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CE:脓毒症及脓毒性休克的管理:当前指南与定义

CE: Managing Sepsis and Septic Shock: Current Guidelines and Definitions.

作者信息

Makic Mary Beth Flynn, Bridges Elizabeth

机构信息

Mary Beth Flynn Makic is a professor in the College of Nursing at the University of Colorado, Anschutz Medical Campus, Aurora. Elizabeth Bridges is a clinical nurse researcher at the University of Washington Medical Center, Seattle, and a professor in the University of Washington School of Nursing. Contact author: Mary Beth Flynn Makic,

出版信息

Am J Nurs. 2018 Feb;118(2):34-39. doi: 10.1097/01.NAJ.0000530223.33211.f5.

Abstract

: Sepsis is a leading cause of critical illness and hospital mortality. Early recognition and intervention are essential for the survival of patients with this syndrome. In 2002, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) launched the Surviving Sepsis Campaign (SSC) to reduce overall patient morbidity and mortality from sepsis and septic shock by driving practice initiatives based on current best evidence. The SSC guidelines have been updated every four years, with the most recent update completed in 2016. The new guidelines have increased the focus on early identification of infection, risks for sepsis and septic shock, rapid antibiotic administration, and aggressive fluid resuscitation to restore tissue perfusion.In 2014, the SCCM and the ESICM convened a task force of specialists to reexamine the definitions of terms used to identify patients along the sepsis continuum. In 2016, this task force published the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The new definitions and recommendations included tools, based on an updated understanding of the pathobiology of sepsis, that can be used to predict adverse outcomes in patients with infection.This article discusses the new SSC treatment guidelines, changes in the sepsis bundle interventions, and the Sepsis-3 definitions and tools, all of which enable nurses to improve patient outcomes through timely collaborative action.

摘要

脓毒症是危重病和医院死亡的主要原因。早期识别和干预对于患有这种综合征的患者的生存至关重要。2002年,危重病医学会(SCCM)和欧洲重症监护医学会(ESICM)发起了拯救脓毒症运动(SSC),通过推动基于当前最佳证据的实践举措,降低脓毒症和脓毒性休克患者的总体发病率和死亡率。SSC指南每四年更新一次,最近一次更新于2016年完成。新指南更加注重早期识别感染、脓毒症和脓毒性休克的风险、快速使用抗生素以及积极的液体复苏以恢复组织灌注。2014年,SCCM和ESICM召集了一个专家特别工作组,重新审视用于识别脓毒症连续体中患者的术语定义。2016年,该特别工作组发布了《脓毒症和脓毒性休克第三次国际共识定义》(Sepsis-3)。新的定义和建议包括基于对脓毒症病理生物学的最新理解的工具,可用于预测感染患者的不良结局。本文讨论了新的SSC治疗指南、脓毒症集束化干预措施的变化以及Sepsis-3定义和工具,所有这些都使护士能够通过及时的协作行动改善患者结局。

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