Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI))

K Reinhart, F M Brunkhorst, H-G Bone, J Bardutzky, C-E Dempfle, H Forst, P Gastmeier, H Gerlach, M Gründling, S John, W Kern, G Kreymann, W Krüger, P Kujath, G Marggraf, J Martin, K Mayer, A Meier-Hellmann, M Oppert, C Putensen, M Quintel, M Ragaller, R Rossaint, H Seifert, C Spies, F Stüber, N Weiler, A Weimann, K Werdan, T Welte, German Sepsis Society, German Interdisciplinary Association of Intensive Care and Emergency Medicine, K Reinhart, F M Brunkhorst, H-G Bone, J Bardutzky, C-E Dempfle, H Forst, P Gastmeier, H Gerlach, M Gründling, S John, W Kern, G Kreymann, W Krüger, P Kujath, G Marggraf, J Martin, K Mayer, A Meier-Hellmann, M Oppert, C Putensen, M Quintel, M Ragaller, R Rossaint, H Seifert, C Spies, F Stüber, N Weiler, A Weimann, K Werdan, T Welte, German Sepsis Society, German Interdisciplinary Association of Intensive Care and Emergency Medicine

Abstract

Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1(st) revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the "German Instrument for Methodological Guideline Appraisal" of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.

Keywords: German Sepsis Aid; German Sepsis Society; diagnosis; follow-up care; guideline; prevention; septic shock; severe sepsis; treatment.

Figures

Table 1. Diagnostic criteria for sepsis, severe…
Table 1. Diagnostic criteria for sepsis, severe sepsis and septic shock (modified after [411]), in line with the ACCP/SCCM consensus conference criteria [11].
Table 2. Collection, storage and transport of…
Table 2. Collection, storage and transport of blood cultures [33]
Table 3. Modified “clinical pulmonary infection score…
Table 3. Modified “clinical pulmonary infection score (CPIS)” [43]
Table 4. SDD and SOD regimens according…
Table 4. SDD and SOD regimens according to Krüger WA, IntensivNews 2009, mod. after: de Smet et al, New Engl J Med. 2009;360:20-31 [137]. In a modified form, following mouth cleansing and oral suction, SDD or SOD may also be administered with a syringe as oral suspensions: 10 ml q.i.d. according to the following formulation: 1.0 g polymyxin E = Colistin (alternatively, 0.5 g polymyxin B), 800 mg of tobramycin, 2.5 g of amphotericin B ad 100 mL distilled water)
Table 5. Definition of criteria for acute…
Table 5. Definition of criteria for acute kidney injury (AKI) [412]
Table 6. Definition of acute lung injury…
Table 6. Definition of acute lung injury (ALI) and adult respiratory distress syndrome (ARDS)
Table 7. Ventilation management in ALI/ARDS patients…
Table 7. Ventilation management in ALI/ARDS patients according to the recommendations by ARDSNET [290], modified as per [22].
Figure 1. An example of a weaning…
Figure 1. An example of a weaning scheme after Kuhlen (modified after [303, 413])

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