Sepsis-Update: evidenzbasierte Therapie

Zusammenfassung

Sepsis und septischer Schock stellen medizinische Notfälle dar, die einer kompetenten Früherkennung und eines entsprechenden sofortigen, zielgerichteten Managements bedürfen. Die Therapie der Sepsis und des septischen Schocks hat sich während der letzten Jahre kontinuierlich weiterentwickelt. Dieser Beitrag gibt einen Überblick über die aktuelle Evidenz der Therapie der Sepsis und des septischen Schocks und deren Umsetzung in die klinische Praxis.

Abstract

Like polytrauma, acute myocardial infarction or stroke, sepsis and septic shock are medical emergencies that require adequate early detection and immediate, targeted management. The therapy of sepsis and septic shock has developed continuously in recent years. This article provides an overview of the current evidence of sepsis and septic shock therapy and its implementation into clinical practice.

Kernaussagen

• Sepsis und septischer Schock stellen einen medizinischen Notfall dar.

• Das „1-h-Bündel“ der SSC-Leitlinie soll als Referenz die Behandelnden im frühen Management der Therapie der Sepsis und des septischen Schocks leiten.

• Die Zeit stellt nicht nur bei der Fokussanierung, sondern auch bei der Initiierung der antimikrobiellen Therapie sowie der adäquaten Volumen- und Katecholamin-Therapie eine kritische Variable für den Therapieerfolg der Sepsis und des septischen Schocks dar.

• Ein mittlerer arterieller Blutdruck von > 65 mmHg ist der Zielwert bei Patienten mit septischem Schock.

• Zur hämodynamischen Stabilisierung sind balancierte Kristalloide (30 ml/kgKG binnen der ersten 3 h) sowie Noradrenalin Mittel der Wahl.

• Kristalloide sind, wenn möglich, gegenüber halbsynthetischen Kolloiden zu bevorzugen.

• Wenn nach Einschätzung des Arztes eine akute Hypovolämie allein mit Kristalloiden nicht ausreichend therapiert werden kann, können darüber hinaus Gelatine und Humanalbumin zum Einsatz kommen.

• Auf den Einsatz von HES soll ausdrücklich verzichten werden.

• Falls eine hämodynamische Stabilisierung trotz adäquater Volumen- und Katecholamin-Therapie nicht erreicht werden kann, kann der Einsatz von Hydrokortison erwogen werden.

Schlüsselwörter

Sepsis - septischer Schock - Surviving Sepsis Campaign - SSC - Laktat - Antibiotika

Key words

sepsis - septic shock - Surviving Sepsis Campaign - SSC - lactate - antibiotics

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