Research Information System
Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey
Approval Date: 2011
Student: GÖKMEN UMUT ERDEM
Supervisor: MELDA TÜRKOĞLU
Abstract:This study aimed to present the data of the patients who were followed up in the intensive care unit (ICU) of the internal medicine department of Gazi University for septic shock, to evaluate the diagnosis and treatment based on international sepsis guidelines developed in 2008 by Surviving Sepsis Campaign, and to determine the factors affecting the success in the treatment of septic shock. The study evaluated 70 septic shock attacks in 60 patients, 31 of whom developed the shock in the 9-bed ICU of the Internal Medicine department of Gazi University. On the first day of sepsis development, the acute physiology and chronic health evaluation score (APACHE II) of the patients was 31 [25-37]; sequential organ failure assessment (SOFA) score, 14 [9-16], and glasgow coma score (GKS) 9 [7-13]. Most of the patients (63%) were admitted from the in-patient units of the same hospital. Of the patients, 40% were cancer patients and 35% were immunosuppressed. The mortality rate of ICU is 68%, and the mortality rate of the hospital is 73%. The most common infection focus was the lungs, and the most commonly isolated organisms were gram negatives and A. baumannii. The most common symptoms of the patients in septic shock were respiratory and neurological deficits. Of these patients, 73% were given effective antimicrobial treatment. Among the attacks evaluated, the rate of conformation to 6 hr sepsis was 71%, and the rate of conformation to 24 hr sepsis was 55%. Our conformation rate was the lowest in the steps of optimization of central venous oxygen saturation, timely outset of antibiotic treatment or timely changes in the treatment, active protein c application, and timely monitorization of blood sugar. The most important factors affecting the success rate in the treatment of sepsis shock were the presence of neutropenia (p=0.04), invasive MV (p=0.02), optimization of central venous oxygen saturation (p=0.01), renal damage sepsis based on SOFA score on the onset of sepsis (p=0.01), and neurological damage (p=0.00), infection in blood circulation (p=0.02), and chronic renal failure/chronic renal disease (p=0.04). The epidemiology of most of the patients followed in ICU for sepsis shock is of pulmonary origin, and gram negative microorganisms have a major role. In such patients, despite current advances and protocols used, the mortality rate remains high and conformation with the guidelines is limited.