surviving sepsis going beyond the guidelines幸存的败血症超越指南.pdfVIP

Marik Annals of Intensive Care 2011, 1:17 /content/1/1/17 REVIEW Open Access Surviving sepsis: going beyond the guidelines Paul E Marik Abstract The Surviving Sepsis Campaign is a global effort to improve the care of patients with severe sepsis and septic shock. The first Surviving Sepsis Campaign Guidelines were published in 2004 with an updated version published in 2008. These guidelines have been endorsed by many professional organizations throughout the world and come regarded as the standard of care for the management of patients with severe sepsis. Unfortunately, most of the recommendations of these guidelines are not evidence-based. Furthermore, the major components of the 6-hour bundle are based on a single-center study whose validity has been recently under increasing scrutiny. This paper reviews the validity of the Surviving Sepsis Campaign 6-hour bundle and provides a more evidence-based approach to the initial resuscitation of patients with severe sepsis. Sepsis is among the most common reasons for admission recommendations), the core recommendation’s remained to intensive care units (ICUs) throughout the world. Dur- largely unchanged [5]. ing the past two decades, the incidence of sepsis in the These core recommendations were principally based on United States has tripled and is now the tenth leading the results of a small, single-center study by Rivers et al. cause of death. In the United States alone, approximately (Early Goal-Directed Therapy [EGDT]) whose validity 750,000 cases of sepsis occur each year, at least 225,000 has been recently under increasing scrutiny [6,7]. It is of which are fatal [1,2]. Septic patients are generally hos- important to note that the majority of recommendations