• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Critical care medicine >Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008.
【24h】

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008.

机译：脓毒症幸存运动：严重脓毒症和脓毒性休克的国际处理指南：2008年。

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

OBJECTIVE:: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," published in 2004. DESIGN:: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. This process was conducted independently of any industry funding. METHODS:: We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations. A strong recommendation (1) indicates that an intervention's desirable effects clearly outweigh its undesirable effects (risk, burden, cost) or clearly do not. Weak recommendations (2) indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence. In areas without complete agreement, a formal process of resolution was developed and applied. Recommendations are grouped into those directly targeting severe sepsis, recommendations targeting general care of the critically ill patient that are considered high priority in severe sepsis, and pediatric considerations. RESULTS:: Key recommendations, listed by category, include early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm potential source of infection (1C); administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis of septic shock (1B) and severe sepsis without septic shock (1D); reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate (1C); a usual 7-10 days of antibiotic therapy guided by clinical response (1D); source control with attention to the balance of risks and benefits of the chosen method (1C); administration of either crystalloid or colloid fluid resuscitation (1B); fluid challenge to restore mean circulating filling pressure (1C); reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfusion (1D); vasopressor preference for norepinephrine or dopamine to maintain an initial target of mean arterial pressure >/=65 mm Hg (1C); dobutamine inotropic therapy when cardiac output remains low despite fluid resuscitation and combined inotropic/vasopressor therapy (1C); stress-dose steroid therapy given only in septic shock after blood pressure is identified to be poorly responsive to fluid and vasopressor therapy (2C); recombinant activated protein C in patients with severe sepsis and clinical assessment of high risk for death (2B except 2C for postoperative patients). In the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage, target a hemoglobin of 7-9 g/dL (1B); a low tidal volume (1B) and limitation of inspiratory plateau pressure strategy (1C) for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure in acute lung injury (1C); head of bed elevation in mechanically ventilated patients unless contraindicated (1B); avoiding routine use of pulmonary artery catheters in ALI/ARDS (1A); to decrease days of mechanical ventilation and ICU length of stay, a conservative fluid strategy for patients with established ALI/ARDS who are not in shock (1C); protocols for weaning and sedation/analgesia (1B); using either intermittent bolus sedation or continuous infusion sedation with daily interruptions or lightening (1B); avoidance of neuromuscular blockers, if at all possible (1B); institution of glycemic control (1B), targeting
机译：目的：：提供原始生存败血症运动临床管理指南的更新，“重症脓毒症和败血性休克管理的生存脓毒症运动指南”，出版于2004年。设计：：改良的Delphi方法，由55位国际专家组成的共识会议，小组的后续会议和关键人物，电话会议以及小组之间以及整个委员会之间的基于电子的讨论。此过程独立于任何行业资金进行。方法：：我们使用推荐，评估，发展和评估等级（GRADE）系统来指导对证据质量的评估，从高（A）到极低（D），并确定推荐的强度。强烈的建议（1）表明干预措施的预期效果明显大于其预期效果（风险，负担，成本）或明显没有。较弱的建议（2）表明，理想效果与不良效果之间的权衡尚不明确。与证据质量的字母水平差异相比，强或弱的等级被认为具有更大的临床重要性。在未经完全同意的地区，制定并采用了正式的解决程序。建议分为直接针对严重脓毒症的建议，针对重症脓毒症中被优先考虑的重症患者一般护理的建议以及儿科注意事项。结果：主要建议，按类别列出，包括在识别后的最初6小时内对败血症患者进行早期目标导向的复苏（1C）;抗生素治疗前的血液培养（1C）;及时进行影像学检查以确认潜在的感染源（1C）;在感染性休克（1B）和没有败血症性休克（1D）的严重脓毒症的诊断后1小时内给予广谱抗生素治疗;在适当时用微生物学和临床数据对抗生素疗法进行重新评估，以缩小覆盖范围（1C）;通常在临床反应指导下进行7-10天的抗生素治疗（1D）;源代码控制，注意所选方法（1C）的风险和收益之间的平衡;进行晶体或胶体液体复苏（1B）;挑战流体以恢复平均循环填充压力（1C）;归档压力增加导致输液速度降低，组织灌注无改善（1D）;血管加压药对去甲肾上腺素或多巴胺的偏好，以维持平均动脉压的初始目标> / = 65 mm Hg（1C）;多巴酚丁胺正性肌力疗法，尽管进行了液体复苏但心输出量仍然较低，并且正性肌力/升压药联合治疗（1C）;压力剂量的类固醇疗法仅在血压升高后发生败血症性休克时才被确认对液体和血管加压药疗法反应不佳（2C）;严重脓毒症患者中的重组活化蛋白C和高死亡风险的临床评估（术后患者2C除外2C）。在没有组织灌注不足，冠状动脉疾病或急性出血的情况下，靶向血红蛋白为7-9 g / dL（1B）;对于急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS），低潮气量（1B）和吸气平台压力策略的限制（1C）;在急性肺损伤中施加最小量的呼气末正压（1C）;除非有禁忌，否则机械通气患者的床头抬高（1B）;避免在ALI / ARDS中常规使用肺动脉导管（1A）;减少机械通气天数和重症监护病房（ICU）的住院时间，这是针对已建立ALI / ARDS且未处于休克状态的患者的保守输液策略（1C）;断奶和镇静/镇痛方案（1B）;使用间歇推注镇静或连续输注镇静并每日中断或减轻（1B）;尽可能避免使用神经肌肉阻滞剂（1B）;血糖控制机构（1B），针对性

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号