What happens in the body
Normally, the immune system limits the infection to the site. With sepsis, the response becomes excessive and spreads throughout the body: blood vessels dilate, their permeability increases, and fluid leaves the bloodstream into the tissues. The pressure drops, the blood delivers oxygen less well, and the organs begin to suffer from a lack of it. At the same time, the coagulation system is activated, microthrombi are formed in small vessels, which aggravates the disturbance of blood flow. When the drop in pressure cannot be corrected with fluid administration, it is referred to as septic shock, the most severe form.
- Excessive systemic response to infection
- Vasodilation and loss of fluid from the bed
- Impaired oxygen delivery to organs
- Microthrombi and coagulation disorders
- Septic shock with persistent drop in blood pressure
- Multiple organ failure
Where does it start?
The source becomes any source of infection that was not recognized or treated in time. The most common are pneumonia, urinary tract infections, especially against the background of stones and catheters, infections of the abdominal organs with appendicitis, cholecystitis and intestinal perforation, as well as purulent lesions of the skin and soft tissues. Separately, infections associated with vascular catheters, postoperative complications and postpartum sepsis are distinguished. In newborns, the source may be an infection acquired during childbirth. Sometimes the focus cannot be found, and they continue to look for it during treatment.
- Pneumonia
- Pyelonephritis and urinary tract infections
- Appendicitis, cholecystitis, peritonitis
- Purulent wounds, phlegmon, erysipelas
- Catheter-associated infections
- Postoperative and postpartum complications
Signs you can't miss
Sepsis does not always look like a high fever: in older and frail people, the temperature may be normal or even reduced. Much more important is the combination of infection with a change in consciousness, rapid breathing and low blood pressure. One should also be wary of a sharp deterioration in a seemingly ordinary illness, severe weakness, trembling and chills, marbled cold skin, and a decrease in the amount of urine. In children, lethargy, unusual crying, refusal to eat, pallor, and a rash that does not fade with pressure are considered alarming. This combination requires immediate help.
- Confusion or drowsiness due to infection
- Rapid breathing and shortness of breath
- Low blood pressure, dizziness
- Chills, trembling, feeling very unwell
- Cold marble skin
- Decreased urine output
- In children - lethargy, pallor, refusal to eat
Diagnostics
Diagnosis is made by a combination of signs of infection and organ dysfunction, assessing consciousness, breathing rate and blood pressure. The laboratory determines a general blood count, C-reactive protein, procalcitonin, blood lactate, kidney and liver function indicators, coagulogram, blood gases. Before starting antibiotics, they strive to take blood cultures and material from the suspected lesion, but this should not delay treatment. To find the source, X-rays, ultrasound and computed tomography are used. All studies are carried out in parallel with the start of therapy, and not sequentially.
- Assessment of consciousness, breathing and pressure
- Complete blood count and C-reactive protein
- Procalcitonin and blood lactate
- Creatinine, urea, bilirubin, coagulogram
- Culture of blood and material from the lesion
- X-ray, ultrasound, CT to find the source
Treatment and prevention
Treatment begins in the first hours and is carried out in the intensive care unit. Broad-spectrum antibiotics are administered intravenously without waiting for culture results, and they are adjusted later based on the sensitivity of the pathogen. At the same time, the volume of fluid is replenished with solutions, if necessary, the pressure is maintained with special drugs, oxygen is provided, and in case of severe respiratory failure, the patient is transferred to artificial ventilation. An obligatory stage is eliminating the source: opening the abscess, removing the infected catheter, surgery for inflammation in the abdominal cavity. Prevention is the timely treatment of infections, care of wounds and catheters, vaccination against influenza and pneumococcus in risk groups, control of chronic diseases.
- Intravenous antibiotics in the first hours
- Fluid therapy and pressure support
- Oxygen and artificial ventilation if necessary
- Surgical removal of the source of infection
- Monitoring kidney function and blood clotting
- Prevention: treatment of infections, wound care, vaccinations
- Rehabilitation after discharge