Sepsis – was ist gesichert, was ist neu?

Kernaussagen

Die Ecksteine einer erfolgreichen Sepsistherapie sind:

• möglichst früher Therapiebeginn

• möglichst schnelle kausale Therapie

• möglichst effektive antibiotische Therapie

• Steuerung der frühen hämodynamischen Therapie mit Hilfe der zentralvenösen Sättigung

• großzügige initiale Volumensubstitution

• strenge Indikationsstelle der Volumensubstitution im weiteren Verlauf

• Herzindex nach ausreichender Volumensubstitution niedriger als 3 – 4 l/min/m²: Gabe von Dobutamin

• Mittlere arterielle Druck nach ausreichender Volumensubstitution niedriger als 65 mmHg: Gabe von Noradrenalin

• Ggf. kombinierte Gabe von Noradrenalin und Dobutamin

• Vasopressineinsatz nur als Ultima Ratio und dann auch nur in niedriger Dosierung

• Versuch der Therapie mit 200 – 300 mg Hydrokortison pro Tag als Ultima Ratio beim septischen Schock und sehr hohen Katecholamindosen

• Literatur

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