SEPSIS

Dr Riyas A

MD Anaesthesia

SEPSIS Severe sepsis and septic shock are

major health care problems

DEFINITIONS Sepsis:presence of infection with

systemic manifestation of infection Severe sepsis;presence of sepsis with

evidence of sepsis induced organ dysfunction or tissue hypoperfusion

Septic shock:sepsis induced hypotension persisting despite fluid resucitation

MANAGEMENT A)initial resuscitation B)screening C)diagnosis D)antimicrobial therapy E)source control F)infective prevention G)fluid therapy H) Vasopressor I) Corticosteroid

MANAGEMENT J) supportive therapy a) blood products administration b) immunoglobulins c) selenium d) recombinant activated protein

c e) sedation,analgesia,NMB f) glucose control g)RRT

H)bicarbonate therapy i)DVT prophylaxis J)stress ulcer prophylaxis K)nutrtion support

RESUSCITATION GOALS IN FIRST 6 HOURS

Central venous pressure 8 to 12 mm Hg (grade 1C)

Mean arterial pressure (MAP) ≥65 mm Hg (grade 1C)

Urine output ≥0.5 mL/kg/hour (grade 1C)

Superior vena cava oxygenation saturation (Scvo2) 70%

mixed venous oxygen saturation (Svo2) 65%

DIAGNOSTIC CRITERIA

THINGS TO BE COMPLETE IN FIRST 6 HRS

FIRST 3 HR

Obtain blood culture Measure lactate level Broad spectrum antibiotis 30ml/kg fluid for hypoension or lactate

level

WITH IN 6HR Vasopressors Remeasure lactate level

FLUIDS

Crystalloids as first choice for initial fluid resuscitation (grade 1B)

Initial minimum crystalloid challenge of 30 mL/kg (grade 1C)

DIAGNOSIS 10 ml of blood From two site percutaneous and insitu

catheter Other culture samples

ANTIMICROBIALS

within 1 hour of recognition of septic shock (grade 1B) and severe sepsis without septic shock (grade 1C)

Broad spectrum 7-10 days Recently used one should be avoided Combination therapy

INFECTION PREVENTION Selective oral as well as digestive

decontamination Others include hand hygeine nursing care elevated head end of the table Sub glottic suctioning

VASOPRESSORS AND INOTROPES

Norepinephrine as first choice NE+Epn Vasopressin 0.03u/min Phenylephrine not recommended

Dobutamine infusion trial up to 20 µg/kg/minute administered or added to vasopressor in the case of myocardial dysfunction or ongoing signs of hypoperfusion

CORTICOSTEROIDS

No corticosteroids in the absence of refractory shock (grade 1D)

Supportive therapy for sever sepsis

BLOOD PRODUCTS

PRBC transfusion when Hb ≤ 7gm% target hemoglobin concentration of 7.0–

9.0 g/dL in adults (grade 1B)

IMMUNOGLOBULINS No role

SELENIUM & PROTEIN C No role

MECHANICAL VENTILATION ARDS protocol

SEDATION ANALGESIA AND NMB CONTINOUS OR INTERMITTENT

SEDATION CONTINOUS OR INTERMITTENT UNDER

TRAIN OF FOUR MONITORING

GLUCOSE CONTROL ≤180 MG% To be monitored every 1 or 2 hr

OTHER RRT Stress ulcer prophlyalxis Dvt prophylaxis Nutrition support

THANK YOU