Williams Julian M, Keijzers Gerben, Macdonald Stephen Pj, Shetty Amith, Fraser John F
Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Emerg Med Australas. 2018 Apr;30(2):144-151. doi: 10.1111/1742-6723.12951.
Although comprehensive guidelines for treatment of sepsis exist, current research continues to refine and revise several aspects of management. Imperatives for rapid administration of broad-spectrum antibiotics for all patients with sepsis may not be supported by contemporary data. Many patients may be better served by a more judicious approach allowing consideration of investigation results and evidence-based guidelines. Conventional fluid therapy has been challenged with early evidence supporting balanced, restricted fluid and early vasopressor use. Albumin, vasopressin and hydrocortisone have each been shown to support blood pressure and reduce catecholamine requirements but without effect on mortality, and as such should be considered for ED patients with septic shock on a case-by-case basis. Measurement of quality care in sepsis should incorporate quality of blood cultures and guideline-appropriateness of antibiotics, as well as timeliness of therapy. Local audit is an essential and effective means to improve practice. Multicentre consolidation of data through agreed minimum sepsis data sets would provide baseline quality data, required for the design and evaluation of interventions.
尽管存在脓毒症治疗的综合指南，但当前的研究仍在不断完善和修订管理的几个方面。当代数据可能并不支持对所有脓毒症患者迅速给予广谱抗生素的必要性。采用更审慎的方法，考虑检查结果和循证指南，可能会使许多患者受益更多。传统的液体疗法受到了挑战，早期证据支持平衡、限制性液体治疗以及早期使用血管升压药。白蛋白、血管加压素和氢化可的松均已显示可维持血压并减少儿茶酚胺的用量，但对死亡率无影响，因此对于急诊室中感染性休克患者，应根据具体情况考虑使用。脓毒症优质护理的衡量应纳入血培养质量、抗生素使用符合指南的程度以及治疗的及时性。局部审核是改善医疗实践的重要且有效手段。通过商定的最低脓毒症数据集进行多中心数据整合，将提供设计和评估干预措施所需的基线质量数据。
