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KMID : 0371320060710010001
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Journal of the Korean Surgical Society
2006 Volume.71 No. 1 p.1 ~ p.11
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Management of Critically Ill Patients - Surviving Sepsis Campaign Guidelines -
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이영주/Lee YJ
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Abstract
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Introduction: In 2003, the critical care and infectious disease experts, who representing 11 international organizations developed 18 evidence-based management guidelines for treating severe sepsis and septic shock. This was done under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve the outcome in severe sepsis. I would like to introduce this Surviving Sepsis Campaign Guideline as an integral recommendation for the management of critically ill patients.
Subjects: Key recommendations, include early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition; ascertain the causative organisms before starting antibiotics; early administration of broad-spectrum antibiotic therapy; aggressive fluid challenge to restore mean circulating filling pressure; vasopressor preference for norepinephrine and dopamine; cautious use of vasopressin; consideration of dobutamine inotropic therapy; stress-dose steroid therapy for septic shock; use of recombinant activated protein C; targeting a hemoglobin of 7∼9 g/dl; appropriate use of fresh frozen plasma and platelets; a low tidal volume and limitation of inspiratory plateau pressure strategy for acute lung injury and acute respiratory distress syndrome; protocols for weaning and sedation/analgesia; avoidance of neuromuscular blockers; maintenance of blood glucose ＜150 mg/dl; equivalence of continuous veno-veno hemofiltration and intermittent hemodialysis; avoiding the use of bicarbonate for pH＞ or =7.15; deep vein thrombosis/stress ulcer prophylaxis; and consideration of limitations of life support.
Conclusion: In our country, epidemiologic studies of critically ill patients including those suffering with sepsis and septic shock have not been well defined. However, these situations would not be much different from the European and American countries. "Surviving Sepsis Campaign Guidelines" would be helpful to improve the outcome of sepsis. (J Korean Surg Soc 2006;71:1-11)
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