Nesterenko O. Principles of diagnosis and intensive care of surgical sepsis.

A new approach to solve an actual scientific and practical problem of diagnosis and intensive therapy of surgical sepsis had been theoretically justified and proposed based on analysis of treatment of 241 patients with surgical sepsis. The new data on the etiology, the state of antimicrobial resistance of nosocomial pathogens of surgical sepsis received. The key role of immune distress, the role of microcirculatory and mitochondrial, metabolic distress syndromes in the mechanisms of pathogenesis, thanatogenesis, in formation of organ dysfunction in surgical sepsis had been received. Predictors of organ dysfunction had been established. Clinical and pathomorphological diagnosis criteria of the phases of the surgical sepsis had been defined. Predictive value of these predictors and diagnostic significance of these criteria had been proved. The fact of the clinical pathomorphosis of sepsis received it confirmation. The criteria for selection of drugs and method of antimicrobial therapy, including in patients with severe anemia in sepsis had been clarified. The clinical and pathomorphological substantiation of pathogenetically expediency of an early substitutive immunocorrection in patients with surgical sepsis had been done. The algorithm of emergency organ protective targeted therapy had been developed and implemented. It includes: emergency diagnosis, early etiological, early infusional and transfusional, early pathogenetically oriented organ protective therapy; early surgical sanation of the focus of infection, an early substitutive immune correction and timely prosthesis of vital functions allowed to prevent the transformation of the pathogenesis of sepsis to it thanatogenesis. So, in patients with severe surgical sepsis the absolute risk reduction (ARR) of death was 15,74% [95% CI: 2-28,7%], p = 0,038; in patients with septic shock the ARR of death was 36,43% [95% CI: 6-58,9%], p = 0,046.