Introduction to Severe Sepsis, Septic Shock - Introduction to General Medicine - Lecture Slides, Slides of Medicine

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Introduction

• Severe Sepsis and Septic Shock are major healthcare problems
• High mortality
• Increasing in incidence
• APPROPRIATED AND RAPID MANAGEMENT INFLUENCE THE OUTCOME

Introduction

SYSTEMIC INFLAMMATORY RESPONSE

SYNDROME (SRIS):

2 o more of:

• Fever: oral temperature >38C or hypothermia (<36C)
• Tachypnea: >24 breaths/min
• Tachycardia: heart reat >90 beats/min

Introduction

SEPSIS:

SIRS in response to documented infection

Introduction

SEVERE SEPSIS:

Sepsis with evidence of acute organ dysfunction

• CV: SBP <90 mmHg or MAP <70 mmHg
• RENAL: urine output <0.5 ml/kg/hr
• RESPIRATORY: PaO2/FIO2 <
• HEMATOLOGIC: platelet count <80.000/ul
• METABOLIC ACIDOSIS: pH <7.30 or plasma lactate >2mmol/L

Introduction

• Guidelines have been created to improve outomes in severe sepsis and septic shock
• These Guidelines are evidence-based medicine methodology system

International Guidelines – Sepsis

Initial Resuscitation

NEJM 2001; 345:1368-

Early-Goal Directed Therapy in Sepsis

Early-Goal Directed Therapy in Sepsis

Initial Resuscitation

During the first 6 hours, goals are:

• CV pressure 8-12 mmHg. In mechanical ventilated patients or patients with known preexisting decreased ventricular compliance, target will be 12 – 15 mmHg
• MAP > 65 mmHg

Grade 1-B

Initial Resuscitation

During the first 6 hours, goals are:

• Urine output > 0.5 ml/kg/h
• Central venous saturation (SVO2) > 70% Intermitent or continuous measurements of O are the same

Grade 1-B

International Guidelines – Sepsis

Diagnosis

Diagnosis

• Obtain appropriate cultures before antimicrobial therapy is initiated, if such cultures do not cause delay in antibiotic administration. Grade 1-C
• Imaging studies should be performed promptly in attempts to confirm a potential source of infection

Antibiotic Therapy

Critical Care Medicine 2006. 34, 6

• Retrospective Cohort study
• 2731 patients with Septic Shock
• 50% of them received effective antimicrobial administration within the first hour of documented hypotension
• Increased survival was seen among them

Antibiotic Therapy

• IV antibiotic therapy must be started as early as possible and within the first hour of recognition of severe sepsis or septic shock
• Broad spectrum therapy until the causative organisms and susceptibilities are known

Evidence 1-C