Sepsis in der Notaufnahme

Sepsis – ein Krankheitsbild mit hoher Letalität und eine große Herausforderung für den Arzt in der Notaufnahme. Das frühzeitige Erkennen durch gezielte Diagnostik, die zeitnahe Einleitung der Antibiose, die Kreislaufstabilisierung und die rasche Fokussanierung sind die wichtigsten Säulen für eine erfolgreiche Therapie, die in der Notaufnahme eingeleitet wird.

Schlüsselwörter

Sepsis - Ersteinschätzung - Hour-1-Bundle - Volumentherapie - vasopressorische Therapie - Sepsisdiagnostik

• Literatur

• 1 Singer M, Deutschmann CS, Seymour CW. et al. The Third International Consensus Definitions for Sepsis and Septic Shock. JAMA 2016; 315: 801-810
• 2 Fleischmann C, Thomas-Rueddel DO, Hartmann M. et al. Hospital incidence and mortality rates of sepsis. Dtsch Ärztebl Int 2016; 113: 159-166
• 3 Seymour CW, Liu VX, Iwashhyna TJ. et al. Assessment for clinical criteria for sepsis for the third international consensus definitions for sepsis and septic shock. JAMA 2016; 315: 762-774
• 4 Brunkhorst FM. Sepsis-3-Definition – Ein Fortschritt?. Notfall und Rettungsmedizin 2019; 22: 184-187
• 5 Hayden GE, Tuuri RE, Scott R. et al. Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED. Am J Emerg Med 2016; 34: 1-9
• 6 Nakayama I, Izawa J, Mouri H. et al. Mortality and detailed characteristics of pre-ICU qSOFA-negative patients with suspected sepsis: an observational study. Ann Intensive Care 2018; 8: 44
• 7 Seymour CW, Kennedy JN, Wang S. et al. Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes in Sepsis. JAMA 2019; 321: 2003-2017
• 8 Norberg A, Christopher NC, Ramundo ML. et al. Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter. JAMA 2003; 289: 726-729
• 9 Levy B. Lactate and shock state: the metabolic view. Curr Opin Crit Care 2006; 12: 315-321
• 10 Freund Y, Lemachatti N, Krastinova F. et al. Prognostic accuracy of Sepsis-3 Criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA 2017; 317: 301-308
• 11 Rello J, Valenzuela-Sánchez F, Ruiz-Rodriguez M. et al. Sepsis: A Review of Advances in Management. Adv Ther 2017; 34: 2393-2411
• 12 Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 Update. Intensive Care Med 2018; 44: 925-928
• 13 Rhodes A, Evans LE, Alhazzani W. et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017; 43: 304-377
• 14 Seymour CW, Gesten F, Prescott H. et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med 2017; 376: 2235-2244
• 15 Hershey TB, Kahn JM. State Sepsis Mandates – A New Era for Regulation of Hospital Quality. N Engl J Med 2017; 376: 2311-2113
• 16 Freund Y, Khoury A, Möckel M. et al. European Society of Emergency Medicine position paper on the 1-hour sepsis bundle of the Surviving Sepsis Campaign: expression of concern. Eur J Emerg Med 2019; 26: 232-233
• 17 Rivers E, Nguyen B, Havstad S. et al. Early goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368-1377
• 18 Rowan KM. The PRISM Investigators. Early, goal-directed therapy for septic shock – a patient-level meta-analysis. N Engl J Med 2017; 376: 2223-2234
• 19 Khanna A, English SW, Wang XS. et al. Angiotensin II for the treatment of vasodilatory shock. . N Engl J Med 2017; 377: 419-429
• 20 Ferrer R, Martin-Loeches I, Phillips G. et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med 2014; 42: 1749-1755
• 21 Kumar A, Safdar N, Kethireddy S. et al. A survival benefit of combination antibiotic therapy for seriuos infections associated with sepsis and septic shock is contingent only on the risk of death: a metaanalytic/meta-regression study. Crit Care Med 2010; 38: 1651-1664