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Sepsis

Sepsis. Bundle Approach to Therapy. 2004 Guidelines SSC. Dellinger et al Crit Care Med 2004; 32:858. 2008 Guidelines SSC. Dellinger et al Crit Care Med 2008; 36:296. Sepsis. Resuscitative Phase. Rivers et al N Engl J Med 2001; 345:1368. Sepsis Resuscitation Bundle – IHI/SSC.

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Sepsis

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  1. Sepsis Bundle Approach to Therapy

  2. 2004 Guidelines SSC Dellinger et al Crit Care Med 2004; 32:858

  3. 2008 Guidelines SSC Dellinger et al Crit Care Med 2008; 36:296

  4. Sepsis Resuscitative Phase

  5. Rivers et al N Engl J Med 2001; 345:1368

  6. Sepsis Resuscitation Bundle – IHI/SSC • Measure serum lactate • Obtain blood cultures, prior to antibiotic administration • Administer broad spectrum antibiotics within 3 hrs ED admission, or 1 hr non-ED sepsis • Treat hypotension and/or elevated lactate with fluids: • Initial minimum 20 mL/kg crystalloid or equivalent • Apply vasopressors for hypotension not responsive to initial fluids. Maintain MAP > 65 mmHg • Continue vasopressors for ongoing hypotension • For persistent hypotension despite fluids, and/or lactate > 4 mmol/L: • Achieve central venous pressure > 8 mmHg • Achieve ScvO2 > 70% or SvO2 > 65% http://www.ihi.org/IHI/Topics/CriticalCare/Sepsis/

  7. Dellinger et al Crit Care Med 2008; 36:296

  8. Dellinger et al Crit Care Med 2008; 36:296

  9. Compliance with early Sepsis Bundle and Mortality Gao et al Crit Care 2005; 9(6):764

  10. Bundle Management of Early Severe Sepsis and Outcome % Mortality Nguyen et al Crit Care Med 2007: 35:1105

  11. Protocol for Early Goal-Directed Therapy Rivers E et al. N Engl J Med 2001;345:1368-1377

  12. Sepsis Management Phase

  13. Sepsis Management Bundle – IHI/SSC • Administer low-dose steroids for septic shock in accordance with a standardized ICU policy • Administer drotecogin alfa (activated) in accordance with a standardized ICU policy • Maintain glucose control: > LLN and < 180 mg/dL • Maintain inspiratory plateau pressure < 30 cmH2O for mechanically ventilated patients http://www.ihi.org/IHI/Topics/CriticalCare/Sepsis/

  14. Dellinger et al Crit Care Med 2008; 36:296

  15. Dellinger et al Crit Care Med 2008; 36:296

  16. Pediatric Considerations • Guide fluid resuscitation by clinical parameters: HR, UOP, capillary refill, LOC • Dopamine as first vasopressor of choice • Dobutamine for low cardiac output state (as determined clinically) • Hydrocortisone reserved for children with catecholamine resistance and suspected/proven adrenal insufficiency • No rhAPC • ? Glycemic control • Consider IVIG Dellinger et al Crit Care Med 2008; 36:296

  17. Pediatric Considerations Dellinger et al Crit Care Med 2008; 36:296

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