Abstract
The mortality of septic patients is still very high. Sepsis is caused by the host
response to invasive microbial infections and arises when the body’s response to an
infection injures its own tissues and organs. Sepsis is diagnosed by a mosaic of clinical
and laboratory parameters. Therapy consists of antimicrobial and surgical measures
for source control, supportive intensive care therapy and adjunctive therapies. Sepsis
is an emergency that requires immediate antimicrobial and supportive therapy. Goals
for hemodynamic stabilization are (CVP ≥ 8/≥ 12 mmHg under mechanical ventilation,
MAP ≥ 65 mmHg, ScvO2 ≥ 70 %) to achieve an adequate cellular oxygen supply. Further supportive measures
are lung protective ventilation (6 ml/kg predicted body weight in patients with ARDS/ALI),
and organsupportive measures as necessary. Recombined activated Protein C and Selenium
can be considered for adjunctive therapy. Low dose corticosteroids may be only administered
in patients with refractory septic shock despite high dose vasopressor support.
Kernaussagen
Die Sepsis ist trotz aller medizinischen Fortschritte noch immer eine der häufigsten
Todesursachen auf deutschen Intensivstationen. Bei der Genese dieser Erkrankung spielt
das Zusammenwirken von Infektion und Immunantwort eine entscheidende Rolle. Dabei
sind alle Mikroorganismen wie Bakterien, Pilze, Viren oder Parasiten in der Lage,
eine Sepsis auszulösen. Die Diagnose „Sepsis” beruht auf einem Mosaik von klinischen
und laborchemischen Parametern.
Bei der Therapie unterscheidet man einerseits die kausalen antimikrobiellen bzw. operativen
interventionellen Maßnahmen zur Herdsanierung und andererseits die elementare supportive
(organbezogene) intensivmedizinische Therapie sowie adjunktive (potenziell zusätzliche)
therapeutische Ansätze. Hierbei hat die kausale antimikrobielle Therapie bzw. die
chirurgische Herdsanierung die höchste Priorität.
Bei den supportiven Maßnahmen ist die hämodynamische Stabilisierung (ZVD ≥ 8, unter
Beatmung ≥ 12 mmHg, MAD ≥ 65 mmHg, ScvO2 ≥ 70 %) mit Volumen- und Katecholamintherapie mit dem Ziel eines adäquaten zellulären
Sauerstoffangebots von großer Bedeutung. Nicht zu vernachlässigen sind eine adäquate
Beatmungstherapie (6 ml/kgKG), eine frühzeitige Organersatztherapie und eine suffiziente
Ernährungstherapie. Zu den adjunktiven therapeutischen Therapieansätzen gehören das
rekombinierte aktivierte Protein C, Selen und Hydrokortison, deren endgültiger Stellenwert
erst nach weiteren Studien zu beurteilen ist.
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Dr. med. Ole Bayer
Friedrich-Schiller-Universität Jena
Klinik für Anästhesiologie und Intensivtherapie
Erlanger Allee 101
07747 Jena
Email: Ole.Bayer@med.uni-jena.de
