Early Goal Directed Theraphy2
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Transcript of Early Goal Directed Theraphy2
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EARLY GOAL DIRECTEDTHERAPHY
(EGDT)
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Definition
usually referring to the specificresuscitation of severely septic
patients, or patients in septic shock,
immediately at presentation to thehospital.
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Components
1. Early recognition2. Early and adequate antibiotic therapy
3. Source control
4. Early hemodynamic resuscitation and
continued support
Corticosteroids
Tight glycemic control
Surgical treatmentProper ventilator management with low tidal
volume in patients with acute respiratory distresssyndrome (ARDS)
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Respiratory support: Supplementaloxygen with early intubation and
mechanical ventilation
Circulatory support/ FLUID
RESUSCITATION: initial crystalloid fluid challenge of 20-30
mL/kg (1-2 L) over 30-60 minutes 1 L over30 minutescentral venous pressure
(CVP) goal between 8 and 12 mmHg Urine output (UOP) 30-50 mL/h
Administration of colloid
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Antimicrobial therapy: broadspectrum, covering gram-positive,
gram-negative, and anaerobic
bacteria. Metabolic support: hyperglycemia
and electrolyte abnormalities
(hypokalemia, hypomagnesemia, andhypophosphatemia)
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Correction of anemia andcoagulopathy: Hemoglobin as low as
8 g/dL, thrombocytopenia and
coagulopathy Nutritional support: high protein and
energy requirements, the enteral route
is preferred, glutamine administration
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Principles OF EGDT
The first step: crystalloid fluid administration toCVP by initial administering 500-mL boluses (8
and 12 mm Hg)
The second step: vasopressors administration to
attain a mean arterial pressure (MAP) greater than65 mm Hg.
The third step: evaluation the central venous
oxygen saturation (ScvO2), which is measured from
the central venous line in the superior vena cava(65-70%).
Dobutamine: 10.3 mcg/kg/min
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Vasopressor Therapy: if the patient does not respond
to several liters of volume infusion with isotonic
crystalloid solution (usually 4 L or more) or evidence ofvolume overload.
Persistent hypotension: SBP < 90 mmHg, or MAP < 65
mmHg.
Norepinephrine: 5-20 mcg/min (0.2-1.5 g/kg/min - 3.3
g/kg/min)
Dopamine: 5-10 g/kg/min IV - 20 g/kg/min.
Epinephrine Phenylephrine
Vasopressin (antidiuretic hormone (ADH))
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Inotropic Therapy andAugmented Oxygen Delivery
Dobutamine: recommended if
ScvO2< 70 mm Hg after CVP,
MAP, and hematocrit goals have
been met.
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Surgical Treatment: infected foci,soft-tissue abscess, superficial
abscess, deep abscess or suspected
necrotizing fasciitis.
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Management of Acute RespiratoryDistress Syndrome
A major complication of sepsis and septic
shock. Primarily supportive
General supportive management : antibiotics
Appropriate fluid management Hemodynamic monitoring.
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Long-Term Monitoring
Admission to the hospital.
Patientsrespond to EGDT in the ED
and show no evidence of end-organ
hypoperfusion : a general hospital unit.
Patientsdo notrespond to initial ED
treatment: ICU / advanced life support
monitoring to another hospital
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GOAL of EGDT
Decreases these components of care:1. Mortality by 16-20%
2. Components of inflammatory response
3. Morbidity of organ dysfunction4. Need for vasopressor therapy
5. Need for mechanical ventilation
6. Sudden cardiopulmonary complications in the
first 24 hours7. Length of hospital stay
8. Health care resource consumption
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Thank you for your kind attention