全身炎癥反應綜合癥與膿毒血癥下(存儲版)
【正文】 必須先選擇廣譜抗生素，再在細菌學的指導下過渡到窄譜抗生素。345:135967 Van den Berghe, G. et al. N Engl J Med 20xx。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)。 全身炎癥反應綜合癥 與膿毒血癥 （下） XXXX醫(yī)院 Corticus Study ? Multicenter, doubleblind, RCT ? 52 ICUs, March 20xx – Nov 20xx (3 189。g/dl or a random cortisol of 10 181。 to reduce VAP Grade 2C ? Remend against routine use of PA catheter Grade 1A (NEJM 20xx) ? Remend conservative fluid strategy to decrease MV days and ICU LOS Grade 1C (NEJM 20xx) GLYCEMIC CONTROL Glucose Control ? Remend that patients with severe sepsis and hyperglycemia who are admitted to the ICU receive IV insulin to decrease blood glucose Grade 1B ? Maintain BG 150 mg/dl using insulin G
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