| Sažetak | Sepsa je ,,po život opasna disfunkcija organa, uzrokovana nereguliranim imunološkim odgovorom domaćina na infekciju“. Sepsu uzrokuju mnogobrojni mikroorganizmi kao što su bakterije, virusi, gljivice, toksini. Sepsu može dobiti svatko, bez obzira na dob i spol.Rizičnim skupinama smatraju se kronični bolesnici, osobe starije od 65 godina, novorođenčad i mala djeca, trudnice te imunokompromitirani bolesnici. Za liječenje sepse potrebna je nadoknada tekućine, primjena antibiotika, kontrola glukoze u krvi, oksigenacija i prehrana. Najveći je izvor financijskih troškova te uzrok prijema i smrti u jedinicama intenzivnog liječenja. Cilj ovog rada bio je ispitati pojavnost sepse kod pacijenata u Jedinici intenzivnog liječenja Opće bolnice ,,Dr. Tomislav Bardek'' Koprivnica u razdoblju od 2019. do 2022. godine. Nadalje, svrha ovog rada je saznati učestalost obolijevanja od sepse, vrsti prijema, uzroke i ishodišta nastanka sepse, koliko je bolesnika dijalizirano prije i za vrijeme pandemije COVID-19, koliko je bolesnika sa sepsom imalo COVID-19 bolest te ustanoviti kolika je smrtnost bolesnika s obzirom na dob i spol. Istraživanje je bilo retrospektivno i obuhvatilo je sve bolesnike kojima je dijagnosticirana sepsa ili su došli sa sepsom u jedinicu intenzivnog liječenja. Rezultati su prikazani sumiranjem individualnih podataka na odjelu intenzivne njege OB ,,Dr. Tomislav Bardek'' Koprivnica u razdoblju od 01.01.2019. godine do 31.12.2022. godine uz odobrenje Etičkog povjerenstva. Analizom dobivenih deskriptivnih pokazatelja uzorak ispitanika činio je 231 muškarac (54%) i 200 žena (46%). Osobe su bile pretežno starije dobi iznad 60 godina života (njih 88%). Najniža dob je 21 godina dok je najviša 93 godine. Naime, medijalna dob oboljelih muškaraca bila je 73 godine, dok je kod žena medijalna dob bila 75 godina. Broj hospitaliziranih pacijenata zbog sepse vrlo je različit u promatrane četiri godine. Najmanji je bio u pretpandemijskoj 2019. godini, a najveći u pandemijskim godinama 2021. i 2022. Većina pacijenata je hospitalizirana u JIL-a jednom (njih 94%). Dio ih je zbog pogoršanja stanja ponovno smješten u JIL-a, u istoj kalendarskoj godini (njih 6%). Veći udio hospitaliziranih u JIL-a bio je s drugih bolničkih odjela (oko 2/3) nego s hitnog prijema (oko 1/3). Kao najveći uzročnik sepse je bakterija Acinetobacter baumannii (23%), a na ostale četiri vrste bakterija otpadaju postoci pacijenata između 11% i 15%. Najveće ishodište infekcije kod bolesnika oboljelih od sepse liječenih u JIL-a bio je respiratorni sustav, kod 55% pacijenata. Većina bolesnika u JIL-a nije dijalizirana, približno 2/3. Preostalih 1/3 pacijenata je dijalizirano CVVHDF metodom odnosno kontinuiranom venovenskom hemodijafiltracijom koja predstavlja kontinuiranu metodu nadomještanja bubrežne funkcije u liječenju anuričnih i oliguričnih bolesnika. Većina pacijenata sa sepsom (njih 77%) nije imala COVID-19 bolest. Liječenje sepse kod većine pacijenata nije bilo uspješno. Naime, od 100 liječenih bolesnika od sepse njih 69 je umrlo. Sepsa je složen sindrom koji zahtijeva istinski individualiziranu procjenu bolesnika uz golemu lepezu kliničkih podataka i predstavlja glavni uzrok prijema i smrtnosti u jedinici intenzivnog liječenja. Prepoznavanje izvora infekcije bitan je korak u liječenju sepse koji se provodi odgovarajućim antibioticima, održavanjem cirkulatorne funkcije te provođenjem dijalize.Liječenje znakova i simptoma sepse u ranoj fazi dijagnoze pokazalo se boljim ishodom za pacijente i smanjila se učestalost morbiditeta i mortaliteta. Medicinske sestre igraju ključnu ulogu ne samo u prepoznavanju ranih znakova i simptoma u samom početku bolesti nego sudjeluju u pravovremenoj primjeni odgovarajuće terapije te na promicanju mjera u prevenciju bolesti. Veliki postotak slučajeva sepse je preventabilan i na tom segmentu podizanja javne svijesti o sepsi trebamo najviše raditi. Sepsa predstavlja vrlo ozbiljan globalni zdravstveni problem s posljedicama opasnim po život, što zahtijeva hitan fokus, posebice u ranoj dijagnostici te inovativnom i učinkovitom terapijskom liječenju. Kad posumnjamo na sepsu trebamo ju tretirati kao hitno stanje, pridržavati se propisanih preporuka i snopova prevencije te sudjelovati u educiranju sebe i drugih u cilju spašavanja života. |
| Sažetak (engleski) | Sepsis is a "life-threatening organ dysfunction caused by an unregulated immune response of the host to an infection". Sepsis is caused by many microorganisms such as bacteria, viruses, fungi and toxins. Anyone can get sepsis, regardless of age and gender. Chronic patients, people older than 65, newborns and small children, pregnant women, and immunocompromised patients are considered risk groups. Treatment of sepsis requires fluid replacement, antibiotic administration, corticosteroid therapy, blood glucose control, and oxygenation. It is the biggest source of financial costs and the cause of admission and death in intensive care units.
The aim of this work was to examine the occurrence of sepsis in patients in the Intensive Care Unit of the General Hospital, Dr. Tomislav Bardek'' Koprivnica in the period from 2019 to 2022. Furthermore, the purpose of this paper is to find out the incidence of sepsis, the type of admission, the causes and origins of sepsis, how many patients were dialyzed before and during the COVID-19 pandemic, how many patients with sepsis had COVID-19 disease, and to determine the patient mortality rate with regard to age and sex. The research was retrospective and included all patients who were diagnosed with sepsis or came to the intensive care unit with sepsis. The results are presented by summarizing individual data at the intensive care unit of the General Hospital, Dr. Tomislav Bardek'' Koprivnica in the period from 01.01.2019. until December 31, 2022. with the approval of the Ethics Committee.
Analyzing the obtained descriptive indicators, the sample of respondents consisted of 231 men (54%) and 200 women (46%). The people were predominantly older than 60 years of age (88%). The lowest age is 21, while the highest is 93. Namely, the median age of affected men was 73 years, while the median age of women was 75 years. The number of hospitalized patients due to sepsis is very different in the observed four years. It was the lowest in the pre-pandemic year 2019, and the highest in the pandemic years 2021 and 2022. Most patients were hospitalized in the ICU once (94%). Some of them were re-admitted to the ICU in the same calendar year due to worsening conditions (6% of them). A higher proportion of those hospitalized in the ICU are from other hospital departments (about 2/3) than from the emergency department (about 1/3). The biggest cause of sepsis is the bacterium Acinetobacter baumannii (23%), and the other four types of bacteria account for between 11% and 15% of patients. The main source of infection in sepsis patients treated in the ICU was the respiratory system, in 55% of patients. Most patients in the ICU are not on dialysis, approximately 2/3 of them. The remaining 1/3 of the patients were dialyzed by the CVVHDF method (continuous venovenous hemodiafiltration, which represents a continuous method of replacement of renal function in the treatment of anuric and oliguric patients). Most patients with sepsis (77%) did not have COVID-19. Treatment of sepsis in most patients was not successful. Namely, out of 100 patients treated for sepsis, 69 of them died.
Sepsis is a complex syndrome that requires a truly individualized assessment of the patient with a huge array of clinical data and is the main cause of admission and mortality in the intensive care unit. Identifying the source of infection is an important step in the treatment of sepsis, which is carried out with appropriate antibiotics, maintaining circulatory function and conducting dialysis. Nurses play a key role not only in recognizing early signs and symptoms at the very beginning of the disease, but also in the timely application of appropriate therapy and in the promotion of disease prevention measures. A large percentage of sepsis cases are preventable, and we need to do the most work on that segment of raising public awareness about sepsis. Sepsis remains a serious global health problem with life-threatening consequences, which requires an urgent focus, especially on early diagnosis and innovative and effective therapeutic treatment. When we suspect sepsis, we should treat it as an emergency, adhere to prescribed recommendations and prevention bundles, and educate ourselves and others in order to save lives. |
