Surviving the first hours in sepsis: getting the basics right (an intensivist's perspective)
Surviving the first hours in sepsis: getting the basics right (an intensivist's perspective)
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DOI：
10.1093/jac/dkq515
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发表时间：
2011-04-01
影响因子：
5.2
通讯作者：
Daniels, Ron
中科院分区：
文献类型：
--
作者：
Daniels, Ron
严重败血症是发病和死亡的主要原因，在英国每年夺走 36 000 至 64 000 人的生命，死亡率为 35%。拯救脓毒症运动于 2004 年发布了治疗严重脓毒症的国际指南，并将其浓缩为两个护理包。 2010 年，该运动公布了其改进计划的结果，显示尽管随着捆绑包依从性的提高，在 2 年内绝对死亡率降低了 5.4%，但并未实现可靠性，捆绑包依从率仅达到 31%。本文探讨了脓毒症护理当前的挑战和进一步改进的机会。基本护理任务 [微生物采样和 1 小时内抗生素输送、液体复苏和使用血清乳酸（或替代方案）进行风险分层] 可能对患者最有利，但执行起来并不可靠。障碍包括缺乏意识和健全的流程、缺乏支持性对照试验以及导致识别延迟的复杂诊断标准。可靠、及时地交付更复杂的救生任务（例如早期目标导向治疗）需要更高的认识、更快的识别和启动基本护理，以及在重症监护和微生物学和传染病等专家支持服务中前线的临床医生和护士之间更有效的合作。拯救脓毒症、拯救脓毒症运动和全球脓毒症联盟等组织正在努力提高人们的认识并推动进一步的改进举措。未来的发展将集中在脓毒症生物标志物和微阵列技术上，以快速筛查病原体、使用基因分析进行风险分层，以及开发针对免疫调节的新型治疗剂。
Severe sepsis is a major cause of morbidity and mortality, claiming between 36 000 and 64 000 lives annually in the UK, with a mortality rate of 35%. International guidelines for the management of severe sepsis were published in 2004 by the Surviving Sepsis Campaign and condensed into two Care Bundles. In 2010, the Campaign published results from its improvement programme showing that, although an absolute mortality reduction of 5.4% was seen over a 2 year period in line with increasing compliance with the Bundles, reliability was not achieved and Bundle compliance reached only 31%. This article explores current challenges in sepsis care and opportunities for further improvements. Basic care tasks [microbiological sampling and antibiotic delivery within 1 h, fluid resuscitation, and risk stratification using serum lactate (or alternative)] are likely to benefit patients most, yet are unreliably performed. Barriers include lack of awareness and robust process, the lack of supporting controlled trials, and complex diagnostic criteria leading to recognition delays. Reliable, timely delivery of more complex life-saving tasks (such as early goal-directed therapy) demands greater awareness, faster recognition and initiation of basic care, and more effective collaboration between clinicians and nurses on the front line, in critical care and in specialist support services, such as microbiology and infectious diseases. Organizations such as Survive Sepsis, the Surviving Sepsis Campaign and the Global Sepsis Alliance are working to raise awareness and promote further improvement initiatives. Future developments will focus on sepsis biomarkers and microarray techniques to rapidly screen for pathogens, risk stratification using genetic profiling, and the development of novel therapeutic agents targeting immunomodulation.