Skip to main content
SpringerLink
Log in

Sepsis

  • Living reference work entry
  • Latest version View entry history
  • First Online:
Die Intensivmedizin

Part of the book series: Springer Reference Medizin ((SRM))

  • 91 Accesses

Zusammenfassung

In der Sepsistherapie wird zwischen den kausalen antimikrobiellen bzw. operativ-interventionellen Maßnahmen zur Herdsanierung sowie den elementaren supportiven (organbezogenen) intensivmedizinischen Standardmaßnahmen und adjunktiven (potenziell zusätzlichen) therapeutischen Ansätzen unterschieden. Auf die wichtigsten dieser evidenzbasierten supportiven und adjunktiven Therapiemaßnahmen wird in diesem Beitrag eingegangen. Zeit ist der entscheidende Faktor: Die kausale Therapie muss umgehend, die supportive Therapie zur Wiederherstellung der Gewebsperfusion in der ersten Stunde nach Diagnosestellung und die adjunktive Therapie zusätzlich und parallel zur kausalen und supportiven Therapie innerhalb der ersten 24 h durchgeführt werden. Darüber hinaus ist die Prognose hinsichtlich Überleben und Lebensqualität nach Erleiden einer Sepsis thematisiert.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Literatur

  • Angeletti S, Battistoni F, Fioravanti M et al (2013) Procalcitonin and mid-regional pro-adrenomedullin test combination in sepsis diagnosis. Clin Chem Lab Med 51(5):1059–1067

    Article  CAS  PubMed  Google Scholar 

  • Angstwurm MW, Engelmann L, Zimmermann T, Lehmann C, Spes CH, Abel P, Strauss R, Meier-Hellmann A, Insel R, Radke J et al (2007) Selenium in Intensive Care (SIC): results of a prospective randomized, placebo-controlled, multiple-center study in patients with severe systemic inflammatory response syndrome, sepsis, and septic shock. Crit Care Med 35(1):118–126

    Article  CAS  PubMed  Google Scholar 

  • Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G et al (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288(7):862–871

    Article  CAS  PubMed  Google Scholar 

  • Annane D, Vignon P, Renault A, Bollaert PE, Charpentier C, Martin C, Troche G, Ricard JD, Nitenberg G, Papazian L et al (2007) Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial. Lancet 370(9588):676–684

    Article  CAS  PubMed  Google Scholar 

  • Arnold RC, Shapiro NI, Jones AE, Schorr C, Pope J, Casner E, Parrillo JE, Dellinger RP, Trzeciak S (2009) Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis. Shock 32(1):35–39

    Article  CAS  PubMed  Google Scholar 

  • Asfar P, Meziani F, Hamel JF, Investigators SEPSISPAM et al (2014) High versus low blood-pressure target in patients with septic shock. N Engl J Med 370(17):1583–1593

    Article  CAS  PubMed  Google Scholar 

  • Beale R, Janes JM, Brunkhorst FM, Dobb G, Levy MM, Martin GS, Ramsay G, Silva E, Sprung CL, Vallet B et al (2010) Global utilization of low-dose corticosteroids in severe sepsis and septic shock: a report from the PROGRESS registry. Crit Care 14(3):R102

    Article  PubMed  PubMed Central  Google Scholar 

  • Berghe G van den, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345(19):1359–1367

    Google Scholar 

  • Blet A, Deniau B, Santos K, van Lier DPT, Azibani F, Wittebole X, Chousterman BG, Gayat E, Hartmann O, Struck J, Bergmann A, Antonelli M, Beishuizen A, Constantin JM, Damoisel C, Deye N, Di Somma S, Dugernier T, François B, Gaudry S, Huberlant V, Lascarrou JB, Marx G, Mercier E, Oueslati H, Pickkers P, Sonneville R, Legrand M, Laterre PF, Mebazaa A, AdrenOSS-1 Study Investigators (2021) Monitoring circulating dipeptidyl peptidase 3 (DPP3) predicts improvement of organ failure and survival in sepsis: a prospective observational multinational study. Crit Care 25(1):61

    Article  PubMed  PubMed Central  Google Scholar 

  • Bloos F, Muller S, Harz A, Gugel M, Geil D, Egerland K, Reinhart K, Marx G (2009) Effects of staff training on the care of mechanically ventilated patients: a prospective cohort study. Br J Anaesth 103(2):232–237

    Article  CAS  PubMed  Google Scholar 

  • Bloos F, Trips E, Nierhaus A, Briegel J, Heyland DK, Jaschinski U, Moerer O, Weyland A, Marx G, Gründling M, Kluge S, Kaufmann I, Ott K, Quintel M, Jelschen F, Meybohm P, Rademacher S, Meier-Hellmann A, Utzolino S, Kaisers UX, Putensen C, Elke G, Ragaller M, Gerlach H, Ludewig K, Kiehntopf M, Bogatsch H, Engel C, Brunkhorst FM, Loeffler M, Reinhart K, for SepNet Critical Care Trials Group (2016) Effect of sodium selenite administration and procalcitonin-guided therapy on mortality in patients with severe sepsis or septic shock: a randomized clinical trial. JAMA Intern Med 176(9):1266–1276

    Article  PubMed  Google Scholar 

  • Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, Mercier JC, Offenstadt G, Regnier B (1995) Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA 274(12):968–974

    Article  CAS  PubMed  Google Scholar 

  • Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S et al (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358(2):125–139

    Article  CAS  PubMed  Google Scholar 

  • Brunkhorst FM, Oppert M, Marx G, Bloos F, Ludewig K, Putensen C, Nierhaus A, Jaschinski U, Meier-Hellmann A, Weyland A et al (2012) Effect of empirical treatment with moxifloxacin and meropenem vs meropenem on sepsis-related organ dysfunction in patients with severe sepsis: a randomized trial. JAMA 307(22):2390–2399

    Article  CAS  PubMed  Google Scholar 

  • Cocchi MN, Dargin J, Chase M, Patel PV, Grossestreuer A, Balaji L, Liu X, Moskowitz A, Berg K, Donnino MW (2022) Esmolol to treat the hemodynamic effects of septic shock: a randomized controlled trial. Shock 57(4):508–517

    Article  CAS  PubMed  Google Scholar 

  • Deutsche Sepsis-Gesellschaft (DSG, DIVI) (2010) Prävention, Diagnose, Therapie und Nachsorge der Sepsis. In. AWMF-Leitlinien-Register 079/001

    Google Scholar 

  • Engel C, Brunkhorst FM, Bone HG, Brunkhorst R, Gerlach H, Grond S, Gruendling M, Huhle G, Jaschinski U, John S et al (2007) Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med 33(4):606–618

    Article  PubMed  Google Scholar 

  • Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M (2021) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47(11):1181–1247

    Article  PubMed  PubMed Central  Google Scholar 

  • Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR et al (2009) Intensive versus conventional glucose control in critically ill patients. N Engl J Med 360(13):1283–1297

    Article  PubMed  Google Scholar 

  • Forceville X (2007) Effects of high doses of selenium, as sodium selenite, in septic shock patients a placebo-controlled, randomized, double-blind, multi-center phase II study-selenium and sepsis. J Trace Elem Med Biol 21(Suppl 1):62–65

    Article  CAS  PubMed  Google Scholar 

  • Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34(6):1589–1596

    Article  PubMed  Google Scholar 

  • Laterre PF, Pickkers P, Marx G, Wittebole X, Meziani F, Dugernier T, Huberlant V, Schuerholz T, François B, Lascarrou JB, Beishuizen A, Oueslati H, Contou D, Hoiting O, Lacherade JC, Chousterman B, Pottecher J, Bauer M, Godet T, Karakas M, Helms J, Bergmann A, Zimmermann J, Richter K, Hartmann O, Pars M, Mebazaa A, AdrenOSS-2 Study Participants (2021) Safety and tolerability of non-neutralizing adrenomedullin antibody adrecizumab (HAM8101) in septic shock patients: the AdrenOSS-2 phase 2a biomarker-guided trial. Intensive Care Med 47(11):1284–1294

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Levy MM, Artigas A, Phillips GS, Rhodes A, Beale R, Osborn T, Vincent JL, Townsend S, Lemeshow S, Dellinger RP (2012) Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study. Lancet Infect Dis 12(12):919–924

    Article  PubMed  Google Scholar 

  • Macdonald SPJ, Taylor DM, Keijzers G, Arendts G, Fatovich DM, Kinnear FB, Brown SGA, Bellomo R, Burrows S, Fraser JF, Litton E, Ascencio-Lane JC, Anstey M, McCutcheon D, Smart L, Vlad I, Winearls J, Wibrow B (2017) REstricted Fluid REsuscitation in Sepsis-associated Hypotension (REFRESH): study protocol for a pilot randomised controlled trial. Trials 18(1):399

    Article  PubMed  PubMed Central  Google Scholar 

  • Mebazaa A, Geven C, Hollinger A, Wittebole X, Chousterman BG, Blet A, Gayat E, Hartmann O, Scigalla P, Struck J, Bergmann A, Antonelli M, Beishuizen A, Constantin JM, Damoisel C, Deye N, Di Somma S, Dugernier T, François B, Gaudry S, Huberlant V, Lascarrou JB, Marx G, Mercier E, Oueslati H, Pickkers P, Sonneville R, Legrand M, Laterre PF, AdrenOSS-1 Study Investigators (2018) Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study. Crit Care 22(1):354

    Article  PubMed  PubMed Central  Google Scholar 

  • Micek ST, Lloyd AE, Ritchie DJ, Reichley RM, Fraser VJ, Kollef MH (2005) Pseudomonas aeruginosa bloodstream infection: importance of appropriate initial antimicrobial treatment. Antimicrob Agents Chemother 49(4):1306–1311

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Morelli A, Ertmer C, Westphal M, Rehberg S, Kampmeier T, Ligges S, Orecchioni A, D’Egidio A, D’Ippoliti F, Raffone C, Venditti M, Guarracino F, Girardis M, Tritapepe L, Pietropaoli P, Mebazaa A, Singer M (2013) Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial. JAMA 310(16):1683–1691

    Article  PubMed  Google Scholar 

  • Morgenthaler NG, Struck J, Alonso C, Bergmann A (2005) Measurement of midregional proadrenomedullin in plasma with an immunoluminometric assay. Clin Chem 51(10):1823–1829

    Article  CAS  PubMed  Google Scholar 

  • Nguyen HB, Kuan WS, Batech M, Shrikhande P, Mahadevan M, Li CH, Ray S, Dengel A (2011) Outcome effectiveness of the severe sepsis resuscitation bundle with addition of lactate clearance as a bundle item: a multi-national evaluation. Crit Care 15(5):R229

    Article  PubMed  PubMed Central  Google Scholar 

  • Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J (2008) Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med 177(5):498–505

    Article  CAS  PubMed  Google Scholar 

  • Parlato M, Philippart F, Rouquette A, Moucadel V, Puchois V, Blein S, Bedos JP, Diehl JL, Hamzaoui O, Annane D, Journois D, Ben Boutieb M, Estève L, Fitting C, Treluyer JM, Pachot A, Adib-Conquy M, Cavaillon JM, Misset B, Captain Study Group (2018) Circulating biomarkers may be unable to detect infection at the early phase of sepsis in ICU patients: the CAPTAIN prospective multicenter cohort study. Intensive Care Med 44(7):1061–1070

    Article  CAS  PubMed  Google Scholar 

  • Perl TM, Dvorak L, Hwang T, Wenzel RP (1995) Long-term survival and function after suspected gram-negative sepsis. JAMA 274(4):338–345

    Article  CAS  PubMed  Google Scholar 

  • Preiser JC, Devos P, Ruiz-Santana S, Melot C, Annane D, Groeneveld J, Iapichino G, Leverve X, Nitenberg G, Singer P et al (2009) A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med 35(10):1738–1748

    Article  CAS  PubMed  Google Scholar 

  • Quartin AA, Schein RM, Kett DH, Peduzzi PN (1997) Magnitude and duration of the effect of sepsis on survival. Department of Veterans Affairs Systemic Sepsis Cooperative Studies Group. JAMA 277(13):1058–1063

    Article  CAS  PubMed  Google Scholar 

  • Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, Van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43(3):304–377

    Article  PubMed  Google Scholar 

  • Rüddel H, Thomas-Rüddel DO, Reinhart K, Bach F, Gerlach H, Lindner M, Marshall JC, Simon P, Weiss M, Bloos F, Schwarzkopf D, MEDUSA Study Group (2022) Adverse effects of delayed antimicrobial treatment and surgical source control in adults with sepsis: results of a planned secondary analysis of a cluster-randomized controlled trial. Crit Care 26(1):51

    Article  PubMed  PubMed Central  Google Scholar 

  • Russell JA, Walley KR, Singer J, Gordon AC, Hebert PC, Cooper DJ, Holmes CL, Mehta S, Granton JT, Storms MM et al (2008) Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 358(9):877–887

    Article  CAS  PubMed  Google Scholar 

  • Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL (2004) Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 32(9):1825–1831

    Article  PubMed  Google Scholar 

  • Sakr Y, Gath V, Oishi J, Klinzing S, Simon TP, Reinhart K, Marx G (2010) Characterization of buccal microvascular response in patients with septic shock. Eur J Anaesthesiol 27(4):388–394

    Article  CAS  PubMed  Google Scholar 

  • Sandiumenge A, Diaz E, Bodi M, Rello J (2003) Therapy of ventilator-associated pneumonia. A patient-based approach based on the ten rules of „The Tarragona Strategy“. Intensive Care Med 29(6):876–883

    Article  PubMed  Google Scholar 

  • Sands KE, Bates DW, Lanken PN, Graman PS, Hibberd PL, Kahn KL, Parsonnet J, Panzer R, Orav EJ, Snydman DR (1997) Epidemiology of sepsis syndrome in 8 academic medical centers. Academic Medical Center Consortium Sepsis Project Working Group [see comments]. JAMA 278(3):234–240

    Article  CAS  PubMed  Google Scholar 

  • Schuerholz T, Marx G (2008) Management of sepsis. Minerva Anestesiol 74(5):181–195

    CAS  PubMed  Google Scholar 

  • Schuetz P, Litke A, Albrich WC, Mueller B (2013) Blood biomarkers for personalized treatment and patient management decisions in community-acquired pneumonia. Curr Opin Infect Dis 26(2):159–167

    Article  CAS  PubMed  Google Scholar 

  • SepNet Critical Care Trials Group (2016) Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study. Intensive Care Med 42:1980–1989

    Article  Google Scholar 

  • Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315(8):801–810

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, Weiss YG, Benbenishty J, Kalenka A, Forst H et al (2008) Hydrocortisone therapy for patients with septic shock. N Engl J Med 358(2):111–124

    Article  CAS  PubMed  Google Scholar 

  • Warren BL, Eid A, Singer P, Pillay SS, Carl P, Novak I, Chalupa P, Atherstone A, Penzes I, Kubler A et al (2001) Caring for the critically ill patient. High-dose antithrombin III in severe sepsis: a randomized controlled trial. JAMA 286(15):1869–1878

    Article  CAS  PubMed  Google Scholar 

  • Wiener RS, Wiener DC, Larson RJ (2008) Benefits and risks of tight glucose control in critically ill adults: a meta analysis. JAMA 300(8):933–944

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinikum Aachen, Aachen, Deutschland

    Tobias Schürholz & Gernot Marx

Authors
  1. Tobias Schürholz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gernot Marx
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tobias Schürholz .

Editor information

Editors and Affiliations

  1. Klinik für Anästhesiologie, RWTH Aachen Universitätsklinikum Aachen, Aachen, Deutschland

    Gernot Marx

  2. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Deutschland

    Elke Muhl

  3. Dir. der Klinik fuer Anaesthesie Intensivmed. und Schmerzther., Frankfurt, Hessen, Deutschland

    Kai Zacharowski

  4. Medizinische Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main, Hessen, Deutschland

    Stefan Zeuzem

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Schürholz, T., Marx, G. (2023). Sepsis. In: Marx, G., Muhl, E., Zacharowski, K., Zeuzem, S. (eds) Die Intensivmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54675-4_84-2

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-54675-4_84-2

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54675-4

  • Online ISBN: 978-3-642-54675-4

  • eBook Packages: Springer Referenz Medizin

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Sepsis
    Published:
    30 April 2023

    DOI: https://doi.org/10.1007/978-3-642-54675-4_84-2

  2. Original

    Sepsis
    Published:
    23 June 2015

    DOI: https://doi.org/10.1007/978-3-642-54675-4_84-1

Search

Navigation