2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department.
2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department.
复制标题
2023年成人脓毒症与脓毒性休克最新进展：急诊科的处理
DOI：
10.3390/jcm12093188
复制
发表时间：
2023-04-28
影响因子：
3.9
通讯作者：
De Giorgio, Roberto
中科院分区：
文献类型：
--
作者：
Guarino, Matteo;Perna, Benedetta;Cesaro, Alice Eleonora;Maritati, Martina;Spampinato, Michele Domenico;Contini, Carlo;De Giorgio, Roberto
背景：脓毒症/脓毒性休克是一种危及生命且依赖时间的疾病，需要及时处理以降低死亡率。这篇综述旨在更新医生关于治疗这种潜在疾病的主要支柱。方法：检索PubMed、Scopus和EMBASE，重点检索时间为2021年11月- 2023年1月。结果：脓毒症/感染性休克的管理具有挑战性，涉及不同的病理生理方面，包括经验性抗菌治疗（在微生物试验后立即给予）、液体（晶体）替代（根据液体耐受性和液体反应性确定）和血管活性药物（如去甲肾上腺素（NE）），用于维持平均动脉压在65 mmHg以上并降低液体过载的风险。在难治性休克的情况下，加压素（而不是肾上腺素）应与NE联合使用以达到可接受的压力控制水平。如需机械通气，潮气量应从10 mL/kg降至6 mL/kg。肝素用于预防静脉血栓栓塞，并建议控制血糖。其他治疗方法（如质子泵抑制剂、碳酸氢钠等）的疗效在很大程度上存在争议，这些治疗方法可能会根据具体情况而定。结论：脓毒症/脓毒性休克的治疗在过去几年中取得了显著进展。提高对这一具有挑战性的疾病的主要治疗基础的了解对于获得更好的患者预后至关重要。
Background: Sepsis/septic shock is a life-threatening and time-dependent condition that requires timely management to reduce mortality. This review aims to update physicians with regard to the main pillars of treatment for this insidious condition. Methods: PubMed, Scopus, and EMBASE were searched from inception with special attention paid to November 2021–January 2023. Results: The management of sepsis/septic shock is challenging and involves different pathophysiological aspects, encompassing empirical antimicrobial treatment (which is promptly administered after microbial tests), fluid (crystalloids) replacement (to be established according to fluid tolerance and fluid responsiveness), and vasoactive agents (e.g., norepinephrine (NE)), which are employed to maintain mean arterial pressure above 65 mmHg and reduce the risk of fluid overload. In cases of refractory shock, vasopressin (rather than epinephrine) should be combined with NE to reach an acceptable level of pressure control. If mechanical ventilation is indicated, the tidal volume should be reduced from 10 to 6 mL/kg. Heparin is administered to prevent venous thromboembolism, and glycemic control is recommended. The efficacy of other treatments (e.g., proton-pump inhibitors, sodium bicarbonate, etc.) is largely debated, and such treatments might be used on a case-to-case basis. Conclusions: The management of sepsis/septic shock has significantly progressed in the last few years. Improving knowledge of the main therapeutic cornerstones of this challenging condition is crucial to achieve better patient outcomes.
登录
查看更多内容
影响因子：
38.9
作者：
Bloos, Frank;Rueddel, Hendrik;Reinhart, Konrad
通讯作者：
Reinhart, Konrad
影响因子：
158.5
作者：
Arabi, Y. M.;Al-Hameed, F.;Al-Dawood, A.
通讯作者：
Al-Dawood, A.
DOI：
10.1164/rccm.201903-0557oc
发表时间：
2019-12-15
影响因子：
24.7
作者：
Brown, Ryan M.;Wang, Li;Semler, Matthew W.
通讯作者：
Semler, Matthew W.
影响因子：
120.7
作者：
Annane, Djillali;Siami, Shidasp;Chevret, Sylvie
通讯作者：
Chevret, Sylvie
影响因子：
4.4
作者：
Bystritsky, Rachel J.
通讯作者：
Bystritsky, Rachel J.