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1 The Japanese guidelines for the Management of sepsis sepsis Registry 1 sepsis Registry Royal Brisbane and Women's Hospital, Department of Intensive Care Medicine The University of Queensland, UQ Centre for Clinical Research 2 COI 2012 11 6 3 4 6 1.

2 9 2. 14 3. 17 4. 36 5. 39 6. 48 7. 56 8. 60 9. 72 10. DIC 79 11. 88 12. 100 13. 106 109 4 surviving sepsis campaign guidelines (SSCG) critical care 2004 [1] 2008 [2] 2 2012 Society of Critical Care Medicine, Annual Meeting 2008 SSCG randomized controlled trial: RCT severe sepsis septic shock SSCG [3,4] innate immunity cytokine RCT RCT SSCG RCT sepsis humoral mediator continuous hemodiafiltration (CHDF) SSCG proinflammatory cytokine high mobility group box 1 protein (HMGB1)

3 Severe sepsis , septic shock RCT critical care RCT [5] sepsis Registry severe sepsis , septic shock SSCG infection-induced SIRS severe sepsis , septic shock [6] SSCG 2 severe sepsis , septic shock sepsis 2 critical care sepsis severe sepsis 5 1.

4 Dellinger RP, Cartlet JM, Masur H, et al. surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-72. 2. Dellinger RP, Levy MM, Carlet JM, et al. surviving sepsis campaign : International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36:296 327. 3. Revise surviving sepsis campaign guidelines 2008;5:301-11. 4. surviving sepsis campaign guidelines 2009;43:161-5. 5. Vincent JL. We should abandon randomized controlled trials in the intensive care unit. Crit Care Med 2010;38:S534-8. 6. Vincent JL. Dear SIRS, I'm sorry to say that I don't like Crit Care Med 1997;25:372-4. 6 sepsis Registry EBM sepsis Registry 1 2007 10 1 12 31 47 226 2 2009 10 1 2010 3 31 39 310 2000 PubMed Medline(Ovid)

5 Cochran Database of Systematic Reviews sepsis severe sepsis septic shock Web RCT RCT RCT 13 CQ 3-5 1 CQ SSCG2008[1-3] 2011 [4] A RCT B RCT C D 1 100 RCT 1000 7 RCT sepsis Registry SSCG2008 GRADE 2 2 GRADE A A GRADE B A GRADE C B GRADE D C CQ answer.

6 A 2 GRADE 3 4 8 * 1. Dellinger RP, Levy MM, Carlet JM, et al. surviving sepsis campaign : International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36:296-327. 2. GRADE working group. Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490-8. 3. Guyatt G, Gutterman D, Baumann MH, et al. Grading strength of recommendations and quality of evidence in clinical guidelines : report from an American College of Chest Physicians task force.

7 Chest 2006;129:174-81. 4. 2011 2012;29:75-120. 9 CQ1 A1 sepsis systemic inflammatory response syndrome: SIRS infection-induced SIRS SIRS 4 2 1C 1 38 C 36 C 2 90 / 3 20 / PaCO2 32 Torr 4 12,000mm3 4,000mm3 band 10 1C (1C) 38 C 36 C 90/ 2SD 20 / 24 20mL/kg 120mg/dL WBC 12000/ L WBC 4000/ L 10% CRP * , IL-6 ( 1,000pg/mL*) 90mmHg 70mmHg 40mmHg SD 10 PaO2/FIO2 300 Cre PT-INR aPTT 60 100,000/ L T-Bil 4mg/dL 2mmol/L * 1989 Bone sepsis syndrome [1] 1991 Society of Critical Care Medicine (SCCM)/American College of Chest Physicians (ACCP)

8 1992 [2] SIRS 10 SCCM/ESICM/ACCP/ATS/SIS 2003 [3] infection-induced SIRS Weiss [4] 2003 1992 1992 ( Clostridium difficile ) 2003 CDC [5] International sepsis Forum (ISF) [6] 1.

9 Bone RC, Fisher Jr CJ, Clemmer TP, et al. sepsis syndrome: A valid clinical entity. Crit Care Med 1989;17:389-93. 2. Members of the American College of Chest Physicians/ Society of Critical Care Medicine 11 consensus conference committee. American College of Chest Physicians/ Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis . Crit CareMed 1992;20:864-74. 3. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International sepsis Definitions Conference. Crit Care Med 2003;31:1250-6. 4. Weiss M, Huber-Lang M, Taenzer M, et al. Different patient case mix by applying the 2003 SCCM/ESICM/ACCP/ATS/SIS sepsis definitions instead of the 1992 ACCP/SCCM sepsis definitions in surgical patients: a retrospective observational study. BMC Med Inform Decis Mak 2009;9:25. 5. Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections, 1988.

10 Am J Infect Control 1988;16:128-40. 6. Calandra T, Cohen J, for the International sepsis Forum Definition of Infection in the ICU Consensus Conference. The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med 2005;33:1538-48. CQ2 severe sepsis septic shock A2 (1C) SOFA 1C 90mmHg 40mmHg 1C 1992 severe sepsis septic shock [1,2] 2003 Marshall MODS [3] ESICM SOFA [4] Rivers early goal-directed therapy[5] Bernard C [6] Annane [7] 1.