全身炎症反应综合症与脓毒血症中(编辑修改稿)

全身炎症反应综合症与脓毒血症中(编辑修改稿)内容摘要：

81。 g/dl  Free cortisol has advantages over total cortisol but not widely available  The ACTH stim test should not be used to identify the subset of adult pts with septic shock who should receive hydrocortisone (2B) Marik PE, Pastores SM, Annane D, Meduri GU, Sprung C, et al. Crit Care Med 20xx (under review) Adrenal Task Force Consensus Panel Treatment and Duration  Treatment regimens: • 100 mg hydrocortisone IV q 8 h • 100/200 mg bolus of hydrocortisone then 10 mg/h • 50 mg hydrocortisone IV q 6 h  Full dose hydrocortisone treatment should be continued for 57 days before tapering assuming there is no recurrence of signs of sepsis or shock (2C)  Marik PE, Pastores SM, Annane D, Meduri GU, Sprung C, et al. Crit Care Med 20xx (under review) Consensus Statement  Patients with septic shock should not receive dexamethasone if hydrocortisone is available (2B)  Fludrocortisone is optional if hydrocortisone is used (2C)  Doses of corticosteroids parable to 300 mg of hydrocortisone daily not be used in septic shock (1A) Marik PE, Pastores SM, Annane D, Meduri GU, Sprung C, et al. Crit Care Med 20xx (under review)。 SCC 20xx Update 20xx Rebinant Human Activated Protein C  Remended in adult pts with sepsisinduced an dysfunction associated with a high risk of death (APACHE II 25) or multiple an failure and with no contraindications related to bleeding Grade 2B  Adult patients with severe sepsis and low risk of death (APACHE II 20) or one an failure should not receive rhAPC Grade 1A Bernard GR, et al. N Engl J Med 20xx。 344:699709 0 7 14 21 28 70 80 90 100 Days from Start of Infusion to Death Percent Survivors P=.006 (stratified logrank test) 0 Placebo (n=840) Drotrecogin alfa (activated) (n=850) Drotrecogin Alfa (Activated) Significantly Reduced Mortality in PROWESS 6% Absolute mortality difference Stephen M. Pastores, MD, FCCM, FCCP, FACP Professor of Medicine in Anesthesiology Weill Cornell Medical College Director, Critical Care Medicine Fellowship Program Memorial Sloan Kettering Cancer Center New York, NY Diagnosis and Management of Severe Sepsis and Septic Shock Objectives  Review the epidemiology and pathophysiology of severe sepsis  Discuss history of existing medical therapies for sepsis  Provide key evidencebased remendations from Surviving Sepsis Guidelines 20xx Update Severe Sepsis: Scope of the Problem  750,000 new cases per year in the .  Mortality rates range from 28% to 50%  Approximately 500 to 1,000 Americans die daily of severe sepsis Angus DC, et al. Crit Care Med 20xx。 29:130310 Murphy SL. National Center for Health Statistics, 20xx. DHHS. Severe Sepsis: Comparative Incidence and Mortality Angus DC, et al. Crit Care Med 20xx。 American Cancer Society 050100150200250300A I D S Br e as tC an c e r1s t M I S e v e r eS e p s i sIncidence Cases/100,000 05000010000015000020xx00250000A I D S Br e as tC an c e rA M I S e v e r eS e p s i sMortality Deaths/Year Mortality of Severe Sepsis by Age in the United States Angus DC, et al. Crit Care Med 20xx. •0% •5% •10% •15% •20% •25% •30% •35% •40% •45% •0 •1 •5 •10 •15 •20 •25 •30 •35 •40 •45 •50 •55 •60 •65 •70 •75 •80 •85 Age Mortality •Without Comorbidity •With Comorbidity •Overall Severe Sepsis: Primary Source  Pulmonary: 50%  Abdomen/Pelvis: ~25%  Primary bacteremia: ~15%  Urosepsis: 10%  Skin: 5%  Vascular: 5%  Other: ~15% Martin GS, et al. NEJM 20xx。 348:1546 Microbiology of Sepsis Martin GS, et al. NEJM 20xx。 348:1546 Sepsis Battlef。