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
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