SSC Surviving Sepsis Guidelines 2008

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Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008
Crit Care Med 2008; 36:296-327

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SSC Surviving Sepsis Guidelines 2008

  1. 1. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008<br />Volume 36(1), January 2008, pp 296-327<br />summarized by sun yaicheng<br />http://decode-medicine.blogspot.com/<br />
  2. 2. MANAGEMENT OF SEVERE SEPSIS<br />Sepsis Guidelines 2008<br />
  3. 3. Initial Resuscitation (First 6 hrs)<br />Begin resuscitation immediately <br /> in patients with hypotension <br /> or serum lactate > 4 mmol/L; <br /> do not delay pending ICU admission<br />Resuscitation goals:<br />CVP 8–12 mm Hg<br />MAP ≥ 65 mm Hg<br />Urine output ≥ 0.5 mL. kg-1.hr-1<br />Central venous O2 saturation ≥ 70%, <br /> or mixed venous ≥ 65% <br />If venous O2 saturation target not achieved: <br />consider further fluid<br />transfuse pRBC to Hct ≥ 30% and/or <br />dobutamine infusion max 20 μg.kg-1.min-1<br />
  4. 4. Diagnosis<br />Obtain appropriate cultures before starting antibiotics. <br />Perform imaging studies promptly in order to confirm and sample any source of infection.<br />
  5. 5. Antibiotic Therapy<br />Begin antibiotics as early as possible, and always within the first hour of recognizing severe sepsis and septic shock. <br />
  6. 6. Source Control<br />
  7. 7.
  8. 8. Fluid Therapy<br />Fluid-resuscitate using crystalloids or colloids.<br />Target CVP ≥ 8 mmHg (≥ 12 mmHg if mechanically ventilated)<br />Give fluid challenges of 1000 ml of crystalloids or 300–500 ml of colloids over 30 min. <br />
  9. 9. Vasopressors<br />Maintain MAP ≥ 65 mm Hg.<br />Norepinephrine or dopamine centrally administered are the initial vasopressors of choice. <br />Use epinephrine as the first alternative agent in septic shock when BP is poorly responsive to norepinephrine or dopamine. <br />In patients requiring vasopressors, insert an arterial catheter as soon as practical.<br />
  10. 10. Steroids<br />Consider intravenous hydrocortisone for adult septic shock when hypotension remains poorly responsive to adequate fluid resuscitation and vasopressors.<br />Hydrocortisone dose should be < 300 mg/day.<br />
  11. 11. Recombinant human activated protein C (rhAPC)<br />Consider rhAPC in adult patients with sepsis-induced organ dysfunction with clinical assessment of high risk of death (APACHE II ≥ 25 or multiple organ failure) if there are no contraindications. <br /> ( for post-operative patients)<br />
  12. 12. Blood Product Administration<br />Give RBC when Hb < 7.0 g/dl to target HB 7.0–9.0 g/dl in adults.<br />Administer platelets when: <br />platelet counts are < 5,000/mm3regardless of bleeding. <br />platelet counts are 5000 to 30,000/mm3 and there is significant bleeding risk. <br />platelet counts ≥ 50,000/mm3 are required for surgery or invasive procedures. <br />
  13. 13. Glucose Control<br />Use IV insulin to control hyperglycemia in severe sepsis<br />Keep blood glucose < 150 mg/dl<br />
  14. 14. Bicarbonate Therapy<br />Do not use bicarbonate therapy when treating hypoperfusion-induced lactic acidemia with pH ≥ 7.15 <br />

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