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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

Published online by Cambridge University Press:  21 May 2015

Robert S. Green ,
Dennis Djogovic ,
Sara Gray ,
Daniel Howes ,
Peter G. Brindley ,
Robert Stenstrom ,
Edward Patterson ,
David Easton ,
Jonathan S. Davidow  and
au nom du comité C4 (pour CAEP Critical Care Interest Group)
Robert S. Green*
Affiliation:
département de médecine d'urgence, Université Dalhousie, Halifax, N.-É.,
Dennis Djogovic
Affiliation:
département de l'urgence de l'Université de l'Alberta, Edmonton, Alb.
Sara Gray
Affiliation:
département de médecine d'urgence de l'Université de Toronto et de médecine d'urgence et de soins intensifs de l'Hôpital St. Michael de Toronto, Ont.
Daniel Howes
Affiliation:
Médecine d'urgence et soins critiques, Université Queen's et département de médecine d'urgence, Hôpital Général de Kingston, KingstonOnt.
Peter G. Brindley
Affiliation:
département de l'urgence de l'Université de l'Alberta, Edmonton, Alb.
Robert Stenstrom
Affiliation:
Providence Health Care et département de médecine d'urgence de l'Hôpital St. Paul, Vancouver, C.-B.
Edward Patterson
Affiliation:
départements de médecine interne et de médecine d'urgence de la région sanitaire de Qu'Appelle à Régina et de l'Université de la Saskatchewan, Régina, Sask.
David Easton
Affiliation:
département de médecine d'urgence du Centre des sciences de la santé, Winnipeg, Man.
Jonathan S. Davidow
Affiliation:
département de l'urgence de l'Université de l'Alberta, Edmonton, Alb.
*
CAEP Critical Care Interest Group; 1278 Chemin Tower, bureau 349, édifice Bethune, Halifax N.-É. B3H 2Y9; greenrs@dal.ca

Résumé

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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.

Keywords

sepsissepsis gravechoc septiquemédecine d'urgencelignes directricesréanimation
Type
Mise à jour de l’ACMU • CAEP Update
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 6 , November 2008 , pp. 553 - 571
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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