Title: Other Than Hemodynamic Pearls from the Surviving Sepsis Guideline
题目：2013年国际脓毒症急救指南除血液动力学以外的要素
Author 作者：Feng Xiao

Antibiotics
抗菌素
Early and rapid resuscitation during the first 6 hrs (1C); blood cultures before antibiotic therapy (1C); broad-spectrum antimicrobials within 1 hr of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy.
第一个6小时内的早期和快速的复苏（1C）；给抗菌素前要做血培养（1C）；治疗的目标是在感染性休克（1B）或严重脓毒症没有休克（1C）一小时内给广谱抗菌素。
Hemoglobin
血红蛋白
Hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B).
在没有组织低灌注，缺血性冠状动脉病，或急性出血的情况下，保持血红蛋白在7－9g／dl（1B）。
Mechanical ventilation
呼吸机
Low tidal volume (1A) and inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO2/FIO2 ratio of ≤ 100 mm Hg (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B).
对急性呼吸窘迫综合症（ARDS）要用低潮气量（1A），低吸气平台压（1B），和最少也要有一定的PEEP（1B）；对脓毒症导致的中重度ARDS病人要用高一些的PEEP（2C）；对由ARDS造成的顽固性低氧的脓毒症的病人可采用肺复张手法（2C）；脓毒症ARDS病人如PaCO2／FiO2小于100mmHg时可将病人置俯卧位（2C）；如没有禁忌症，可将机械通气病人的床头抬高（1B）。
Fluid resuscitation
液体复苏
A conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C).
没有组织低灌注迹象的ARDS，液体复苏要保守一些。
IV sedation
静脉镇静剂
Protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B).
要建立停止呼吸机和镇静的方案（1A）；限制间歇性静脉注射或持续静脉滴注镇静药，设定具体的指标（1B）。
Neuromuscular blockers
神经肌肉阻滞剂
Avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 hrs) for patients with early ARDS and a Pao2/Fio2 < 150 mm Hg (2C).
对没有ARDS的脓毒症病人，尽量不要用神经肌肉阻滞剂（1C）；如病人出现早期ARDS并PaO2／FiO2小于150mmHg，可考虑短期应用（不超过48小时）神经肌肉阻滞剂（2C）。
Insulin
胰岛素
Starting insulin when two consecutive blood glucose levels are > 180 mg/dL, targeting an upper blood glucose ≤ 180 mg/dL (1A).
如连续两次血糖水平超过180mg／dl，要开始使用胰岛素，保持最高血糖低于180（1A）。

References 参考文献
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock. Crit Care Med. 2013 Feb;41(2):580-637.