On the Threshold of a Dream.
On the Threshold of a Dream.
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站在梦想的门槛上。
DOI：
10.1097/ccm.0000000000001323
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发表时间：
2015
影响因子：
8.8
通讯作者：
Zimmerman,JerryJ
中科院分区：
文献类型：
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作者：
Zimmerman,JerryJ
采用捆绑治疗方法的败血症标准工作强调需要时刻关注时间(1)。与创伤一样，败血症复苏也存在“黄金时刻”(2)。因此，初始液体给药时间（3,4）和适当的抗菌素给药时间（5,6）是早期败血症复苏的关键因素，与改善患者预后相关。然而，在脓毒症可以治疗之前，必须认识到它。脓毒症的识别和验证必须发生，以便开始实施脓毒症包。然而，这个过程可能很复杂。例如，据报道，急诊医生可能低估了发烧幼儿严重细菌感染的可能性，导致抗生素治疗不足。相反，这些没有细菌感染的儿童中有20%开了抗生素。对细菌感染进行敏感、特异、实时的诊断是非常必要的(7)。现有的基于培养的微生物鉴定是缓慢和不可靠的。特别是在ICU，假阴性培养是有问题的，通常可能与并发抗生素治疗有关。同时，败血症的漏诊或延迟诊断是一个质量问题。在这方面，文森特等人(8)在本期《重症监护医学》上发表的文章对研究人员和临床医生都很有吸引力。
Standard work for sepsis employing a bundled treatment approach emphasizes the need to keep an eye on the clock (1). Like trauma, there also exists a “golden hour” for sepsis resuscitation (2). Accordingly time to initial fluid administration (3, 4) and time to administration of appropriate antimicrobials (5, 6) represent key elements of early sepsis resuscitation that are associated with improved patient outcomes. However, before sepsis can be treated, it must be recognized. Sepsis recognition and verification must occur in order to initiate implementation of the sepsis bundle. However, this process may be complicated. As one example, it has been reported that emergency physicians may underestimate the likelihood of serious bacterial infection among young children with fever, resulting in undertreatment with antibiotics. Conversely, 20% of such children without bacterial infection were prescribed antibiotics. There is a real need for sensitive and specific, real-time diagnosis of bacterial infection (7). Existing culture-based microbe identification is slow and unreliable. Particularly in the ICU, false-negative cultures are problematic and are often likely associated with concurrent antibiotic treatment. Meanwhile, missed or delayed sepsis diagnosis is a quality issue. In this regard, the article by Vincent et al (8) in this issue of Critical Care Medicine is intriguing to both researchers and clinicians alike.