Michael Baram Medical Critical Care. SevereSepsis Relationship Between SIRS, Sepsis and Severe...
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Transcript of Michael Baram Medical Critical Care. SevereSepsis Relationship Between SIRS, Sepsis and Severe...
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