Deputy Head of the Department for science and education of Anaesthesiology, Resuscitation and Intensive Medicine, University Hospital Ostrava, Czech Republic
Sepsis is a serious life-threatening condition characterized by the presence of organ dysfunctions arising from the dysregulated host response to infection. The view of sepsis has evolved rapidly in recent decades. Mainly it is due to the increasing knowledge about its epidemiology, pathophysiology and therapy. As a result of population aging, increasing number of co-morbidities and improved diagnosis, the incidence of sepsis is increasing. Although sepsis is one of the most important topics and critical areas in intensive care, general and professional awareness remains inadequate. In 2016, a new definition of sepsis (sepsis-3) and a 5th revision of the Surviving Sepsis Campaign were recommended for intensive care patients with sepsis and septic shock. The presented algorithm is a necessary and clear knowhow to what to hold and what to think of a patient with sepsis. It highlights the need for rapid identification of the diagnosis and pathological agent and early initiation of supportive and causal treatment of sepsis.
Severe form of acute respiratory failure (ARF) together with the most severe form acute respiratory distress syndrome (ARDS) is heterogeneous and potentially life-threatening pathological conditions. Rapid diagnosis and causal resolution of the triggering factor is inevitable when influencing the prognosis of the patient. Other vital elements in the patient´s care with ARF are correctly indicated and used supportive and rescuing interventions which enable to span the most severe phase of the disease. The view of professional public on respiratory insufficiency management has been developing dynamically in recent decades. This is in virtue not only of increase in new diagnostic methods, but also of the rapid development of interventions (technologies and indications), some of which currently belong to the standard patient´s care in critical care medicine (mechanical lung ventilation, pronation), and others are aiming for it (extracorporeal membrane oxygenation). The occurrence of various ARF forms is and will continue to be on the leading position among pathological conditions in intensive care medicine. The presented algorithm is a necessary guide to the care of the patient with ARF symptoms. It logically covers all of the phases of health care from pre-hospital to hospital. It emphasizes the need for a rapid identification of the diagnosis and an early initiation of the whole spectrum of adequate supportive and causal therapy.