Sepsis 2012 andbeyond

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beyond surviving epsis guidline

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Sepsis 2012 andbeyond

  1. 1. Dr Riyas A MD Anaesthesia
  2. 2.  Severe sepsis and septic shock are major health care problems
  3. 3.  Sepsis:presence of infection with systemic manifestation of infection  Severe sepsis;presence of sepsis with evidence of sepsis induced organ dysfunction or tissue hypoperfusion  Septic shock:sepsis induced hypotension persisting despite fluid resucitation
  4. 4.  A)initial resuscitation  B)screening  C)diagnosis  D)antimicrobial therapy  E)source control  F)infective prevention  G)fluid therapy  H) Vasopressor  I) Corticosteroid
  5. 5.  J) supportive therapy  a) blood products administration  b) immunoglobulins  c) selenium  d) recombinant activated protein c  e) sedation,analgesia,NMB  f) glucose control  g)RRT
  6. 6.  H)bicarbonate therapy  i)DVT prophylaxis  J)stress ulcer prophylaxis  K)nutrtion support
  7. 7.  Central venous pressure 8 to 12 mm Hg (grade 1C)  Mean arterial pressure (MAP) ≥65 mm Hg (grade 1C)  Urine output ≥0.5 mL/kg/hour (grade 1C)  Superior vena cava oxygenation saturation (Scvo2) 70%  mixed venous oxygen saturation (Svo2) 65%
  8. 8.  Obtain blood culture  Measure lactate level  Broad spectrum antibiotis  30ml/kg fluid for hypoension or lactate level
  9. 9.  Vasopressors  Remeasure lactate level
  10. 10.  Crystalloids as first choice for initial fluid resuscitation (grade 1B)  Initial minimum crystalloid challenge of 30 mL/kg (grade 1C)
  11. 11.  10 ml of blood  From two site percutaneous and insitu catheter  Other culture samples
  12. 12.  within 1 hour of recognition of septic shock (grade 1B) and severe sepsis without septic shock (grade 1C)  Broad spectrum  7-10 days  Recently used one should be avoided  Combination therapy
  13. 13.  Selective oral as well as digestive decontamination  Others include hand hygeine nursing care elevated head end of the table Sub glottic suctioning
  14. 14.  Norepinephrine as first choice  NE+Epn  Vasopressin 0.03u/min  Phenylephrine not recommended
  15. 15.  Dobutamine infusion trial up to 20 µg/kg/minute administered or added to vasopressor in the case of myocardial dysfunction or ongoing signs of hypoperfusion
  16. 16.  No corticosteroids in the absence of refractory shock (grade 1D)
  17. 17.
  18. 18.  PRBC transfusion when Hb ≤ 7gm%  target hemoglobin concentration of 7.0–9.0 g/dL in adults (grade 1B)
  19. 19.  No role
  20. 20.  No role
  21. 21.  ARDS protocol
  22. 22.  CONTINOUS OR INTERMITTENT SEDATION  CONTINOUS OR INTERMITTENT UNDER TRAIN OF FOUR MONITORING
  23. 23.  ≤180 MG%  To be monitored every 1 or 2 hr
  24. 24.  RRT  Stress ulcer prophlyalxis  Dvt prophylaxis  Nutrition support
  25. 25.  THANK YOU

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