Search

This paper presents a diagnosis of the likely risk of sepsis using the National Early Warning Score (NEWS2). Accor­ding to the UK National Health Service and the Royal College of General Practitioners, sepsis should be suspected and immediate intensive care should be considered if a patient has NEWS2 score of 5 or more, or if the patient has NEWS2 score of 3 or more: non-blanching rash, mottled/ashen/cyanotic skin; responds only to voice/pain or does not respond; no urination in the last 18 hours or diuresis less than 0.5 ml/kg on catheterization; serum lactate more than 2 mmol/l. The measures to be taken within the first hour of a diagnosis of the likely risk of sepsis are outlined, as well as criteria for the lack of their effectiveness; the main goals of intensive care in sepsis: identification and control of foci of infection; antibiotic therapy, fluid resuscitation, additional oxygen supply; recommended parameters for continuous or half-hour monitoring of patients with sepsis who are at high risk of deterioration; blocks of intensive care, which should be initiated only by specialists experienced in sepsis management. The indicators of hospital lethality depending on the level of blood serum lactate are given: less than 2 mmol/l — 15 %, from 2.1 to 3.9 mmol/l — 25 %, more than 4 mmol/l — 38 %. The presented algorithm is fully consistent with the Surviving Sepsis Campaign guidelines (2021).

In late 2019, a new coronavirus, called severe acute respiratory syndrome coronavirus 2, led to an epidemic of acute respiratory syndrome and subsequently to a pandemic. The Surviving Sepsis Campaign COVID-19 expert group developed 54 urgent statements on the management of COVID-19 in the intensive care unit, of which 4 are best practice statements, 9 are strong recommendations, and 35 are weak recommendations. The authors did not undertake a new systematic prioritization of results but used the current work of the Surviving Sepsis Campaign Guideline 2020 and expert opinion. The Surviving Sepsis Campaign COVID-19 Panel is divided into 4 groups: 1) infection control and testing: identification of aerosol-generating procedures, healthcare workers perform aerosol-generating procedures in a negative pressure room, using appropriate respiratory masks (N95 respirators, FFP2) and protective equipment (gloves, gown, eye protection, etc.); 2) laboratory monitoring and specimens: each patient admitted to the intensive care unit with signs of respiratory infection should be considered as potentially infected with severe acute respiratory syndrome, and samples from the lower airways should be obtained after intubation and ventilation for diagnostic testing; 3) hemodynamic support; 4) respiratory support. The Grading of Recommendations, Assessment, Deve­lopment approach was used to assess the quality of evidence. The quality of evidence was assessed as high, moderate, low and very low. Online software was used — GDT (http://gdt.guidelinedevelopment.org) to generate the evidence profiles.