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首页> 外文期刊>Intensive care medicine >Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock, 2012
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Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock, 2012

机译：败血症生存运动：严重败血症和败血性休克管理国际指南，2012年

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Objective: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. Design: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods: The authors were advised to follow the principles of the Grading of Recommendations 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 as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. Results: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS);
机译：目的：提供最新的《严重脓毒症和脓毒性休克管理中生存的脓毒症运动指南》（最新版本），该指南于2008年发布。设计：召集了代表30个国际组织的68名国际专家组成的共识委员会。名义小组在主要的国际会议上集结（针对参加会议的委员会成员）。在流程开始时制定了正式的利益冲突政策，并在整个过程中执行。整个准则流程独立于任何行业资金进行。为所有小组负责人，副主席和副主席以及选定的个人举行了独立会议。各小组之间以及整个委员会之间的电话会议和基于电子的讨论是发展的组成部分。方法：建议作者遵循建议评估，发展和评估等级系统（GRADE）的原则，以指导对证据质量的评估，从高（A）到极低（D），并确定建议的强度。强（1）或弱（2）。强调了在存在低质量证据的情况下提出强烈建议的潜在弊端。建议分为三类：（1）直接针对严重败血症的建议; （2）那些针对重症患者的一般护理并被认为在严重败血症中具有较高优先权的人群; （3）儿科注意事项。结果：按类别列出的主要建议和建议包括：在识别后的最初6小时内对败血症患者进行早期定量复苏（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（UG）;在认识到败血性休克（1B）和无败血性休克（1C）的严重脓毒症后1小时内进行广谱抗菌药物治疗;适当时，每天对降级的抗菌治疗进行重新评估（1B）;感染源控制应在诊断后12小时内注意所选方法的风险和收益之间的平衡（1C）;初次使用晶体进行液体复苏（1B）并考虑继续需要大量晶体以维持足够的平均动脉压（2C）并避免使用头药配方的患者中添加白蛋白（1B）;败血症诱导的组织灌注不足和怀疑血容量不足的患者最初的体液激发至少达到30 mL / kg晶体（某些患者可能需要更快速的给药和更多的体液（1C）;体液激发技术继续只要血流动力学的改善基于动态或静态变量（UG）;去甲肾上腺素是维持平均动脉压≥65mmHg的首选血管加压药（1B）;当需要另外的药物来维持足够的血压时使用肾上腺素（2B） ;可以将去氧肾上腺素（0.03 U / min）添加到去甲肾上腺素中以升高平均动脉压以达到目标或降低去甲肾上腺素的剂量，但不应用作初始升压药（UG）;除在高度选择的情况下（2C外，不建议使用多巴胺）;多巴酚丁胺输注在有（a）心肌功能不全的情况下给予或加到升压药中，这是由于心脏充盈压升高和心律不振所致或（b）尽管获得了足够的血管内容量和足够的平均动脉压（1C），但仍存在灌注不足的迹象;如果适当的液体复苏和升压药能够恢复血流动力学稳定性，则避免在成人败血症性休克患者中使用静脉氢化可的松（2C）;在没有组织灌注不足，缺血性冠状动脉疾病或急性出血的情况下，血红蛋白靶标为7-9 g / dL（1B）;低潮气量（1A）和吸入性高原压力的限制（1B）用于急性呼吸窘迫综合征（ARDS）;

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