Die postoperative Sepsis: Diagnose, Besonderheiten, Management

Zusammenfassung

Die postoperative Sepsis gilt es vor allem früh zu erkennen. Es kann schwierig sein, die Sepsis vom normalen postoperativen SIRS zu unterscheiden. Häufige Frühzeichen sind Verwirrtheit und respiratorische Insuffizienz. Sie sollten Anlass geben, aggressiv nach einem Sepsisfokus zu fahnden, insbesondere aus dem Operationsgebiet. Rasche Sicherung der Oxygenierung, Stabilisierung des Kreislaufes nach definierten Zielkriterien, Breitspektum-Antibiotika-Applikation innerhalb der ersten Stunde und zügige Fokussanierung unter Berücksichtigung der Vorteile und Risiken des gewählten Vorgehens sind die Eckpunkte der Sepsistherapie. Bei abdominalem Fokus hat sich das Konzept der Relaparotomie on demand durchgesetzt.

Abstract

A high level of suspicion is necessary to detect postoperative sepsis in good time. It may be difficult to differentiate sepsis from normal SIRS in the postoperative setting. Early signs and symptoms include delirium and respiratory compromise. These should trigger the search for a septic focus aggressively with special attention to the original site of surgery. Key recommendations include early goal-directed resuscitation of the septic patient, administration of broad-spectrum antibiotic therapy within 1 hour of diagnosis, and source control with attention to the balance of risks and benefits of the chosen method. In cases of severe abdominal sepsis the concept of relaparotomy on-demand has become most popular.

postoperative Peritonitis - Sepsis - Komplikation - Anastomoseninsuffizienz - Antibiotikatherapie

postoperative peritonitis - sepsis - complications - anastomotic insufficiency - antibiotic treatment

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