The George Institute for Global Health, Sydney, New South Wales, Australia.
University of New South Wales, Sydney, New South Wales, Australia.
Intern Med J. 2019 Feb;49(2):160-170. doi: 10.1111/imj.14199.
Sepsis, defined as life-threatening organ dysfunction due to a dysregulated host response to infection, is recognised by the World Health Organization as a global health priority. Each year, 5000 of the 18 000 adults with sepsis treated in Australian intensive care units die, with survivors suffering long-term physical, cognitive and psychological dysfunction, which is poorly recognised and frequently untreated. There are currently no effective pharmacological treatments for sepsis, making early recognition, resuscitation and immediate treatment with appropriate antibiotics the key to reducing the burden of resulting disease. The majority of sepsis, around 70-80%, is community acquired making emergency departments and primary care key targets to improve recognition and early management. Case fatality rates for sepsis are decreasing in many countries with the reduction attributed to national or regional screening and quality improvement programmes focused on early identification and immediate treatment. The optimum approach to treating established sepsis has been informed by high-quality, multicentre investigator initiated randomised trials with much of the valuable data coming from National Health and Medical Research Council-funded trials run from Australia. While early recognition and improved management of the acute episode are important steps in reducing death and disability from sepsis, a substantial reduction in the burden of sepsis-related disease requires action across the entire healthcare system. In this narrative review, we provide a summary of current knowledge on epidemiology of sepsis and septic shock and recommendations on the optimum approach to the management of these conditions in adults.
脓毒症是一种由宿主对感染的失调反应引起的危及生命的器官功能障碍，世界卫生组织已将其视为全球卫生重点。在澳大利亚重症监护病房接受治疗的 18000 名脓毒症成人患者中，每年有 5000 人死亡，幸存者会遭受长期的身体、认知和心理功能障碍，但这些问题往往未被认识到，也未得到有效治疗。目前，脓毒症尚无有效的药物治疗方法，因此早期识别、复苏和立即使用适当的抗生素是降低疾病负担的关键。大多数脓毒症（约 70-80%）是社区获得性的，因此急诊科和初级保健是提高认识和早期管理的关键目标。许多国家的脓毒症病死率正在下降，这归因于国家或地区的筛查和质量改进计划，这些计划侧重于早期识别和及时治疗。高质量、多中心的研究者发起的随机试验为治疗已确立的脓毒症提供了最佳方法，其中许多有价值的数据来自澳大利亚国家卫生和医学研究委员会资助的试验。虽然早期识别和改善急性发作的管理是降低脓毒症死亡和残疾的重要步骤，但要想大幅减少脓毒症相关疾病的负担，还需要在整个医疗保健系统中采取行动。在这篇叙述性综述中，我们总结了脓毒症和感染性休克的流行病学知识，并就成人脓毒症和感染性休克的最佳管理方法提出了建议。
