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#1
21.05.2006, 15:04
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Рекомендации по тактике лечения сепсиса и септического шока
Рекомендации представлены в свободном доступе на сайте The American College of Critical Care Medicine (ACCM)[Ссылки доступны только зарегистрированным пользователям ]. Ниже представлен перевод данных рекомендаций.
ЗЫ - заранее приношу извинения за качество текста, но никак не хватает времени сделать литературную версию перевода  ЗЗЫ - пришлось порезать файл. Скачиваем все три части, разархивируем в одну папку и запускаем первую часть. 
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#2
29.05.2006, 17:04
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... и на сайте http://www.survivingsepsis.org
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#4
14.11.2007, 16:18
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Цитата:
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#5
09.01.2008, 13:35
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Surviving Sepsis Campaign 2008
Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008 Jan;36(1):296-327.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL; for the International Surviving Sepsis Campaign Guidelines Committee. OBJECTIVE:: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," published in 2004. DESIGN:: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. This process was conducted independently of any industry funding. METHODS:: We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations. A strong recommendation (1) indicates that an intervention's desirable effects clearly outweigh its undesirable effects (risk, burden, cost) or clearly do not. Weak recommendations (2) indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence. In areas without complete agreement, a formal process of resolution was developed and applied. Recommendations are grouped into those directly targeting severe sepsis, recommendations targeting general care of the critically ill patient that are considered high priority in severe sepsis, and pediatric considerations. RESULTS:: Key recommendations, listed by category, include early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm potential source of infection (1C); administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis of septic shock (1B) and severe sepsis without septic shock (1D); reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate (1C); a usual 7-10 days of antibiotic therapy guided by clinical response (1D); source control with attention to the balance of risks and benefits of the chosen method (1C); administration of either crystalloid or colloid fluid resuscitation (1B); fluid challenge to restore mean circulating filling pressure (1C); reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfusion (1D); vasopressor preference for norepinephrine or dopamine to maintain an initial target of mean arterial pressure >/=65 mm Hg (1C); dobutamine inotropic therapy when cardiac output remains low despite fluid resuscitation and combined inotropic/vasopressor therapy (1C); stress-dose steroid therapy given only in septic shock after blood pressure is identified to be poorly responsive to fluid and vasopressor therapy (2C); recombinant activated protein C in patients with severe sepsis and clinical assessment of high risk for death (2B except 2C for postoperative patients). In the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage, target a hemoglobin of 7-9 g/dL (1B); a low tidal volume (1B) and limitation of inspiratory plateau pressure strategy (1C) for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure in acute lung injury (1C); head of bed elevation in mechanically ventilated patients unless contraindicated (1B); avoiding routine use of pulmonary artery catheters in ALI/ARDS (1A); to decrease days of mechanical ventilation and ICU length of stay, a conservative fluid strategy for patients with established ALI/ARDS who are not in shock (1C); protocols for weaning and sedation/analgesia (1B); using either intermittent bolus sedation or continuous infusion sedation with daily interruptions or lightening (1B); avoidance of neuromuscular blockers, if at all possible (1B); institution of glycemic control (1B), targeting a blood glucose <150 mg/dL after initial stabilization (2C); equivalency of continuous veno-veno hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1A); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding using H2 blockers (1A) or proton pump inhibitors (1B); and consideration of limitation of support where appropriate (1D). Recommendations specific to pediatric severe sepsis include greater use of physical examination therapeutic end points (2C); dopamine as the first drug of choice for hypotension (2C); steroids only in children with suspected or proven adrenal insufficiency (2C); and a recommendation against the use of recombinant activated protein C in children (1B). CONCLUSIONS:: There was strong agreement among a large cohort of international experts regarding many level 1 recommendations for the best current care of patients with severe sepsis. Evidenced-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improved outcomes for this important group of critically ill patients. [Ссылки доступны только зарегистрированным пользователям ]
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#6
09.01.2008, 14:45
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Гайдлайн кстати еще не появился на сайте Surviving Sepsis Campaign.
Возможно авторы озаботятся русским переводом обновленного гайдлайна. Пока на русском доступна предыдущая версия 2004 года - http://ssc.sccm.org/files/translatio...guidelines.pdf
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#9
28.03.2007, 21:05
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У меня тоже не открываются, а нужны
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#10
28.03.2007, 21:08
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Цитата:
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#11
17.04.2007, 21:53
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Цитата:
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#12
17.04.2007, 16:35
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Кстати,интересное сообщение(свежее) по поводу методики инфузии гидрокортизона при септическом шоке(вроде предпочтительнее постоянная)([Ссылки доступны только зарегистрированным пользователям ]
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#14
17.04.2007, 21:50
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Printer-Friendly Email This
Hydrocortisone by Continuous Infusion Favored for Septic Shock Patients NEW YORK (Reuters Health) Feb 23 - Continuous infusion of hydrocortisone offers advantages over bolus administration in patients with septic shock, according to a February 16th online report in Critical Care. "This is the first study that has compared bolus versus continuous hydrocortisone infusion in the treatment of septic shock," Dr. Pekka Loisa from Paijat-Hame Central Hospital, Lahti, Finland told Reuters Health. "Minor differences (favoring continuous infusion) can be observed in the glycemic control between these two regimens." Dr. Loisa and colleagues investigated how the two corticosteroid treatment modalities would influence glucose profiles in septic shock and compared the reversal of shock and nursing workload needed between the two regimens. The study involved 48 patients who received 200 mg/day hydrocortisone either as a continuous infusion or by 50-mg bolus every 6 hours. Mean daily blood glucose levels, insulin requirements, and calorie intake were similar between the two treatment groups (bolus administration and continuous infusion), the researchers report. Despite similar mean blood glucose levels, they say, hyperglycemic episodes were significantly more common in the bolus group than in the continuous infusion group. There were also more hypoglycemic episodes in the bolus group (3 episodes) than in the continuous infusion group (1 episode). Nursing workload needed to maintain normoglycemia was higher in the bolus group due to an increased number of insulin infusion rate adjustments, the results indicate. The reversal of shock did not differ between the study groups, the report shows. Overall ICU mortality was 23%, with 4 deaths from refractory hypotension in the continuous infusion group and 2 such deaths in the bolus group. "Our findings suggest that, in septic shock, strict normoglycemia is more easily achieved with continuous hydrocortisone infusion," the investigators conclude. "However, the differences between the study groups were rather marginal and in both groups the normoglycemic goal could be achieved quite successfully." "There was a tendency that the amount of insulin needed, adjusted to administered calories, was lower in the infusion treated patients throughout the study period," Dr. Loisa said. "Unfortunately this difference was not statistically significant, but it may reflect that the insulin resistance is resolved more rapidly in those patients who received hydrocortisone by continuous infusion." Crit Care 2007;11:R21.
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#15
18.04.2007, 14:27
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Цитата:
Двумя руками за, если есть свободный шприц-дозатор (и место под него у постели шокового пациента ) с расходником и гидрокортизон.
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Комбинированный вид
