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Hämodynamische Stabilisierung des septischen Patienten in der Notaufnahme

Zeitschrift:: Notfall + Rettungsmedizin > Ausgabe 3/2019

Autoren:: Dr. med. T. Schmoch, M. Bernhard, B. H. Siegler, T. Brenner, M. A. Weigand

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Wichtige Hinweise

Redaktion

F. Brunkhorst, Jena

M. Christ, Zürich

Zusammenfassung

Sepsis und septischer Schock stellen die schwersten Verlaufsformen einer Infektion dar. Sie sind Notfälle, die sowohl im Rettungs- und Notarztdienst als auch in der Zentralen Notaufnahme ohne Zeitverzug einer adäquaten Therapie zugeführt werden müssen. Für die Prognose von Patienten mit Sepsis sind die frühzeitige Identifikation von Risikopatienten, der schnelle Beginn einer antiinfektiven Therapie und die sofortige hämodynamische Stabilisierung entscheidend. Der vorliegende Artikel gibt eine Übersicht über die notwendigen Behandlungsschritte, die zwingend in der Notaufnahme begonnen werden müssen, wobei der Fokus auf der hämodynamischen Stabilisierung liegt.

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Abboud I, Lerolle N, Urien S et al (2009) Pharmacokinetics of epinephrine in patients with septic shock: modelization and interaction with endogenous neurohormonal status. Crit Care 13:R120. https://doi.org/10.1186/cc7972 CrossRefPubMedPubMedCentral

Ait-Oufella H, Lemoinne S, Boelle PY et al (2011) Mottling score predicts survival in septic shock. Intensive Care Med 37:801–807. https://doi.org/10.1007/s00134-011-2163-y CrossRefPubMed

Andrews B, Semler MW, Muchemwa L et al (2017) Effect of an early resuscitation protocol on in-hospital mortality among adults with sepsis and hypotension: a randomized clinical trial. JAMA 318:1233–1240. https://doi.org/10.1001/jama.2017.10913 CrossRefPubMedPubMedCentral

Annane D, Renault A, Brun-Buisson C et al (2018) Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med 378:809–818. https://doi.org/10.1056/NEJMoa1705716 CrossRefPubMed

ARISE Investigators, ANZICS Clinical Trials Group, Peake SL et al (2014) Goal-directed resuscitation for patients with early septic shock. N Engl J Med 371:1496–1506. https://doi.org/10.1056/NEJMoa1404380 CrossRef

Asfar P, Meziani F, Hamel J‑F et al (2014) High versus low blood-pressure target in patients with septic shock. N Engl J Med 370:1583–1593. https://doi.org/10.1056/NEJMoa1312173 CrossRef

Auchet T, Regnier M‑A, Girerd N, Levy B (2017) Outcome of patients with septic shock and high-dose vasopressor therapy. Ann Intensive Care 7:43. https://doi.org/10.1186/s13613-017-0261-x CrossRefPubMedPubMedCentral

Bai X, Yu W, Ji W et al (2014) Early versus delayed administration of norepinephrine in patients with septic shock. Crit Care 18:532. https://doi.org/10.1186/s13054-014-0532-y CrossRefPubMedPubMedCentral

Baxter Deutschland GmbH, B. Braun Melsungen AG, Fresenius Kabi Deutschland GmbH, Serumwerk Bernburg AG (2013) Rote-Hand-Brief zu HES-haltigen Infusionslösungen: Neue Kontraindikationen und Anwendungsbeschränkungen

10.

Bayer O, Schwarzkopf D, Stumme C et al (2015) An early warning scoring system to identify septic patients in the prehospital setting: the PRESEP score. Acad Emerg Med 22:868–871. https://doi.org/10.1111/acem.12707 CrossRefPubMed

11.

Bergamin FS, Almeida JP, Landoni G et al (2017) Liberal versus restrictive transfusion strategy in critically ill oncologic patients: the transfusion requirements in critically ill oncologic patients randomized controlled trial. Crit Care Med 45:766. https://doi.org/10.1097/CCM.0000000000002283 CrossRefPubMed

12.

Bernhard M, Brenner T, Brunkhorst FM, Weigand MA (2015) Frühe innerklinische Sepsistherapie. Notfall Rettungsmed 18:595–605. https://doi.org/10.1007/s10049-015-0098-5 CrossRef

13.

Bernhard M, Ramshorn-Zimmer A, Hartwig T et al (2014) Schockraummanagement kritisch erkrankter Patienten. Anaesthesist 63:144–153. https://doi.org/10.1007/s00101-013-2258-7 CrossRefPubMed

14.

Bloch A, Berger D, Takala J (2016) Understanding circulatory failure in sepsis. Intensive Care Med 42:2077–2079. https://doi.org/10.1007/s00134-016-4514-1 CrossRefPubMed

15.

Brunkhorst FM, Engel C, Bloos F et al (2008) Intensive insulin therapy and Pentastarch resuscitation in severe sepsis. N Engl J Med 358:125–139. https://doi.org/10.1056/NEJMoa070716 CrossRefPubMed

16.

Caironi P, Tognoni G, Masson S et al (2014) Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med 370:1412–1421. https://doi.org/10.1056/NEJMoa1305727 CrossRefPubMed

17.

Cardenas-Garcia J, Schaub KF, Belchikov YG et al (2015) Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med 10:581–585. https://doi.org/10.1002/jhm.2394 CrossRefPubMed

18.

Casserly B, Phillips GS, Schorr C et al (2015) Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med 43:567–573. https://doi.org/10.1097/CCM.0000000000000742 CrossRefPubMed

19.

Cherpanath TGV, Hirsch A, Geerts BF et al (2016) Predicting fluid responsiveness by passive leg raising: a systematic review and meta-analysis of 23 clinical trials. Crit Care Med 44:981–991. https://doi.org/10.1097/CCM.0000000000001556 CrossRefPubMed

20.

Churpek MM, Snyder A, Han X et al (2016) qSOFA, SIRS, and early warning scores for detecting clinical deterioration in infected patients outside the ICU. Am J Respir Crit Care Med. https://doi.org/10.1164/rccm.201604-0854OC CrossRef

21.

Damiani E, Donati A, Serafini G et al (2015) Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies. PLoS ONE 10:e125827. https://doi.org/10.1371/journal.pone.0125827 CrossRefPubMedPubMedCentral

22.

Datta D, Grahamslaw J, Gray AJ et al (2016) Lactate—arterial and venous agreement in sepsis: a prospective observational study. Eur J Emerg Med. https://doi.org/10.1097/MEJ.0000000000000437 CrossRef

23.

Delaney AP, Dan A, McCaffrey J, Finfer S (2011) The role of albumin as a resuscitation fluid for patients with sepsis: a systematic review and meta-analysis. Crit Care Med 39:386–391. https://doi.org/10.1097/CCM.0b013e3181ffe217 CrossRefPubMed

24.

Dellinger RP, Carlet JM, Masur H et al (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–873 CrossRef

25.

Dellinger RP, Levy MM, Rhodes A et al (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41:580–637. https://doi.org/10.1097/CCM.0b013e31827e83af CrossRefPubMed

26.

Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (federführend) (2014) S3-Leitlinie Intravasale Volumentherapie beim Erwachsenen

27.

DeWitt S, Chavez SA, Perkins J et al (2017) Evaluation of fever in the emergency department. Am J Emerg Med 35:1755–1758. https://doi.org/10.1016/j.ajem.2017.08.030 CrossRefPubMed

28.

Donnelly JP, Safford MM, Shapiro NI et al (2017) Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) classification: a retrospective population-based cohort study. Lancet Infect Dis 17:661–670. https://doi.org/10.1016/S1473-3099(17)30117-2 CrossRefPubMedPubMedCentral

29.

Fleischmann C, Thomas-Rueddel D, Hartmann M et al (2016) Fallzahlen und Sterblichkeitsraten von Sepsis-Patienten im Krankenhaus. Dtsch Arztebl 113(10):159–161

30.

Freund Y, Lemachatti N, Krastinova E et al (2017) Prognostic accuracy of sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA 317:301–308. https://doi.org/10.1001/jama.2016.20329 CrossRefPubMedPubMedCentral

31.

Gaieski DF, Mikkelsen ME, Band RA et al (2010) Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med 38:1045. https://doi.org/10.1097/CCM.0b013e3181cc4824 CrossRefPubMed

32.

Gargani L, Volpicelli G (2014) How I do it: lung ultrasound. Cardiovasc Ultrasound 12:25. https://doi.org/10.1186/1476-7120-12-25 CrossRefPubMedPubMedCentral

33.

Glassford NJ, Eastwood GM, Bellomo R (2014) Physiological changes after fluid bolus therapy in sepsis: a systematic review of contemporary data. Crit Care. https://doi.org/10.1186/s13054-014-0696-5 CrossRefPubMedPubMedCentral

34.

de Groot B, Stolwijk F, Warmerdam M et al (2017) The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study. Scand J Trauma Resusc Emerg Med 25:91. https://doi.org/10.1186/s13049-017-0436-3 CrossRefPubMedPubMedCentral

35.

Haas SA, Lange T, Saugel B et al (2016) Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med 42:202–210. https://doi.org/10.1007/s00134-015-4127-0 CrossRefPubMed

36.

Hamzaoui O, Scheeren TWL, Teboul J‑L (2017) Norepinephrine in septic shock: when and how much? Curr Opin Crit Care 23:342–347. https://doi.org/10.1097/MCC.0000000000000418 CrossRefPubMed

37.

Hernandez G, Luengo C, Bruhn A et al (2014) When to stop septic shock resuscitation: clues from a dynamic perfusion monitoring. Ann Intensive Care 4:30. https://doi.org/10.1186/s13613-014-0030-z CrossRefPubMedPubMedCentral

38.

Holst LB (2016) Benefits and harms of red blood cell transfusions in patients with septic shock in the intensive care unit. Dan Med J 63. https://www.ncbi.nlm.nih.gov/pubmed/26836806

39.

Holst LB, Haase N, Wetterslev J et al (2014) Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med 371:1381–1391. https://doi.org/10.1056/NEJMoa1406617 CrossRefPubMed

40.

Howell MD, Donnino MW, Talmor D et al (2007) Performance of severity of illness scoring systems in emergency department patients with infection. Acad Emerg Med 14:709–714. https://doi.org/10.1197/j.aem.2007.02.036 CrossRefPubMed

41.

Jaffee W, Hodgins S, McGee WT (2017) Tissue edema, fluid balance, and patient outcomes in severe sepsis: an organ systems review. J Intensive Care Med. https://doi.org/10.1177/0885066617742832 CrossRefPubMed

42.

Janssens U, Jung C, Hennersdorf M et al (2016) Empfehlungen zum hämodynamischen Monitoring in der internistischen Intensivmedizin. Kardiologe:149–169. https://doi.org/10.1007/s12181-016-0060-x CrossRef

43.

Keh D, Trips E, Marx G et al (2016) Effect of hydrocortisone on development of shock among patients with severe sepsis: the HYPRESS randomized clinical trial. JAMA 316:1775–1785. https://doi.org/10.1001/jama.2016.14799 CrossRefPubMed

44.

Kumar A, Roberts D, Wood KE et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34:1589–1596. https://doi.org/10.1097/01.CCM.0000217961.75225.E9 CrossRefPubMed

45.

Lamontagne F, Day AG, Meade MO et al (2017) Pooled analysis of higher versus lower blood pressure targets for vasopressor therapy septic and vasodilatory shock. Intensive Care Med. https://doi.org/10.1007/s00134-017-5016-5 CrossRefPubMed

46.

Lamontagne F, Meade MO, Hébert PC et al (2016) Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial. Intensive Care Med 42:542–550. https://doi.org/10.1007/s00134-016-4237-3 CrossRefPubMed

47.

Leisman D, Wie B, Doerfler M et al (2016) Association of fluid resuscitation initiation within 30 minutes of severe sepsis and septic shock recognition with reduced mortality and length of stay. Ann Emerg Med. https://doi.org/10.1016/j.annemergmed.2016.02.044 CrossRefPubMed

48.

Leisman DE, Doerfler ME, Schneider SM et al (2017) Predictors, prevalence, and outcomes of early crystalloid responsiveness among initially hypotensive patients with sepsis and septic shock. Crit Care Med. https://doi.org/10.1097/CCM.0000000000002834 CrossRefPubMed

49.

Levy MM, Dellinger RP, Townsend SR et al (2010) The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med 38:367–374. https://doi.org/10.1097/CCM.0b013e3181cb0cdc CrossRefPubMed

50.

Levy MM, Evans LE, Rhodes A (2018) The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med 44:925–928. https://doi.org/10.1007/s00134-018-5085-0 CrossRefPubMed

51.

Levy MM, Fink MP, Marshall JC et al (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31:1250–1256. https://doi.org/10.1097/01.CCM.0000050454.01978.3B CrossRef

52.

Levy MM, Rhodes A, Phillips GS et al (2015) Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Crit Care Med 43:3–12. https://doi.org/10.1097/CCM.0000000000000723 CrossRefPubMed

53.

Liu VX, Morehouse JW, Marelich GP et al (2016) Multicenter implementation of a treatment bundle for patients with sepsis and intermediate lactate values. Am J Respir Crit Care Med 193:1264–1270. https://doi.org/10.1164/rccm.201507-1489OC CrossRefPubMedPubMedCentral

54.

Long B, Koyfman A (2017) Clinical mimics: an emergency medicine–focused review of sepsis mimics. J Emerg Med 52:34–42. https://doi.org/10.1016/j.jemermed.2016.07.102 CrossRefPubMed

55.

Loubani OM, Green RS (2015) A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care 30:653.e9–653.17. https://doi.org/10.1016/j.jcrc.2015.01.014 CrossRef

56.

Macdonald SPJ, Taylor DM, Keijzers G et al (2017) REstricted Fluid REsuscitation in Sepsis-associated Hypotension (REFRESH): study protocol for a pilot randomised controlled trial. Trials 18:399. https://doi.org/10.1186/s13063-017-2137-7 CrossRefPubMedPubMedCentral

57.

Maitland K, Kiguli S, Opoka RO et al (2011) Mortality after fluid bolus in African children with severe infection. N Engl J Med 364:2483–2495. https://doi.org/10.1056/NEJMoa1101549 CrossRefPubMed

58.

Malbrain MLNG, Marik PE, Witters I et al (2014) Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther 46:361–380. https://doi.org/10.5603/AIT.2014.0060 CrossRefPubMed

59.

Marik PE, Monnet X, Teboul J‑L (2011) Hemodynamic parameters to guide fluid therapy. Ann Intensive Care 1:1. https://doi.org/10.1186/2110-5820-1-1 CrossRefPubMedPubMedCentral

60.

Mazer CD, Whitlock RP, Fergusson DA et al (2017) Restrictive or liberal red-cell transfusion for cardiac surgery. N Engl J Med 377:2133–2144. https://doi.org/10.1056/NEJMoa1711818 CrossRefPubMed

61.

Moeller C, Fleischmann C, Thomas-Rueddel D et al (2016) How safe is gelatin? A systematic review and meta-analysis of gelatin-containing plasma expanders vs crystalloids and albumin. J Crit Care 35:75–83. https://doi.org/10.1016/j.jcrc.2016.04.011 CrossRefPubMed

62.

Mouncey PR, Osborn TM, Power GS et al (2015) Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 372:1301–1311. https://doi.org/10.1056/NEJMoa1500896 CrossRefPubMed

63.

Mouncey PR, Osborn TM, Power GS et al (2015) Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 372:1301–1311. https://doi.org/10.1056/NEJMoa1500896 CrossRefPubMed

64.

Myburgh JA, Finfer S, Bellomo R et al (2012) Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 367:1901–1911. https://doi.org/10.1056/NEJMoa1209759 CrossRefPubMed

65.

Perel P, Roberts I, Ker K (2013) Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD000567.pub6 CrossRefPubMed

66.

Perner A, Haase N, Guttormsen AB et al (2012) Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med 367:124–134. https://doi.org/10.1056/NEJMoa1204242 CrossRefPubMed

67.

CESS Investigators, Yealy DM, Kellum JA et al (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370:1683–1693. https://doi.org/10.1056/NEJMoa1401602 CrossRef

68.

ProCESS/ARISE/ProMISe Methodology Writing Committee, Huang DT, Angus DC et al (2013) Harmonizing international trials of early goal-directed resuscitation for severe sepsis and septic shock: methodology of ProCESS, ARISE, and ProMISe. Intensive Care Med 39:1760–1775. https://doi.org/10.1007/s00134-013-3024-7 CrossRef

69.

Rathour S, Kumar S, Hadda V et al (2015) PIRO concept: staging of sepsis. J Postgrad Med 61:235–242. https://doi.org/10.4103/0022-3859.166511 CrossRefPubMedPubMedCentral

70.

Reinhart K, Brunkhorst FM, Bone H‑G et al (2010) Prävention, Diagnose, Therapie und Nachsorge der Sepsis. Anaesthesist 59:347–370. https://doi.org/10.1007/s00101-010-1719-5 CrossRefPubMed

71.

Rhodes A, Evans LE, Alhazzani W et al (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43:304–377. https://doi.org/10.1007/s00134-017-4683-6 CrossRefPubMed

72.

Ricard J‑D, Salomon L, Boyer A et al (2013) Central or peripheral catheters for initial venous access of ICU patients: a randomized controlled trial. Crit Care Med 41:2108–2115. https://doi.org/10.1097/CCM.0b013e31828a42c5 CrossRefPubMed

73.

Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377. https://doi.org/10.1056/NEJMoa010307 CrossRefPubMed

74.

Rochwerg B, Alhazzani W, Sindi A et al (2014) Fluid resuscitation in sepsis: a systematic review and network meta-analysis. Ann Intern Med 161:347–355. https://doi.org/10.7326/M14-0178 CrossRefPubMed

75.

Russell JA, Rush B, Boyd J (2018) Pathophysiology of septic shock. Crit Care Clin 34:43–61. https://doi.org/10.1016/j.ccc.2017.08.005 CrossRefPubMed

76.

Russell JA, Walley KR, Singer J et al (2008) Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 358:877–887. https://doi.org/10.1056/NEJMoa067373 CrossRefPubMed

77.

Scheer CS, Fuchs C, Kuhn S‑O et al (2017) Quality improvement initiative for severe sepsis and septic shock reduces 90-day mortality: a 7.5-year observational study. Crit Care Med 45:241–252. https://doi.org/10.1097/CCM.0000000000002069 CrossRefPubMed

78.

Schmoch T, Bernhard M, Uhle F et al (2017) New sepsis-3 definition: do we have to treat sepsis before we can diagnose it from now on? Anaesthesist. https://doi.org/10.1007/s00101-017-0316-2 CrossRefPubMed

79.

SepNet Critical Care Trials Group (2016) Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study. Intensive Care Med. https://doi.org/10.1007/s00134-016-4504-3 CrossRef

80.

Seymour CW, Gesten F, Prescott HC et al (2017) Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med 376:2235–2244. https://doi.org/10.1056/NEJMoa1703058 CrossRefPubMedPubMedCentral

81.

Seymour CW, Rea TD, Kahn JM et al (2012) Severe sepsis in pre-hospital emergency care: analysis of incidence, care, and outcome. Am J Respir Crit Care Med 186:1264–1271. https://doi.org/10.1164/rccm.201204-0713OC CrossRefPubMedPubMedCentral

82.

Siegler BH, Bernhard M, Brenner T et al (2015) ZVD – adé? Bitte nicht! Anaesthesist 64:489–493. https://doi.org/10.1007/s00101-015-0050-6 CrossRefPubMed

83.

Siegler BH, Weiterer S, Lichtenstern C et al (2014) Einsatz von Biomarkern in der Sepsis. Anaesthesist:1–13. https://doi.org/10.1007/s00101-014-2347-2 CrossRefPubMed

84.

Singer M, Deutschman CS, Seymour CW et al (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315:801–810. https://doi.org/10.1001/jama.2016.0287 CrossRefPubMedPubMedCentral

85.

SSC Executive Committee (2015) Surviving Sepsis Campaign Bundels – Revised 4/2015

86.

Study Investigators (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256. https://doi.org/10.1056/NEJMoa040232 CrossRef

87.

Venkatesh B, Finfer S, Cohen J et al (2018) Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med 378:797–808. https://doi.org/10.1056/NEJMoa1705835 CrossRefPubMed

88.

Vincent JL, Moreno R, Takala J et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710 CrossRef

89.

Vincent J‑L, Quintairos E, Silva A, Couto L, Taccone FS (2016) The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care 20:257. https://doi.org/10.1186/s13054-016-1403-5 CrossRefPubMedPubMedCentral

90.

Williams JM, Greenslade JH, McKenzie JV et al (2016) SIRS, qSOFA and organ dysfunction: insights from a prospective database of emergency department patients with infection. Chest. https://doi.org/10.1016/j.chest.2016.10.057 CrossRefPubMedPubMedCentral

91.

Young P, Bailey M, Beasley R et al (2015) Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: the SPLIT randomized clinical trial. JAMA 314:1701–1710. https://doi.org/10.1001/jama.2015.12334 CrossRefPubMed

Titel: Hämodynamische Stabilisierung des septischen Patienten in der Notaufnahme
Autoren:: Dr. med. T. Schmoch
M. Bernhard
B. H. Siegler
T. Brenner
M. A. Weigand
Publikationsdatum: 12.09.2018
DOI: https://doi.org/10.1007/s10049-018-0515-7
Verlag: Springer Medizin
Zeitschrift: Notfall + Rettungsmedizin Zeitschrift für präklinische und innerklinische Notfallmedizin
Ausgabe 3/2019
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578

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