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Features of development of sepsis in operated cancer patients

Alexey Portnov, medical expert
Last reviewed: 23.04.2024

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The frequency of sepsis development in operated oncological patients is 3.5-5%, lethality is 23-28%.

trusted-source [1], [2], [3], [4], [5]

Causes of development of sepsis in operated oncological patients

At the heart of the development of sepsis in oncosurgical patients is a pronounced secondary immunodeficiency. A decrease in IgM, IgG and IgA levels in 1,2-2,5 times, lymphopenia (less than 1,0х10 ⁹ / l), a decrease in the phagocytic capacity of neutrophils (FI 5 min <0), low concentrations of pro-inflammatory cytokines (TNF, IL- 1, IL-6) in the blood serum, as well as a decrease in the expression of HLA-DR on monocytes. The level of lymphocytes decreases intraoperatively, due to lymphadenectomy, since oncological operations are extended, with a high traumatism and a large volume of surgical tissue trauma, a clinical picture.

The clinical picture of sepsis is characterized by a low level of total blood protein (35-45 g / l), including albumin (15-25 g / l), which is accompanied by a shortage of preload, increased vascular permeability (impaired lymphatic drainage function), low CODE (14 -17 mmHg), hypercoagulation and thrombus formation in the deep veins of the lower extremities and small pelvis, stress ulcers in the digestive tract also often develop.

Early onset of sepsis (2-4 days after surgery) due to severe immunodeficiency.
Difficulties in diagnosis arise due to the development of SSRS and an increase in the level of procalcitonin (> 5 ng / ml) 1-3 days after surgery, in response to surgical tissue trauma.
Prevalence as a causative agent of gram-negative resistant flora.
The development of the syndrome often occurs both during the development of the septic process, and through surgical intervention involving the relevant organs and systems.
Most often, sepsis develops due to peritonitis (abdominal sepsis in general) and pneumonia.

trusted-source [6], [7], [8], [9],

Diagnostics

Control of the focus of the infection and the isolation of the pathogen from it.
Control hemodynamics, including central (invasive and non-invasive methods).
Biochemical and clinical analysis of blood definition of leukocyte formula, coagulogram, CBS, RCD and level of procalcitonin.
Analysis of urine.
X-ray diagnosis and CT.
Dynamics of the state (scales APACHE, MODS, SOFA).

trusted-source [10]

Treatment of sepsis in operated oncological patients

Intensive therapy for sepsis is aimed at sanation of the foci of infection, correction of manifestations of SSRM and PON.

Assign solutions of hydroxyethyl starch (30-40 ml / kg) and 20% albumin solution 5 ml / kg iv, they allow to bring the COD up to 23-26 mm. Gt; Art. And thus maintain an adequate preload level and avoid hyperhydration of the lungs. Use a combination of colloidal solutions, vasopressors and hydrocortisone (with septic shock).
Combination of antibacterial drugs (protected cephalosporins III, cephalosporins IV, carbapenems) and immunoglobulin solution are administered intravenously. Due to such a combination, elimination of the pathogen is sought and development of resistance to antibiotics is avoided.
Application of LMWH and proton pump inhibitors.
Substitution of functions of organs with PON. Use the so-called protective strategy of ventilation (with the development of ARDS), HD or hemodiafiltration (with the development of arresters).