2021版脓毒症和脓毒症休克国际指南学习思维导图

U377008251

2024-09-10

浏览量: 39

疾病治疗

液体管理

药物治疗

脓毒症定义，诊断筛查，抗感染治疗等内容讲解

树图思维导图提供《2021版脓毒症和脓毒症休克国际指南学习》在线思维导图免费制作，点击“编辑”按钮，可对《2021版脓毒症和脓毒症休克国际指南学习》进行在线思维导图编辑，本思维导图属于思维导图模板主题，文件编号是：24d3ace7f585b138d5cdadbc5b739bd8

思维导图大纲

脓毒症定义

脓毒症是由感染引起的危机生命的器官功能障碍。

脓毒症的诊断和筛查

诊断标准（如qSOFA、SIRS等）

The qSOFA uses 3 variables to predict death and prolonged ICU stay in patients with known or suspected sepsis: a Glasgow Coma Score < 15, a respiratory rate ≥ 22 breaths/min and a systolic blood pressure ≤ 100 mmHg. When any two of these variables are present simultaneously the patient is considered to be qSOFA positive.qSOFA使用3个变量预测已知或疑似脓毒症患者的死亡和ICU住院时间延长：格拉斯哥昏迷评分< 15，呼吸频率≥ 22次/min和收缩压≤ 100 mmHg。当这些变量中的任何两个同时存在时，患者被认为是qSOFA阳性。

筛选工具

2. We recommend against using qSOFA compared to SIRS, NEWS, or MEWS as a single screening tool for sepsis or septic shock Strong recommendation, moderate-quality evidence2.与SIRS、NEWS或MEWS相比，我们不建议使用qSOFA作为脓毒症或脓毒性休克的单一筛查工具。强烈建议，中等质量的证据

3. For adults suspected of having sepsis, we suggest measuring blood lactate Weak recommendation, low-quality evidence3.对于疑似脓毒症的成人，我们建议测量血乳酸。

抗感染治疗

11For adults with suspected sepsis or septic shock but unconfirmed infection, we recommend continuously reevaluating and searching for alternative diagnoses and discontinuing empiric antimicrobials if an alternative cause of illness is demonstrated or strongly suspected 11.对于疑似脓毒症或脓毒性休克但未确认感染的成人，我们建议持续重新评估和寻找其他可能诊断，如果证实或强烈怀疑疾病的其他原因，则停用经验性抗生素。

感染的诊断

12. For adults with possible septic shock or a high likelihood for sepsis, we recommend administering antimicrobials immediately, ideally within 1 h of recognition Strong recommendation,12.对于可能出现感染性休克或很可能出现败血症的成人，我们建议立即使用抗菌药物，最好在发现后1小时内使用。

抗生素使用时机

13For adults with possible sepsis without shock, we recommend rapid assessment of the likelihood of infectious versusnon infectious causes of acute illness 13.对于可能患有败血症但没有休克的成人，我们建议快速评估急性疾病可能的感染性和非感染性原因。

14. For adults with possible sepsis without shock, we suggest a timelimited course of rapid investigation and if concern for infection persists, the administration of antimicrobials within 3 h from the time when sepsis was first recognised 14.对于可能患有败血症但没有休克的成人，我们建议进行限时快速调查，如果持续怀疑感染存在，则在首次发现败血症后3小时内使用抗菌药物。

15. For adults with a low likelihood of infection and without shock, we suggest deferring antimicrobials while continuing to closely monitor the patient. 15.对于感染可能性低且无休克的成人，我们建议在继续密切监测患者的同时，缓用抗生素。

16.For adults with suspected sepsis or septic shock, we suggest against using procalcitonin plus clinical evaluation to decide when to start antimicrobials, as compared to clinical evaluation alone 16.对于疑似脓毒症或脓毒性休克的成人，我们建议不要使用降钙素原临联合床评估来决定何时开始使用抗菌药物，而只使用临床评估。

开始使用抗生素的生物标记物

17.For adults with sepsis or septic shock at high risk of methicillin-resistant staph aureus (MRSA), we recommend using empiric antimicrobials with MRSA coverage over using antimicrobials without MRSA coverage Best Practice Statement 17.对于具有耐甲氧西林金黄色葡萄球菌(MRSA)高风险的脓毒症或脓毒性休克成人，我们建议经验性覆盖MRSA的经验性抗菌药物，而不是使用不覆盖MRSA的抗菌药物。

抗菌药物选择

18.For adults with sepsis or septic shock at low risk of methicillin resistant staph aureus (MRSA), we suggest against using empiric antimicrobials with MRSA coverage, as compared with using antimicrobials without MRSA coverage 18.对于具有耐甲氧西林金黄色葡萄球菌(MRSA)低风险的脓毒症或脓毒性休克的低风险耐甲氧西林金黄色葡萄球菌(MRSA)的成人，我们建议不要经验性使用覆盖MRSA的抗菌药物，而使用不覆盖MRSA的抗菌药物。

19. For adults with sepsis or septic shock and high risk for multidrug resistant (MDR) organisms, we suggest using two antimicrobials with gramnegative coverage for empiric treatment over one gramnegative agent 19.对于患有脓毒症或脓毒性休克以及多重耐药(MDR)微生物高风险的成人，我们建议使用两种覆盖革兰氏阴性菌的抗菌药物进行经验性治疗，而不是一种。

20. For adults with sepsis or septic shock and low risk for MDR organisms, we suggest against using twoGramnegative agents for empiric treatment,ascompared to one Gramnegative agent 20.对于患有脓毒症或脓毒性休克且MDR风险较低的成人，我们建议不要使用两种覆盖革兰氏阴性菌的抗菌药物进行经验性治疗，而使用一种。

21. For adults with sepsis or septic shock, we suggest against using double gramnegative coverage once the causative pathogen and the susceptibilities are known 21.对于患有脓毒症或脓毒性休克的成人，我们建议一旦明确致病病原体和药敏结果，不需使用两种覆盖革兰氏阴性菌的抗菌药。

22. For adults with sepsis or septic shock at high risk of fungal infection, we suggest using empiric antifungal therapy over no antifungal therapy 22.对于有真菌感染高风险的成人脓毒症或脓毒性休克患者，我们建议使用经验性抗真菌治疗。

抗真菌疗法

23. For adults with sepsis or septic shock at low risk of fungal infection, we suggest against empiric use of antifungal therapy 23.对于真菌感染低风险的脓毒症或脓毒性休克的成人，我们建议不要经验性使用抗真菌治疗。

24. We make no recommendation on the use of antiviral agents24.在抗病毒药物使用方面，我们没有推荐意见。

25. For adults with sepsis or septic shock, we suggest using prolonged infusion of betalactams for maintenance (after an initial bolus) over conventional bolus infusion 25.对于患有脓毒症或脓毒性休克的成人，我们建议延长β-内酰胺类药物的输注时间(初始推注后)，而不是常规的推注。

抗生素的输注

26. For adults with sepsis or septic shock, we recommend optimising dosing strategies ofantimicrobialasedonaccepted pharmacokinetic/pharmacodynamic (PK/PD) principles and specific drug properties26.对于脓毒症或脓毒性休克成人患者，我们建议根据公认的药代动力学/药效动力学(PK/PD)原则和具体的药物特性优化抗菌药物的给药剂量。

药代动力学和药效动力学

27. For adults with sepsis or septic shock, we recommend rapidly identifying or excluding a specific anatomical diagnosis of infection that requires emergent source control and implementing any required source control intervention as soon as medically and logistically practical 27.对于患有脓毒症或脓毒性休克的成人，我们建议快速识别或排除需要紧急控制的特定感染源的解剖学诊断，并在医疗和后勤保障下尽快实施控制感染源的干预。

感染源控制

28. For adults with sepsis or septic shock, we recommend prompt removal of intravascular access devices that are a possible source of sepsis or septic shock after other vascular access has been established 28.对于患有脓毒症或脓毒性休克的成人，我们建议在建立其他血管通路后，立即移除可能导致脓毒症或脓毒性休克的血管内通路装置。

29. For adults with sepsis or septic shock, we suggest daily assessment for deescalation of antimicrobials over using fixed durations of therapy without daily reassessment for deescalation 29.对于患有脓毒症或脓毒性休克的成人，我们建议每日评估抗菌药物的降级，而不是使用固定疗程的抗感染治疗而不每日重新评估降级。

抗生素降级

30. For adults with an initial diagnosis of sepsis or septic shock and adequate source control, we suggest using shorter over longer duration of antimicrobial therapy 30.对于初步诊断为败血症或脓毒性休克且有感染源得以充分控制的成人，我们建议使用持续时间较短而不是较长的抗菌治疗。

31. For adults with an initial diagnosis of sepsis or septic shock and adequate source control where optimal duration of therapy is unclear, we suggest using procalcitonin AND clinical evaluation to decide when to discontinue antimicrobials over clinical evaluation alone 31.对于初次诊断为脓毒症或脓毒性休克且感染源得到充分控制的成人患者，在最佳疗程不明确的情况下，我们建议使用降钙素原和临床评估来决定何时停用抗菌药物，而不是仅通过临床评估

停用抗生素的生物标志物

液体管理

4. Sepsis and septic shock are medical emergencies, and we recommend that treatment and resuscitation begin immediately Best Practice Statement 14.脓毒症和脓毒性休克是医疗紧急情况，我们建议立即开始治疗和复苏。对于脓毒症诱导的低灌注或脓毒性休克患者，我们建议在复苏的前3小时内给予至少30 mL/kg的静脉（IV）晶体液。

抗生素的持续时间

5. For patients with sepsis induced hypoperfusion or septic shock we suggest that at least 30 mL/kg of intravenous (IV) crystalloid fluid should be given within the first 3 h of resuscitation Weak recommendation, low-quality evidence5..对于脓毒症引起的低灌注或脓毒性休克患者，我们建议在复苏后的前3小时内静脉（IV）给予至少30 mL/kg的晶体液弱建议，低质量证据

6. For adults with sepsis or septic shock, we suggest using dynamic measures to guide fluid resuscitation, over physical examination or static parameters alone Weak recommendation, very low-quality evidence6.对于患有脓毒症或脓毒性休克的成人，我们建议使用动态措施来指导液体复苏，而不是单独进行体格检查或静态参数。

7. For adults with sepsis or septic shock, we suggest guiding resuscita‑ tion to decrease serum lactate in patients with elevated lactate level, over not using serum lactate Weak recommendation, low-quality evidence7。对于脓毒症或脓毒性休克的成人患者，我们建议指导复苏以降低乳酸水平升高患者的血清乳酸，而不是不使用血清乳酸。

8. For adults with septic shock, we suggest using capillary refill time to guide resuscitation as an adjunct to other measures of perfusion Weak recommendation, low-quality evidence8.对于成人感染性休克患者，我们建议使用毛细血管再充盈时间指导复苏，作为其他灌注指标的辅助手段。

9. For adults with septic shock on vasopressors, we recommend an initial target mean arterial pressure (MAP) of 65 mm Hg over higher MAP targets Strong recommendation, moderate-quality evidence9.对于接受血管加压药治疗的感染性休克成人患者，我们建议初始平均动脉压（MAP）目标值为65 mmHg，高于较高的MAP目标值。强烈建议，中等质量证据。

32. For adults with sepsis or septic shock, we recommend using crystalloids as first-line fluid for resuscitation 32.对于患有脓毒症或脓毒性休克的成人，我们建议使用晶体作为一线复苏液体。

33. For adults with sepsis or septic shock, we suggest using balanced crystalloids instead of normal saline for resuscitation 33.对于成人脓毒症或脓毒性休克，我们建议使用平衡晶体液而不是生理盐水进行复苏。

34. For adults with sepsis or septic shock, we suggest using albumin in patients who received large volumes of crystalloids over using crystalloids alone 34.对于患有脓毒症或脓毒性休克的成人，我们建议在接受大量晶体液的患者中使用白蛋白，而不是单独使用晶体液。

35. For adults with sepsis or septic shock, we recommend against using starches for resuscitation 35.对于患有脓毒症或脓毒性休克的成人，我们建议不要使用人工胶体进行复苏。

36. For adults with sepsis and septic shock, we suggest against using gelatin for resuscitation 36.对于成人败血症和感染性休克，我们建议不要使用明胶进行复苏。

血管活性药物

37. For adults with septic shock, we recommend using norepinephrine as the first ‑line agent over other vasopressors. Strong recommendation Dopamine. High quality evidence Vasopressin. Moderate ‑quality evidence Epinephrine. Low‑ quality evidence Selepressin. Low-quality evidence Angiotensin II. Very low-quality evidence 血管活性药物 37.对于感染性休克的成人，我们建议使用去甲肾上腺素作为一线药物，而不是其他升压药。强推荐多巴胺：证据质量高血管加压素：证据质量中等肾上腺素：证据质量低选择性血管加压素：证据质量低血管紧张素II：证据质量非常低

38. For adults with septic shock on norepinephrine with inadequate MAP levels, we suggest adding vasopressin instead of escalating the dose of norepinephrine Weak recommendation, moderate-quality evidence Remark In our practice, vasopressin is usually started when the dose of norepi‑ nephrine is in the range of 0.25–0.5 μg/kg/min 38.对于使用去甲肾上腺素MAP不理想的感染性休克的成人，我们建议加用加压素而不是增加去甲肾上腺素的剂量。弱推荐，证据质量中等注意在我们的实践中，当去甲肾上腺素的剂量在0.25–0.5μg/kg/min范围内时，通常开始使用加压素。

39. For adults with septic shock and inadequate MAP levels despite norepinephrine and vasopressin, we suggest adding epinephrine。 Weak recommendation, low-quality evidence 39.对于感染性休克和MAP不理想的成人，尽管使用了去甲肾上腺素和血管加压素，我们建议加用肾上腺素。弱推荐，证据质量低

40. For adults with septic shock, we suggest against using terlipressin Weak recommendation, low quality of evidence 40.对于感染性休克的成人，我们建议不要使用特利加压素。弱推荐，证据质量低

41. For adults with septic shock and cardiac dysfunction with persistent hypoperfusion despite adequate volume status and arterial blood pressure, we suggest either adding dobutamine to norepinephrine or using epinephrine alone Weak recommendation, low quality of evidence 强心药 41.对于感染性休克和心脏功能不全的成年患者，尽管容量状态和动脉血压尚可，但仍存在持续低灌注时，我们建议在去甲肾上腺素中加入多巴酚丁胺或单独使用肾上腺素。弱推荐，证据质量低

42. For adults with septic shock and cardiac dysfunction with persistent hypoperfusion despite adequate volume status and arterial blood pres‑ sure, we suggest against using levosimendan Weak recommendation, low quality of evidence 42.对于脓毒性休克和心脏功能不全的成年患者，尽管有足够的容量和动脉血压，但仍存在持续低灌注，我们建议不要使用左西孟旦。弱推荐，证据质量低

43. For adults with septic shock, we suggest using invasive monitoring of arterial blood pressure over non‑invasive monitoring, as soon as practical and if resources are available Weak recommendation, very low quality of evidence 监控和静脉注射 43.对于感染性休克的成人，我们建议在可行且资源允许的情况下，尽快使用有创动脉血压监测而不无创监测。弱推荐，证据质量非常低

44. For adults with septic shock, we suggest starting vasopressors peripherally to restore MAP rather than delaying initiation until a central venous access is secured Weak recommendation, very low quality of evidence Remark When using vasopressors peripherally, they should be administered only for a short period of time and in a vein in or proximal to the antecubital fossa 44.对于感染性休克的成人，我们建议从外周开始使用升压药来恢复平均动脉压，而不是等到中心静脉通路备全后再开始使用。弱推荐，证据质量非常低注意当在外周使用血管加压药时，只能在短时间内通过肘前窝内或肘前窝附近的静脉给药。

45. There is insufficient evidence to make a recommendation on the use of restrictive versus liberal fluid strategies in the first 24 h of resuscitation in patients with sepsis and septic shock who still have signs of hypoperfusion and volume depletion after initial resuscitation. Remarks Fluid resuscitation should be given only if patients present with signs of hypoperfusion 液体平衡 45.对于初次复苏后仍有低灌注和容量衰竭迹象的脓毒症和脓毒性休克患者，没有足够的证据推荐在复苏的第一个24小时内使用限制性或开放性液体策略。注意只有当病人出现灌注不足的症状时，才应该进行液体复苏。

机械通气与氧疗

46. There is insufficient evidence to make a recommendation on the use of conservative oxygen targets in adults with sepsis‑induced hypoxemic respiratory failure 46.没有足够的证据推荐在脓毒症导致的低氧性呼吸衰竭的成人中使用保守的氧合目标。

机械通气氧合目标

47. For adults with sepsis‑induced hypoxemic respiratory failure, we suggest the use of high flow nasal oxygen over non‑invasive ventilation 47.对于脓毒症导致的低氧性呼吸衰竭的成人，我们建议使用经鼻高流量氧疗而非无创通气。

经鼻高流量氧疗

48. There is insufficient evidence to make a recommendation on the use of non‑invasive ventilation in comparison to invasive ventila‑ tion for adults with sepsis‑induced hypoxemic respiratory failure 48.没有足够的证据推荐使用无创通气还是有创通气治疗脓毒症导致的低氧性呼吸衰竭。

无创通气

49.对于脓毒症导致的成人ARDS，我们建议使用低潮气量通气策略(6 mL/kg)，而不是高潮气量策略(> 10 mL/kg)。

50. For adults with sepsis‑induced severe ARDS, we recommend using an upper limit goal for plateau pressures of 30 cm H2O, over higher plateau pressures Strong recommendation, moderate quality of evidence 50.对于脓毒症诱发的严重急性呼吸窘迫综合征的成人患者，我们建议以30cmH2O为平台压力上限目标，而不是更高的平台压力。 5

51. For adults with moderate to severe sepsis‑induced ARDS, we suggest using higher PEEP over lower PEEP 51.对于中度至重度脓毒症诱发的成人ARDS，我们建议使用较高的PEEP而不是较低的PEEP。

52. For adults with sepsis‑induced respiratory failure (without ARDS), we suggest using low tidal volume as compared to high tidal volume ventilation 非ARDS呼吸衰竭的低潮气量 52.对于脓毒症诱发的呼吸衰竭(无ARDS)的成人患者，我们建议使用低潮气量而不是高潮气量通气。

53. For adults with sepsis‑induced moderate‑severe ARDS, we suggest using traditional recruitment maneuvers 53.对于脓毒症诱发的中重度ARDS成人患者，我们建议使用传统的肺复张策略。

肺复张策略

54. When using recruitment maneuvers, we recommend against using incremental PEEP titration/strategy 54.当使用复张策略时，我们建议不要使用增量呼气末正压的滴定措施或策略。

55. For adults with sepsis‑induced moderate‑severe ARDS, we recommend using prone ventilation for more than 12 h daily 55.对于患有败血症诱发的中重度ARDS的成人，我们建议每天使用俯卧通气超过12小时

俯卧位通气

56. For adults with sepsis induced moderate ‑severe ARDS, we suggest using intermittent NMBA boluses, over NMBA continuous infusion Weak recommendation, moderate quality of evidence 56.对于成人脓毒症诱发的中重度ARDS，我们建议使用间歇性推注NMBA，而不是持续输注NMBA。

神经肌肉阻断剂（NMBA）

57. For adults with sepsis‑induced severe ARDS, we suggest using veno ‑ venous (VV) ECMO when conventional mechanical ventilation fails in experienced centers with the infrastructure in place to support its use 57.对于脓毒症诱发的严重急性呼吸窘迫综合征成人患者，我们建议在有基础设施支持的经验丰富的中心，当常规机械通气失败时，使用VV-ECMO。

体外膜肺氧合(ECMO)

其他治疗

58. For adults with septic shock and an ongoing requirement for vasopressor therapy we suggest using IV corticosteroids 其他疗法糖皮质激素 58.对于感染性休克且持续需要血管收缩药升压治疗的成人，我们建议使用静脉注射糖皮质激素。

59. For adults with sepsis or septic shock, we suggest against using polymyxin B haemoperfusion 59.对于患有脓毒症或脓毒性休克的成人，我们建议不要使用多粘菌素B血液灌流。

血液净化

60. There is insufficient evidence to make a recommendation on the use of other blood purification techniques 60.没有足够的证据推荐使用其他血液净化技术。

61. For adults with sepsis or septic shock, we recommend using a restrictive (over liberal) transfusion strategy 61.对于患有脓毒症或脓毒性休克的成人，我们建议使用限制性(而不是开放性)输血策略。

红细胞(RBC)输血目标

62. For adults with sepsis or septic shock, we suggest against using intravenous immunoglobulins 62.对于成人脓毒症或脓毒性休克，我们建议不要使用静脉注射免疫球蛋白。

免疫球蛋白类

63. For adults with sepsis or septic shock, and who have risk factors for gastrointestinal (GI) bleeding, we suggest using stress ulcer prophylaxis 63.对于患有脓毒症或脓毒性休克的成年人，以及有胃肠道出血危险因素的成年人，我们建议预防应激性溃疡。

预防应激性溃疡

For adults with sepsis or septic shock, we recommend using pharmacologic VTE prophylaxis unless a contraindication to such therapy exists 对于患有脓毒症或脓毒性休克的成人，我们建议使用药物预防VTE预防，除非存在此类治疗的禁忌症。

静脉血栓栓塞(VTE)预防

65. For adults with sepsis or septic shock, we recommend using low molecular weight heparin (LMWH) over unfractionated heparin (UFH) for VTE prophylaxis 65.对于成人脓毒症或脓毒性休克，我们建议使用低分子量肝素(LMWH)而非普通肝素(UFH)预防VTE。

66. For adults with sepsis or septic shock, we suggest against using mechanical VTEprophylaxis in addition to pharmacological prophy laxis, over pharmacologic prophylaxis alone 66.对于患有脓毒症或脓毒性休克的成人，我们建议不要在药物预防的基础上再使用机械预防VTE。

67. In adults with sepsis or septic shock and AKI who require renal replacement therapy, we suggest using either continuous or intermittent renal replacement therapy 67.对于需要肾脏替代治疗的成人脓毒症或脓毒性休克和AKI患者，我们建议使用连续或间断肾脏替代治疗。

肾脏替代疗法

68. In adults with sepsis or septic shock and AKI, with no definitive indications for renal replacement therapy, we suggest against using renal replacement therapy 68.对于患有脓毒症或脓毒性休克和AKI的成人，没有明确的肾脏替代治疗指征，我们建议不要使用肾脏替代治疗

69. For adults with sepsis or septic shock, we recommend initiating insulin therapy at a glucose level of ≥ 180 mg/dL (10 mmol/L) 69.对于患有脓毒症或脓毒性休克的成人，我们建议在血糖水平≥ 180 mg/dL (10 mmol/L)时开始胰岛素治疗。

胰岛素治疗

70.Weak recommendation, low quality of evidence 70.对于患有败血症或脓毒性休克的成人，我们建议不要静脉注射维生素C。

维生素C

71. For adults with septic shock and hypoperfusioninduced lactic acidemia, we suggest against using sodium bicarbonate therapy to improve haemodynamics or to reduce vasopressor requirements 71.对于感染性休克和低灌注诱导的乳酸血症的成人，我们建议不要使用碳酸氢钠治疗来改善血液动力学或减少血管加压药的需求

碳酸氢盐疗法

72. For adults with septic shock, severe metabolic acidemia (pH ≤ 7.2) and AKI (AKIN score 2 or 3), we suggest using sodium bicarbonate therapy 72.对于感染性休克、严重代谢性酸血症(pH ≤ 7.2)和AKI (AKIN评分2或3)的成人，我们建议使用碳酸氢钠治疗。

73. For adult patients with sepsis or septic shock who can be fed enter ally, we suggest early (within 72 h) initiation of enteral nutrition 73.对于可以肠内喂养的成人脓毒症或脓毒性休克患者，我们建议早期(72小时内)开始肠内营养

营养

74. For adults with sepsis or septic shock, we recommend discussing goals of care and prognosis with patients and families over no such discussion 74.对于患有脓毒症或脓毒性休克的成人，我们建议与患者和家属讨论治疗和预后目标。

治疗目标

75. For adults with sepsis or septic shock, we suggest addressing goals of care early (within 72 h) over late 75.对于患有脓毒症或脓毒性休克的成人，我们建议尽早(72小时内)关注治疗目标。

77. For adults with sepsis or septic shock, we recommend integrating principles of palliative care (which may include palliative care consultation based on clinician judgement) into the treatment plan, when appropriate, to address patient and family symptoms and suffering 77.对于患有脓毒症或脓毒性休克的成人，我们建议在适当的时候将姑息治疗的原则(可能包括基于临床医生判断的姑息治疗咨询)纳入治疗计划，以解决患者和家属的症状和痛苦。

姑息治疗

82. For adults with sepsis or septic shock and their families, we recommend screening for economic and social support (including housing, nutritional, financial, and spiritual support), and make referrals where available to meet these needs Best Practice Statement 82.对于患有脓毒症或脓毒性休克的成年人及其家人，我们建议筛查经济和社会支持(包括住房、营养、经济和精神支持)，并在可行的情况下进行转诊以满足这些需求。

经济或社会支持和筛查

病人和家属的脓毒症教育

83. For adults with sepsis or septic shock and their families, we suggest offering written and verbal sepsis education (diagnosis, treatment, and post ICU/post sepsis syndrome) prior to hospital discharge and in the followup setting 83.对于患有脓毒症或脓毒性休克的成人及其家属，我们建议在出院前和随访期间提供书面和口头的脓毒症教育(诊断、治疗和ICU后/脓毒症后综合征)。

84. For adults with sepsis or septic shock and their families, we recommend the clinical team provide the opportunity to participate in shared decision making in postICU and hospital discharge planning to ensure discharge plans are acceptable and feasible 84.对于患有脓毒症或脓毒性休克的成人及其家属，我们建议临床团队提供其参与共同决策转出ICU和出院后计划的机会，以确保出院计划是可接受的和可行的。

共同决策

85. For adults with sepsis and septic shock and their families, we suggest using a critical care transition programme, compared to usual care, upon transfer to the floor 85.对于患有败血症和感染性休克的成年人及其家人，我们建议在转移到基层时采用危重病治疗过渡方案，而不是常规治疗方案。

出院计划

86. For adults with sepsis and septic shock, we recommend reconciling medications at both ICU and hospital discharge 86.对于成人败血症和感染性休克，我们建议在转出ICU和出院时调整药物治疗。

87. For adult survivors of sepsis and septic shock and their families, we recommend including information about the ICU stay, sepsis and related diagnoses, treatments, and common impairments after sepsis in the written and verbal hospital discharge summary 87.对于脓毒症和脓毒性休克的成年幸存者及其家人，我们建议在书面和口头出院总结中包括关于ICU住院时间、脓毒症和相关诊断、治疗以及脓毒症后常见功能损伤的信息。

88. For adults with sepsis or septic shock who developed new impairments, we recommend hospital discharge plans include followup with clinicians able to support and manage new and longterm sequelae 88.对于新发器官功能损害的成人脓毒症或脓毒性休克患者，我们建议出院计划中包括对临床医生的随诊，随诊的医生应具备支持和处理新的长期后遗症的能力。

90. There is insufficient evidence to make a recommendation on early cognitive therapy for adult survivors of sepsis or septic shock 90.没有足够的证据建议对脓毒症或脓毒性休克的成年幸存者提出早期认知治疗

认知疗法

91. For adult survivors of sepsis or septic shock, we recommend assess ment and followup for physical, cognitive, and emotional problems after hospital discharge 91.对于脓毒症或脓毒性休克的成年幸存者，我们建议出院后对身体、认知和情绪问题进行评估和随访。

子主题 1