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Die aktuelle Sepsisleitlinie

The current sepsis guidelines

  • Intensivmedizin
  • Published:
Wiener klinisches Magazin Aims and scope

Zusammenfassung

Die aktuelle internationale Sepsisleitlinie aus dem Jahr 2021 basiert auf der Arbeit eines Panels von 60 internationalen Experten aus verschiedenen Bereichen. Sie beinhaltet insgesamt 93 Empfehlungen, wobei einige Empfehlungen verglichen mit der Leitlinienversion von 2016 neue Aspekte beinhalten. Der vorliegende Beitrag bietet eine subjektive Zusammenstellung zweier internistischer Intensivmediziner, die einige Aspekte aufzeigen, insbesondere Veränderungen innerhalb der Leitlinie im Vergleich zur vorherigen Version. Der Fokus liegt auf den Bereichen Screening, Sepsis-Campaign-Bündel, Flüssigkeits- und Vasopressorentherapie und adjuvante Therapien. Zudem wird in dieser Leitlinie erstmalig das wichtige Thema der Langzeitfolgen für Sepsisüberlebende und deren Umfeld angesprochen.

Abstract

The current international sepsis guidelines from 2021 are based on the work of a panel of 60 international experts from various fields. They include a total of 93 recommendations, some of which include new aspects compared to the 2016 version of the guidelines. This article provides a subjective compilation by two internal medicine intensivists who highlight some aspects, especially of changes within the guidelines compared to the previous version. The focus is on the fields of screening, sepsis bundles, fluid and vasopressor treatment and adjuvant treatment. In addition, for the first time these guidelines address the important issue of long-term sequelae for sepsis survivors and their environment.

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Literatur

  1. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C et al (2021) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med 49:e1063–e143

    Article  PubMed  Google Scholar 

  2. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C et al (2021) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intens Care Med 47:1181–1247

    Article  Google Scholar 

  3. Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP et al (2020) Executive summary: surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intens Care Med 46:1–9 (https://www.ncbi.nlm.nih.gov/pubmed/32030528)

    Article  Google Scholar 

  4. Alhazzani W, Moller MH, Arabi YM, Loeb M, Gong MN, Fan E et al (2020) Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intens Care Med 46:854–887 (https://www.ncbi.nlm.nih.gov/pubmed/32222812)

    Article  Google Scholar 

  5. Alhazzani W, Moller MH, Arabi YM, Loeb M, Gong MN, Fan E et al (2020) Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med 48:e440–e469 (https://www.ncbi.nlm.nih.gov/pubmed/32224769)

    Article  CAS  PubMed  Google Scholar 

  6. Levy MM, Evans LE, Rhodes A (2018) The surviving sepsis campaign bundle: 2018 update. Crit Care Med 46:997–1000 (https://www.ncbi.nlm.nih.gov/pubmed/29767636)

    Article  PubMed  Google Scholar 

  7. Pro CI, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA et al (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370:1683–1693 (https://www.ncbi.nlm.nih.gov/pubmed/24635773)

    Article  Google Scholar 

  8. Investigators A, Group ACT, Peake SL, Delaney A, Bailey M, Bellomo R et al (2014) Goal-directed resuscitation for patients with early septic shock. N Engl J Med 371:1496–1506 (https://www.ncbi.nlm.nih.gov/pubmed/25272316)

    Article  Google Scholar 

  9. Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD et al (2015) Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 372:1301–1311 (https://www.ncbi.nlm.nih.gov/pubmed/25776532)

    Article  CAS  PubMed  Google Scholar 

  10. Damiani E, Donati A, Serafini G, Rinaldi L, Adrario E, Pelaia P et al (2015) Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies. PLoS ONE 10:e125827

    Article  PubMed  PubMed Central  Google Scholar 

  11. Islam MDM, Nasrin T, Walther BA, Wu C‑C, Yang H‑C, Li Y‑C (2019) Prediction of sepsis patients using machine learning approach: a meta-analysis. Comput Methods Programs Biomed 170:1–9

    Article  PubMed  Google Scholar 

  12. Downing NL, Rolnick J, Poole SF, Hall E, Wessels AJ, Heidenreich P et al (2019) Electronic health record-based clinical decision support alert for severe sepsis: a randomised evaluation. BMJ Qual Saf 28:762

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hooper MH, Weavind L, Wheeler AP, Martin JB, Gowda SS, Semler MW et al (2012) Randomized trial of automated, electronic monitoring to facilitate early detection of sepsis in the intensive care unit*. Crit Care Med 40:2096–2101

    Article  PubMed  PubMed Central  Google Scholar 

  14. Shimabukuro DW, Barton CW, Feldman MD, Mataraso SJ, Das R (2017) Effect of a machine learning-based severe sepsis prediction algorithm on patient survival and hospital length of stay: a randomised clinical trial. BMJ Open Respir Res 4:e234

    Article  PubMed  PubMed Central  Google Scholar 

  15. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A et al (2016) Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315:762–774

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Serafim R, Gomes JA, Salluh J, Povoa P (2018) A comparison of the quick-SOFA and systemic inflammatory response syndrome criteria for the diagnosis of sepsis and prediction of mortality: a systematic review and meta-analysis. Chest 153:646–655 (https://www.ncbi.nlm.nih.gov/pubmed/29289687)

    Article  PubMed  Google Scholar 

  17. Liu VX, Lu Y, Carey KA, Gilbert ER, Afshar M, Akel M et al (2020) Comparison of early warning scoring systems for hospitalized patients with and without infection at risk for in-hospital mortality and transfer to the intensive care unit. JAMA Netw Open 3:e205191

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rivers E et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377

    Article  CAS  PubMed  Google Scholar 

  19. Meyhoff TS, Hjortrup PB, Wetterslev J, Sivapalan P, Laake JH, Cronhjort M et al (2022) Restriction of intravenous fluid in ICU patients with septic shock. N Engl J Med 386:2459–2470

    Article  CAS  PubMed  Google Scholar 

  20. Network NH Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials, Shapiro NI, Douglas IS, Brower RG, Brown SM, Exline MC et al (2023) Early restrictive or liberal fluid management for sepsis-induced hypotension. N Engl J Med 388:499–510

    Article  Google Scholar 

  21. Rochwerg B, Alhazzani W, Sindi A, Heels-Ansdell D, Thabane L, Fox-Robichaud A et al (2014) Fluid resuscitation in sepsis: a systematic review and network meta-analysis. Ann Intern Med 161:347–355 (https://www.ncbi.nlm.nih.gov/pubmed/25047428)

    Article  PubMed  Google Scholar 

  22. Semler MW, Self WH, Wanderer JP, Ehrenfeld JM, Wang L, Byrne DW et al (2018) Balanced Crystalloids versus saline in critically ill adults. N Engl J Med 378:829–839 (https://www.ncbi.nlm.nih.gov/pubmed/29485925)

    Article  PubMed  PubMed Central  Google Scholar 

  23. Brown RM, Wang L, Coston TD, Krishnan NI, Casey JD, Wanderer JP et al (2019) Balanced Crystalloids versus saline in sepsis. A secondary analysis of the SMART clinical trial. Am J Respir Crit Care Med 200:1487–1495

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Zampieri FG, Machado FR, Biondi RS, Freitas FGR, Veiga VC, Figueiredo RC et al (2021) Effect of intravenous fluid treatment with a balanced solution vs 0.9 % saline solution on mortality in critically ill patients. JAMA 326:818–829

    Article  CAS  Google Scholar 

  25. Prescott HC, Iwashyna TJ (2018) Improving sepsis treatment by embracing diagnostic uncertainty. Ann Am Thorac Soc 16:426–429

    Article  Google Scholar 

  26. Rhee C, Kadri SS, Danner RL, Suffredini AF, Massaro AF, Kitch BT et al (2016) Diagnosing sepsis is subjective and highly variable: a survey of intensivists using case vignettes. Crit Care 20:89

    Article  PubMed  PubMed Central  Google Scholar 

  27. Klouwenberg PMCK, Cremer OL, van Vught LA, Ong DSY, Frencken JF, Schultz MJ et al (2015) Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study. Crit Care 19:319

    Article  Google Scholar 

  28. Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS et al (2017) Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med 376:2235–2244

    Article  PubMed  PubMed Central  Google Scholar 

  29. Liu VX, Fielding-Singh V, Greene JD, Baker JM, Iwashyna TJ, Bhattacharya J et al (2017) The timing of early antibiotics and hospital mortality in sepsis. Am J Respir Crit Care Med 196:856–863

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hagel S, Bach F, Brenner T, Bracht H, Brinkmann A, Annecke T et al (2022) Effect of therapeutic drug monitoring-based dose optimization of piperacillin/tazobactam on sepsis-related organ dysfunction in patients with sepsis: a randomized controlled trial. Intens Care Med 48:311–321

    Article  CAS  Google Scholar 

  31. Tian DH, Smyth C, Keijzers G, Macdonald SP, Peake S, Udy A et al (2020) Safety of peripheral administration of vasopressor medications: a systematic review. Emerg Med Australas 32:220–227

    Article  PubMed  Google Scholar 

  32. Loubani OM, Green RS (2015) A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care 30:653.e9–653.e17

    Article  CAS  PubMed  Google Scholar 

  33. Delaney A, Finnis M, Bellomo R, Udy A, Jones D, Keijzers G et al (2020) Initiation of vasopressor infusions via peripheral versus central access in patients with early septic shock: a retrospective cohort study. Emerg Med Australas 32:210–219

    Article  PubMed  Google Scholar 

  34. Annane D, Renault A, Brun-Buisson C, Megarbane B, Quenot JP, Siami S et al (2018) Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med 378:809–818

    Article  CAS  PubMed  Google Scholar 

  35. Venkatesh B, Finfer S, Cohen J, Rajbhandari D, Arabi Y, Bellomo R et al (2018) Adjunctive Glucocorticoid therapy in patients with septic shock. N Engl J Med 378:797–808

    Article  CAS  PubMed  Google Scholar 

  36. Gordon AC, Mason AJ, Thirunavukkarasu N, Perkins GD, Cecconi M, Cepkova M et al (2016) Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: the VANISH randomized clinical trial. JAMA 316:509–518

    Article  CAS  PubMed  Google Scholar 

  37. Rygard SL, Butler E, Granholm A, Moller MH, Cohen J, Finfer S et al (2018) Low-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis. Intensive Care Med 44:1003–1016

    Article  PubMed  Google Scholar 

  38. Fang F, Zhang Y, Tang J, Lunsford LD, Li T, Tang R et al (2019) Association of corticosteroid treatment with outcomes in adult patients with sepsis: a systematic review and meta-analysis. JAMA Intern Med 179:213–223

    Article  PubMed  Google Scholar 

  39. Lamontagne F, Masse M‑H, Menard J, Sprague S, Pinto R, Heyland DK et al (2022) Intravenous vitamin C in adults with sepsis in the intensive care unit. N Engl J Med 386:2387–2398

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Medizinische Fakultät und Universitätsklinikum Köln, Klinik I für Innere Medizin, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO), Universität zu Köln, Köln, Deutschland

    Matthias Kochanek

  2. Universitätsspital Zürich, Institut für Intensivmedizin, Zürich, Schweiz

    Sascha David

  3. Medizinische Hochschule Hannover, Nieren- und Hochdruckerkrankungen, Hannover, Deutschland

    Sascha David

Authors
  1. Matthias Kochanek
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  2. Sascha David
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Correspondence to Matthias Kochanek.

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Interessenkonflikt

M. Kochanek und S. David geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Dieser Beitrag wurde in der Zeitschrift Die Innere Medizin (2023) 64(10):939–945. https://doi.org/10.1007/s00108-023-01585-z erstveröffentlicht. Zweitpublikation mit freundlicher Genehmigung der Autoren.

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Kochanek, M., David, S. Die aktuelle Sepsisleitlinie. Wien klin Mag 27, 38–43 (2024). https://doi.org/10.1007/s00740-024-00527-1

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  • DOI: https://doi.org/10.1007/s00740-024-00527-1

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