Therapy of sepsis

被引：0

作者：

Bloos, Frank ^{[1
]}

机构：

[1] Univ Klinikum Jena, Klin Anasthesiol & Intens Med, Klinikum 10, D-07747 Jena, Germany

来源：

ANASTHESIOLOGIE INTENSIVMEDIZIN NOTFALLMEDIZIN SCHMERZTHERAPIE | 2023年 / 58卷 / 01期

关键词：

sepsis; fluid therapy; antibiotic therapy; hydrocortisone; SEPTIC SHOCK; VITAMIN-C; HYDROCORTISONE; INTERVENTION; METAANALYSIS; MORTALITY;

D O I：

10.1055/a-1813-2319

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Sepsis as a development of an acute infection-related organ dysfunction significantly increases the risk of death for the patient. Therefore, fast and consistent management is required. The sepsis bundle is a convenient algorithm for initial sepsis therapy within the first hour of sepsis diagnosis consisting of blood cultures, lactate measurement, antibiotics, fluid resuscitation, and vasopressor therapy. Cristalloid solutions are first choice for fluid therapy but albumin and gelatine may be considered if colloid solutions are required. Norepinephrine is the vasopressor of first choice. After initial therapy, further fluid resuscitation should be guided by dynamic criteria. Vasopressin may be added as an additional vasopressor. Goal of resuscitation is to achieve lactate clearance. In shock refractory to therapy, addition of hydrocortisone (200 mg/day) should be considered. Further additional therapies such as immunoglobulins, blood purification, and metabolic resuscitation (combination of hydrocortisone, thiamine, vitamine C) are currently not supported by studies and should not be considered as standard therapy.

引用

页码：40 / 50

页数：11

共 24 条

[1] Hydrocortisone plus Fludrocortisone for Adults with Septic Shock [J].

Annane, D. ;

Renault, A. ;

Brun-Buisson, C. ;

Megarbane, B. ;

Quenot, J. -P. ;

Siami, S. ;

Cariou, A. ;

Forceville, X. ;

Schwebel, C. ;

Martin, C. ;

Timsit, J. -F. ;

Misset, B. ;

Benali, M. Ali ;

Colin, G. ;

Souweine, B. ;

Asehnoune, K. ;

Mercier, E. ;

Chimot, L. ;

Charpentier, C. ;

Francois, B. ;

Boulain, T. ;

Petitpas, F. ;

Constantin, J. -M. ;

Dhonneur, G. ;

Baudin, F. ;

Combes, A. ;

Bohe, J. ;

Loriferne, J. -F. ;

Amathieu, R. ;

Cook, F. ;

Slama, M. ;

Leroy, O. ;

Capellier, G. ;

Dargent, A. ;

Hissem, T. ;

Maxime, V. ;

Bellissant, E. .

NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (09) :809-818

[2] Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock [J].

Azuhata, Takeo ;

Kinoshita, Kosaku ;

Kawano, Daisuke ;

Komatsu, Tomonori ;

Sakurai, Atsushi ;

Chiba, Yasutaka ;

Tanjho, Katsuhisa .

CRITICAL CARE, 2014, 18 (03)

[3] Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial [J].

Bloos, Frank ;

Rueddel, Hendrik ;

Thomas-Rueddel, Daniel ;

Schwarzkopf, Daniel ;

Pausch, Christine ;

Harbarth, Stephan ;

Schreiber, Torsten ;

Guerndling, Matthias ;

Marshall, John ;

Simon, Philipp ;

Levy, Mitchell M. ;

Weiss, Manfred ;

Weyland, Andreas ;

Gerlach, Herwig ;

Schuerholz, Tobias ;

Engel, Christoph ;

Matthaeus-Kraemer, Claudia ;

Scheer, Christian ;

Bach, Friedhelm ;

Riessen, Reimer ;

Poidinger, Bernhard ;

Dey, Karin ;

Weiler, Norbert ;

Meier-Hellmann, Andreas ;

Haeberle, Helene H. ;

Woebker, Gabriele ;

Kaisers, Udo X. ;

Reinhart, Konrad .

INTENSIVE CARE MEDICINE, 2017, 43 (11) :1602-1612

[4]

Bodmann KF., AWMF REGISTERNUMMER, V82

[5] Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality [J].

Boyd, John H. ;

Forbes, Jason ;

Nakada, Taka-aki ;

Walley, Keith R. ;

Russell, James A. .

CRITICAL CARE MEDICINE, 2011, 39 (02) :259-265

[6] Adequate anti-infective treatment. Importance of individual dosing and application [J].

Brinkmann, A. ;

Roehr, A. C. ;

Koeberer, A. ;

Fuchs, T. ;

Krueger, W. A. ;

Koenig, C. ;

Richter, D. ;

Weigand, M. A. ;

Frey, O. R. .

ANAESTHESIST, 2018, 67 (06) :461-474

[7] S3-Guideline Sepsis - Prevention, Diagnosis, Therapy and Aftercare Extended Version [J].

Brunkhorst, F. M. ;

Weigand, M. A. ;

Pletz, M. ;

Gastmeier, P. ;

Lemmen, S. W. ;

Meier-Hellmann, A. ;

Ragaller, M. ;

Weyland, A. ;

Marx, G. ;

Bucher, M. ;

Gerlach, H. ;

Salzberger, B. ;

Grabein, B. ;

Welte, T. ;

Werdan, K. ;

Kluge, S. ;

Bone, H. G. ;

Putensen, C. ;

Rossaint, R. ;

Quintel, M. ;

Spies, C. ;

Weiss, B. ;

John, S. ;

Oppert, M. ;

Joerres, A. ;

Brenner, T. ;

Elke, G. ;

Gruendling, M. ;

Mayer, K. ;

Weimann, A. ;

Felbinger, T. W. ;

Axer, H. .

MEDIZINISCHE KLINIK-INTENSIVMEDIZIN UND NOTFALLMEDIZIN, 2020, 115 :S37-S109

[8]

Busani S, 2016, MINERVA ANESTESIOL, V82, P559

[9]

Evans L, 2021, INTENS CARE MED, V47, P1181, DOI [10.1007/s00134-021-06506-y, 10.1097/CCM.0000000000005337]

[10] Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock The VITAMINS Randomized Clinical Trial [J].

Fujii, Tomoko ;

Luethi, Nora ;

Young, Paul J. ;

Frei, Daniel R. ;

Eastwood, Glenn M. ;

French, Craig J. ;

Deane, Adam M. ;

Shehabi, Yahya ;

Hajjar, Ludhmila A. ;

Oliveira, Gisele ;

Udy, Andrew A. ;

Orford, Neil ;

Edney, Samantha J. ;

Hunt, Anna L. ;

Judd, Harriet L. ;

Bitker, Laurent ;

Cioccari, Luca ;

Naorungroj, Thummaporn ;

Yanase, Fumitaka ;

Bates, Samantha ;

McGain, Forbes ;

Hudson, Elizabeth P. ;

Al-Bassam, Wisam ;

Dwivedi, Dhiraj Bhatia ;

Peppin, Chloe ;

McCracken, Phoebe ;

Orosz, Judit ;

Bailey, Michael ;

Bellomo, Rinaldo ;

French, Craig J. ;

Deane, Adam M. ;

Hajjar, Ludhmila A. ;

Oliveira, Gisele ;

Orford, Neil ;

Shehabi, Yahya ;

Udy, Andrew A. ;

Young, Paul J. ;

McCracken, Phoebe ;

Board, Jasmin ;

Martin, Emma ;

Vallance, Shirley ;

Young, Meredith ;

Bellomo, Rinaldo ;

Eastwood, Glenn. M. ;

Cioccari, Luca ;

Bitker, Laurent ;

Yanase, Fumitaka ;

Naorungroj, Thummaporn ;

Hessels, Lara ;

Peck, Leah .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2020, 323 (05) :423-431

← 1 2 3 →