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Sumary of surviving sepsis campaign 2008

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  • 1. Surviving Sepsis Campaign 2008: Summary of Recommendation a) Notes from journal’s authors; 1. These recommendations are intended to provide guidance for the clinician caring for a patient with severe sepsis or septic shock. 2. Recommendations from these guidelines cannot replace the clinician’s decision-making capability when he or she is provided with a patient’s unique set of clinical variables 3. Most of these recommendations are appropriate for the severe sepsis patient in both the intensive care unit (ICU) and non-ICU settings 4. The greatest outcome improvement can be made through education and process change for those caring for severe sepsis patients in the non-ICU setting and across the spectrum of acute care 5. Resource limitations in some institutions and countries may prevent physicians from accomplishing particular recommendations b) Summary of recommendation; 1. Early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition 2. Administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis of septic shock and severe sepsis without septic shock 3. Blood cultures before antibiotic therapy 4. Imaging studies performed promptly to confirm potential source of infection 5. Reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate 6. A usual 7–10 days of antibiotic therapy guided by clinical response 7. Source control with attention to the balance of risks and benefits of the chosen method 8. Administration of either crystalloid or colloid fluid resuscitation 9. Fluid challenge to restore mean circulating filling pressure 10. Reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfusion 11. Vasopressor preference for norepinephrine or dopamine to maintain an initial target of mean arterial pressure >65 mm 12. Dobutamine inotropic therapy when cardiac output remains low despite fluid resuscitation and combined inotropic/vasopressor therapy 13. Stress-dose steroid therapy given only in septic shock after blood pressure is identified to be poorly responsive to fluid and vasopressor therapy
  • 2. 14. Recombinant activated protein C in patients with severe sepsis and clinical assessment of high risk for death 15. In the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage, target a hemoglobin of 7–9 g/dl 16. A low tidal volume and limitation of inspiratory plateau pressure strategy for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); 17. Application of at least a minimal amount of positive end-expiratory pressure in acute lung injury 18. Head of bed elevation in mechanically ventilated patients unless contraindicated 19. Avoiding routine use of pulmonary artery catheters in ALI/ARDS 20. To decrease days of mechanical ventilation and ICU length of stay, a conservative fluid strategy for patients with established ALI/ARDS who are not in shock 21. Protocols for weaning and sedation/analgesia 22. Using either intermittent bolus sedation or continuous infusion sedation with daily interruptions or lightening 23. Avoidance of neuromuscular blockers, if at all possible 24. Institution of glycemic control targeting a blood glucose <150 mg/dl after initial stabilization 25. Equivalency of continuous veno-veno hemofiltration or intermittent hemodialysis prophylaxis for deep vein thrombosis 26. Use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding using H2 blockers or proton pump inhibitors and consideration of limitation of support where appropriate 27. Recommendations specific to pediatric severe sepsis include greater use of physical Examination therapeutic end points ; dopamine as the first drug of choice for Hypotension ; steroids only in children with suspected or proven adrenal insufficiency ; and a recommendation against the use of recombinant activated protein C in children Taken from: R. Phillip Dellinger, Mitchell M. Levy, Jean M. Carlet et al , “ Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008”, Crit Care Med 2008 Vol. 36, No. 1, Lippincott Williams & Walkins Disclaimer: This summary is a personal note belonging to Muhamad Na’im B. Ab Razak for educational purposes and not to generate income. It is not a publication made by owner but rather a cut and paste of what he think is important from the original paper.Therefore, author will not taken any responsibility if there is a misuse of this work.

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