Today we will talk about what constitutes severe sepsis, which has the medical name septicopyemia. In detail, we will examine its manifestation, treatment and prognosis for such a disease.
Features of the disease
Severe sepsis, called "septicopyemia", is considered as a very life-threatening development stage of septicemia or sepsis, a generalized( infectious-infectious-inflammatory) , often with an allergic component caused by the active spread of bacteria fromprimary focus of suppuration in the systemic circulation, lymphatic system, organs and tissues.
Sepsis, septicemia and septicopyemia in surgery, obstetrics and other areas - what's the difference? Let's find out more.
Problems with severe sepsis - topic of the next video:
Difference from sepsis
Infection of blood in the phase of severe sepsis differs in the passage of septicemia, when bacteria circulate in the blood, but secondary foci do not form, into septicopiaemia characterized by:
- with severe intoxication
with bacterial poisons;
- by rapid formation in the organs of many septic abscesses - secondary purulent foci;
- severe organ function disorders( organ dysfunction),
- life-threatening blood pressure lowering.
Secondary metastases are formed as:
- purulent inflammation in the organs, for example, in the meninges( purulent meningitis);
- empyema - accumulations of large pus inside the hollow organ - in the gall bladder, cecum( appendicitis), pleural cavity( purulent pleurisy);
- focal hemorrhages observed in tissues, mucous membranes due to a clotting disorder due to severe poisoning with toxins that the microbial flora secretes.
Places of occurrence of secondary suppuration are connected:
- with microorganism-causative agent .Streptococcal aggression is more often directed to the kidneys, heart valves, gonococcal sepsis affects joints, bones, tendons.
- with a place of development of the primary focus .So, if initially the septic process hit the valves of the left part of the myocardium, then secondary metastases are often found in the tissues of the brain and kidneys. When septic foci occur in other areas of the heart muscle, secondary suppurations in the lungs and point infarcts in the heart are revealed.
Symptomatic of severe sepsis
Classification of septicopyemia
Septicemia( sepsis without metastases) and septicopyemia( severe sepsis) are two stages of a single pathological process of blood infection.
Severe sepsis is classified:
- At the site of infection:
- surgical , which develops when spilling internal and external ulcers, suppuration of open and closed wounds. To it carry obstetric, wound, gynecological.
- postoperative , which occurs in hospitals in violation of the rules of decontamination during operations;
- therapeutic , in which blood infection occurs in response to purulent processes in the internal organs: pneumonia, bacterial angina, inflammation and perforation in the organs of the abdominal cavity, esophagus, internal abscesses, osteomyelitis, pyelonephritis, otitis media, cholecystitis, pancreatitis.
2. For a bacterium-pathogen similar to sepsis.
3. By leaking. Manifestations of severe sepsis increase in 2 - 3 days, so it can be attributed to acute and lightning-fast form. Lethal outcome without therapy occurs within 1 - 2 days.
Reasons for the
The key cause of the transition of sepsis into severe form is the progression of the generalized inflammatory reaction to attack of pyogenic organisms, their further spread with increasing dysfunction( impairment of function) of all organs. A similar condition occurs when the immune system is unable to stop the process of blood infection in the first stages, which is due to the severity of the underlying illness of the patient that served as the initial focus for the septic process, or incorrect untimely therapy.
More often severe sepsis develops with staphylococcal activity and aggression of Pseudomonas aeruginosa.
The clinical picture at the septicopyroid stage consists of the following components:
- of the symptoms of the first stage of the development of blood infection - a syndrome of systemic inflammatory reaction;
- signs of hypoperfusion - a violation of blood circulation in microvessels of the brain, kidneys, liver, lungs, leading to necrosis( death) of tissues;
- menacing lowering of blood pressure;
- a variety of manifestations, characteristic for organ disorders - organ dysfunction, including encephalopathy( brain disorders), acute failure of the respiratory, renal and hepatic system and heart.
- tachycardia( more frequent myocardium contractions) in excess of 100 beats per minute, practically independent of temperature( i.e., if the temperature is normal, there is no slowing of the pulse);
- strong fluctuations in body temperature: hypothermia up to 39 - 40 C in the mornings and a sharp drop in the evening( usually in patients with weak immune response) below 36 - 35C, often such jumps occur up to 3-4 times a day;
- skin dullness;
- shortness of breath, in which the frequency of respiration in adults - more than 20 - 22 per minute;
- tremendous chills, cold profuse sweat;
- nausea, vomiting, diarrhea, often replaced by intestinal paresis( inhibition of peristalsis);
- very difficult overall condition, misunderstanding of what is happening, severe headache;
- failure in the rhythm of the heart( arrhythmia), noise;
- articular, muscle pain, soreness of the spleen, liver, eyeballs;
- enlargement of the liver and spleen, which is a constant sign in severe sepsis;
- yellowing of the skin, mucous membranes, eye scleres of different degrees;
- small vascular hemorrhages on the skin throughout the body( petechiae), pinpoint bloody rashes, conjunctival outflows, blisters with blood on the oral mucosa and tongue, the appearance of bruises( development of hemorrhagic syndrome due to disruption of blood clotting and damage to the walls of blood vessels).
Since septicopyemia affects all important organs, the course and manifestations of pathology depend on the location of secondary metastases. Therefore, together with the common signs of severe blood infection, specific, reflecting the growth of the purulent process in the lungs, heart, brain( including the dorsal), liver and kidneys also appear.
Individual symptoms with probable localization of abscesses:
| Symptoms of || Pathology and organ in which purulent metastases of |
- have arisen, painful headache;
- stiffness of the occiput muscles( inability to press the chin to the chest);
- vomiting, phobia of light, neurological disorders
| penetration of the infection into the membranes of the brain( meningitis, meningoencephalitis) |
- drawing acute low back pain;
- oliguria( abnormal decrease in volume of excreted urine), anuria( cessation of urination)
- severe skin itching( not always)
| development of acute kidney failure on the background of nephronecrosis. |
- angina attacks;
- severe chest pain, cough;
- ringing and tinnitus;
- decrease in blood pressure( systolic) less than 90 mm Hg.p.
- heart rate increases to 140-150 bpm, arrhythmia( skipping of cuts), dyspnea
| bacterial endocarditis( inflammation of the inner cardiac membrane) with damage to the mitral and aortic valve |
- inadequate behavior;
- mental and motor excitation or, conversely, abnormal inhibition, lack of reactions, apathy;
- convulsions, coma
| encephalopathy due to cerebral edema |
- lack of air;
- panic, dyspnea in adults over 20, in children from a year - more than 25, in infants - over 40 respiratory cycles per minute, wheezing, choking;
- blue lips, nails;
- appearance of pink sputum( with swelling);
- loss of consciousness
| acute respiratory failure in pneumonia with multiple abscesses, pulmonary edema |
- Severe right pain in the hypochondrium;
- jaundice of the skin, sclera, mucous membranes;
- nausea, vomiting of bile
| purulent cholecystitis, cholangitis |
All symptoms of the first stage of sepsis, manifested as a systemic inflammatory reaction, as well as signs of pyoinflammatory processes( peritonitis, meningitis, pneumonia, purpura, encephalitis) progress.
Blood poisoning in the phase of septicopiaemia is diagnosed by external symptoms, which is confirmed by laboratory data from blood, urine and instrumental tests. The main task is to detect the source of infection and secondary abscesses in the organs.
In biological fluids( blood, urine, liquor),
- reveals a large number of pathogens, the species of which are determined by bacteriological analysis, simultaneously revealing the reaction of the bacterial flora to different antibiotics;
- increase in the blood of procalcitonin( above 5.5 ng / ml), which is important for clarifying the diagnosis, confirming septicopyemia and allowing to distinguish severe sepsis from other diseases with similar symptoms;
- is very high in white blood cells( leukocytes) - more than 15-16( in units of 109 / L, in weak patients, on the contrary, leukopenia is defined - an abnormally low number of leukocytes
The higher the leukocytosis, the more inflammatory the reaction to the septic processIn case of infection of blood caused by staphylococcus, the content of leukocytes reaches 60 to 70 g / L. Sepsis, provoked by the aggression of gram-negative microbes, gives less pronounced leukocytosis, and septicopyemia, which occurs when the Pseudomonas aeruginosa is propagated, is possibleeykopeniya.
In addition, for severe sepsis, urine and blood are indicative of internal organ damage:
- high erythrocyte sedimentation rate( ESR);
- abnormal low diuresis( urine output per time unit) - less than 0.5 ml of urine excreted per kilogram of patient weight per hour;
- decreased hemoglobin below 90, lactate-acidosis( high lactic acid content);
- thrombocytopenia - reduced platelet count to 50%, indicating a sharp decrease in blood viscosity and a high risk of hemorrhage;
- high content of bilirubin( from 34 μmol / liter and above), as well as an increase in 2 times the level of AST, ALT, indicating the development of liver failure;
- creatinine content above 0.18 mmol / liter, large amounts of uric acid in the blood, residual nitrogen, urea( kidney damage);
- in the urine revealed an increased content of protein, erythrocytes, cylinders, leukocytes( nephritis, nephrosis).
In such instrumental studies as ultrasound of uterus and abdominal organs, hysteroscopy, lung X-ray, computed tomography and MRI, laparoscopy, the goal is to identify foci of infection.
Treatment of such pathologies as septicemia and septicopii( severe sepsis) in newborns, in adults is described below.
The course of septicopyemia and its manifestations are little related to the type of microorganism-pathogen and to the place of primary suppuration. But the place of development of purulent metastasis and the type of microbe are of great importance in the development of a program of integrated treatment, especially - the choice of an antimicrobial agent.
Therapy of septicopyemia is carried out according to the treatment of sepsis, but including the mandatory surgical treatment of metastases. The program provides:
- effective antimicrobial therapy;
- complete surgical treatment of foci of suppuration;
- measures to maintain the patient's life, prevent and medically correct disorders in the work of organs( multi-organ dysfunction) with a wide program of infusion of infusion saline solutions.
Medicated and therapeutic
- The same medicines are used as in the first stage of sepsis. Dosages and the appointment of alternative types of antimicrobial medicines are adjusted in accordance with the severity of the process. More commonly used: Cefotaxime, Ceftriaxone, Vancomycin, Amoxicillin with clavulanic acid, Cefipim, Imipenem, Ofloxacin.
- Active detoxification( elimination of poisons from the body) is carried out, which prevents organ disorders: intravenous infusion of large volumes of infusion solutions, boosting diuresis. Apply irradiation of blood with ultraviolet, purification by plasmapheresis, hemosorption.
The tasks of maintaining:
- of lung function and prevention of acute respiratory failure, including artificial ventilation and inhalation of calculated non-toxic doses of oxygen, are being solved;
- myocardial contractility and cardiac output;
- activity of kidney, liver, prevention of acute renal and hepatic insufficiency;
- exchange cellular processes;
In addition, medication is administered with the aim of:
- preventing anaphylaxis( acute allergic reactions) and shock with blood transfusion( blood transfusion);
- control and prevention of glycemia( increase in blood glucose) with further insulin therapy;
- normalization of blood clotting, prevention of bleeding, deep vein thrombosis, ulceration of the intestinal mucosa, stomach, esophagus.
If symptoms of acute development of renal insufficiency appear, solve the problem of immediate hemodialysis procedure.
Features of infusion therapy
When expressed violations of blood coagulability( coagulopathy) is shown the infusion of fresh frozen plasma, but it is recommended to limit the introduction of erythrocyte mass due to the high probability of complications, including anaphylactic( allergic) shock and acute damage to lung tissue.
Provision is required for an autopsy, active sanitation of abscesses( external and internal) followed by drainage( excretion of pus) lying in areas accessible for surgical intervention.
With obstetric sepsis, if there is purulent melting of the uterus tissues, the issue of its extirpation( complete removal) is promptly solved.
Prevention Prevention of septicopyemia involves the competent management of a patient with blood infection during systemic reaction and septicemia to prevent the septic process from flowing into the phase of multiple development of purulent metastases.
The entire treatment program for sepsis must be carefully performed with mandatory dosage adjustment.
Complications of septicopyemia: progression of the septic process and its transition to the stage of septic shock with multiple organ dysfunction( disruption of several organs at the same time), acute disorders of tissue blood supply and subsequent coma.
The more difficult the response to therapy is for the underlying disease, and the weaker the patient, the more serious the prediction is with septicopyemia.
In the phase of severe sepsis, 5 people die from a hundred patients who have a severe lesion of one organ( mono-organ dysfunction).If the septic process captures four organs or more, deaths are found in 80 to 100% of cases of the disease.