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セプティック ショック: 診断 と 治療 の 進歩
Christopher W Seymour1, Matthew R Rosengart2
1Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania2Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Pittsburgh, Pennsylvania.
JAMA
|August 19, 2015
まとめ
早期診断と治療は 常見の緊急事態である 性ショックの鍵です 最近の証拠は,プロトコルのケアが 個別化された管理戦略に比べてほとんど利点がないことを示唆しています.
科学分野:
- クリティカル ケア 医療
- 緊急 医療
- 感染症
背景:
- セプティックショックは毎年23万人を超える米国患者に 影響を及ぼし,臨床的に大きな課題となっています.
- 感染した患者の低血圧と低血流の兆候によって定義され,緊急に認識する必要があります.
研究 の 目的:
- セプティックショックに関する現在の理解と管理戦略をレビューする.
- 最近の証拠に基づいた診断アプローチと治療上の考慮事項を強調する.
主な方法:
- セプティックショックの臨床的定義と診断ツールのレビュー
- 治療プロトコルに関するランダム化臨床試験の証拠の分析
- 液体蘇生と血管活性薬の戦略についての議論
主要な成果:
- 3つの試験では,プロトコル化された治療は,プロトコル化されていない治療と比較して最小限の効果を示した.
- 集中超音波は複雑な生理を特定するのに役立ちます.
- ハイドロキシエチル粉は推奨されない.結晶体とアルバミンの役割は議論されている.
結論:
- 早期の診断は 病歴,身体検査,そして潜在的に焦点を当てた超音波検査に 依存しています
- 静脈内注射液と血管活性薬は 循環の回復に不可欠です
- 臨床医は,セプティックショック管理におけるプロトコルベースの治療の限界を認識しなければなりません.
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