Clinical demonstration of optimization of volume status in a female patient with sepsis

Abstract Relevance. Clinical practice shows that intensive care of severe sepsis complicated by septic shock and multiple organ failure, and especially the choice of infusion therapy tactics, is a very difficult task. The presence of heart failure in conditions of reduced total peripheral vascular resistance in septic shock complicates infusion therapy to ensure normal tissue perfusion and requires a more balanced and individual approach to prevent hypervolemia and hyperhydration. Description of a clinical case. The article presents the experience of correcting water-electrolyte balance disorders (WED), optimizing infusion therapy for multiple organ failure in a patient with abdominal sepsis, which led to complications from the cardiovascular system: dilated cardiomyopathy and unstable hemodynamics. When calculating the infusion volume, attention was focused on the inadmissibility of hyperinfusion in myocardial dysfunction in a patient with sepsis. An individual approach has been implemented to ensure the maintenance of normal cardiac output (CO) and perfusion in heart failure and dehydration. Conclusion. It has been demonstrated that balanced polyionic solutions are the drugs of choice for the correction of extravascular fluid deficiency, which improves the prognosis and increases the survival of patients with this pathology. This clinical demonstration has shown the possibility of targeted sepsis therapy based on the conceptual model "Resuscitation. Optimization. Stabilization. Evacuation" (ROSE) according to Malbrain M. L. et al.; 2018). Methods for monitoring volumetric parameters were also applied and demonstrated in order to assess the adequacy of infusion therapy in the conditions of limited material and technical resources of a level 2 hospital.