[Protocol of the management of patients with severe sepsis and septic shock].

Severe sepsis and septic shock remains the most urgent problem. In severe sepsis and septic shock should be early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition; -appropriate diagnostic studies to ascertain causative organisms before starting antibiotics; -early administration of broad-spectrum antibiotic therapy; -reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate; -a usual 7-10 days of antibiotic therapy guided by clinical response; -source control with attention to the method that balances risks and benefits; -equivalence of crystalloid and colloid resuscitation; aggressive fluid challenge to restore mean circulating filling pressure; -vasopressor preference for norepinephrine and dopamine; -cautious use of vasopressin pending further studies; -avoiding low-dose dopamine administration for renal protection; consideration of dobutamine inotropic therapy in some clinical situations; -stress-dose steroid therapy for septic shock; use of recombinant activated protein C in patients with severe sepsis and high risk for death; -with resolution of tissue hypoperfusion and in the absence of coronary artery disease or acute hemorrhage, targeting a hemoglobin of 7-9 g/dL; -a low tidal volume and limitation of inspiratory plateau pressure strategy for acute lung injury and acute respiratory distress syndrome; -application of a minimal amount of positive end-expiratory pressure in acute lung injury/acute respiratory distress syndrome; -protocols for weaning and sedation, using either intermittent bolus sedation or continuous infusion sedation with daily interruptions/lightening; -avoidance of neuromuscular blockers, if at all possible; -maintenance of blood glucose <150 mg/dL after initial stabilization.

[Clinical trials and intensive therapy of the swine flu (H1N1)].

During the recent years there's a high index of the swine flu А (H1N1) disease in the whole world. In Georgia it began to spread at the end of Autumn 2009. The aim of our study was to define clinical trials of the swine flu (H1N1) in patients of Republic Clinical Hospital in Batumi from 2009 to 2011 and to generalize the methods of treatment. In the hospital there were 94 patients suffering from the swine flu (H1N1) disease, 20 of which due to their critical situation of the disease were treated in the department of the intensive therapy. We studied case histories of 20 patients, who were undergoing treatment in the department of the intensive therapy by the generally acknowledged programme of study and monitoring due to their hard disease. Among these 20 patients 10 were women and 10 men. 10 patients died. The programme of intensive treatment consisted of infusive-transfusive therapy by the negative water balance, antivirus treatment (Tamiflu/Relenza), de-escalation antibiotic therapy, mechanic ventilation of lungs, aerosol therapy, plus symptom treatment. In 2011 there were fewer cases of the swine flu and the death rate compared to the earlier years. In 2011 of 25 patients only one patient died, but in 2009-2010 of 69 patients 7 patients died), which was conditioned by immunity development. The most frequently used regime of lung mechanic ventilation was BIPAR. In the first days antibiotic therapy is not defining. It is necessary to find more effective method of antivirus treatment.