Sepsis und Multiorganversagen - Update der aktuellen Therapiekonzepte

Zusammenfassung

Die schwere Sepsis mit Multiorganversagen ist heute die führende Todesursache auf nicht-kardiologischen Intensivstationen. Aufgrund der steigenden Zahl an alten und immun-kompromittierten Patienten, der Ausweitung chirurgischer Indikationen und invasiver Prozeduren und einer Zunahme resistenter Keime wird die Inzidenz der Sepsis auf unseren Intensivstationen weiter steigen. Trotz der enormen finanziellen Aufwendungen für Diagnostik und Therapie verbleibt die Mortalität der Sepsis auf einem nahezu unverändert hohen Niveau von 28 - 50 %. Basierend auf den enttäuschenden Erfahrungen mit antiinflammatorischen Therapien haben wir realisiert, dass die Sepsis weitaus mehr als nur ein inflammatorisches Problem ist. Neue therapeutische Ansätze tragen dieser Erkenntnis und den differenzierten pathophysiologischen Veränderungen Rechnung, indem die erfolgreiche Modulation der Gerinnung mit verbesserten intensivmedizinischen Konzepten kombiniert wird, die darauf abzielen, die aus der Sepsis resultierenden Organdysfunktionen zu beeinflussen. In dieser Übersicht werden aktuelle intensivmedizinische Konzepte vorgestellt, die zur Senkung der inakzeptabel hohen Mortalität der Sepsis beitragen können.

Summary

Severe sepsis with multiple organ dysfunctions is still the leading cause of death in non-cardiac intensive care units. The incidence is expected to rise in the future due to the growing number of older and immuno-compromized patients, the use of invasive procedures, and an increase in the percentage of aggressive or resistant microorganisms. Despite the enormous investment in critical care resources, mortality of severe sepsis remaines on a high level and ranges from 28 - 50 %. Based on the disappointing experiences with anti-inflammatory strategies, we now realize that sepsis is more than just inflammation. The new therapeutic approaches take account of this more sophisticated view of pathophysiologic changes, resulting in the modulation of the coagulation in combination with an improvement of the ICU-management of organ dysfunctions. This review discusses the therapeutic concepts, reported es exciting new interventions in the ICU setting to decrease the inacceptable high mortality in patients with severe sepsis.

Schlüsselwörter

Sepsis - Gerinnung - Katecholamine - Kortikoide - Beatmung

Key words

Sepsis - coagulation - catecholamines - corticoids - ventilation

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