideline. Materials and methods. Under our observation were 283 patients with sepsis, who were treated in the purulent-septic center of the KNP “City Hospital No. 3 of Zaporizhzhia” during 1991-2024. The studied patients were distributed as follows: the main group 90 (31,8%) patients, who were treated according to the protocols of the “Sepsis-3” guideline. The comparison group 193 patients (68,2%), who were treated according to the decisions of the Conciliation Conference. The comparison group included 118 (61,1%) patients with sepsis and 75 (38,9%) with septic shock (SS), the main group 90 (62,2%) patients with sepsis and 34 (37,8%) — with SS. That is, there were 109 patients with SS in both groups. Results. Of the 75 patients with SS in the comparison group, 56 patients died, the mortality rate was 74,7%. In patients with SS in the main group, 23 patients died, the mortality rate was 67,6%. 17 patients (30,4%) in the comparison group died without surgery in the first hours or days, while in the main group of such cases there were only 4 (17,4%) patients. Mortality in patients with SS who were not operated on decreased by 13,0% (x2=5.63; P<0,0177). The average length of stay of patients with SS in the hospital also decreased by (4,7±0,24) days (t=4.36; P<0,001). Conclusions. Intensive therapy should be continued while hemodynamic indicators continue to improve. Noradrenaline should be used in the early stages of SS. In patients with adequate control of the source of infection, shorter rather than longer antimicrobial therapy should be used. The optimal regimen for ABT is the use of carbapenems at maximum dosage in combination with linezolid.