Sepsis

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Enumerates the latest advancements in the management of sepsis and the search into its pathophysiology.

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Sepsis

  1. 1. SEPSIS<br />DR UNNIKRISHNAN P / CCU<br />
  2. 2. .<br />“SEPSIS AT ITS INCEPTION IS DIFFICULT TO RECOGNIZE BUT EASY TO TREAT; LEFT UNATTENDED IT BECOMES EASY TO RECOGNIZE BUT DIFFICULT TO TREAT” <br /> Machiavelli<br />
  3. 3.
  4. 4. INFECTION<br />.<br />
  5. 5. BACTEREMIA<br />
  6. 6. SYSTEMIC INFLAMMATORY RESPONSE SYNDROME<br />Generalized inflammatory response of the body to a variety of clinical conditions including infection, but not limited to infection<br />2 or more of the following<br />
  7. 7. SIRS<br />
  8. 8. SEPSIS<br />SIRS due to infection<br />
  9. 9. SEVERE SEPSIS<br />Sepsis associated with organ dysfunction, hypoperfusion or hypotension<br />May include lactic acidosis,oliguria,altered mentation <br />
  10. 10. ORGAN DYSFUNCTION<br />Arterial hypotension<br /> SBP&lt;90 MAP&lt;70 x 1hour<br /> despite fluid resuscitation<br /> perfusion abnormalities <br /> (that could include,lactic acidosis, oliguria, and/or acute change in mental status).<br />
  11. 11. ORGAN DYSFUNCTION<br />Thrombocytopenia<br /> drop by &gt;30% within 24 hrs OR count &lt;100G/L<br />
  12. 12. ORGAN DYSFUNCTION<br />Arterial hypoxaemia<br /> PaO2 &lt; 75 mm of Hg (room air) OR <br /> PaO2 /FiO2 &lt; 250 (oxygen supplimentation)<br />
  13. 13. ORGAN DYSFUNCTION<br />Renal dysfunction<br /> Urine output &lt; 0.5 ml/ kg x 2 hrs despite fluid loading OR S. creatinine &gt; 2x reference range<br />
  14. 14. ORGAN DYSFUNCTION<br />Metabolic acidosis<br /> BE &lt; 5 mmol/L OR S.lactate &gt; 1.5 x upper value<br />
  15. 15. MODS<br />Presence of altered organ function lasting for &gt; 24 hrs in an acutely ill patient, such that homeostasis cant be maintained without intervention.<br />
  16. 16. Organ wise…<br />
  17. 17. HOW?<br />
  18. 18. True or false…..?<br />The immune response by the host is minimal in sepsis..<br />
  19. 19. Sepsis and septic shock<br />Bacterial infection<br />Excessive host response<br />Host factors lead to cellular damage<br />Organ damage<br />Death<br />
  20. 20. PATHOGENESIS<br />
  21. 21. The events…..<br />
  22. 22. Coagulation and sepsis<br />
  23. 23. .<br />
  24. 24. MANAGEMENT<br />
  25. 25. Be on the lookout for disaster<br />
  26. 26. INITIAL RESUSCITATION [1st 6 hrs]<br />Central venous pressure (CVP): 8–12 mm Hg / 12-15 if mechanical ventilation<br />Mean arterial pressure (MAP) &gt;65 mm Hg<br />Urine output &gt;0.5 mL/kg/hour<br />Central venous (superior vena cava) or mixed venous oxygen saturation &gt;70% or &gt;65%, respectively<br />
  27. 27. if central venous oxygen saturation not achieved<br />FLUID<br />PRBC ( Hct&gt;30)<br />DOBUTAMINE : max 20µ/kg/min<br />
  28. 28. DIAGNOSIS<br />
  29. 29. BLOOD CULTURE<br />
  30. 30. ANTIBIOTICS<br />
  31. 31. SOURCE IDENTIFICATION/CONTROL<br />
  32. 32. HEMODYNAMIC SUPPORT<br />
  33. 33. VASOPRESSORS<br />
  34. 34. INOTROPES<br />
  35. 35. STEROIDS<br />Poorly responsive hypotension<br />Hydrocortisone &gt; dexamethasone<br />Hydrocortisone &lt;300 mg / day<br />Fludrocortisone 50 µg OD optional<br />Weaned when no vasopressors<br />No steroid if no shock<br />
  36. 36. Recombinant Activated Protein C<br />APACHE II &gt;25<br />
  37. 37. BLOOD PRODUCTS<br />
  38. 38. PLATELETS<br />
  39. 39. MECHANICAL VENTILATION-ARDS<br />
  40. 40. MECHANICAL VENTILATION-ARDS<br />
  41. 41. SEDATION- ANALGESIA- NMB<br />
  42. 42. GLUCOSE CONTROL<br />
  43. 43. GLUCOSE CONTROL<br />
  44. 44. RENAL REPLACEMENT<br />Intermittent HD = CVVH<br />CVVH if hypotension<br />
  45. 45. Bicarbonate therapy<br />Not for hypoperfusion induced lactic acidemia with pH &gt;7.15<br />
  46. 46. DVT PROPHYLAXIS<br />
  47. 47. STRESS ULCER PROPHYLAXIS<br />
  48. 48. SEPSIS RESUSCITATION BUNDLE- 6 h<br />
  49. 49. SEPSIS MANAGEMENT BUNDLE – 24HR<br />
  50. 50. OUTCOME IMPROVED BY<br />Early goal directed therapy<br />Lung protective ventilation <br />Appropriate antibiotic coverage<br />Activated protein C<br />Tight control of sugars 80-100mg/dl<br />Steroids<br />
  51. 51. A clinician, armed with the sepsis bundles, attacks the three heads of severe sepsis: hypotension, hypoperfusion and organ dysfunction<br />
  52. 52. THANK YOU<br />.<br />
  53. 53. Convert PowerPoint to flash for web sharing. Post your slide show on Myspace and blog. <br />Learn More<br />PowerPoint Slide Show<br />Add flash-based quizzes and demo to slide show to interact with your audience.<br />Learn More<br />Convert PowerPoint to video or burn to DVD. Present your slide show on TV to share with family.<br />Learn More<br />

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