Surviving sepsis going beyond the guidelines 英文参考文献.docVIP

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Surviving sepsis going beyond the guidelines 英文参考文献.doc

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Surviving sepsis going beyond the guidelines 英文参考文献

MarikAnnalsofIntensiveCare2011,1:17 /content/1/1/17 REVIEW OpenAccess Survivingsepsis:goingbeyondtheguidelines PaulEMarik Abstract TheSurvivingSepsisCampaignisaglobalefforttoimprovethecareofpatientswithseveresepsisandsepticshock. ThefirstSurvivingSepsisCampaignGuidelineswerepublishedin2004withanupdatedversionpublishedin2008. Theseguidelineshavebeenendorsedbymanyprofessionalorganizationsthroughouttheworldandcomeregarded asthestandardofcareforthemanagementofpatientswithseveresepsis.Unfortunately,mostofthe recommendationsoftheseguidelinesarenotevidence-based.Furthermore,themajorcomponentsofthe6-hour bundlearebasedonasingle-centerstudywhosevalidityhasbeenrecentlyunderincreasingscrutiny.Thispaper reviewsthevalidityoftheSurvivingSepsisCampaign6-hourbundleandprovidesamoreevidence-basedapproach totheinitialresuscitationofpatientswithseveresepsis. Sepsisisamongthemostcommonreasonsforadmission recommendations),thecorerecommendation’ sremained tointensivecareunits(ICUs)throughouttheworld.Dur- largelyunchanged[5]. ingthepasttwodecades, theincidence ofsepsis inthe Thesecorerecommendationswereprincipallybasedon United States has tripled and isnowthe tenth leading theresultsofasmall,single-centerstudybyRiversetal. causeofdeath.IntheUnitedStatesalone,approximately (Early Goal-Directed Therapy [EGDT]) whose validity 750,000casesofsepsisoccureachyear,atleast225,000 has been recently under increasing scrutiny [6,7]. Itis ofwhicharefatal[1,2].Septicpatientsaregenerallyhos- importanttonotethatthemajorityofrecommendations pitalized for extended periods, rarely leaving the ICU inbothsetsofguidelineswerebasedonthelowestlevel before2-3weeks.Despitetheuseofantimicrobialagents ofscientific evidence (Grade E-uncontrolled studies, and advanced life-support, the case fatality rate for caseseriesandexpertopinion).Barochiaandcolleagues patientswithsepsishasremainedbetween20%and30% performedasystemicreviewoftheassociation between duringthepast2decades[1