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Review
. 2017 Dec;58(12):1264-1271.
doi: 10.1007/s00108-017-0338-5.

[Sepsis-3 : What has been confirmed in therapy?]

[Article in German]
S David  1 , F M Brunkhorst  2   3   4
Affiliations
Review

[Sepsis-3 : What has been confirmed in therapy?]

[Article in German]
S David et al. Internist (Berl). 2017 Dec.

Abstract
in English, German

Hugo Schottmüller realized already over 100 years ago that sepsis is a syndrome that occurs as a consequence of an infection defined by a systemic overreaction to a periodic invasion of bacilli. Consistent with this old concept, the term "systemic inflammatory response syndrome" (SIRS) was coined about 25 years ago and has been regularly used ever since. In 2016, a sepsis task force was formed to re-evaluate the current definition on a scientific basis. The task force suggested a third definition (sepsis-3) of the disease that now focuses both on the pathological host response and on organ dysfunction as obligatory key features to diagnose sepsis. In this review article, the definition is explained in detail and we summarize the novel international sepsis guideline from 2017 with personal commentaries.

Hugo Schottmüller erkannte bereits vor über 100 Jahren, dass es sich bei der Sepsis um ein Syndrom handelt, bei dem nicht die Infektion an sich, sondern eine Überreaktion des Organismus auf eine periodische Einschwemmung von Krankheitserregern unsere Patienten schädigt. Vor etwa 25 Jahren wurde entsprechend diesem Konzept der Begriff des Syndroms der systemischen Inflammationsreaktion („systemic inflammatory response syndrome“ [SIRS]) geprägt. Er wird im klinischen Alltag quasi ständig gebraucht. Im Jahr 2016 hat sich eine Expertenkommission bemüht, eine dritte Sepsisdefinition (Sepsis-3) zu erstellen, die auf wissenschaftlichen Daten beruhen sollte. In den Vordergrund rückt nun die fehlregulierte Wirtsantwort auf eine Infektion zusammen mit der Organdysfunktion als obligate Voraussetzung der Diagnosestellung. In diesem Beitrag wird die neue Definition im Detail erläutert. Zudem wird die Anfang des Jahres 2017 erschienene internationale Leitlinie zusammengefasst und kommentiert.

Keywords: Fluid therapy; Guideline; Organ dysfunction scores; Septic shock; Systemic inflammatory response syndrome.

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