[Present possibilities of therapy of septic shock in surgical patients]

The authors present a review of contemporary possibilities of septic shock in surgical patients. As mentioned by the authors, the most frequent cause of Gram-negative sepsis in surgery are intraabdominal inflammatory diseases or septic complications after planned surgery. Based on an experimental study on acute endotoxin shock in dogs and treatment with hydrocortisone, dopamine and antihypertensive drugs (mepamil and metazosine), the authors present some principles of the therapeutic procedure in endotoxin shock under clinical conditions. They emphasize in particular administration of antibodies against endotoxin and cytokines. In the clinical part they submit results of comprehensive therapy of intraabdominal sepsis in patients hospitalized at the intensive care unit of the Surgical Clinic at the Third Medical Faculty in Prague. They give an account of the principles of peroperative and postoperative treatment within the framework of differentiated care. During the postoperative period it is important to ensure prevention and treatment of septic complications such as septic shock and the syndrome of multiorgan systemic failure as well as rational antimicrobial therapy, immunotherapy and adequate nutrition. The authors emphasize that it is essential that specific antibodies are available and indications of their administration must be defined. The expected effect of immunotherapy is limited by the period of administration in relation to early stages of sepsis.