Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, Dublin, Ireland.
Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Spain.
Intensive Care Med. 2024 Dec;50(12):2043-2049. doi: 10.1007/s00134-024-07694-z. Epub 2024 Nov 12.
This review explores the current landscape and evolving understanding of sepsis, highlighting both challenges and future directions. Sepsis remains a major global health burden, with diverse clinical presentations complicating timely diagnosis and management. Existing definitions, including the Sepsis-3 criteria, emphasize the importance of organ dysfunction, yet early sepsis detection remains limited by available tools. The Sequential Organ Failure Assessment (SOFA) score, though widely used, may not fully capture early stages of infection or account for complex presentations like noncatecholamine-resistant shock. Additionally, the review underscores the pressing need for standardized terminology across sepsis and shock characterization to ensure consistency in diagnosis and treatment strategies. Accessible, resource-adapted solutions are particularly crucial in low- and middle-income countries where sepsis-related mortality rates are higher due to limited resources. Future research should focus on developing and validating integrated, multi-parameter tools that combine clinical, biochemical, and microbiological data to improve sepsis outcomes globally. Advancing sepsis care will require both technological innovation and collaborative, globally consistent guidelines to bridge disparities in healthcare delivery.
这篇综述探讨了脓毒症的现状和不断发展的认识,强调了挑战和未来的方向。脓毒症仍然是一个主要的全球健康负担,其多样化的临床表现使得及时诊断和管理变得复杂。现有的定义,包括 Sepsis-3 标准,强调了器官功能障碍的重要性,但早期脓毒症的检测仍然受到现有工具的限制。序贯器官衰竭评估(SOFA)评分虽然被广泛应用,但可能无法完全捕捉到感染的早期阶段,也无法解释非儿茶酚胺抵抗性休克等复杂表现。此外,该综述强调了在脓毒症和休克特征描述中使用标准化术语的迫切需求,以确保诊断和治疗策略的一致性。在资源有限的中低收入国家,由于脓毒症相关死亡率较高,因此需要使用易于获取且适用于资源的解决方案。未来的研究应侧重于开发和验证综合的、多参数工具,将临床、生化和微生物学数据结合起来,以改善全球脓毒症的预后。推进脓毒症的护理需要技术创新和全球一致的协作指南,以弥合医疗服务提供方面的差距。