Michael BaramMedical Critical Care

SevereSevereSepsisSepsis

Relationship Between SIRS,Sepsis and Severe Sepsis

Bone RC, et al. Chest 1992;101:1644-55.Vincent JL. Crit Care Med 1997;25:372-4.

Trauma

Infection

SepsisOther

Pancreatitis

Burns

SIRS

Wall street journal

Surviving SepsisBundles• Sepsis Resusciation Bundle

① ② ③ ④ ⑤ ⑥ ⑦

①

• Management Bundle① .② ③ .④ ⑤ ⑥

•VentilatorBundle① ② ③ ④ ⑤ .

Surviving SepsisBundles• Sepsis Resusciation Bundle

Lactate . Early Cultures . Appropriate Abx . Source Control . Volume Expansion Cvp 8-12 . PressorsMAP >65 .

Inotropes SCVO2 > 70 .(t/c blood) .

• Management Bundle Glycemic Control . Activated Protein C . Stress Steroids . Limit Blood Products . Limit Vent Stretch . Limit Bicarb .

pH<7.15 .

•VentilatorBundle① Head of bed .② Oral Care .③ Sedation Holiday .④ Peptic Ulcer .⑤ DVT Proph .

Surviving SepsisBundles• Sepsis Resusciation Bundle

① Lactate .② Early Cultures③ Appropriate Abx④ Source Control⑤ Volume Expansion Cvp 8-12

⑥ PressorsMAP >65

⑦ Inotropes SCVO2 > 70(t/c blood)

• Management Bundle① Glycemic Control.② Activated Protein C③ Stress Steroids.④ Limit Blood Products⑤ Limit Vent Stretch⑥ Limit Bicarb

pH<7.15

•VentilatorBundle① Head of bed② Oral Care③ Sedation Holiday④ Peptic Ulcer⑤ DVT Proph.

Guidelines.pdf

Lactate- Predictor of Mortality

• Ann Emergency Med. 2005;45:524-528

• 1200 consecutive patients presenting with sepsis

• Ann Emergency Med. 2005;45:524-528

• 1200 consecutive patients presenting with sepsis

Early Appropriate ABX

Kumar et al, Critical Care 2006 Jun 34 (6) 1589-96

Control

Treatment

RR (95% C.I.)

P-value

In-hospital 46.5 30.5 0.58 0.009

28-day Mortality 49.2 33.3 0.58 0.01

60-day Mortality 56.9 44.3 0.67 0.03

CVP failed to Predict:CVP failed to Predict: volume status volume status

Wrong Vent Setting

normal lung 5 minutes (peak press 45) 20 min (peak 45)

Dreyfuss Am. J. Respir. Crit. Care Med., Volume 157, Number 1, January 1998, 294-323