Service de Réanimation, Medical Intensive Care Unit, Hôpital Bichat-Claude Bernard, AP-HP, 46 Rue Henri Huchard, 75018, Paris, France,
Intensive Care Med. 2014 Dec;40(12):1843-52. doi: 10.1007/s00134-014-3490-6. Epub 2014 Sep 20.
Although the recent literature contains plenty of studies concerning all aspects of infective endocarditis (IE), very few focus on severe IE requiring admission to the ICU.
In 2004, we published a report on the clinical spectrum and prognostic factors in 228 consecutive critically ill patients with IE. Septic shock, neurological complications and immunocompromised state were independently associated with in-hospital mortality. Cardiac surgery during the acute phase of EI was associated with better survival. A lot of information has been accumulated during the past 10 years on management of IE. Although three sets of blood cultures allow the identification of about 90% of cases, culture-negative IE still remains a diagnostic challenge. Blood-polymerase chain reaction in valve tissue may yield a microbiologic diagnosis. New imaging techniques such as positron emission tomography computed tomography (PET-CT) have shown additive value in patients with an intracardiac device or valvular prosthesis. Systematic cerebral magnetic resonance imaging can lead to modification of therapeutic plans. The decision to operate and the timing of cardiac surgery should take into account the presence of congestive heart failure, neurological complications, renal failure and multiorgan dysfunction syndrome. In 2011 and 2013, we published the results of a multicentre prospective observational study of 198 ICU patients with left-sided IE and confirmed that cardiac surgery was associated with better outcome. The strongest independent predictor of post-operative mortality was the pre-operative multiorgan failure score. Neurological failure also represented a major determinant of mortality, regardless of the mechanism of neurological complication.
In the present paper, we propose algorithms to optimize the medico-surgical approach.
尽管最近的文献中包含了大量关于感染性心内膜炎（IE）各个方面的研究，但很少有研究关注需要入住 ICU 的重症 IE。
2004 年，我们发表了一篇关于 228 例连续重症 IE 患者的临床特征和预后因素的报告。感染性休克、神经系统并发症和免疫抑制状态与院内死亡率独立相关。IE 急性期行心脏手术与更好的生存相关。在过去的 10 年中，IE 的治疗方面积累了大量信息。尽管三套血培养可识别约 90%的病例，但血培养阴性 IE 仍然是一个诊断挑战。瓣膜组织中的血液聚合酶链反应可提供微生物学诊断。新的成像技术，如正电子发射断层扫描计算机断层扫描（PET-CT），在有心脏内装置或瓣膜假体的患者中显示出附加价值。系统的脑磁共振成像可导致治疗计划的改变。手术决策和心脏手术时机应考虑充血性心力衰竭、神经系统并发症、肾衰竭和多器官功能障碍综合征的存在。2011 年和 2013 年，我们发表了一项关于 198 例左侧 IE 患者的多中心前瞻性观察研究的结果，证实心脏手术与更好的结果相关。术后死亡率的最强独立预测因素是术前多器官衰竭评分。无论神经系统并发症的机制如何，神经系统衰竭也是死亡率的主要决定因素。
在本文中，我们提出了优化医-外科治疗方法的算法。
