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SEPSIS & SEPTIC SHOCK 10.15. 2009. Jaime Palomino, MD Pulmonary & Critical Care Medicine Tulane University Health Sciences Center New Orleans, Louisiana. Epidemiology. Sepsis yearly incidence 50 – 95 cases / 100,000 Increasing by 9% each year 2% hospital admissions
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SEPSIS & SEPTIC SHOCK 10.15. 2009 Jaime Palomino, MD Pulmonary & Critical Care Medicine Tulane University Health Sciences Center New Orleans, Louisiana
Epidemiology • Sepsis yearly incidence 50 – 95 cases / 100,000 • Increasing by 9% each year • 2% hospital admissions • 9% sepsis severe sepsis • 3% severe sepsis septic shock • 10% of ICU admissions
Septic Shock – Treatment • Initial Resuscitation
Septic Shock – Treatment • What are the recommended vasopressors in septic shock patients? • MAP ≥ 65 mmHg • Norepinephrine and Dopamine initial vasopressors of choice • Epinephrine first alternative when BP is poorly responsive to Norepinephrine or Dopamine
Septic Shock – Treatment • Vasopressors • Vasopressin • May be subsequently added to Norepinephrine (Dose: 0.03units/min) with anticipation of an effect equivalent to Norepinephrine alone.
Septic Shock – Treatment • Vasopressors • Comparison of Dopamine and Norepinephrine as the First Vasopressor Agent in the Management of Shock • De Backer D. NCT00314704 • Primary Outcome Measures: 28 day survival • Estimated Enrollment: 1600 • Study Start Date: December 2003 • Estimated Study Completion Date: December 2010
Septic Shock – Treatment • Steroids
Relative Adrenal Insufficiency Diagnosis Thomas Z et al. Ann Pharmacother 2007;41:1456-65
Septic Shock – Treatment • Glucose Control
Septic Shock– Treatment • Activated Protein C