Evidenzbasierte Therapie der Sepsis - Antiinfektiöse Strategien mit supportiven und adjunktiven Maßnahmen kombinieren

Zusammenfassung

Die Therapie der schweren Sepsis und des septischen Schocks besteht aus der Sanierung des infektiösen Fokus, supportiven Maßnahmen sowie einer adjunktiven Therapie. Adjunktive Therapiemaßnahmen können jedoch nur dann sinnvoll eingesetzt werden, nachdem die Fokussanierung und die supportiven Behandlungen eingeleitet worden sind. Für viele Teilfragen in der Behandlung existieren lediglich Behandlungsoptionen mit niedrigem Empfehlungsgrad. Doch gab es gerade in den letzten Jahren auch große Studien mit hohem Evidenzgrad, aus denen sich eindeutigere Empfehlungen ableiten lassen. Dies sind für die supportiven Behandlungen die initiale Kreislaufstabilisierung nach den Kriterien der „early goal directed therapy”, lungenprotektive Beatmungsverfahren sowie Thrombose- und Ulkusprophylaxe.

Bei den adjunktiven Behandlungen gibt es entsprechende Empfehlungen für niedrig dosiertes Hydrokortison und rekombinantes humanes aktiviertes Protein C.

Summary

The treatment of severe sepsis and septic shock consists of the control of the infectious focus as well as supportive and adjunctive therapies. Adjunctive treatment strategies can only be applied if focus control and sufficient supportive measures are initiated. Only treatment options with a low recommendation grade still exist for many subquestions. However, several large studies with a good level of evidence have been published especially during the last couple of years allowing the expression of clear recommendations. This includes the initial cardiovascular resuscitation according to the Early Goal Directed Therapy, lung protective ventilation as well as stress ulcer and deep vein thrombosis prophylaxis for the supportive therapies. For the adjunctive therapy, application of low-dose hydrocortisone and/or recombinant humane activated protein C is recommended.

Key Words

sepsis - focus control - early goal directed therapy - hydrocortisone - protein C

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1 acute physiology and chronic health evaluation

2 administration of drotrecogin alfa (activated) in early severe sepsis

Anschrift für die Verfasser