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Updates on sepsis & septic shock
- 1. UPDATES ON SEPSIS & SEPTIC SHOCK Dr Shashi kant prasad,G.N.H,cccl, Ranchi
- 4. statistics Sepsis is the leading cause of death in ICU High mortality rate ,30% to 60% Causes more deaths than breast cancer,prostate cancer,HIV/AIDS combined together
- 5. NO GOLD STANDARD TEST AVAILABLE FOR SPECIFIC DIAGNOSIS OF SEPSIS
- 6. “Hectic fever (sepsis by current definition) at its conception is difficult to recognise but easy to treat,left untreated; it becomes easy to recognise but difficult to treat.” Machiavelli,The Prince,1505
- 7. How likely to miss diagnosis of sepsis? 0 15 30 45 60 Extremely likely Very likely Somewhat likely Not very likely Not likely at all Not sure 3% 27% 51% 17% 0% 2%
- 9. Risk factors for sepsis Very young or very old Have compromised immune system / chronic illness e.g diabetes,cancer,on chemotherapy,immuno suppressive drugs or steroids,HIV/AIDS Are already very sick ,often in hospital’s ICU Have wounds,injuries or burns Have invasive devices such as i.v catheters, breathing tubes
- 15. New Theory Of Sepsis Not a stage of uncontrolled hyper inflammation only but also an anti inflammatory hypo immune state Organs in sepsis are not dead except gut cells & lymphocytes in spleen Dysfunctional organs are not just stunned and go into hibernation or hypo immune status So , focus of attention has shifted from inflammation to organ dysfunction
- 18. Sepsis is not merely an infection THE CULPRIT HERE IS OVER REACTION OF OUR DEFENCE MECHANISM – NOT THE INVADER ALONE.
- 28. clinical manifestations sepsis Fever or hypothermia Altered mental status(early clue in elderly & debilitated) Tachypnoea with early respiratory alkalosis is an early & consistent finding ,Cyanosis Pain in large muscles of back & thigh due to accumulation of lactic acid(frequently misdiagnosed as pyelonephritis) Hyperglycaemia in absence of diabetes Hypotension is a late finding Petechia,purpura,thrombocytopenia necrotic or gangrenous lesions of skin Any unexplained new organ damage should raise suspicion
- 29. 2 stages of septic shock 1. Early warm shock or hyper dynamic stage 2. Late cold shock or hypo dynamic stage
- 30. Early warm shock Decreased SVR (dilated blood vessels) Warm and flushed skin A hyper dynamic stage Cardiac output is maintained initially d/d Anaphylaxis, Acute adrenal insufficiency,Neurogenic shock,Drugs..narcotics,Psychotropics
- 31. Late cold shock Increased SVR(vasoconstriction) Cold skin & typical shock like features A hypo dynamic stage Cardiac output falls
- 32. Principles of management • Blood culture before administering antibiotics • Estimate serum lactate (within 3 hours) • Measure urine output on hourly basis to maintain @ 0.5 ml /kg/hour • oxygen inhalation • Broad spectrum antibiotics (within 1 hour),each hour delay increases mortality risk by 7.6% • Adequate fluid administration (30 ml /kg) & use of vasopressors(nor adrenaline) if required to maintain MAP of 70 mm of Hg. Decision regarding use of vasopressors to be taken within 6 hours
- 33. SEPSIS SIX BUNDLE OF MANAGEMENT