Sepsis und Multiorganversagen – Therapeutische Möglichkeiten

Zusammenfassung

Die Therapie der Sepsis hat das Ziel, den Infektionsfokus zu eliminieren sowie die Mikrozirkulation zu erhalten oder wiederherzustellen. Dabei muss eine schwere Sepsis oder ein septischer Schock ebenso rasch und aggressiv wie ein hämorrhagischer Schock behandelt werden, da die Zeit zwischen Krankheitsbeginn und Initiierung der Therapie die kritische Variable für die Überlebenswahrscheinlichkeit der Patienten ist. Die durch die „Surviving-Sepsis-Campaign“ implementierten Maßnahmen-Bündel können die Letalität signifikant reduzieren. Entscheidend sind hier vor allem die Compliance mit den Maßnahmen-Bündeln und die konsequente Schulung der Mitarbeiter für vorher festgelegte Zielparameter und Therapie-Protokolle. Die besondere Aufmerksamkeit liegt auf den in den ersten sechs Stunden zu treffenden Maßnahmen.

Abstract

Sepsis therapy is aiming to eliminate the focus of infection and to obtain or to restore microcirculation. Severe sepsis and septic shock have to be treated as fast and aggressively as hemorrhagic shock, because the time between onset of disease and initiating the therapy is crucial for the probability of survival. The bundle measures introduced by the Surviving-Sepsis-Campaign are able to reduce mortality significantly. The compliance with the bundle measures and consequent training of medical staff to predefined goal measures and therapy protocols is determining the success of sepsis therapy. The bundle measures of the first six hours (resuscitation bundle) deserve special attention.

Kernaussagen

• Die Zeit ist eine der kritischsten Variablen für die Therapie von Patienten mit schwerer Sepsis und septischem Schock.

• Die umgehende Fokussanierung senkt die Letalität und ist einer der Pfeiler der Sepsistherapie.

• Je früher die antiinfektive Therapie nach der Diagnose schwere Sepsis oder septischer Schock initiiert wird, desto geringer ist die Letalität.

• Die vollständige Durchführung der „Surviving Sepsis Campaign“-Bündel und die Compliance zu den Bündelmaßnahmen sind Faktoren, welche die Letalität reduzieren.

• Frühzeitige Wahrnehmung der Sepsis, frühzeitige Antibiotikagabe und frühzeitige, adäquate Volumengabe sind wesentliche Elemente einer protokollbasierten Therapie.

• Bei der Festlegung der Zielparameter für die Volumen- und Katecholamintherapie sind individuelle Risikofaktoren mit einzubeziehen.

Schlüsselwörter:

Sepsis - Therapie - Zeit - Maßnahmen-Bündel

Key words:

Sepsis - therapy - time - bundle measures

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