新定義 敗血性休克 ：敗血症病患中,
因循環 /細胞/代謝太過異常,以致增加死亡率
臨床上敗血性休克定義 : 經過足夠輸液急救後 ，仍需要昇壓劑來維持 MAP >65 mmHg 以及血中乳酸濃度 > 2 mmol/L 的病患。
Sepsis 新一代定義 將於 2016/02/22 於 JAMA 刊出
Singer M, et al: The Sepsis Definitions Task Force The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, Feb 22, 2016).
在刊出前，ESICM (歐洲醫學會 )寫了一篇 short review
http://www.esicm.org/…/Sepsis-3-International-Consensus-def…
簡單翻譯一下 KEY DEFINITIONS
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1. Sepsis is now defined as a ‘life-threatening organ dysfunction due to a dysregulated host response to infection’.
SIRS criteria have less of a role to play, as they are considered overly non-specific and of poor clinical utility:
sepsis 新定義為 : 宿主對感染反應失調，導致器官失能而危及生命。
過去的 SIRS : 較 non specific , 較難臨床應用，新定義將較少強調
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2. The key element of sepsis-induced organ dysfunction is defined by ‘an acute change in total SOFA score ≥ 2 points consequent to infection, reflecting an overall mortality rate of approximately 10%’
對 sepsis induced organ dysfunction 新定義 ：
感染後 SOFA分數改變 ≥ 2 分
因為整體死亡率約（增加） 10 ％
相對來說，過去說的 Severe sepsis 可能被捨棄
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3. A simple bedside score (‘qSOFA’, for quick SOFA) has been proposed, which incorporates hypotension (systolic blood pressure ≤100mmHg), altered mental status and tachypnea (respiratory rate > 22/min):the presence of at least two of these criteria strongly predicts the likelihood of poor outcome in out-of-ICU patients with clinical suspicion of sepsis.
如果不是在 ICU, 可以用 qSOFA 來篩選病患
三項 ：低血壓 ( SBP < 100 mmHg) , 意識改變 ，喘 ( rate > 22)
三者有二 ，便可預測 poor outcome
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4. Septic shock is now defined as a ‘subset of sepsis where underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality’. Clinical criteria identifying such condition include the need for vasopressors to obtain a MAP≥ 65mmHg and an increase in lactate concentration > 2 mmol/L, despite adequate fluid resuscitation.
新定義 sepsis shock : sepsis 病患中,
因循環 /細胞/代謝太過異常,以致增加死亡率
臨床上sepsis shock 定義 : 經過足夠 fluid resuscitation 後 ，仍需要昇壓劑來維持 MAP >65 mmHg 以及血中乳酸濃度 > 2 mmol/L 的病患。
