AB 102. Sepsis in intensive care unit

Sepsis is a condition in which the body is fighting against serious infections that spreading through the blood. This condition usually develops as a result of excessive defense reaction in our body or in response to a toxic substance produced by infectious agents (bacteria, viruses or fungi). Number of deaths from sepsis in the world, almost doubled in the last twenty years. The reason for this phenomenon is the increase in the number of patients suffering from sepsis. In 1992, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) presented a definition of the syndrome systemic inflammatory response syndrome - SIRS, sepsis, severe sepsis, septic shock and multiple organ dysfunctions (MODS). SIRS is defined as two or more of the following variables: (I) temperatures higher than 38°C or less than 36°C; (II) heart rate greater than 90 beats per minute; (III) respiratory frequency greater than 20 breaths per minute or PaCO₂ value is less than 32 mmHg; disorder in white blood lineage (>12,000 /mL or 10% immature neutrophils). SIRS is nonspecific reactions and can be induced by ischemia, inflammation, trauma, or a combination of several causes and is not always associated with infection. Infection was defined as microbial phenomenon characterized as an inflammatory response to invading microorganisms. Sepsis is a systemic response to infection and is defined by the presence of SIRS with documented infection or suspected infection. Severe sepsis is associated with organ failure, hypoperfusion, or hypotension. MODS is the pathophysiologicaliy disorder in which organs are unable to maintain homeostasis. Mortality among patients is 7% (SIRS), 16% (sepsis), 20% (severe sepsis) and 46% (septic shock). Morbidity correlates with the causes of SIRS and the presence of complications in terms of organic or potential failure. Intesive care unit of the Institute for Pulmonary Diseases in Sremska Kamenica annually admits about 140 patients among which 67% with sepsis caused by various disorders. Half (50%) are with severe sepsis, 50% with septic shock. MODS was diagnosed in approximately 44% of patients. Mortality of patients with severe sepsis was 23%, with septic shock 69% and in patients who developed MODS 59%.

Intensive care unit at Institute for pulmonary diseases of Vojvodina is a modern five-bed unit, equipped with hemodynamic monitors; each bed is equipped with modern devices for mechanical ventilation. A multi-filter device for veno-venous hemofiltration (hemodialysis) is also available, which is used for continuous hemodialysis as well. To treat the patients with sepsis or hemodynamic instability, the Swan- Ganz catheter is used, simultaneously monitoring 14 parameters (ten hemodynamic and four oxygenic ones) to assess the tissue perfusion. A variety of accessory diagnostic methods are available 24 hours a day, including the helical CT, echocardiography, bronchoscopy with BAL and other histopathological sampling, microbiological (hemocultures) and complete laboratory diagnostics.

Clinical trials in the field of pneumonia, ventilator associated pneumonia, sepsis and septic shock, MODS, ARDS, acute renal failure and many other severe disorders are conducted in the ICU.