DOI QR코드

DOI QR Code

Treatment of Severe Sepsis-Surviving Sepsis Campaign Guideline을 중심으로

Treatment of Severe Sepsis-Based on Surviving Sepsis Campaign Guideline

  • 이상민 (서울대학교 의과대학 내과학교실)
  • Lee, Sang-Min (Department of Internal Medicine, Seoul National University College of Medicine)
  • 발행 : 2014.05.01

초록

Sepsis is a systemic, deleterious host response to infection. The term "severe sepsis" is used when sepsis is complicated by acute organ dysfunction, and "septic shock" as sepsis complicated by either hypotension that is refractory to fluid resuscitation or by hyperlactatemia. The number of cases with severe sepsis exceeds 750,000 per year in the United States and the mortality is now closer to 20 to 30% in these days. The principles of the initial management bundle are to provide sufficient hemodynamic resuscitation and early initiation of appropriate antibiotics to mitigate uncontrolled infection. Initial resuscitation requires the use of intravenous fluids and vasopressors. It is very important to achieve the target of initial resuscitation. The supportive cares in ICU are also significant such as blood component transfusion, glucose control, renal replacement therapy, deep vein thrombosis prophylaxis and stress ulcer prophylaxis. The goals of care and prognosis including end-of-life care should be discussed with patients and families as early as feasible.

키워드

참고문헌

  1. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med 2013;369:840-851. https://doi.org/10.1056/NEJMra1208623
  2. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-1310. https://doi.org/10.1097/00003246-200107000-00002
  3. Friedman G, Silva E, Vincent JL. Has the mortality of septic shock changed with time? Crit Care Med 1998;26:2078-2086. https://doi.org/10.1097/00003246-199812000-00045
  4. Kumar G, Kumar N, Taneja A, et al. Nationwide trends of severe sepsis in the 21st century (2000-2007). Chest 2011;140:1223-1231. https://doi.org/10.1378/chest.11-0352
  5. Kim JH, Hong SK, Kim KC, et al. Influence of full-time intensivist and the nurse-to-patient ratio on the implementation of severe sepsis bundles in Korean intensive care units. J Crit Care 2012;27:414.e11-21. https://doi.org/10.1016/j.jcrc.2012.03.010
  6. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-1377. https://doi.org/10.1056/NEJMoa010307
  7. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-873. https://doi.org/10.1097/01.CCM.0000117317.18092.E4
  8. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36:296-327. https://doi.org/10.1097/01.CCM.0000298158.12101.41
  9. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39:165-228. https://doi.org/10.1007/s00134-012-2769-8
  10. Bendjelid K, Romand JA. Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med 2003;29:352-360. https://doi.org/10.1007/s00134-002-1615-9
  11. Early Goal-Directed Therapy Collaborative Group of Zhejiang Province. [The effect of early goal-directed therapy on treatment of critical patients with severe sepsis/septic shock: a multi-center, prospective, randomized, controlled study]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2010;22:331-334.
  12. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension prior to initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589-1596. https://doi.org/10.1097/01.CCM.0000217961.75225.E9
  13. Ferrer R, Artigas A, Suarez D, et al. Effectiveness of treatments for severe sepsis: a prospective, multicenter, observational study. Am J Respir Crit Care Med 2009;180:861-866. https://doi.org/10.1164/rccm.200812-1912OC
  14. Barie PS, Hydo LJ, Shou J, Larone DH, Eachempati SR. Influence of antibiotic therapy on mortality of critical surgical illness caused or complicated by infection. Surg Infect (Larchmt) 2005;6:41-54 https://doi.org/10.1089/sur.2005.6.41
  15. Guidet B, Martinet O, Boulain T, et al. Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs 0.9% NaCl fluid replacement in patients with severe sepsis: the CRYSTMAS study. Crit Care 2012;16:R94. [Epub] https://doi.org/10.1186/cc11358
  16. Myburgh JA, Finfer S, Bellomo R, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 2012;367:1901-1911. https://doi.org/10.1056/NEJMoa1209759
  17. Perner A, Haase N, Guttormsen AB, et al. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. N Engl J Med 2012;367:124-134. https://doi.org/10.1056/NEJMoa1204242
  18. Annane D, Siami S, Jaber S, et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. JAMA 2013;310:1809-1817. https://doi.org/10.1001/jama.2013.280502
  19. Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350:2247-2256. https://doi.org/10.1056/NEJMoa040232
  20. Delaney AP, Dan A, McCaffrey J, Finfer S. The role of albumin as a resuscitation fluid for patients with sepsis: a systematic review and meta-analysis. Crit Care Med 2011;39:386-391. https://doi.org/10.1097/CCM.0b013e3181ffe217
  21. Martin C, Viviand X, Leone M, Thirion X. Effect of norepinephrine on the outcome of septic shock. Crit Care Med 2000;28:2758-2765.
  22. Patel GP, Grahe JS, Sperry M, et al. Efficacy and safety of dopamine versus norepinephrine in the management of septic shock. Shock 2010;33:375-380. https://doi.org/10.1097/SHK.0b013e3181c6ba6f
  23. De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 2010;362:779-789. https://doi.org/10.1056/NEJMoa0907118
  24. De Backer D, Aldecoa C, Njimi H, Vincent JL. Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis. Crit Care Med 2012;40:725-730. https://doi.org/10.1097/CCM.0b013e31823778ee
  25. Warren BL, Eid A, Singer P, et al. Caring for the critically ill patient. High-dose antithrombin III in severe sepsis: a randomized controlled trial. JAMA 2001;286:1869-1878. https://doi.org/10.1001/jama.286.15.1869
  26. Ranieri VM, Thompson BT, Barie PS, et al. Drotrecogin alfa (activated) in adults with septic shock. N Engl J Med 2012;366:2055-2064. https://doi.org/10.1056/NEJMoa1202290
  27. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359-1367. https://doi.org/10.1056/NEJMoa011300
  28. van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006;354:449-461. https://doi.org/10.1056/NEJMoa052521
  29. NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009;360:1283-1297. https://doi.org/10.1056/NEJMoa0810625
  30. Kansagara D, Fu R, Freeman M, Wolf F, Helfand M. Intensive insulin therapy in hospitalized patients: a systematic review. Ann Intern Med 2011;154:268-282. https://doi.org/10.7326/0003-4819-154-4-201102150-00008
  31. Lin PC, Chang CH, Hsu PI, Tseng PL, Huang YB. The efficacy and safety of proton pump inhibitors vs histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care patients: a meta-analysis. Crit Care Med 2010;38:1197-1205. https://doi.org/10.1097/CCM.0b013e3181d69ccf
  32. Alhazzani W, Alshahrani M, Moayyedi P, Jaeschke R. Stress ulcer prophylaxis in critically ill patients: review of the evidence. Pol Arch Med Wewn 2012;122:107-114.

피인용 문헌

  1. 요로감염과 관련된 중증 패혈증 및 패혈성 쇼크의 치료 vol.17, pp.3, 2014, https://doi.org/10.22730/jmls.2020.17.3.80