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Sepsis and septic shock

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Babak Jebelli
Babak Jebelli

This document summarizes the pathophysiology, diagnosis, and initial management of sepsis and septic shock. It describes the progression from systemic inflammation to shock and multiple organ dysfunction. Early goals of treatment include identifying the infection source, administering antibiotics within 1 hour, providing intravenous fluid boluses, and monitoring lactate levels and perfusion targets. Patients with sepsis may progress to severe sepsis or septic shock, indicated by worsening organ dysfunction and hypotension not responding to fluids, requiring intensive care management and goals-directed therapy.

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SEPSIS AND SEPTIC SHOCK PATHOPHYSIOLOGY DIAGNOSIS INITIAL MANAGEMENT Last update OCTOBER 2010
Spectrum of Disease Severity With Progression From Inflammation to Shock
What is Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How Does the Body Fight Shock? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Mean Arterial BP MAP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology of Sepsis ,[object Object],[object Object],[object Object],[object Object]
Determinants of Severity in Sepsis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bacterial Factors ,[object Object],[object Object],[object Object],[object Object],[object Object]
Hypotension= MAP< 60 / SBP< 90 Goals are adequate perfusion = Lactic acid < 18 or Urine Output responds to fluid ,[object Object],[object Object],[object Object],[object Object]
Organs Commonly Affected ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DEGREES OF SEVERITY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Systemic Inflammatory Response Syndrome SIRS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patients Who Present With SIRS WHAT DO I DO ,[object Object],[object Object],[object Object],[object Object]
Early Treatment for SIRS/SEPSIS ,[object Object],[object Object],[object Object]
Early Treatment for SIRS/SEPSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fluid Goals/Endpoints ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Empiric Antibiotics for Suspected SIRS / Sepsis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sepsis LACTATE < 36 mg/dl AND EVIDENCE OF ONLY 1 OR NONE signs of ORGAN DYSFUNCTION ,[object Object],[object Object],[object Object],[object Object]
Severe Sepsis SEPSIS PLUS TWO OR MORE ABNORMAL VALUES REPRESENTING SEVERE ORGAN DYSFUNCTION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Septic Shock Severe Sepsis with Sx/Sx of 2 or more Organ Dysfunction WITH NO RESPONSE TO FLUID BOLUS ADMIT TO ICU FOR GOAL DIRECTED THERAPY ,[object Object],[object Object],[object Object],[object Object]
Early Treatment for SIRS/SEPSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SEPSIS & SEPTIC SHOCK ,[object Object],[object Object],[object Object],[object Object],[object Object]
EARLY TREATMENT FIND THE SOURCE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EARLY TREATMENT ,[object Object],[object Object],[object Object],[object Object],Crit Care Med. 2006 Jun;34(6):1589-96
Empiric Antibiotics Should be initiated within 1 hour ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Empiric Antibiotics for Suspected SIRS / Sepsis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
  AIRWAY & BREATHING ,[object Object],[object Object],[object Object]
Circulation / Hypoperfusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Early Treatment for SIRS/SEPSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fluid Goals/Endpoints ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Start @ 20ml/Kg Continue with 500 ml NS Q 30 Until goals met OR Pulmonary Edema Stop @40-60ml/Kg ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PULMONARY EDEMA ARDS & ALI Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
“ PULMONARY EDEMA” ARDS & ALI Diagnosis ALI & ARDS The same except for PaO2 ratio ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
FLUIDS FAIL TO IMPROVE BP/Perfusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SEPSIS & SEPTIC SHOCK ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pyelonephritis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Am J Obstet Gynecol 1991 Feb;164(2):587-90 Baillieres Clin Obstet Gynaecol 1994 Jun;8(2):353-73.
ANTIBIOTICS & PYELONEPHRITIS ,[object Object],[object Object]
ANTIBIOTICS & PYELONEPHRITIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Post treatment Suppression ,[object Object],[object Object],[object Object],[object Object],[object Object]
EARLY RECOGN I T I ON ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CBC, Lactate, BC Consider IV fluids and ABX SBP ≤ 90? yes no Lactate high? 20 ml/kg fluid bolus 18-35 mg/dl IV fluids Consider ABX Repeat lactate in 6 hrs < 18 mg/dl Document Septic Shock (Time Zero) ≥ 36 mg/dl SBP ≤ 90 SBP >90 stop Suspected Sepsis Document Severe Sepsis (Time Zero)
Step 2: Sepsis Resuscitation: The Golden Hours

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Sepsis and septic shock

  • 1. SEPSIS AND SEPTIC SHOCK PATHOPHYSIOLOGY DIAGNOSIS INITIAL MANAGEMENT Last update OCTOBER 2010
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  • 41. Step 2: Sepsis Resuscitation: The Golden Hours