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11/4/2024BacterialinfectionAclinician,armedwiththesepsisbundles,attacksthethreeheadsofseveresepsis:hypotension,hypoperfusionandorgandysfunction.CritCareMed2004感染性休克SepsisandSepticShockImportantHistory1992SIRS2001EGDT2004guideline2008guideline2012guideline败血症（sepsis）来自希腊语，是腐败的代名词。2700年来基本保持不变的意义，直到20世纪以来，随着现代医学的发展，对sepsis有了进一步的理解。休克（shock）来源于法语“choquer”，意思为冲突。其实最初的定义已经确切的表达了疾病的特点。WidespreadinflammatoryresponseTwoormoreofthefollowingTemp>38°C<36°CHeartRate>90bpmTachypneaRR>20orhyperventilationPaCO2<32mmHgWBC>12,000<4000orpresenceof>10%immatureneutrophils.Septicshockwasdefinedassepsis-inducedhypotension(systolicbloodpressure<90mmHg[oradropof>40mmHg])withsignsoftissuehypoperfusiondespiteadequatefluidresuscitation.Definitions2012guideline发病率(DatafromDellingerRP:Cardiovascularmanagementofsepticshock.CritCareMed2003;31TrendsinmortalityratesbysubtypesofheartdiseaseintheUnitedStates,2000-2010[J].JAMA.2014NovAHA《心脏病和卒中统计数据（2014版）》Hotchkissetal,NEJM2003348:138Cohen,Nature:2002420:885OrgandysfunctionattimeofseveresepsisrecognitionThethreecomponentsofthehemodynamicprofileofsepticshockHemodynamicValuesinSepsisSyndromeHemodynamicvariablesArterialhypotension(SBP<90mmHg,MAP<70mmHg,oranSBPdecrease>40mmHginadultsorlessthantwosdbelownormalforage)MANAGEMENTOFSEVERESEPSISEGDT2001：DoctorRivers，EmergencyphysicianEGDT2012GuidelinesTOBECOMPLETEDWITHIN6HOURSOFTIMEOFPRESENTATION:DOCUMENTREASSESSMENTOFVOLUMESTATUSANDTISSUEPERFUSIONWITH:RCTchangeGuidelineFluidChallenge:benefitorriskFluidresuscitationsafetospecialpatients?Werecommendfluidresuscitationwitheithernatural/artificialcolloidsorcrystalloids.Thereisnoevidence-basedsupportforonetypeoffluidoveranother(Grade1B).SAFEstudyNEJM2004Intensivecareunitsof16hospitalsinAustraliaandNewZealand.1,218patientswithseveresepsisatbaseline,603and615wereassignedtoreceivealbuminandsaline,respectively.AdministrationofalbumincomparedtosalinedidnotimpairrenalorotherorganfunctionandmayhavedecreasedtheriskofdeathCritCareMed2011Conclusions基于NE
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