Септический шок у взрослых: клинические рекомендации Общероссийской общественной организации «Федерация анестезиологов и реаниматологов»

В статье представлены основные положения клинических рекомендаций по септическому шоку у взрослых, утвержденных Общероссийской общественной организацией «Федерация анестезиологов и реаниматологов» в 2023 г. Актуальность проблемы связана со значительной распространенностью и высокими показателями летальности при септическом шоке. Рекомендации включают вопросы этиологии, патогенеза, клинической картины, методов лабораторной и инструментальной диагностики септического шока. Представлена стартовая интенсивная терапия септического шока, включая подходы по назначению вазопрессорных и инотропных препаратов, рекомендации по выбору антибактериальных препаратов, особенности инфузионной и адъювантной терапии, в том числе при рефрактерном к терапии септическом шоке. Обсуждены вопросы хирургического лечения очага инфекции. Представлены критерии качества оказания медицинской помощи взрослым пациентам с септическим шоком и алгоритмы действий врача при диагностике и интенсивной терапии пациентов с септическим шоком

The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe