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脓毒症的定义：探寻黄金标准以及医疗保险和医疗补助服务中心的错误之处

Sepsis Definitions: The Search for Gold and What CMS Got Wrong.

作者信息

Kalantari Annahieta, Mallemat Haney, Weingart Scott D

机构信息

Aria Jefferson Health, Department of Emergency Medicine, Philadelphia, Pennsylvania.

Philadelphia College of Osteopathic Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania.

出版信息

West J Emerg Med. 2017 Aug;18(5):951-956. doi: 10.5811/westjem.2017.4.32795. Epub 2017 Jul 10.

DOI:10.5811/westjem.2017.4.32795
PMID:28874949
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5576633/
Abstract

On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. These core measures are controversial among healthcare providers. This article will address that there is no gold standard definition for sepsis, severe sepsis or septic shock and the CMS-assigned definitions for severe sepsis and septic shock are premature and inconsistent with evidence-based definitions.

摘要

2015年10月1日，美国医疗保险和医疗补助服务中心（CMS）发布了一项针对脓毒症患者护理的核心指标。这些核心指标在医疗服务提供者中存在争议。本文将指出，对于脓毒症、严重脓毒症或脓毒性休克，不存在金标准定义，且CMS对严重脓毒症和脓毒性休克所指定的定义为时过早，与循证定义不一致。

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Sepsis Definitions: The Search for Gold and What CMS Got Wrong.脓毒症的定义：探寻黄金标准以及医疗保险和医疗补助服务中心的错误之处
West J Emerg Med. 2017 Aug;18(5):951-956. doi: 10.5811/westjem.2017.4.32795. Epub 2017 Jul 10.
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本文引用的文献

1
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.拯救脓毒症运动：脓毒症与脓毒性休克管理国际指南：2016版
Crit Care Med. 2017 Mar;45(3):486-552. doi: 10.1097/CCM.0000000000002255.
2
Quick Sepsis-related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients outside the Intensive Care Unit.快速脓毒症相关器官功能衰竭评估、全身炎症反应综合征及早期预警评分用于检测重症监护病房以外感染患者的临床病情恶化
Am J Respir Crit Care Med. 2017 Apr 1;195(7):906-911. doi: 10.1164/rccm.201604-0854OC.
3
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).《脓毒症及脓毒性休克第三次国际共识定义（脓毒症-3）》
JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287.
4
Lactate Clearance Predicts Survival Among Patients in the Emergency Department with Severe Sepsis.乳酸清除率可预测急诊科严重脓毒症患者的生存率。
West J Emerg Med. 2015 Dec;16(7):1118-26. doi: 10.5811/westjem.2015.10.27577. Epub 2015 Dec 8.
5
Multicenter Implementation of a Treatment Bundle for Patients with Sepsis and Intermediate Lactate Values.针对脓毒症和中度乳酸值患者的治疗集束方案的多中心实施
Am J Respir Crit Care Med. 2016 Jun 1;193(11):1264-70. doi: 10.1164/rccm.201507-1489OC.
6
Trial of early, goal-directed resuscitation for septic shock.早期目标导向性复苏治疗脓毒性休克的试验。
N Engl J Med. 2015 Apr 2;372(14):1301-11. doi: 10.1056/NEJMoa1500896. Epub 2015 Mar 17.
7
Goal-directed resuscitation for patients with early septic shock.目标导向性复苏治疗早期感染性休克患者。
N Engl J Med. 2014 Oct 16;371(16):1496-506. doi: 10.1056/NEJMoa1404380. Epub 2014 Oct 1.
8
Clinical predictors of adverse outcome in severe sepsis patients with lactate 2-4 mM admitted to the hospital.入院时血乳酸浓度为 2-4mM 的严重脓毒症患者不良预后的临床预测因子。
QJM. 2015 Apr;108(4):279-87. doi: 10.1093/qjmed/hcu186. Epub 2014 Sep 4.
9
A randomized trial of protocol-based care for early septic shock.一项基于方案的早期脓毒性休克护理的随机试验。
N Engl J Med. 2014 May 1;370(18):1683-93. doi: 10.1056/NEJMoa1401602. Epub 2014 Mar 18.
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Fluid balance and cardiac function in septic shock as predictors of hospital mortality.脓毒性休克中的液体平衡和心脏功能作为医院死亡率的预测指标
Crit Care. 2013 Oct 20;17(5):R246. doi: 10.1186/cc13072.