羟乙基淀粉 vs. 晶 体液治疗脓毒血症
和感染性休克患者 -德国 SepNet
VISEP 试验结果( 英文)1
ICU team
• ICU manager • 7 ICU-Consultants • 28 ICU registrars • 200 ICU nurses
2
ICU
• ICU of tomorrow • New IT concepts
11
Treatment costs for sepsis
- Intensive care units of three university hospitals (Jena, Göttingen, Halle)
n = 388 Mortality 42.6%
ICU-days
16.6
Hospital-days 32.5
12
Estimated costs of sepsis in German intensive care units
Estimated number of ICU days in Germany / year:
3.17 mio. days 5.3 billion € costs for intensive care medicine1
Prevalence and incidence estimates
Patients in German ICUs
(per day)
Mean duration of disease (days)
New cases (per year)
Deaths (per year)
Sepsis
1.742 9,2
~79.000 ~20.000
Burden of organ dysfunction
Prognosis
15
Early Goal-Directed
Therapy
16
Initial Resuscitation
Goals during first 6 hours:
• Central venous pressure: 8–12 mm Hg • Mean arterial pressure 65 mm Hg • Urine output 0.5 mL kg-1/hr-1 • Central venous (superior vena cava) or mixed
80.000 60.000
64.229
59.344
59.117
40.000
39.286 37.579
20.000
20.888 5.739
0 CHD
MI
SepsisHeart
failure Lung
Cancer
StrokePneumonia
Sepsis
88
German Prevalence Study 2003
Direct treatment costs of sepsis 1.77 billion € 2
In Germany, 30% of total costs of intensive care are spent for sepsis treatment.
1 Dtsch. Krankenhaus-Gesellschaft 2 Moerer O et al.,Intensive Care Med 2002; 28: 1440-1446.
established • 50 surgical ICU beds
3
4
Aufenthalte
Entwicklung Patientenzahlen
4000 3500 3000 2500 2000 1500 1000
500 01Biblioteka 9819992000
2001
2002
Jahre
2003
2004
2005
2003 2922 12620 4,33 487567 / 38,63 1691 923
0 1929 (66%)
1373 556
2004 3591 14475 4,03 616401 / 42,45 1715 1090
12 2486 (70%)
1862 624
2005 3797 16426 4,33 653574 / 39,79 2038 1517
17 2654 (70%)
1976 678
6
Epidemiology
7
Most frequent causes of death in Germany 2003
100.000 92.673
PrevalenceStudy SepNet 2003
Federal Agency for Statistics
5
KAI-ICU
Patients Treatmentdays Mean ICU stay TISS-28 total / average Bronchoscopies Dialysisdays Liver replcement therapydays Ventilated patients
< 24 h > 24 h
70%
60%
7%
50%
40%
7%
54%
7%
30%
20%
40%
55%
47%
10%
0%
severe sepsis
septic shock
severe sepsis / septic shock
* 454 ICUs (310 hospitals) representative for 1380 hospitals (490.000 beds), 2.075 ICUs (19.000 beds)
Severe sepsis / septic shock
1.545
Total
3.287
8,5 ~75.000 ~40.000
~154.000 ~60.000
10
German Prevalence Study 2003
Mortality
Prozent
100% 90%
ICU
Hospital
80%
p = 0,004
13
Volume replacement
14
Delayed treatment = increased mortality: diagnosis, diagnosis, diagnosis, …
Delay in diagnosis Pre-hospital ED
Ward
Start of ICU treatment
Average treatment costs Survivors Non-survivors
per patient
25,695 € 24,014 € 28,503 €
per day
1,454 € 1,269 € 1,848 €
Moerer O et al.,Intensive Care Med 2002; 28: 1440-1446.