Recommendations for sepsis management in resource-limited settings
Recommendations for sepsis management in resource-limited settings
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DOI：
10.1007/s00134-012-2521-4
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发表时间：
2012-04-01
影响因子：
38.9
通讯作者：
Schultz, Marcus J.
中科院分区：
文献类型：
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作者：
Duenser, Martin W.;Festic, Emir;Schultz, Marcus J.
为在资源有限的环境中执业的临床医生提供一个框架，以提高儿科和成人脓毒症患者的诊断和治疗。特别注意在资源有限的环境中识别脓毒症管理的临床证据。建议分为急性和急性后干预。急性干预包括自由液体复苏以实现充分的组织灌注、正常的心率和动脉血压、尽管液体复苏但仍使用肾上腺素或多巴胺以用于组织灌注不足、在血流动力学不稳定的患者中频繁测量动脉血压、向需要儿茶酚胺的患者施用氢化可的松或泼尼松龙、施用氧气以实现氧饱和度> 90%、半卧位和/或侧卧位，无创通气以增加呼吸功或低氧血症（尽管进行了氧疗），及时给予足够的抗菌剂，进行彻底的临床研究以识别感染源，进行液体/组织采样和微生物检查，清除、引流或清创感染源。急性期后干预包括定期重新评估抗菌药物治疗，给予足够但不延长的抗菌药物，避免低血糖，药物或机械性深静脉血栓形成预防，复苏和恢复意识后恢复口服食物摄入，谨慎使用阿片类药物和镇静剂，早期动员和主动脱离侵入性支持。对于疟疾、产褥期脓毒症和HIV/AIDS患者脓毒症的特殊考虑也包括在内。对于在资源有限的环境中管理儿童和成人脓毒症，仅有很少的证据。提出的建议可能有助于改善中低收入国家的脓毒症管理。
To provide clinicians practicing in resource-limited settings with a framework to improve the diagnosis and treatment of pediatric and adult patients with sepsis.The medical literature on sepsis management was reviewed. Specific attention was paid to identify clinical evidence on sepsis management from resource-limited settings.Recommendations are grouped into acute and post-acute interventions. Acute interventions include liberal fluid resuscitation to achieve adequate tissue perfusion, normal heart rate and arterial blood pressure, use of epinephrine or dopamine for inadequate tissue perfusion despite fluid resuscitation, frequent measurement of arterial blood pressure in hemodynamically unstable patients, administration of hydrocortisone or prednisolone to patients requiring catecholamines, oxygen administration to achieve an oxygen saturation > 90%, semi-recumbent and/or lateral position, non-invasive ventilation for increased work of breathing or hypoxemia despite oxygen therapy, timely administration of adequate antimicrobials, thorough clinical investigation for infectious source identification, fluid/tissue sampling and microbiological work-up, removal, drainage or debridement of the infectious source. Post-acute interventions include regular re-assessment of antimicrobial therapy, administration of antimicrobials for an adequate but not prolonged duration, avoidance of hypoglycemia, pharmacological or mechanical deep vein thrombosis prophylaxis, resumption of oral food intake after resuscitation and regaining of consciousness, careful use of opioids and sedatives, early mobilization, and active weaning of invasive support. Specific considerations for malaria, puerperal sepsis and HIV/AIDS patients with sepsis are included.Only scarce evidence exists for the management of pediatric and adult sepsis in resource-limited settings. The presented recommendations may help to improve sepsis management in middle- and low-income countries.