{"id":538,"date":"2016-02-23T01:00:21","date_gmt":"2016-02-23T00:00:21","guid":{"rendered":"http:\/\/news-papers.eu\/?p=538"},"modified":"2016-02-28T19:52:21","modified_gmt":"2016-02-28T18:52:21","slug":"die-neue-definition-der-sepsis-und-des-septischen-schocks-teil-1","status":"publish","type":"post","link":"http:\/\/news-papers.eu\/?p=538","title":{"rendered":"Die neue Definition der Sepsis und des septischen Schocks &#8211; Teil 1"},"content":{"rendered":"<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"539\" data-permalink=\"http:\/\/news-papers.eu\/?attachment_id=539\" data-orig-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?fit=960%2C1280\" data-orig-size=\"960,1280\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Sepsis\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Definition der Sepsis &#8211; Teil 1&lt;\/p&gt;\n\" data-medium-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?fit=225%2C300\" data-large-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?fit=768%2C1024\" class=\"size-medium wp-image-539 alignright\" src=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?resize=225%2C300\" alt=\"Sepsis\" width=\"225\" height=\"300\" srcset=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?resize=225%2C300 225w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?resize=768%2C1024 768w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?resize=750%2C1000 750w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?w=960 960w\" sizes=\"auto, (max-width: 225px) 100vw, 225px\" \/>Am 23.02.2016 sind im <strong>The Journal of the American Medical Association<\/strong>\u00a0(JAMA) wichtige\u00a0Publikation zur <strong>Definition der Sepsis und des septischen Schocks<\/strong> erschienen.<\/p>\n<blockquote><p><em>Abraham E. New definition for sepsis and septic shock. Continuing evolution but with much still to be done.\u00a0<\/em><br \/>\n<em><strong>JAMA<\/strong> 2016; 315: 757-759<\/em><\/p>\n<p><em>Seymour SW, et al. Assessment of clinical criteria for sepsis for the third international consensus conference definitions for sepsis and septic shock (Sepsis-3).<\/em><br \/>\n<em><strong>JAMA<\/strong> 2016; 315: 762-774<\/em><\/p>\n<p><em>Shankar-Hari M, et al. Developing a new definition and assessing new clinical criteria for septic shock\u00a0for the third international consensus conference definitions for sepsis and septic shock (Sepsis-3).<\/em><br \/>\n<em><strong>JAMA<\/strong> 2016; 315: 775-787\u00a0<\/em><\/p>\n<p><em>Singer M, et al. The third international consensus conference definitions for sepsis and septic shock (Sepsis-3).<\/em><br \/>\n<em><strong>JAMA<\/strong> 2016; 315: 801-810<\/em><\/p><\/blockquote>\n<p style=\"text-align: justify;\">Die letzte Definition der Sepsis und des septischen Schocks stammt aus dem Jahr 2003 (<em>Levy MM, et al. <strong>Crit Care Med<\/strong> 2003; 31: 1250-1256<\/em>). Von Experten (der Society of Critical Care Medicine und European Society of Intensive Care Medicine) wurde nun auf der <strong>3. internationalen Consensuskonferenz zur Definition der Sepsis und des septischen Schocks (SEPSIS-3)<\/strong>\u00a0ein neues diagnostisches Instrument zur <strong>Detektion der Sepsis<\/strong>\u00a0eingef\u00fchrt: <strong>quickSOFA (qSOFA) <\/strong>(<em>Singer M, et al. <strong>JAMA<\/strong> 2016; 315: 801-810<\/em>). Das diagnostische Instrument qSOFA beinhaltet drei Parameter, um fr\u00fchzeitig\u00a0im Notarztdienst, der Zentralen Notaufnahme oder auch auf der peripheren Station einen Patienten mit einer potentiellen Sepsis zu erkennen:<\/p>\n<ul>\n<li><strong>Verwirrtheit\u00a0<\/strong><\/li>\n<li><strong>systolischer Blutdruck \u2264100 mmHg<\/strong><\/li>\n<li><strong>Atemfrequenz &gt;22\/min<\/strong><\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Wenn ein Patient <strong>\u22652 positive Komponenten des qSOFA<\/strong> aufweist, soll nach einem Organversagen gefahndet werden. Die Daten wurden an 148.907 Patienten einer initialen Patientenkohorte evaluiert und nachfolgend an 706.399 Patienten in einer erg\u00e4nzenden Untersuchung best\u00e4tigt. Der <strong>qSOFA<\/strong> wies in einer Analyse an 66.522 Patienten mit vermuteter Sepsis eine hohe pr\u00e4diktive Validit\u00e4t auf [AUROC: 0,81 (95%CI: 0,80-0,82)], die signifikant h\u00f6her war als die der \u00fcblichen SIRS-Kritierien\u00a0(AUROC: 0,76 [95%CI: 0,75-0,77]).<\/p>\n<p style=\"text-align: justify;\">Nach dieser neuen Definition wird Sepsis als das Vorliegen einer Infektion mit dem\u00a0Vorliegen einer lebensbedrohlichen Organdysfunktion (mehr als 2 Punkten im SOFA, s.u., beobachtete\u00a0Mortalit\u00e4t &gt;10%) aufgefasst. Sepsis ist keine spezifische Erkrankung, sondern ein Syndrom.<\/p>\n<p style=\"text-align: justify;\">In diesem Zusammenhang wird darauf hingewiesen, dass Patienten mit septischen Schock mehr Komplikationen und eine h\u00f6heres Risiko aufweisen zu versterben. Ein septischer\u00a0Schock beinhaltet zirkulatorische, zellul\u00e4re und metabolische Ver\u00e4nderungen, die mit einem h\u00f6heren Risiko zu Versterben assoziiert sind, im Vergleich zu einer alleinigen Sepsis. Die Expertengruppe der SEPSIS-3 identifizierten <strong>zwei neue Kriterien, um einen septischen Schock zu diagnostizieren:<\/strong><\/p>\n<ul>\n<li><strong>persistierende Hypotension, bei der Vasopressoren eingesetzt werden m\u00fcssen, um einen mittleren arteriellen Blutdruck (MAP)\u00a0\u226565 mm Hg zu erreichen<\/strong><\/li>\n<li><strong>Laktat &gt;2 mmol\/l trotz Volumentherapie (volume resuscitation)<\/strong><\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Die untersuchten Daten zeigten eine <strong>vierfach h\u00f6here Letalit\u00e4tsrate<\/strong> bei Patienten, die die beiden vorgenannten Kriterien aufwiesen (Mortalit\u00e4t &gt;40%).<\/p>\n<p style=\"text-align: justify;\">Eine wesentliche Ver\u00e4nderung der neuen Sepsisdefinition ist, dass der Begriff SIRS (Kriterien: Tachykardie &gt;90\/min, Tachypnoe &gt;20\/min oder paCO2&lt;32 mmHg, Hyperthermie &gt;38\u00b0C\/Hypothermie &lt;36\u00b0C, Leukozytenzahl &lt;4 oder &gt;12) nicht mehr beinhaltet ist. Dies resultiert aus der Beobachtung, dass viele hospitalisierte Patienten diese Ver\u00e4nderungen aufweisen und diese nicht ausschliesslich Sepsis-assoziiert sind, d.h. nicht als spezifisch genug f\u00fcr das Vorliegen einer Sepsis angesehen werden k\u00f6nnen.<\/p>\n<hr \/>\n<p><strong>SOFA = Sequential [Sepsis related] Organ Failure Assessment Score<\/strong><\/p>\n<ul>\n<li>paO2\/FiO2 ratio (Horowitz index)<\/li>\n<li>Glasgow Coma Skala<\/li>\n<li>Mittlere arterielle Blutdruck<\/li>\n<li>Gabe\u00a0von Vasopressoren<\/li>\n<li>Serumkreatinin oder Urinausscheidung<\/li>\n<li>Bilirubin<\/li>\n<li>Thrombozytenzahl<\/li>\n<\/ul>\n<hr \/>\n<p>Weitere Informationen werden in den n\u00e4chsten Tagen folgen. Lesen Sie hier den <a href=\"http:\/\/news-papers.eu\/die-neue-definition-der-sepsis-und-des-septischen-schocks-teil-2\" target=\"_blank\">2. Teil<\/a>.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Am 23.02.2016 sind im The Journal of the American Medical Association\u00a0(JAMA) wichtige\u00a0Publikation zur Definition der Sepsis und des septischen Schocks erschienen. Abraham E. New definition for sepsis and septic shock. [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":539,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"__cvm_playback_settings":[],"__cvm_video_id":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[57],"tags":[70,69,71,67,68],"class_list":["post-538","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sepsis","tag-intensivmedizin","tag-kritischer-kranker-patient","tag-notfallmedizin","tag-sepsis","tag-septischer-schock"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?fit=960%2C1280","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7fR2g-8G","jetpack-related-posts":[{"id":553,"url":"http:\/\/news-papers.eu\/?p=553","url_meta":{"origin":538,"position":0},"title":"Die neue Definition der Sepsis und des septischen Schocks &#8211; Teil 2","author":"Michael Bernhard","date":"Februar 26, 2016","format":false,"excerpt":"K\u00fcrzlich sind wir auf die neue Definition der Sepsis und des septischen Schocks der 3. internationalen Consensuskonferenz SEPSIS-3 eingegangen (hier). Nachfolgend greifen wir weitere Punkte aus dieser Publikation auf. Singer M, et al. The third international consensus conference definitions for sepsis and septic shock (Sepsis-3). JAMA\u00a02016; 315: 801-810 Warum brauchte\u2026","rel":"","context":"In &quot;Sepsis&quot;","block_context":{"text":"Sepsis","link":"http:\/\/news-papers.eu\/?cat=57"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Blutkulturflaschen.jpg?fit=1200%2C900&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Blutkulturflaschen.jpg?fit=1200%2C900&resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Blutkulturflaschen.jpg?fit=1200%2C900&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Blutkulturflaschen.jpg?fit=1200%2C900&resize=700%2C400 2x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Blutkulturflaschen.jpg?fit=1200%2C900&resize=1050%2C600 3x"},"classes":[]},{"id":3747,"url":"http:\/\/news-papers.eu\/?p=3747","url_meta":{"origin":538,"position":1},"title":"Surviving Sepsis Campaign &#8211; Guidelines 2017 &#8211; 4th Edition","author":"Michael Bernhard","date":"Januar 25, 2017","format":false,"excerpt":"Gerade sind die neuen Surviving Sepsis Campaign Guidelines 2017\u00a0erschienen: Gesamte Leitlinie\u00a0(67 Seiten, 655 Literaturstellen):\u00a0 Rhodes A et al.,\u00a0Surviving Sepsis Campaign: International\u00a0Guidelines for Management of Sepsis and Septic\u00a0Shock: 2016. Crit Care Med 2017;\u00a0DOI: 10.1097\/CCM.0000000000002255 (PDF) User\u00b4s Guideline\u00a0(5 Seiten): Dellinger RP, et al. A Users\u2019 Guide to the 2016 Surviving Sepsis\u00a0Guidelines. Crit\u2026","rel":"","context":"In &quot;Sepsis&quot;","block_context":{"text":"Sepsis","link":"http:\/\/news-papers.eu\/?cat=57"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/01\/Bildschirmfoto-2017-01-23-um-07.57.24-e1485154716876.png?fit=500%2C343&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":14421,"url":"http:\/\/news-papers.eu\/?p=14421","url_meta":{"origin":538,"position":2},"title":"Surviving Sepsis Campaign Guideline 2021 &#8211; Teil 4","author":"Michael Bernhard","date":"Oktober 12, 2021","format":false,"excerpt":"Nun zu Teil 4 der\u00a0Surviving Sepsis Campaign Guideline 2021 ist am 02.10.2021 publiziert worden: Evans L, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. This article is co\u2010published in the journals Intensive Care Medicine (https:\/\/doi.org\/10.1007\/s00134\u2010021\u201006506\u2010y) and Critical Care Medicine (https:\/\/doi.org\/10.1097\/CCM.0000000000005337). (PDF) Hier ganz\u2026","rel":"","context":"In &quot;Sepsis&quot;","block_context":{"text":"Sepsis","link":"http:\/\/news-papers.eu\/?cat=57"},"img":{"alt_text":"Sepsis","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2021\/10\/Bildschirmfoto-2021-10-04-um-21.41.56.png?fit=1200%2C1148&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2021\/10\/Bildschirmfoto-2021-10-04-um-21.41.56.png?fit=1200%2C1148&resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2021\/10\/Bildschirmfoto-2021-10-04-um-21.41.56.png?fit=1200%2C1148&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2021\/10\/Bildschirmfoto-2021-10-04-um-21.41.56.png?fit=1200%2C1148&resize=700%2C400 2x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2021\/10\/Bildschirmfoto-2021-10-04-um-21.41.56.png?fit=1200%2C1148&resize=1050%2C600 3x"},"classes":[]},{"id":3737,"url":"http:\/\/news-papers.eu\/?p=3737","url_meta":{"origin":538,"position":3},"title":"Surviving Sepsis Campaign 2017 &#8211; Teil 1","author":"Michael Bernhard","date":"April 11, 2017","format":false,"excerpt":"Die 2016er\u00a0\"Surviving Sepsis Campaign\" Empfehlungen zur Behandlung der Sepsis sind publiziert worden: Rhodes A et al.,\u00a0Surviving Sepsis Campaign: International\u00a0Guidelines for Management of Sepsis and Septic\u00a0Shock: 2016. Crit Care Med 2017;\u00a0DOI: 10.1097\/CCM.0000000000002255 (PDF) oder Rhodes A et al.,\u00a0Surviving Sepsis Campaign: International\u00a0Guidelines for Management of Sepsis and Septic\u00a0Shock: 2016. Intensive\u00a0Care Med 2017;\u00a0DOI\u2026","rel":"","context":"In &quot;Sepsis&quot;","block_context":{"text":"Sepsis","link":"http:\/\/news-papers.eu\/?cat=57"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/01\/Bildschirmfoto-2017-01-23-um-07.57.24-e1485154716876.png?fit=500%2C343&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":14529,"url":"http:\/\/news-papers.eu\/?p=14529","url_meta":{"origin":538,"position":4},"title":"Surviving Sepsis Campaign Guideline 2021 &#8211; Teil 9","author":"Michael Bernhard","date":"Oktober 26, 2021","format":false,"excerpt":"Nun zu Teil 9\u00a0der\u00a0Surviving Sepsis Campaign Guideline 2021 ist am 02.10.2021 publiziert worden: Evans L, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. This article is co\u2010published in the journals Intensive Care Medicine (https:\/\/doi.org\/10.1007\/s00134\u2010021\u201006506\u2010y) and Critical Care Medicine (https:\/\/doi.org\/10.1097\/CCM.0000000000005337). (PDF) Hier ganz frisch\u2026","rel":"","context":"In &quot;Sepsis&quot;","block_context":{"text":"Sepsis","link":"http:\/\/news-papers.eu\/?cat=57"},"img":{"alt_text":"Sepsis","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2021\/10\/Bildschirmfoto-2021-10-04-um-21.41.56.png?fit=1200%2C1148&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2021\/10\/Bildschirmfoto-2021-10-04-um-21.41.56.png?fit=1200%2C1148&resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2021\/10\/Bildschirmfoto-2021-10-04-um-21.41.56.png?fit=1200%2C1148&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2021\/10\/Bildschirmfoto-2021-10-04-um-21.41.56.png?fit=1200%2C1148&resize=700%2C400 2x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2021\/10\/Bildschirmfoto-2021-10-04-um-21.41.56.png?fit=1200%2C1148&resize=1050%2C600 3x"},"classes":[]},{"id":4334,"url":"http:\/\/news-papers.eu\/?p=4334","url_meta":{"origin":538,"position":5},"title":"Blitzlicht: Fr\u00fche Antibiotikatherapie und Mortalit\u00e4t","author":"Michael Bernhard","date":"Juni 3, 2017","format":false,"excerpt":"Dass man bei Sepsis fr\u00fchzeitig eine Antibiotikatherapie applizieren soll, ist jedem klar. Dass man dies bereits im Notarztdienst nach Rekrutierung von Blutkulturen durchf\u00fchrt, wird kontrovers diskutiert. Aber der Zusammenhang zwischen Mortalit\u00e4t und fr\u00fcher Antibiotikagabe wird immer wieder hervorgehoben. Bristol B. Whiles und Kollegen haben nun eine sehr interessante Arbeit zu\u2026","rel":"","context":"In &quot;Sepsis&quot;","block_context":{"text":"Sepsis","link":"http:\/\/news-papers.eu\/?cat=57"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/05\/Blitzlicht-e1491322131188.jpg?fit=500%2C375&resize=350%2C200","width":350,"height":200},"classes":[]}],"jetpack_likes_enabled":true,"_links":{"self":[{"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts\/538","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=538"}],"version-history":[{"count":15,"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts\/538\/revisions"}],"predecessor-version":[{"id":688,"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts\/538\/revisions\/688"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/media\/539"}],"wp:attachment":[{"href":"http:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=538"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=538"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=538"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}