1. Faculty of Medicine and Surgery
Batch 8
Lecture: SEPSIS
Prepared by
Mohamed Abdullahi Osman
2.
3. Sepsis :medical condition characterized by a
whole-body inflammatory state (called a
systemic inflammatory response syndrome or
SIRS) caused by severe infection .
It's sometimes called blood poisoning
Severe Sepsis :One sepsis related organ
dysfunction
4. Septicemia:
medical term referring to the presence of
pathogenic organisms in the bloodstream,
leading to sepsis
Septic Shock
Severe sepsis with Persistant hypotention
When hypotention can not be corrected by
infution of fluid
Septic focus (abscess / cavity / tissue mass)
5.
6. Common places where an infection
might start include:
The bloodstream
The bones (common in children)
The bowel (usually seen with peritonitis)
The kidneys (upper urinary tract infection or
pyelonephritis)
The lining of the brain (meningitis)
The liver or gallbladder
The lungs (bacterial pneumonia)
The skin (cellulitis)
7. In hospitalized patients, common
sites of infection include
intravenous lines,
surgical wounds, surgical drains,
urinary catheters and
sites of skin breakdown known as bedsores
(decubitus ulcers).
8.
9.
10. • tissue oxygenation may decrease as number of
functional capilaries is reduced by luminal
obstruction due to swallowing of endothelial
cells , decrease deformability of RBC,
leukocyte – platelet – fibrin Thrombi
14. Hypotention and DIC predispose to
Acrocyanosis and schemic necrosis of
prepheral tissues most commonly in Digits.
Cellulitis or hemorrhagic lesions may
develop when Hematogenous bacteria or
fungi seed in the skin
When sepsis is accompanied by cutaneous
petchiea or purpura , infection with neisseria
meningitis , h.influenza should be suspected
15. Who is at risk of sepsis?
Those with a weakened immune system. This
could be due to a diseases like AIDS, Diabetes
etc. or due to medical treatment that suppresses
the immunity like anti-cancer chemotherapy
Very young children and infants and the
elderly
16. Who is at risk of sepsis?
Those admitted in the hospital with a serious
illness
After a major surgery or a major accident
After surgeries such as illegal abortion or
instrumentation
Alcohol abusers
Those with extensive burns
17. Why Septic patients are Anemic ?
Causes of anemia in septic patient :
Hemodilution – due to crystaloid infution
Increase blood lose
bleeding : Tauma , because of intuments
Reduction of half life of Red cells due to
destruction mediated by systamic inflamation
Direct inhibition of Erytheropoiesis by
inflammatory Mediatories like interluekins 1,6,
TNF
18. Are they need Blood transfusion ?
Its recommend that red blood cell transfusion
occur only when hemoglobin concentration
decreases to <7.0 g/dL to target a hemoglobin
concentration of 7.0 –9.0 g/dL in adults
19. What is the consequence of Blood
transfusion in patient with sepsis?
• 1. Transfusion increase pulmonary Resistance
• 2. viral Infectious complication Like Hepatitis
and HIV
• 3.Bacterial complication(most common in Platelet
transfusion)
• 4. Non Infectious Complication
• a)Hemolytic reaction
• b) Tranfussion related Acute lung injury
• c) Hypotensive transfused reaction
21. Did you Know this patiens have
hyperglycemia!
What is Name of this hyperglycemic
How did you feel this patients become
hyperglycemic
22. Stress Hyperglycemia
A decreased release of insulin, increased
release of hormones with effects
countering insulin, and increased insulin
resistance combine to produce stress
hyperglycemia in many critically ill
patients.
Hyperglycemia diminishes the ability of
neutrophils and macrophages to combat
infections. Also insulin possesses
antiapoptotic effects.
23. Stress Hyperglycemia
• A large, single-center, randomized trial of more
than 1500 critically ill patients demonstrated that,
maintaining serum glucose levels between 80 and
110 mg/dL (mean morning glucose of 103 mg/dL)
through the use of a continuous insulin infusion
decreased mortality (4.6% vs 8%; P < 0.04),
development of renal failure (P = 0.04),
and episodes of septicemia (P = 0.003), compared
with conventional treatment (mean morning
glucose of 153 mg/dL.
• Physicians liberalize their insulin treatment to
keep blood glucose levels less than 150 mg/dL
due to concerns of hypoglycemia
24. The Mortality Rate of this patients high,
What is the Cause you suspect to
increase rate of mortality ?
How we can lower the incidence and
make better Prognosis?
25. The Mortality Rate of this patients
high Because of :
Admit ion of patient to the hospital in late
Time
Treatment is given too late
26. How we can lower the
incidence
Increase Awareness of health care
Improve the Early , accurate diagnosis of
Sepsis
27. Which is basic investigations you
need
CBC
Blood Culture
Kidney function tests
lactate
PT/PTT,
CXR
28. Steps of sepsis Management in
Order Set
1).Assess airway
2)Insert/maintain 2 peripheral IV lines (18 gauge or larger) or
place TLC for central IV access.
3. Initial Resuscitation
Goals during the first 6 hrs of resuscitation
• Urine output ≥ 0.5 mL/kg/hr d)
• In patients with elevated lactate levels targeting resuscitation
to normalize lactate (grade 2C).
• a) Central venous pressure 8–12 mm Hg
29. 4.Diagnosis
Cultures as clinically appropriate before
antimicrobial therapy.
Imaging studies performed promptly to
confirm a potential source of infection
30. 5.Antimicrobial Therapy
Initial empiric anti-infective therapy of one or
more drugs that have activity against all likely
pathogens (bacterial and/or fungal or viral)
and that penetrate in adequate
concentrations into tissues presumed to be
the source of sepsis
31. 6.Source Control : Drainage of focal source of infection
is essential , catheter should be Removed
The possibility of paranasal sinusitis is considered if
patient undergone NASAL INTUBATION
7.Infection Prevention:
Selective oral decontamination and selective digestive
decontamination should be introduced and investigated
as a method to reduce the incidence of ventilator-
associated pneumonia.
Oral chlorhexidine gluconate (antiseptic) be used as a
form of oropharyngeal decontamination to reduce the
risk of ventilator-associated pneumonia in ICU patients
with severe sepsis
32. Fluid Therapy of Severe Sepsis
. Crystalloids as the initial fluid of choice in
the resuscitation of severe sepsis and septic
shock
Albumin in the fluid resuscitation of severe
sepsis and septic shock when patients require
substantial amounts of crystalloids
Why we need Albumin?
How you determine if there is little
hemodynemic improvement ?
33. 7.Vasopressors:
Vasopressor therapy initially to target a mean
arterial pressure (MAP) of 65 mm Hg
Norepinephrine as the first choice vasopressor
Dopamine as an alternative vasopressor agent
to norepinephrine only in highly selected
patients (eg, patients with low risk of
tachyarrhythmias and absolute or relative
bradycardia)?
34. Inotropic Therapy
1. A trial of dobutamine infusion up to 20
micrograms/kg/min be administered or added
to vasopressor (if in use) in the presence of (a)
myocardial dysfunction as suggested by
elevated cardiac filling pressures and low
cardiac output, or (b) ongoing signs of
35. Consider hydrocortisone 50mg Q6H for 7 to
10 days in patients with hyperdynamic
vasopressor-dependent shock despite
adequate fluid resuscitation, which may help
improve hemodynamic response to
catecholamines. If shock resolves more
rapidly, the dose may be discontinued sooner.
36. 8.Mechanical Ventilation of Sepsis-
Induced ARDS:
That mechanically ventilated sepsis patients be
maintained with the head of the bed elevated to
30-45 degrees to limit aspiration risk and to
prevent the development of ventilator-
associated pneumonia
37. 9. Glucose Control:
Make intensive momitoring to pervent
HYPOGLYCEMIC
Physicians liberalize their insulin treatment to
keep blood glucose levels less than 150 mg/dL
due to concerns of hypoglycemia.
38. 10.Deep Vein Thrombosis Prophylaxis
Patients with severe sepsis receive daily
pharmacoprophylaxis against venous
thromboembolism (VTE) .
This should be accomplished with daily
subcutaneous low-molecular weight heparin in
the absence of significant bleeding risk
Patients with severe sepsis be treated with a
combination of pharmacologic therapy and
intermittent pneumatic compression devices
whenever possible (grade
39. Stress Ulcer Prophylaxis:
Stress ulcer prophylaxis using
H2 blocker
proton pump inhibitor be given to patients
with severe sepsis/septic shock who have
bleeding risk factors .
H2 blocker is the 2nd line
40. Nutrition Therapy;
Maintain blood glucose 100 to 150 through the
use of appropriate caloric support
and insulininfusion following initial stabilization.
Do not administer sodium bicarbonate for
metabolic (anion-gap) acidosis, such as lactic
acidosis if the pH is > 7.15. For a lower pH,
consider a trial of 50 to 100 mEq NaHCO3 by slow
infusion, with evaluation for improvement in
hemodynamic
41. Importance of Documentation
• Documentation in a manner that is accurate and
accessible to all disciplines is imperative:
– Necessary for the ongoing treatment of the patient
– Necessary to monitor quality of care metrics
• Blood cultures before antibiotics
• Early, appropriate, adequate antibiotics
• Initial fluid resuscitation
• Use of vasopressors for hypotension despite
initial fluids
42. Conclusions
The incidence of Sepsis is increasing.
Possible contributing factors :
–Use of antibiotics leading to microbial
resistance
–More invasive procedures
–Increasing use of immunosuppressants
43. what can you do to protect
yourself from sepsis?
1. Make sure you're up-to-date on all appropriate
immunizations: Influenza and pneumonia are
common precursors to sepsis, and they're highly
preventable.
2. Wash your hands regularly: And if you are in the
hospital, make sure all health providers wash their
hands.
3. Don't take antibiotics for common ailments like
colds: Improper antibiotic use creates drug-
resistant bacteria that make sepsis dangerous
4.proper care of urinary catheters and IV
