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
