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Innere Medizin up2date 2013; 01(03/04): 149-162
DOI: 10.1055/s-0033-1344791
Internistische Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Sepsis – was ist gesichert, was ist neu?

Sepsis – solid and new facts
Hans-Georg Bone
,
Jörg Freyhoff
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Publikationsverlauf

Publikationsdatum:
05. Dezember 2013 (online)

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Siehe auch:

Sepsis – was ist gesichert, was ist neu?Intensivmedizin up2date 2010; 6(04): 257-270
DOI: 10.1055/s-0030-1255663

Kernaussagen

Die Ecksteine einer erfolgreichen Sepsistherapie sind:

  • möglichst früher Therapiebeginn

  • möglichst schnelle kausale Therapie

  • möglichst effektive antibiotische Therapie

  • Steuerung der frühen hämodynamischen Therapie mit Hilfe der zentralvenösen Sättigung

  • großzügige initiale Volumensubstitution

  • strenge Indikationsstelle der Volumensubstitution im weiteren Verlauf

  • Herzindex nach ausreichender Volumensubstitution niedriger als 3 – 4 l/min/m2: Gabe von Dobutamin

  • Mittlere arterielle Druck nach ausreichender Volumensubstitution niedriger als 65 mmHg: Gabe von Noradrenalin

  • Ggf. kombinierte Gabe von Noradrenalin und Dobutamin

  • Vasopressineinsatz nur als Ultima Ratio und dann auch nur in niedriger Dosierung

  • Versuch der Therapie mit 200 – 300 mg Hydrokortison pro Tag als Ultima Ratio beim septischen Schock und sehr hohen Katecholamindosen

 

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