Blood Poisoning (Sepsis): Therapy

Immediately make an emergency call! (Call 112)

The therapy of sepsis (blood poisoning) is complex. In addition to “Drug Therapy,” which is one of the mainstays of therapy, causal therapy and supportive therapy (“Hemodynamic Stabilization” see under “Drug Therapy”) are of great importance.

Causal therapy

Focal therapy

The basic prerequisite for successful therapy is complete early sanitation of the source of infection. Depending on the source, this may involve removal of foreign bodies, placement of drains, miracle opening, etc.

Supportive therapy

Renal replacement procedures

• Administration of diuretics (dehydrating drugs) should be considered only to test the kidney after adequate volume therapy.
• In acute renal failure (ANV) in the setting of sepsis, continuous venovenous hemofiltration (CVVH) is equivalent to intermittent hemodialysis; in hemodynamically unstable patients, CVVH is recommended because it is better tolerated.

Airway management/ventilation

• Pulse oximetry-measured oxygen saturation (SpO2) should be >90%.
• Patients with severe sepsis/septic shock should be ventilated early.
• The following parameters should be maintained:Controlled ventilation:
  • Tidal volume (breath volume, or AZV; is the set volume applied per breath): without ARDS (Acute Respiratory Distress Syndrome/acute respiratory failure) 6-8 ml/kg standard body weight.
  • Plateau pressure (measure of end-inspiratory pressure in alveoli in a flow-free phase): with ARDS < 30 cm H2O.
  • Oxygen saturation (SpO2): > 90%.
• PEEP (engl.: positive end-expiratory pressure; positive end-expiratory pressure) as a function of FiO2 (indicates how high the O2 content in the respiratory air is); according to the S3 guideline, invasively ventilated patients should be ventilated with a PEEP not below 5 cm H2O.
• Ventilate patients with ARDS with a VT ≤ 6 ml/kg standard body weight (bw).Note: Tidal volume (VT) corresponds to air volume per breath.
• In severe oxygenation disorders, prone positioning or 135° positioning should be performed.
• Weaning (to wean; or ventilator weaning is the phase of weaning a ventilated patient from the ventilator) should be started as soon as possible.

Nutrition

• All patients who are not expected to be fully nourished with normal food within three days should receive artificial nutrition (enteral or parenteral nutrition).
• Oral or enteral nutrition is generally given preference over parenteral nutrition.
• Patients with severe sepsis/septic shock should be given 30-50% of non-protein (non-protein) calories as fat; these should not contain exclusively long-chain triglycerides; immunonutrition cannot be recommended.
• A diet containing omega-3 fatty acids in combination with antioxidants may be considered.
• Glutamine dipeptide should be supplemented if the patient is receiving only parenteral nutrition; glutamine should not be fed enterally in patients with severe sepsis/septic shock.
• Stress ulcer prophylaxis with histamine-2 receptor blockers or proton pump inhibitors is recommended.