感染性休克的延革.pptx

感染性休克的延革指南的延革Organizations involvedNumber of participantsProcessPublicationFirst1(ISF)9EBM A to EIntensive Care Med, 2001, 27 (Suppl 1): S1-134Second3(ISF, ESICM, SCCM)24EBM A to EIntensive Care Med, 2004,30:536–555Third1655GRADEIntensive Care Med, 2008, 34:17–60Fourth3068GRADEIntensive Care Med, 2013,39(2):165-228.DefinitionsCrit Care Med,2013,41(2):580-637Sepsis ：infection + SIRSSevere sepsis ：sepsis + sepsis-induced organ dysfunction or tissue hypoperfusionSeptic shock ：sepsis-induced hypotension persisting despite adequate fluid resuscitationSepsis-induced tissue hypoperfusion ： infection-induced hypotension, elevated lactate, or oliguria.Sepsis-induced hypotension ：SBP 90 mm Hg or MAP 70 mmHg or a SBP decrease 40 mm Hg or less than two standard deviations below normal for age in the absence of other causes of hypotension.Diagnostic Criteria for SepsisInfection, documented or suspected, and some of the following:General variablesFever ( 38.3°C)Hypothermia (core temperature 36°C)Heart rate 90/min–1 or more than two SD above the normal value for ageTachypneaAltered mental statusSignificant edema or positive fluid balance ( 20 mL/kg over 24 hr)Hyperglycemia (plasma glucose 140 mg/dL or 7.7 mmol/L) in the absence of diabetesDiagnostic Criteria for SepsisInflammatory variablesLeukocytosis (WBC count 12,000 μL–1)Leukopenia (WBC count 4000 μL–1)Normal WBC count with greater than 10% immature formsPlasma C-reactive protein more than two sd above the normal valuePlasma procalcitonin more than two sd above the normal valueHemodynamic variablesArterial hypotension (SBP 90 mm Hg, MAP 70 mm Hg, or an SBP decrease 40 mm Hg in adults or less than SD below normal for age)Diagnostic Criteria for SepsisOrgan dysfunction variablesArterial hypoxemia (Pao2/Fio2 300)Acute oliguria (urine output 0.5 mL/kg/hr for at least 2 hrs despite adequate fluid resuscitation)Creatinine increase 0.5 mg/dL or 44.2 μmol/LCoagulation abnormalities (INR 1.5 or aPTT 60 s)Ileus (absent b