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Dtsch Med Wochenschr 2020; 145(04): 252-259
DOI: 10.1055/a-1019-6379
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Sepsis: Die Folgen für betroffene Patienten und das Gesundheitssystem

Sepsis: Sequelae for Affected Patients and The Health Care System
Christiane S. Hartog
,
Ulf Bodechtel
,
Carolin Fleischmann-Struzek
,
Claudia Denke
,
Björn Weiss
,
Konrad Reinhart
Further Information

Publication History

Publication Date:
18 February 2020 (online)

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Zwei von drei Patienten, die eine Sepsis überleben, entwickeln neue körperliche oder seelische Folgeschäden. Kognitive Defizite, Depression oder Einschränkungen im Alltag beeinträchtigen Lebensqualität und Arbeitsfähigkeit. Die Etablierung interdisziplinärer Rehabilitationskonzepte steht erst am Anfang, die Ziele sind jedoch klar umrissen: Minimierung von Sepsisfolgen bereits während der Akuttherapie sowie frühzeitige Evaluation und Behandlung.

Abstract

The number of patients who survive sepsis is growing. However, two of three sepsis survivors suffer from new physical or mental sequelae. Cognitive deficits, depression or limitations of the activities of daily living can seriously impair quality of life and working ability. Sepsis sequelae cover a range of lesions; current rehabilitation therapies appear unsuited because they are focused on only one organ system. An interdisciplinary approach is necessary to evaluate and treat sepsis sequelae. Survivors and their relatives should be informed about sepsis and possible sequelae as early as possible. Further studies are needed to improve the understanding of pathomechanisms and effectivity of treatment interventions for sepsis sequelae.

Schlüsselwörter

Sepsis - Überlebende - Nachsorge - Lebensqualität - Angehörige

Key words

sepsis - survivors - aftercare - quality of life - family
 

  • Literatur

  • 1 Fleischmann-Struzek C, Mikolajetz A, Schwarzkopf D. et al. Challenges in assessing the burden of sepsis and understanding the inequalities of sepsis outcomes between National Health Systems: secular trends in sepsis and infection incidence and mortality in Germany. Intens Care Med 2018; 44: 1826-1835 . doi:10.1007/s00134-018-5377-4
    CrossrefPubMedGoogle Scholar
  • 2 Angus DC. The lingering consequences of sepsis: a hidden public health disaster?. Jama 2010; 304: 1833-1834
    CrossrefPubMedGoogle Scholar
  • 3 Prescott HC, Angus DC. Enhancing Recovery From Sepsis: A Review. Jama 2018; 319: 62-75 . doi:10.1001/jama.2017.17687
    CrossrefPubMedGoogle Scholar
  • 4 World Health Organisation Executive Board (EB140/12). Improving the prevention, diagnosis and clinical management of sepsis; 2017. https://www.who.int/servicedeliverysafety/areas/sepsis/en/ . Zugriff: 29.11.2019
    PubMedGoogle Scholar
  • 5 Hotchkiss RS, Monneret G, Payen D. Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy. Nat Rev Immunol 2013; 13: 862-874 . doi:10.1038/nri3552
    CrossrefPubMedGoogle Scholar
  • 6 Sensen B, Braune S, de Heer G. et al. Life after ARDS/Leben nach ARDS. Med Klin Intensivmed Notfmed 2017; 112: 605-611 . doi:10.1007/s00063-017-0350-5
    CrossrefPubMedGoogle Scholar
  • 7 Marra A, Pandharipande PP, Girard TD. et al. Co-Occurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness. Crit Care Med 2018; 46: 1393-1401 . doi:10.1097/ccm.0000000000003218
    CrossrefPubMedGoogle Scholar
  • 8 Iwashyna TJ, Ely EW, Smith DM. et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. Jama 2010; 304: 1787-1794
    CrossrefPubMedGoogle Scholar
  • 9 Yende S, Austin S, Rhodes A. et al. Long-Term Quality of Life Among Survivors of Severe Sepsis: Analyses of Two International Trials. Crit Care Med 2016; 44: 1461-1467 . doi:10.1097/CCM.0000000000001658
    CrossrefPubMedGoogle Scholar
  • 10 Scherag A, Hartog CS, Fleischmann C. et al. A patient cohort on long-term sequelae of sepsis survivors: study protocol of the Mid-German Sepsis Cohort. BMJ open 2017; 7: e016827 . doi:10.1136/bmjopen-2017-016827
    CrossrefPubMedGoogle Scholar
  • 11 Konig C, Matt B, Kortgen A. et al. What matters most to sepsis survivors: a qualitative analysis to identify specific health-related quality of life domains. Qual Life Res 2019; 28: 637-647 . doi:10.1007/s11136-018-2028-8
    CrossrefPubMedGoogle Scholar
  • 12 Schefold JC, Bierbrauer J, Weber-Carstens S. Intensive care unit-acquired weakness (ICUAW) and muscle wasting in critically ill patients with severe sepsis and septic shock. J Cachexia Sarcopenia Muscle 2010; 1: 147-157 . doi:10.1007/s13539-010-0010-6
    CrossrefPubMedGoogle Scholar
  • 13 Pandharipande PP, Girard TD, Jackson JC. et al. Long-term cognitive impairment after critical illness. New Engl J Med 2013; 369: 1306-1316 . doi:10.1056/NEJMoa1301372
    CrossrefPubMedGoogle Scholar
  • 14 Semmler A, Widmann CN, Okulla T. et al. Persistent cognitive impairment, hippocampal atrophy and EEG changes in sepsis survivors. J Neurol Neurosurg Psychiatry 2013; 84: 62-69 . doi:10.1136/jnnp-2012-302883
    CrossrefPubMedGoogle Scholar
  • 15 Köhler F. Erfahrungen im Umgang mit kognitiven Störungen und anderen Folgen nach einer überlebten Sepsis 2019. Persönliche Mitteilung
    PubMedGoogle Scholar
  • 16 Davydow DS, Hough CL, Langa KM. et al. Symptoms of depression in survivors of severe sepsis: a prospective cohort study of older Americans. Am J Geriatric Psychiatry 2013; 21: 887-897 . doi:10.1016/j.jagp.2013.01.017
    CrossrefPubMedGoogle Scholar
  • 17 Jackson JC, Pandharipande PP, Girard TD. et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet Respir Med 2014; 2: 369-379 . doi:10.1016/s2213-2600(14)70051-7
    CrossrefPubMedGoogle Scholar
  • 18 Wintermann GB, Brunkhorst FM, Petrowski K. et al. Stress disorders following prolonged critical illness in survivors of severe sepsis. Crit Care Med 2015; 43: 1213-1222 . doi:10.1097/ccm.0000000000000936
    CrossrefPubMedGoogle Scholar
  • 19 Nikayin S, Rabiee A, Hashem MD. et al. Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis. Gen Hosp Psychiatry 2016; 43: 23-29 . doi:10.1016/j.genhosppsych.2016.08.005
    CrossrefPubMedGoogle Scholar
  • 20 Desarmenien M, Blanchard-Courtois AL, Ricou B. The chronic critical illness: a new disease in intensive care. Swiss medical weekly 2016; 146: w14336 . doi:10.4414/smw.2016.14336
    PubMedGoogle Scholar
  • 21 Karagiannidis C, Strassmann S, Callegari J. et al. Evolving Epidemiology of Home Mechanical Ventilation: A Rapidly Growing Challenge for Patient Care. DMW 2019; 144: e58-e63 . doi:10.1055/a-0758-4512
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Hoste EA, Bagshaw SM, Bellomo R. et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intens Care Med 2015; 41: 1411-1423 . doi:10.1007/s00134-015-3934-7
    CrossrefPubMedGoogle Scholar
  • 23 Spacek M, Kunze K, Mehrholz J. Weaning from dialysis after acute kidney injury in chronically critically ill. Med Klin Intensivmed Notfmed 2018; DOI: 10.1007/s00063-018-0488-9.
    CrossrefPubMedGoogle Scholar
  • 24 Prescott HC, Osterholzer JJ, Langa KM. et al. Late mortality after sepsis: propensity matched cohort study. BMJ 2016; 353: i2375 . doi:10.1136/bmj.i2375
    PubMedGoogle Scholar
  • 25 Linder A, Guh D, Boyd JH. et al. Long-term (10-year) mortality of younger previously healthy patients with severe sepsis/septic shock is worse than that of patients with nonseptic critical illness and of the general population. Crit Care Med 2014; 42: 2211-2218 . doi:10.1097/ccm.0000000000000503
    CrossrefPubMedGoogle Scholar
  • 26 Prescott HC, Langa KM, Iwashyna TJ. Readmission diagnoses after hospitalization for severe sepsis and other acute medical conditions. Jama 2015; 313: 1055-1057 . doi:10.1001/jama.2015.1410
    CrossrefPubMedGoogle Scholar
  • 27 Ou SM, Chu H, Chao PW. et al. Long-Term Mortality and Major Adverse Cardiovascular Events in Sepsis Survivors. A Nationwide Population-based Study. Am J Respir Crit Care Med 2016; 194: 209-217 . doi:10.1164/rccm.201510-2023OC
    CrossrefPubMedGoogle Scholar
  • 28 Guirgis FW, Brakenridge S, Sutchu S. et al. The long-term burden of severe sepsis and septic shock: Sepsis recidivism and organ dysfunction. J Trauma Acute Care Surg 2016; 81: 525-532 . doi:10.1097/ta.0000000000001135
    CrossrefPubMedGoogle Scholar
  • 29 Zielske J, Bohne S, Brunkhorst FM. et al. Acute and long-term dysphagia in critically ill patients with severe sepsis: results of a prospective controlled observational study. Eur Arch Otorhinolaryngol 2014; 271: 3085-3093 . doi:10.1007/s00405-014-3148-6
    CrossrefPubMedGoogle Scholar
  • 30 Yende S, Linde-Zwirble W, Mayr F. et al. Risk of cardiovascular events in survivors of severe sepsis. Am J Respir Crit Care Med 2014; 189: 1065-1074 . doi:10.1164/rccm.201307-1321OC
    CrossrefPubMedGoogle Scholar
  • 31 Boeddha NP, Schlapbach LJ, Driessen GJ. et al. Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units: a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS). Crit Care 2018; 22: 143 . doi:10.1186/s13054-018-2052-7
    CrossrefPubMedGoogle Scholar
  • 32 Baumbach P, Gotz T, Gunther A. et al. Prevalence and Characteristics of Chronic Intensive Care-Related Pain: The Role of Severe Sepsis and Septic Shock. Crit Care Med 2016; 44: 1129-1137 . doi:10.1097/ccm.0000000000001635
    CrossrefPubMedGoogle Scholar
  • 33 Poulsen JB, Moller K, Kehlet H. et al. Long-term physical outcome in patients with septic shock. Acta Anaesthesiol Scand 2009; 53: 724-730 . doi:10.1111/j.1399-6576.2009.01921.x
    PubMedGoogle Scholar
  • 34 Konig C, Matt B, Kortgen A. et al. What matters most to sepsis survivors: a qualitative analysis to identify specific health-related quality of life domains. Qual Life Res 2018; DOI: 10.1007/s11136-018-2028-8.
    CrossrefPubMedGoogle Scholar
  • 35 Davydow DS, Hough CL, Langa KM. et al. Depressive symptoms in spouses of older patients with severe sepsis. Crit Care Med 2012; 40: 2335-2341 . doi:10.1097/CCM.0b013e3182536a81
    CrossrefPubMedGoogle Scholar
  • 36 Rosendahl J, Brunkhorst FM, Jaenichen D. et al. Physical and mental health in patients and spouses after intensive care of severe sepsis: a dyadic perspective on long-term sequelae testing the Actor-Partner Interdependence Model. Crit Care Med 2013; 41: 69-75 . doi:10.1097/CCM.0b013e31826766b0
    CrossrefPubMedGoogle Scholar
  • 37 Taskforce DAS, Baron R, Binder A. et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version. Ger Med Sci 2015; 13: Doc19 . doi:10.3205/000223
    PubMedGoogle Scholar
  • 38 Schaller SJ, Anstey M, Blobner M. et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016; 388: 1377-1388 . doi:10.1016/s0140-6736(16)31637-3
    CrossrefPubMedGoogle Scholar
  • 39 Liebl ME, Elmer N, Schwedtke C. et al. Interdisciplinary Acute Medical Rehabilitation after Sepsis – A Retrospective Analysis. Fachübergreifende Frührehabilitation nach Sepsis – Eine retrospektive Analyse. Die Rehabilitation 2018; 57: 372-380 . doi:10.1055/s-0043-117547
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Chao PW, Shih CJ, Lee YJ. et al. Association of postdischarge rehabilitation with mortality in intensive care unit survivors of sepsis. Am J Respir Crit Care Med 2014; 190: 1003-1011 . doi:10.1164/rccm.201406-1170OC
    CrossrefPubMedGoogle Scholar