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脓毒症和脓毒性休克中的超声——从诊断到治疗

Ultrasound in Sepsis and Septic Shock-From Diagnosis to Treatment.

作者信息

Tullo Gianluca, Candelli Marcello, Gasparrini Irene, Micci Sara, Franceschi Francesco

机构信息

Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, 00168 Rome, Italy.

出版信息

J Clin Med. 2023 Feb 2;12(3):1185. doi: 10.3390/jcm12031185.

Abstract

UNLABELLED

Sepsis and septic shock are among the leading causes of in-hospital mortality worldwide, causing a considerable burden for healthcare. The early identification of sepsis as well as the individuation of the septic focus is pivotal, followed by the prompt initiation of antibiotic therapy, appropriate source control as well as adequate hemodynamic resuscitation. For years now, both emergency department (ED) doctors and intensivists have used ultrasound as an adjunctive tool for the correct diagnosis and treatment of these patients. Our aim was to better understand the state-of-the art role of ultrasound in the diagnosis and treatment of sepsis and septic shock.

METHODS

We conducted an extensive literature search about the topic and reported on the data from the most significant papers over the last 20 years.

RESULTS

We divided each article by topic and exposed the results accordingly, identifying four main aspects: sepsis diagnosis, source control and procedure, fluid resuscitation and hemodynamic optimization, and echocardiography in septic cardiomyopathy.

CONCLUSION

The use of ultrasound throughout the process of the diagnosis and treatment of sepsis and septic shock provides the clinician with an adjunctive tool to better characterize patients and ensure early, aggressive, as well as individualized therapy, when needed. More data are needed to conclude that the use of ultrasound might improve survival in this subset of patients.

摘要

未标注

脓毒症和脓毒性休克是全球住院患者死亡的主要原因之一,给医疗保健带来了相当大的负担。早期识别脓毒症以及确定脓毒症病灶的个体情况至关重要,随后要迅速开始抗生素治疗、进行适当的源头控制以及充分的血流动力学复苏。多年来,急诊科医生和重症监护医生都将超声作为辅助工具来正确诊断和治疗这些患者。我们的目的是更好地了解超声在脓毒症和脓毒性休克诊断与治疗中的最新作用。

方法

我们对该主题进行了广泛的文献检索,并报告了过去20年中最重要论文的数据。

结果

我们按主题对每篇文章进行分类,并相应地展示结果,确定了四个主要方面:脓毒症诊断、源头控制与操作、液体复苏和血流动力学优化以及脓毒性心肌病中的超声心动图检查。

结论

在脓毒症和脓毒性休克的诊断和治疗过程中使用超声,为临床医生提供了一种辅助工具,以便在需要时更好地对患者进行评估,并确保早期、积极以及个体化的治疗。需要更多数据才能得出使用超声可能改善这类患者生存率的结论。

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