全身性感染与感染性休克__培训课件.ppt

Sepsis Bundle (6 hour) Gao F, Melody T, Daniels DF, Giles S, Fox S. The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study. Critical Care 2005, 9:R764-R770 (DOI 10.1186/cc3909) Sepsis Bundle (24 hour) RR 1.76 (0.84 – 3.64) P = 0.16 Gao F, Melody T, Daniels DF, Giles S, Fox S. The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study. Critical Care 2005, 9:R764-R770 (DOI 10.1186/cc3909) EGDT in ED Mean ? SD Median Range Central line inserted 2.1 ? 1.7 1.5 1 – 8 CVP goal achieved 6.3 ? 3.8 6.0 1 – 14 MAP goal achieved 5.6 ? 3.2 4.0 2 – 13 ScvO2 measured 2.4 ? 1.8 2.0 1 – 8 ScvO2 goal achieved 6.4 ? 4.0 5.0 2 – 16 Trzeciak S, Dellinger RP, Abate NL, Cowan RM, Stauss M, Kilgannon JH, Zanotti S, Parrillo JE. Translating Research to Clinical Practice: A 1-Year Experience With Implementing Early Goal-Directed Therapy for Septic Shock in the Emergency Department. Chest 2006; 129: 225-232 EGDT in ED Before EGDT EGDT P value 输注晶体液 ED 3509 ? 2312 5685 ? 3021 0.02 ICU第一个24小时 5548 ? 4878 2752 ? 1731 0.03 PAC应用 7 (43.8) 2 (9.1) 0.01 ICU住院日(d) 4.2 (0.5 – 14.3) 1.8 (0.0 – 34.9) 0.12 住院病死率 7 (43.8) 4 (18.2) 0.09 住院费用(USD) 135,199 82,233 0.14 Trzeciak S, Dellinger RP, Abate NL, Cowan RM, Stauss M, Kilgannon JH, Zanotti S, Parrillo JE. Translating Research to Clinical Practice: A 1-Year Experience With Implementing Early Goal-Directed Therapy for Septic Shock in the Emergency Department. Chest 2006; 129: 225-232 感染性休克 标准治疗程序(SOP) EGDT 强化胰岛素治疗 应激剂量激素 rhAPC 肺保护性通气策略 经验性抗生素治疗 感染灶控制 Kortgen A, Niederprüm P, Bauer M. Implementation of an evidence-based “standard operating procedure” and outcome in septic shock. Crit Care Med 2006 (in press) 感染性休克 对照组(n = 30) 治疗组(n = 30) 最初24小时应用多巴酚丁胺 2 12 应用胰岛素 18 30 应用氢化可的松 13 30 应用活化蛋白C 0 7 NE最大剂量(?g/kg/min) 0.91 0.365 至开始控制血糖时间(hr) 10 (2, 26) 0 (0, 1) Kortgen A, Nie