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Adjunctive therapy consists of several approaches to inhibit pathomechanisms of severe sepsis. This is a new recommendation since 2008 because a number of clinical studies have verified that formal screening protocols for sepsis improve outcome (Jones et al. JAMA. 2010;303:739-746; Moore et al. J Trauma. 2009;66:1539-1546). The underlined sections are new to the 2012 guidelines as ample evidence now exists to recommend these, rather than simple suggestions. (Memel L, Ma...
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This section relates to initial resuscitation. For many years, physicians recognized the importance of resuscitating patients with sepsis by administering fluids and vasopressors.In a 2001 landmark paper in the New England Journal of Medicine (Rivers E. N Engl J Med. 2001;345:1368-1377), Rivers and colleagues showed that a protocolized quantitative resuscitation protocol could improve survival in ICU patients with septic shock. This changed the way intensivists approached...
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The Surviving Sepsis Campaign (SSC) has published recommendations and guidelines for the management of severe sepsis and septic shock. Each of the authors who wrote a section of the publication has prepared a slide presentation for that section with emphasis on the changes from the 2008 to the 2012 recommendations and the reasons for them. The European Society of Intensive Care Medicine (ESICM) and Society of Critical Care Medicine (SCCM) are making these slide presentati...
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近日,拯救全身性感染行动(Surviving Sepsis Campaign, SSC)在其官方网站(www.survivingsepsis.org)发布了有关SSC 2012年指南的幻灯片,以帮助读者深入理解指南内容。 幻灯片共包括12个部分 Grading of Recommendations: G. Rubenfeld Initial Resuscitation: D. Annane Infection-Related Issues: S. Opal Adjunctive Therapy: H. Gerlach Mechanical Ventilation: J. Sevransky Glucose Control, Bicarbonate Therapy: C. Sprung Nutrition: F. Machado, D. Angus Renal Replacement Therapy: S. Townsend Pro...
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北京协和医院  杜斌   1992年,循证医学工作组在美国医学会杂志(JAMA)撰文,首次介绍了循证医学(evidence-based medicine, EBM)的概念。在这篇具有里程碑意义的文章中,作者认为,循证医学代表了医学实践的新范例。自此以后,循证医学的概念逐渐深入到临床医学的各个领域。近年来,国内外各个医学专业学会组织专家,依据循证医学的基本原则,纷纷制订本专业常见疾病诊疗的临床指南。互联网上最大的临床指南网站(www.clearinghouse.gov)目前已收录了多达2212个临床指南,就是最好的例证[1]。 面对如此众多的指...
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The ARDS Definifition Task Force, JAMA, June 20, 2012 - Vol 307, No. 23 推荐及翻译:杜斌 (北京协和医院) Acute Respiratory Distress Syndrome The Berlin Definition 1967年以来,曾先后提出多种ARDS诊断标准,造成了临床和流行病学研究的困难。直至1994年,欧美共识会议(AECC)发表了有关ALI/ARDS的定义与诊断标准,将ALI/ARDS定义为多种病因引起的急性呼吸功能衰竭综合征,其病理生理特点为非心源性肺水肿、低氧血症和弥漫性肺实质实变。ALI是这一临床综合征的早期阶段...
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[指南导读] KDIGO的AKI临床指南已关闭评论
Kidney International 2012; 2(Suppl): 1 推荐及翻译:杜斌 (北京协和医院) 推荐意见的强度 分级 意义 患者 临床医生 政策 1级 “我们推荐” 你的医院中大多数患者应当接受推荐的治疗措施,仅有少数患者不然 大多数患者应当接受推荐的治疗措施 推荐意见可以作为制订政策或行为评价的参考 2级 “我们建议” 你的医院中多数患者应当接受推荐的治疗措施,但很多患者不然 不同患者应当有不同的治疗选择。每名患者需要得到帮助,以便作出与其价值观和意愿相符合的决策 在制订政策...
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Intensivist's Focus on the Clinical Practice Guidelines for the Management of Candidiasis 作者:杜斌 [背景] 2009年3月,美国感染性疾病学会(IDSA)发表了对治疗念珠菌病的临床指南的最新修订,CSCCM同时进行了翻译和推荐 (CSCCM原创,转载请注明) 一.不要笼统地谈念珠菌病,而是应当学习指南中区分不同部位感染的重要性 a. 很容易发现,不同部位的念珠菌感染在选择抗真菌药物的种类、剂量和疗程方面存在明显差异。例如: » 对于没有明显转移性并发症的念...
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