Die Behandlung von Patienten mit Sepsis gehört zu den anspruchsvollsten Aufgaben auf der Intensivstation. Schon in der ersten Stunde der Versorgung müssen die richtigen therapeutischen
Weichen gestellt werden. Neben der Sicherung der Vitalfunktionen sind antiinfektive Behandlungen einzuleiten und später anzupassen; zusätzliche Therapieoptionen müssen abgewogen werden.
Hierzu benötigt man ein klares Konzept für das therapeutische Vorgehen.
Abstract
Sepsis as a development of an acute infection-related organ dysfunction significantly increases the risk of death for the patient. Therefore, fast and consistent management is required.
The sepsis bundle is a convenient algorithm for initial sepsis therapy within the first hour of sepsis diagnosis consisting of blood cultures, lactate measurement, antibiotics, fluid
resuscitation, and vasopressor therapy. Cristalloid solutions are first choice for fluid therapy but albumin and gelatine may be considered if colloid solutions are required.
Norepinephrine is the vasopressor of first choice. After initial therapy, further fluid resuscitation should be guided by dynamic criteria. Vasopressin may be added as an additional
vasopressor. Goal of resuscitation is to achieve lactate clearance. In shock refractory to therapy, addition of hydrocortisone (200 mg/day) should be considered. Further additional
therapies such as immunoglobulins, blood purification, and metabolic resuscitation (combination of hydrocortisone, thiamine, vitamine C) are currently not supported by studies and should
not be considered as standard therapy.
Schlüsselwörter
Sepsis - Volumentherapie - Antibiotikatherapie - Hydrokortison
