了解重症监护病房的坏死性软组织感染

Understandingnecrotizingsofttissueinfectionsintheintensivecareunit

Necrotizingsofttissueinfections(NSTIs)areararegroupofsevereandheterogenousinfections.DistinguishingNSTIsfrommuchmorefrequentnon-necrotizinginfectionsisacrucialstepofinitialmanagement,astheformerrequirenotonlymedicaltreatmentbutalsourgentsurgicaldebridementofinfectedtissues.Additionalcategorizationsbasedonthemicrobiologyortheanatomicalextentofthediseasehavebeenproposedbutareoflittlehelptotheclinician.Onlythetopography(i.e.,limb,abdomino-perineal,thoracicorhead/necklocalization)isimmediatelyavailableandcanmodifyearlymanagement.ApproximatelyhalfofNSTIpatientswilldeveloporganfailuresandrequireintensivecareunit(ICU)admission.Thus,intensivistsmustmaintainhighawarenessforthisrarecondition,particularlyinpatientshavingalocallybenigncutaneouspresentationbutwithsignsofsystemictoxicity(i.e.,sepsis/septicshock)andnootherobvioussourceofinfection.Initialmisdiagnosishasbeenreportedinabout50%ofcasesaspresentationcanbeinsidious,withnoreliablebiologicalorradiologicaldiagnostictool.Mortalityrangesfrom10to30%accordingtoinitialpatientseverity,andlong-termhealth-relatedqualityoflifeisdeeplyimpactedinsurvivors,15%ofwhomrequirelimbamputations.ArecentsurveyacrossEuropeanICUsrevealedgreatheterogeneityregardingboththeexpertiseofpractitioners(beitintensivists,surgeonsordermatologists)andthelocalmanagementofpatients.Forsurveyedintensivists,themainfactorscontributingtosurgicaldelay,oneofthemainmodifiableprognosticfactors,weremisdiagnosis,adelayedsurgicaldecisionandlogisticalissuesregardingoperatingroomaccess.Suspectingthediagnosismusttriggertheinitiationofmultipleurgentinterventionsandinvolveamultidisciplinaryteamcoordinatedbythemanagingphysician(Fig.1).预览时标签不可点