Choc septique !!! Que de personnes en meurent, surtout des vieux, parce qu’un vieux, c’est vulnérable comme un duvet au gré du vent.
Et bien que cette situation grave est devenue très courante; rares sont les personnes qui possèdent les informations exactes pour éviter des complications dangereuses qui aboutissent dans 95% des cas à une mort certaine.
Avant tout, expliquons c’est quoi un sepsis qui est à l’ origine du choc septique. Et bien tout simplement, c’est une infection générale du sang. Le choc septique en lui-même est une situation très grave, il apparaît quand le sepsis a provoqué une baisse dangereuse de la pression artérielle, une diminution de l’approvisionnement de l’oxygène aux organes ; le sang n’arrive plus à circuler jusqu’aux organes qui arrêtent de fonctionner correctement.
Le sepsis peut se développer à partir d’une péritonite (infection abdominale), une pyélonéphrite (infection rénale) ou encore une pneumopathie (infection pulmonaire). Les micro-organismes peuvent alors coloniser le site.
Cette affection grave se développe surtout chez les personnes fragiles ou immunodéprimées, comme les nouveau-nés, les femmes enceintes, les personnes souffrant de pathologies chroniques, comme le diabète ou une cirrhose par exemple et surtout chez les personnes âgées. Le choc septique doit être pris en charge rapidement dans une unité de réanimation, il s’agit d’une urgence médicale.
Les premiers signes d’un sepsis sont la fièvre, une tachycardie, une excrétion intense de la sueur, une vasodilatation intense, une coagulation excessive et une augmentation anormale de la fréquence respiratoire.
Ce phénomène, dans un premier temps, sera corrigé par une augmentation du débit cardiaque. Les organes vont être de moins en moins bien perfusés et l’apport en oxygène va diminuer, ce qui va aboutir à une défaillance multi-viscérale.
Le choc septique est donc généralement déclenché par une infection bactérienne, virale ou fongique. Lorsque ces agents pathogènes pénètrent dans l’organisme, ils peuvent provoquer une réaction inflammatoire excessive du système immunitaire. Les organes les plus touchés par ce processus sont le coeur, les reins, le foie et les poumons.
Dans un premier temps, le choc septique se caractérise par les signes d’une infection avec une grande fatigue associée à de la fièvre. Le rythme cardiaque augmente ensuite, ainsi que le rythme respiratoire. Le volume des urines diminue très fortement. Les extrémités peuvent être chaudes.
Cependant, quand le débit cardiaque ne peut plus compenser la diminution de la pression artérielle, d’autres signes peuvent apparaitre, comme un état de confusion mentale (confusion, agitation, somnolence, voire coma), des signes d’altération des organes. Au niveau hépatique, il peut se produire un manque d’irrigation sanguine grave. Au niveau du rein, une insuffisance rénale aiguë peut se développer. Le système digestif peut être le siège d’hémorragies et d’ulcères. Les extrémités deviennent froides et bleuâtres, des marbrures peuvent apparaitre au niveau de la peau.
Pour traiter un choc septique, on peut utiliser une antibiothérapie dite probabiliste. Il s’agit généralement d’antibiotiques à large spectre.
Le remplissage vasculaire est également très important et doit permettre de maintenir la tension artérielle au moins 6,5 mm Hg. L’utilisation de médicaments vasopresseurs (comme de la noradrénaline) peut être utile. Le traitement doit être poursuivi jusqu’à ce que les paramètres hémodynamiques soient acceptables. Si le traitement n’est pas concluant, un traitement corticoïde par hydrocortisone permettant de diminuer l’inflammation peut être mis en place. En cas de difficultés respiratoires, une oxygénothérapie est mise en place. La voie par laquelle l’infection s’est propagée doit être traitée de façon adéquate.
Les conséquences d’un choc septique non traité sont graves et peuvent inclure une défaillance de plusieurs organes (cœur, reins, cerveau…) et dans les cas les plus sévères, le décès du patient.
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