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![INITIAL RESUSCITATION [1st 6 hrs]
• Central venous pressure (CVP): 8–12 mm
Hg / 12-15 if mechanical ventilation
• Mean arterial pressure (MAP) >65 mm Hg
• Urine output >0.5 mL/kg/hour
• Central venous (superior vena cava) or
mixed venous oxygen saturation >70% or
>65%, respectively](https://image.slidesharecdn.com/sepsis-190613051634/85/Sepsis-17-320.jpg)
Uploaded byVeeru Reddy
Sepsis
This document discusses sepsis, a systemic inflammatory response to infection that can lead to organ dysfunction. It defines terms like systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock. The pathogenesis involves inflammation, coagulation, and cytokines. Management involves initial resuscitation, diagnosis via blood cultures, antibiotics, source control, hemodynamic support with vasopressors and inotropes, steroids, mechanical ventilation, glucose control, renal replacement if needed, and DVT prophylaxis. Outcomes have improved with early goal directed therapy, lung protective ventilation, appropriate antibiotics, activated protein C, tight glucose control, and steroids.
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Sepsis
- 1. SEPSIS Dr v veeranadhareddy, Asst prof, department of general surgery
- 3. INFECTION • . Invasion ofnormally sterile host tissue by bacteria.
- 4. BACTEREMIA Presence of viablebacteria in blood
- 5. SYSTEMIC INFLAMMATORY RESPONSE SYNDROME •Generalized inflammatory response of the body to a variety of clinical conditions. • 2 or more of the following
- 6. SIRS •Systemic response manifested by≥ 2 of: –Temp > 38oC or < 36oC –HR > 90 bpm –RR > 20 bpm –WBC > 12 x 109/L, < 4 x 109/L.
- 7. SEPSIS • SIRS withdocumented source of infection
- 8. SEVERE SEPSIS • Sepsisassociated with organ dysfunction, hypoperfusion or hypotension.
- 9. MODS • Presence ofaltered organ function lasting for > 24 hrs in an acutely ill patient, such that homeostasis cant be maintained without intervention.
- 10. Sepsisand septic shock Bacterialinfection Excessivehost response Host factors lead to cellulardamage Organ damage Death
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- 16. Be on thelookout for disaster
- 17. INITIAL RESUSCITATION [1st6 hrs] • Central venous pressure (CVP): 8–12 mm Hg / 12-15 if mechanical ventilation • Mean arterial pressure (MAP) >65 mm Hg • Urine output >0.5 mL/kg/hour • Central venous (superior vena cava) or mixed venous oxygen saturation >70% or >65%, respectively
- 18. if central venousoxygen saturation not achieved • FLUID • PRBC ( Hct >30) • DOBUTAMINE : max 20µ/kg/min
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- 24. VASOPRESSORS NOREPINEPHRINE / DOPAMINE EPINEPHRINEADDED IFPOOR RESPONSE VASOPRESSIN 0.03 UNITS/MIN No low dose Dopamine! MAP >65 Arterial catheter
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- 26. STEROIDS • Poorly responsivehypotension • Hydrocortisone > dexamethasone • Hydrocortisone <300 mg / day • Fludrocortisone 50 µg OD optional • Weaned when no vasopressors • No steroid if no shock
- 27. Recombinant Activated ProteinC • APACHE II >25
- 28. BLOOD PRODUCTS Hb: 7-9g Sepsisrelated anemia- no erythropoetin FFP: only if bleeding / invasive procedures FFP not a nutrient! No antithrombin
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- 30. MECHANICAL VENTILATION-ARDS TIDAL VOLUME:6 ML/KG PLATEAU PRESSURE MAX 30 CM H2O PERMISSIVE HYPERCAPNEA PEEP PRONE POSITION VENTILATION SEMIRECUMBENT : 30-45º STABLE/AROUSABLE/REFLEXES/FAST RECOVERY NIV
- 31. MECHANICAL VENTILATION-ARDS WEANING PROTOCOL SBT:LOW LEVEL PS † PEEP-5 CM H2O OR T-PIECE AROUSABLE STABLE HEMODYNAMICS NO NEW SERIOUS CONDITIONS LOW PEEP REQUIREMENT LOW FiO2 REQUIREMENT
- 32. SEDATION- ANALGESIA- NMB Sedation •Protocol-based with interruption NMB • Only when necessary
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- 35. RENAL REPLACEMENT • IntermittentHD = CVVH • CVVH if hypotension
- 36. Bicarbonate therapy • Notfor hypoperfusion induced lactic acidemia with pH >7.15
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- 38. STRESS ULCER PROPHYLAXIS GIBLEED VAP
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- 40. SEPSIS MANAGEMENT BUNDLE– 24HR STEROID DROTECOGEN α GLUCOSE <150 PIP<30 CM
- 41. OUTCOME IMPROVED BY •Early goal directed therapy • Lung protective ventilation • Appropriate antibiotic coverage • Activated protein C • Tight control of sugars 80-100mg/dl • Steroids
- 42. A clinician, armedwith the sepsis bundles, attacks the three heads of severe sepsis: hypotension, hypoperfusion and organ dysfunction
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