Perioperative management of adult surgical patients with septic shock in resource limiting setting, systematic review

ABSTRACT Background: Infection is the inflammatory response to micro-organisms which leads to sepsis with disregulated host response and life-threatening organ dysfunction. The common causes are, severe burn/trauma, major surgical operations and complications in the perioperative period. The main cause of this has been found to be poor clinical diagnosis and management protocol for sepsis and its consequences such as septic shock and multi-organ dysfunction; and these have been pronounced during perioperative period with additional burdens of surgery and anesthesia. Septic shock may lead to diminished cognitive function, psychological problems, and long-term damage to organ systems increased malignancy risk, and increased hospitalization rates. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Search engines like PubMed through HINARI, Cochrane database and Google Scholars were used to find high-level evidences that help to draw appropriate conclusions. Discussions: Septic shock is a major healthcare problem with high mortality rate in different countries. The mortality rate associated with septic shock has been estimated as being between 28 and 50%, in developed countries and higher (45%-74.6) in countries with low socioeconomic status including Ethiopia. The main cause of this has been found to be poor clinical diagnosis and management protocol for sepsis and its consequences such as septic shock and multi-organ dysfunction; and these have been pronounced during perioperative period with additional burdens of surgery and anesthesia. The aims of septic shock patient management perioperatively is that best survival outcome of the patient through keeping the major organ perfusion, controlling source of sepsis, keeping the intravascular volume, acute lung injury avoidance during mechanical ventilation, hematological renal indices and electrolyte level balancing. Conclusion: Since the incidence of septic shock is a major healthcare problem in the world for the patients who often require surgery, thus the periopratively management is determinant factor for the patient survival outcome for the aim of minimizing the perioperative morbidity, mortality, prolonged hospitalization, health care costs and then increases productivity of the population. Highlights