Die Therapie der schweren Sepsis

Zusammenfassung

Als Sepsis wird eine Infektion mit systemischer Manifestation bezeichnet. Bei Vorliegen mindestens eines Organversagens handelt es sich um eine schwere Sepsis. Die Bedeutung des Krankheitsbildes in der Pneumologie ergibt sich aus der Tatsache, dass in der nichtoperativen Medizin die Pneumonie die häufigste Sepsisursache und das akute Lungenversagen eine der Hauptmanifestationen der schweren Sepsis darstellen. Die empirische Basis der Sepsisbehandlung ist einem erheblichen Wandel unterworfen, da im letzten Jahrzehnt erstmals durch die Bildung von Studiengruppen und Kompetenzzentren die Durchführung großer, aussagekräftiger Interventionsstudien ermöglicht wurde. Neben der Kontrolle der zugrunde liegenden Infektion umfasst die Therapie der schweren Sepsis die Behandlung hämodynamischer, respiratorischer, endokrinologischer, koagulatorischer und immunologischer Aspekte der Erkrankung. Während die neuen Konzepte der Schockbehandlung und der Beatmungstherapie bestätigt werden konnten, sind Ansätze der Antikoagulation und die endokrinologische und die immunologische Therapie noch im Fluss.

Abstract

The sepsis syndrome is defined as a clinically suspected infection accompanied by systemic manifestations. The emergence of one or multiple organ dysfunctions is the hallmark of severe sepsis. The significance of sepsis in pulmonary medicine is highlighted by the fact that severe pneumonia is the most prevalent cause of sepsis in non-surgical intensive care medicine and that acute lung injury is among the prominent manifestations of severe sepsis. The formation of major study groups and competence centres during the last decade has made meaningful prospective interventional studies possible that, in turn, have resulted in the development of clinical treatment algorithms. Today, the multidisciplinary treatment of severe sepsis includes haemodynamic, respiratory, endocrine, immune, and coagulation aspects besides the control of the underlying infection. While new concepts of shock treatment and mechanical ventilation have been established by means of confirmatory studies, endocrine interventions as well as immune and anticoagulation procedures are still under investigation.

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