Chehab May S
Department of Pediatrics, Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia.
Saudi Med J. 2004 Mar;25(3):277-84.
Considerable progress has been made over the last 2 decades in diagnosing and treating sepsis. Although the mortality rate is beginning to decline with the development of new therapeutic interventions, it still remains unacceptably high. Five such interventions are discussed in this review article to provide guidance for intensivists on the integration and implementation of new interventions into the intensive care unit. They were shown in randomized, controlled trials to reduce mortality by limiting the tidal volume in acute lung injury or acute respiratory distress syndrome, the early goal directed therapy, the use of recombinant human activated protein C, the use of moderate doses of steroids and the tight control of blood sugar. Each new intervention has a role in the management of sepsis, however they are not mutually exclusive. This article provides guidelines on optimal patient selection and timing for each intervention and provides advice on how to integrate new therapies in intensive care practice so that mortality rates can be reduced.
在过去20年里，脓毒症的诊断和治疗取得了显著进展。尽管随着新治疗干预措施的发展，死亡率开始下降，但仍然高得令人无法接受。本文综述讨论了五种此类干预措施，为重症监护医生将新干预措施整合并应用于重症监护病房提供指导。在随机对照试验中，它们被证明可通过限制急性肺损伤或急性呼吸窘迫综合征中的潮气量、早期目标导向治疗、使用重组人活化蛋白C、使用中等剂量的类固醇以及严格控制血糖来降低死亡率。每种新干预措施在脓毒症管理中都有作用，然而它们并非相互排斥。本文提供了关于每种干预措施的最佳患者选择和时机的指南，并就如何在重症监护实践中整合新疗法以降低死亡率提供了建议。
