Zusammenfassung
Sepsis ist die Folge einer systemischen Reaktion des Organismus auf eine Infektion. Eine frühe Erkennung der Sepsis sollte bereits in der Präklinik, aber spätestens bei Aufnahme in der Notaufnahme erfolgen. Die schwere Sepsis ist durch ein zusätzliches Organversagen definiert, der septische Schock durch einen persistierenden Schock auch nach initialer Volumengabe. Die frühe kausale Therapie mit Abnahme von Blutkulturen und Breitspektrumantibiotika in der ersten Stunde und die frühe supportive zielgerichtete Therapie mit kristalloiden Lösungen in den ersten 6 h senken die Mortalität bei schwerer Sepsis und septischem Schock. Zielparameter der supportiven Therapie sind der mittlere arterielle Blutdruck und die klinischen Zeichen einer adäquaten Gewebeperfusion. Die Therapie sollte durch invasive Monitoringverfahren nicht verzögert werden. Die Laktat-Clearance und die zentralvenöse Sauerstoffsättigung sind gleichrangige Zielparameter und die Verwendung beider Zielparameter ist möglich.
Abstract
Sepsis is the result of a systemic host response to infection. The early identification of sepsis should take place during the preclinical emergency service stage but definitively at the time of admission to the emergency department. Severe sepsis is defined by additional organ failure and septic shock by persistent hypotension despite adequate fluid resuscitation. Early causal therapy by drawing blood cultures and broad spectrum antibiotics within the first hour and supportive early goal-directed therapy with crystalloid solutions within the first 6 h reduce mortality in patients with severe sepsis and septic shock. Targets of supportive therapy are the mean arterial pressure and clinical signs of adequate tissue perfusion. Therapy should not be delayed by invasive monitoring techniques. Lactate clearance has been shown to be an equivalent goal to central venous oxygen saturation and both parameters may be used.
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Interessenkonflikt. C.E. Wrede und K. Reinhart geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Wrede, C., Reinhart, K. Sepsis in der Notfallmedizin. Notfall Rettungsmed 17, 707–717 (2014). https://doi.org/10.1007/s10049-014-1962-4
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DOI: https://doi.org/10.1007/s10049-014-1962-4