22. Sepsis 24h Bundle

Question 1

Care bundles

Answer 1

Group interventions
related to disease process
executed together = better outcome

Ensure all patients receive bets treatment
based on evidence / logic
100% time

Question 2

Sepsis care bundles 24h

Ventilator / Lung management

Answer 2

TV
6ml/Kg

Upper plateau pressure <30

PaO2>8 aim

Permissive hypercapnia

PEEP optimisation

Other interventions with no proven effect on mortality
but improve oxygenation
Inverse ratio ventilation
Conservative fluids
Prone 
Nitric
Ecmo

Question 3

Glycaemic Control

Answer 3

Monitor & Rx hyperglycaemia

Van den Berghe
study
Suggested improved outcome with tight control (4-8mmol/L)
Current evidence suggest avoid <10

Question 4

Steroid

Answer 4

Short synacthen test
not routine

suggest if steroid deficiency evidence
Panhypopit / PO Steroid rx

Patients unresponsive to fluid & vasopressors

Question 5

DVT prophylaxis

Early enteral nutrition

Answer 5

LMWH per local guideline

Mechanical proph where heparin c/i

Support maintain healthy gut flora
Mesenteric flow benefit
Calorie supplementation
Patency bowel mucosa

Question 6

Stress ulcer prop

Other

Answer 6

H2 blockers or PPIs
Risk vs VAP

Vasopressin if high dose Norad

CVVH optimalin HD unstable patients