Abstract
PurposesAn abdominal inflammatory focus is the second most often source of sepsis with a high risk of death in surgical intensive care units. By establishing evidence-based bundled strategies the surviving sepsis campaign provided an optimized rapid and continuous treatment of these emergency patients. Hereby the hospital mortality decreased from 35 to 30 %. Sepsis treatment is based on three major therapeutic elements: surgical treatment (source control), antiinfective treatment, and supportive care. The international guidelines of the surviving sepsis campaign were updated recently and recommend rapid diagnosis of the infection and source control within the first 12 h after the diagnosis (grade 1c). Interestingly this recommendation is mainly based on studies on soft tissue infections.MethodsIn this retrospective analysis 76 septic patients with an intraabdominal inflammatory focus were included. All patients underwent surgery at different time-points after diagnosis.ResultsWith 80 % patients of the early intervention group had an improved overall survival (vs. 73 % in the late intervention group).ConclusionsLiterature on the time dependency of early source control is rare and in part contradicting. Results of this pilot study reveal that immediate surgical intervention might be of advantage for septic emergency patients. Further multi-center approaches will be necessary to evaluate, whether the TTI has any impact on the outcome of septic patients with intestinal perforation.
Highlights
Despite modern diagnostic and therapeutic developments the in-hospital mortality of septic patients still remains inacceptably high
Literature on the time dependency of early source control is rare and in part contradicting. Results of this pilot study reveal that immediate surgical intervention might be of advantage for septic emergency patients
Further multi-center approaches will be necessary to evaluate, whether the time to intervention (TTI) has any impact on the outcome of septic patients with intestinal perforation
Summary
Despite modern diagnostic and therapeutic developments the in-hospital mortality of septic patients still remains inacceptably high. With 60 % mortality rates in cases of severe sepsis and septic shock a continuous optimization of treatment and rapid diagnosis is necessary and life-saving. In up to 25 % of all septic patients an intraabdominal inflammation can be detected [1]. Results of the PROWESS study reveal, that in 66,5 % of the surgical patients. In February 2013 the new Surviving Sepsis Guideline was published, which underlines the multimodal, rapid treatment for the septic patient with an intraabdominal focus [5]. According to the recent guideline the sepsis therapy can be subdivided into four different subtypes: surgical source control, the antiinfectious therapy, the supportive intensive care medicine and adjunctive therapeutic approaches
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