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1 . septic shock

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7 : [] [].% - septic shock sepsis [] :. :bacteremia -. (microbes ) : septicemia - : Systemic Inflammatory Response Syndrome(SIRS) - :. > ( < ) - PaCO2 / -.. / < -. / > / < -. (SIRS). (SIRS) : sepsis - ) sepsis : sever sepsis - ( DIC. ) sepsis : septic shock - ( >. : refractory septic shock -. : Multiple-organ dysfunction syndrome (MODS) -. :

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11 streptococci - Clostridia - Gram-negative bacteria - Anaerobes - - : % : - Escherichia coli Streptococcus faecalis - Bacteroides fragilis - Acinetobacter species - Pseudomonas species - Enterobacter species - Salmonella species - % : - Neisseria gonorrhoeae - : Gram-negative bacteria - streptococci - Anaerobes - % - Neisseria meningitidis. % - : : fatigue Chills malaise [].. (SIRS). > < :... :. Apprehension. [-] :.

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14 % -. - [] : * :.. % : [-]. PCR : : : [] Systemic Inflammatory Response Syndrome(SIRS) ( > ).

15 .. Procalcitonin (PCT) [22] (SIRS) / <PCT (SIRS) PCT. : [] : : - ( ) ABCs -A. -B. ) -C. % (. [] CVP. - []: //- Dopamine -. Norepinephrine -. //-. //- Dobutamine -. //- Epinephrine -. //- Phenylephrine : -

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17 : [-]. : [--] : Recombinant human activated protein C C -. C Drotrecogin alpha (Xigris) %... [] : -. TNF-α - (IL-1) - - antiplatelet activating factor - Nitric oxide inhibitor - interferon gamma - antithrombin-3 infusion - - [] growth hormone [] pentoxifylline [] naloxone -. granulocyte colony-stimulating factor (G-CSF). FDA : %- []:

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32 Abstract 33 adult patients (13 males) with septic shock were studied at Alassad university hospital in Lattakia from 1/3/2005 to 1/7/2006. The incidence of septic shock was found to increase with age, it happened in 27 patients (81.81%) exeeding50 years. The most important risk factors were: age more than 50 years 27 patients (81.81 %)-diabetes mellitus 18 patients (54.54 %) - cancers 6 patients (18.18 %) - surgery and invasive procedure 5 patients (15.15 %). The source of sepsis was: pulmonary sepsis 10 patients (30.30 %) - biliary system 5 patients (15.15 %) urinary system 5 patients (15.15 %) then the other systems. Blood culture was positive in 10 patients (30.30 %) and the culture of material from the suspected source of sepsis was positive in 9 patients (27.27 %) Mortality rate was very high 31 patients (93.93%).

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34 23- Dellinger RP, Carlet JM, Masur H: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004 Mar; 32(3): Choi PT, Yip G, Quinonez LG, Cook DJ: Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 1999 Jan; 27(1): Martin C, Viviand X, Leone M, Thirion X: Effect of norepinephrine on the outcome of septic shock. Crit Care Med 2000 Aug; 28(8): Brun-Buisson C: The epidemiology of the systemic inflammatory response. Intensive Care Med 2000; 26 Suppl 1: S64-74 response. Intensive Care Med 2000; 26 Suppl 1: S Rivers E, Nguyen B, Havstad S: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001 Nov 8; 345(19): Hotchkiss R. S., Karl I. E.The pathophysiology and treatment of sepsis,n Engl J Med 200; 348: ,9, Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, Chaumet-Riffaut P, Bellissant E. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA Aug 21;288(7): PMID Oppert M, Schindler R, Husung C: Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock. Crit Care Med 2005 Nov; 33(11): Hinds.- Treatment of sepsis with activated protein C, MJ 2001;323: Morris, Meeting Unmet Needs in Patients With Sepsis: the Role of Drotrecogin Alfa (Activated), Am J Crit Care 2003;12: Van Amersfoort ES, Van Berkel TJ, Kuiper J: Receptors, mediators, and mechanisms involved in bacterial sepsis and septic shock. Clin Microbiol Rev 2003 Jul; 16(3): Takala J, Ruokonen E, Webster NR, et al: Increased mortality associated with growth hormone treatment in critically ill adults. N Engl J Med 1999 Sep 9; 341(11): Boeuf B, Gauvin F, Guerguerian AM, et al: Therapy of shock with naloxone: a metaanalysis. Crit Care Med 1998 Nov; 26(11): 36- Staubach KH, Schroder J, Stuber F, et al: Effect of pentoxifylline in severe sepsis: results of a randomized, double-blind, placebo-controlled study. Arch Surg 1998 Jan 37- Abraham et al. Drotrecogin alfa (activated) for adults with severe sepsis and a low risk of death. NEJM 2005;353:

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Billion Surviving : Are we? The 7th National Emergency Medicine Congress Antalya, Turkey Alexander L. Eastman, MD, MPH Department of Surgery UTSW Severe : A Significant Healthcare Challenge Major cause of morbidity