Spezielle Aspekte bei Sepsispatienten

Abstract

This article deals with specific aspects of the patient with sepsis and his treatment. With adequate therapy (antibiotics started within the first hour, early goal-directed therapy) initiated as early as possible, the patient with community-aquired severe sepsis in the emergency department has a considerable better chance to survive than the patient with prolonged severe sepsis in the ICU. The average age of patients with severe sepsis and septic shock treated at the ICU is rising, with consequences like oligosymptomatic presentation, altered pharmakokinetics according to older-age-induced reduced organ functions and prolonged stay at the ICU due to comorbidity. Due to sexual dimorphisms of the immune system, women have a better prognosis in sepsis than men. In an animal sepsis model activation of the estrogen receptor beta improves prognosis. Within six months after having survived severe sepsis, morbidity and mortality is still increased. Taking care for the patient in a post-ICU outpatient department during this time will help to recognize these problems and to effectively treat the patient as soon as possible.

Gender differences and inflammation: an in vitro model of blood cells stimulation in prepubescent children

“…Conversely, the prognosis is better for females than males during sepsis [4,5] or extended burns [6,7], which could reflect a more efficient mobilization of neutrophils and/or related inflammatory reaction.…”

Sex and Gender Differences in Infection and Treatments for Infectious Diseases

“…Several other murine and human studies show that prognosis during sepsis, shock, and trauma is better for females than males (see Chap. 9) (Angele et al 2000;Marriott et al 2006;Muller-Werdan et al 2009). Watson and colleagues found significantly more sepsis cases and sepsis-related mortality among male than female infants in the USA (Hartman et al 2013), with a persistently higher case rate but not mortality persisting to adolescence.…”

The Evaluation of Emergency Admissions

“…On the one hand, it is frequently not the task of the emergency room to arrive at the definitive diagnosis, but only to propose a suspected diagnosis with further diagnostic and/or therapeutic consequences. On the other hand, it should not be forgotten that important emergency treatments should also be undertaken in the emergency room, such as the guideline-indicated administration of an antibiotic during the first hour when sepsis is suspected (10). Thus, the DE "only" reflects the diagnostic component of emergency room activities, but not the equally important therapeutic component.…”