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  2014年5月19日更新 早期感染性休克患者接受程序化治疗的临床研究(ProCESS)发表以来,拯救全身性感染行动(SSC)已经收到许多来信,询问有关上述研究对SSC指南修订的影响[1]。 (1)   ProCESS研究再次证实此前我们业已达成的共识,即感染性休克的早期诊断至关重要。值得注意的是,该研究中所有各组在随机分配前均已接受平均至少2L的液体复苏,并且75%以上在随机分配前已接受抗生素治疗—这两项均为拯救全身性感染行动3小时集束化治疗的要素[2]。ProCESS研究所附的编者按同样强调了这些概念[3]。 (2)   ...
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This slide set summarizes new findings pertinent to pediatric considerations in the surviving sepsis campaign which have been reported since the last update in 2008. We comment on the following categories as a companion to the adult recommendations trying to emphasize what is different rather than the same.   The initial resuscitation section is new in the 2012 guidelines.  It represents no new data but a simpler reorganization of the 2008 recommendations. This se...
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This section relates to setting goals of care. The majority of ICU patients, including those with severe sepsis, receive full support with aggressive, life-sustaining treatments. Many patients with multiple organ system failure or severe neurological injuries will not survive or have a poor quality of life. The Statement of the Fifth International Consensus Conference in Critical Care, endorsed by the American Thoracic Society, European Respiratory Society, European Socie...
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The starting point of 2012 recommendations was the 2008 SSC guidelines. Recent meta-analyses reviewing use of histamine-2 receptor antagonists (H2RA) and proton pump inhibitors (PPI) on clinically important bleeding, ventilator-associated pneumonia (VAP), and Clostridium difficile infections were used. A new meta-analysis was performed to compare effects of PPI versus H2RA on the noted outcomes. The 2004 and 2008 guidelines recognized the frequency of the problem and rec...
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This section relates to prophylaxis for venous thromboembolic disorders.  It summarizes the guidelines recently published in Critical Care Medicine and Intensive Care Medicine.  We also will detail the ways in which the new recommendations differ from those published in 2008. Risk factors for sepsis are equal to or greater than those for other ICU patients because of exaggerated physiologic derangements and enhanced hypercoagulability. VTE prophylaxis is generally effec...
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This section relates to renal replacement therapy. The level of the recommendations in this section amount to suggestions rather than formal recommendations based on the available evidence. In particular, little evidence exists in severe sepsis and septic shock to compare modalities of continuous dialysis versus intermittent dialysis. In practice, many clinicians favor continuous dialysis because of its gentler hemodynamic profile. However, this has not been shown to impa...
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This is the first version of SSC recommendations for nutritional support in severe sepsis.   Nutrition is a broad subject, and a detailed discussion of this field would have been beyond the scope of the SSC guidelines. Thus, we selected four major subjects to review. The current literature is extensive, although it consists mainly of small, unpowered studies with methodological limitations, assessing critically ill patients in general and not specifically septic one...
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  This section relates to glucose control and bicarbonate therapy. For many years, physicians were not very aggressive about the treatment of hyperglycemia within the ICU, and it was not unusual to see patients with serum glucose levels above 200 mg/dL. In a 2001 landmark paper in the New England Journal of Medicine, van den Berghe and colleagues showed that intensive insulin therapy could improve survival in ICU patients. This changed the way intensivists approached...
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  This section relates to guideline recommendations pertinent to mechanical ventilation in the patient with acute respiratory distress syndrome.  The 2008 Surviving Sepsis Campaign guidelines recommended targeting a tidal volume of 6 mL/kg predicted body weight in patients with sepsis-induced acute lung injury. This recommendation has been continued in the 2012 guidelines, and is supported by the ARMA trial, which is described in the following slide. Because the ARM...
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Adjunctive therapy consists of several approaches to inhibit pathomechanisms of severe sepsis. The 2008 “positive“ formulation (“…only in patients…“) was reversed into a “negative“ phrasing according to the principle of “primum non nocere.“ As long as septic shock patients can be stabilized by volume and vasopressors, steroids should not be used. If this is not possible, thus raising the overall mortality risk, low-dose hydrocortisone could be used. According to some stu...
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