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Lignes directrices de l’Association canadienne des médecins d’urgence sur le sepsis : la prise en charge optimale du sepsis grave dans les départements d’urgence canadiens

  • Robert S. Green (a1), Dennis Djogovic (a2), Sara Gray (a3), Daniel Howes (a4), Peter G. Brindley (a2), Robert Stenstrom (a5), Edward Patterson (a6), David Easton (a7), Jonathan S. Davidow (a2) and au nom du comité C4 (pour CAEP Critical Care Interest Group)...

Résumé

Introduction:

La prise en charge optimale du sepsis grave dans les départements d'urgence a connu une évolution rapide. Le but des présentes lignes directrices est de revoir pour le bénéfice des médecins d'urgence canadiens les principes clés qui régissent la prise en charge du sepsis grave en se fondant sur un système de classification fondé sur des preuves.

Méthodes:

Ce sont les membres du comité de l'ACMU pour les soins critiques, ou comité C4 (pour CAEP Critical Care Interest Group) qui ont déterminé les secteurs clés de la prise en charge des patients atteints de sepsis. Chaque membre du C4 avait pour tâche de répondre à une question qui lui avait été assignée après avoir fait un survol de la littérature établie selon le système de classification Oxford, après quoi, chaque secteur faisait l'objet d'une seconde révision par un autre membre du C4. D'autres experts de l'extérieur ont procédé à un troisième examen et les modifications ont été déterminées par voie de consensus. La classification reposait sur des publications révisées par des pairs uniquement, et là où les preuves étaient insuffisantes pour répondre à une question importante, le groupe a proposé un «point pratique».

Résultats:

Le projet a débuté en 2005 et a pris fin en décembre 2007. Les secteurs clés qui ont été passés en revue incluent la définition du terme sepsis, l'utilisation des interventions effractives, la réanimation liquidienne, l'utilisation d'agents vasopresseurs/inotropes, l'importance des prélèvements pour culture aux départements d'urgence, l'antibiothérapie et le contrôle des sources. Parmi les autres secteurs examinés, mentionnons l'utilisation des corticostéroïdes, la protéine C activée, les transfusions et la ventilation mécanique.

Conclusion:

La prise en charge précoce du sepsis dans les départements d'urgence est extrêmement importante pour améliorer le pronostic des patients. L'énoncé de position du C4 sur le sepsis fournit un cadre de travail afin d'améliorer les soins prodigués à cette population de patients dans les départements d'urgence.

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Corresponding author

CAEP Critical Care Interest Group; 1278 Chemin Tower, bureau 349, édifice Bethune, Halifax N.-É. B3H 2Y9; greenrs@dal.ca

References

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Lignes directrices de l’Association canadienne des médecins d’urgence sur le sepsis : la prise en charge optimale du sepsis grave dans les départements d’urgence canadiens

  • Robert S. Green (a1), Dennis Djogovic (a2), Sara Gray (a3), Daniel Howes (a4), Peter G. Brindley (a2), Robert Stenstrom (a5), Edward Patterson (a6), David Easton (a7), Jonathan S. Davidow (a2) and au nom du comité C4 (pour CAEP Critical Care Interest Group)...

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