FARMAKOTERAPIYa TYaZhELOGO SEPSISA I ShOKA: DOKAZATEL'NYE OSNOVY


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Resumo

The article presents current recommendations for pharmacotherapy of severe sepsis (SevS) and septic shock (SepS), reflecting the interdisciplinary experience of experts in more than 30 associations united in the initiative «Surviving Sepsis Campaign». The treatment program is based on an initial and subsequent stages of treatment. The aim of initial stage includes achievement of target parameters of hemodynamics and oxygen status; along with adequate surgical control of the source of infection, it is is implemented by hemodynamic and respiratory support, as well as the optimal mode of antibacterial therapy. A number of provisions of the treatment program in SevS and SEPS has the highest level of reliability: crystalloids are infusion solutions of the choice; hydroxyethyl starches should not be used for infusion therapy; noradrenaline - vazopressor of choice; dobutamine is considered as the drug of choice to increase cardiac output; restrictive strategy in relation to the use of corticosteroids, blood products, and muscle relaxants; per protocol glycemic control to achieve the target level ≤110 mg/dL; pharmacoprophylaxis of venous thromboembolic complications with the preferred use of low molecular weight heparins, and pharmacoprophylaxis of stress gastric ulcers with proton pump inhibitors.

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