zabmedvestnikЗабайкальский медицинский вестникTransbaikalian Medical Bulletin1998-6173Читинская государственная медицинская академия10.52485/19986173_2025_3_143zabmedvestnik-428Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWSИНТЕНСИВНАЯ ТЕРАПИЯ В ОСТРОМ ПЕРИОДЕ ПНЕВМОНИЙ, ОСЛОЖНЁННЫХ СЕПСИСОМINTENSIVE CARE MANAGEMENT IN THE ACUTE PHASE OF PNEUMONIA COMPLICATED BY SEPSIShttps://orcid.org/0009-0001-0990-2014КолмаковА. И.KolmakovA. I.

Колмаков Андрей Игоревич, д.м.н., врач анестезиолог-реаниматолог, аспирант

194100, г. Санкт-Петербург, ул. Литовская, д. 2

Kolmakov A.I., Doctor of Medical Sciences, anesthesiologist-resuscitator, graduate student

2 Litovskaya St., St. Petersburg, 194100

kolmakov073@gmail.comhttps://orcid.org/0009-0000-2833-9020СтепановА. Ю.StepanovA. Yu.

Степанов Алексей Юрьевич, врач анестезиолог-реаниматолог, аспирант

194100, г. Санкт-Петербург, ул. Литовская, д. 2

Stepanov A.YU., Doctor of Medical Sciences, anesthesiologist-resuscitator, graduate student

2 Litovskaya St., St. Petersburg, 194100

ghbpyfrb@gmail.comhttps://orcid.org/0000-0002-2131-4813АлександровичЮ. С.AleksandrovichYu. S.

Александрович Юрий Станиславович, д.м.н., профессор, проректор по послевузовскому, дополнительному профессиональному образованию и региональному развитию здравоохранения, заведующий кафедрой анестезиологии, реаниматологии и неотложной педиатрии ФП и ДПО

194100, г. Санкт-Петербург, ул. Литовская, д. 2

Aleksandrovich Y.S., Doctor of Medical Sciences, Professor, Vice-Rector for Postgraduate, Additional Professional Education and Regional Health Development, Head of the Department of Anesthesiology, Intensive Care Medicine and Emergency Pediatrics

2 Litovskaya St., St. Petersburg, 194100

jalex1963@mail.ruhttps://orcid.org/0000-0003-3669-1993ЭсауленкоЕ. В.EsaulenkoE. V.

Эсауленко Елена Владимировна, д.м.н., профессор, заведующий кафедрой инфекционных болезней взрослых и эпидемиологии

194100, г. Санкт-Петербург, ул. Литовская, д. 2

Еsaulenko E.V., Doctor of Medical Sciences, Professor; Head of the Department of Infectious Diseases of Adults and Epidemiology

2 Litovskaya St., St. Petersburg, 194100

eve-gpmu@mail.ruhttps://orcid.org/0000-0002-3577-604XПогорельчукВ. В.PogorelchukV. V.

Погорельчук Виктор Викторович, к.м.н., доцент кафедры анестезиологии, реаниматологии и неотложной педиатрии

194100, г. Санкт-Петербург, ул. Литовская, д. 2

Pogorelchuk V.V., Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology, Resuscitation and Emergency Pediatrics

2 Litovskaya St., St. Petersburg, 194100

viktor-pogorelchuk@yandex.ruФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» Министерства здравоохранения РФРоссияSaint Petersburg State Pediatric Medical UniversityRussian Federation20250211202503143156Copyright © Колмаков А.И., Степанов А.Ю., Александрович Ю.С., Эсауленко Е.В., Погорельчук В.В., 20252025Колмаков А.И., Степанов А.Ю., Александрович Ю.С., Эсауленко Е.В., Погорельчук В.В.Kolmakov A.I., Stepanov A.Y., Aleksandrovich Y.S., Esaulenko E.V., Pogorelchuk V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.zabmedvestnik.ru/jour/article/view/428

Актуальность. Пневмония, осложнённая сепсисом, остаётся одной из ведущих причин летальности пациентов отделений интенсивной терапии. Раннее выявление жизнеугрожающих состояний и применение современных методов интенсивной терапии крайне важны для улучшения исхода.Цель исследования: Обобщить современные представления о диагностике и интенсивной терапии внебольничной, внутрибольничной и вирусной пневмонии, осложнённой сепсисом, с учётом актуальных клинических рекомендаций.Материал и методы. Выполнен обзор публикаций 2018–2024 гг., включая отечественные и зарубежные гайдлайны (IDSA, SSC), а также данные клинических исследований по новым антибактериальным препаратам, биомаркерам и методам экстракорпоральной терапии.Результаты. Современная стратегия включает персонализированную антибактериальную терапию, использование биомаркеров (PCT, MR-proADM, suPAR, presepsin), молекулярную диагностику (NGS), а также селективную гемосорбцию и иммунотерапию (ингибиторы IL-6, JAK/STAT). Особое внимание уделяется стратификации риска и раннему началу лечения. Обсуждение. Остаются нерешёнными вопросы отбора пациентов для инновационных методов терапии, сроков их применения и оценки эффективности. Персонализированный подход требует дальнейшего изучения.Заключение. Интенсивная терапия пневмонии, осложнённой сепсисом, учитывающая этиологию, данные мониторинга тяжести состояния и маркерный профиль, а также интеграцию новых терапевтических технологий, способствует снижению летальности и улучшению исходов.

Relevance. Pneumonia complicated by sepsis remains one of the leading causes of mortality in intensive care units. Early recognition of life-threatening conditions and the implementation of modern therapeutic strategies are crucial for improving outcomes.The aim of the research. To summarize current approaches to the diagnosis and intensive care management of community-acquired, hospital-acquired, and viral pneumonia complicated by sepsis, based on recent clinical guidelines.Materials and Methods. A literature review was conducted covering publications from 2018 to 2024, including national clinical guidelines and international recommendations (IDSA, SSC), as well as clinical studies on novel antibacterial agents, biomarkers, and extracorporeal therapies.Results. Current treatment strategies include personalized antibiotic therapy, use of prognostic and diagnostic biomarkers (PCT, MR-proADM, suPAR, presepsin), molecular diagnostics (NGS), selective hemoadsorption, and targeted immunotherapy (IL-6 and JAK/STAT inhibitors). Special attention is given to early risk stratification and timely therapeutic intervention.Discussion. Key issues remain unresalved regarding patient selection for advanced therapies, optimal timing, and criteria for treatment effectiveness. Further research is needed to refine personalized treatment approaches.Conclusion. Intensive care for pneumonia complicated by sepsis requires an integrated approach based on pathogen profile, disease severity, immune status, and prognostic markers. Incorporation of innovative treatment methods can reduce mortality and improve clinical outcomes.

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The authors declare that there are no conflicts of interest present.