Sepsis Flashcards
Full SOFA score components
SOFA score a. A scoring/grading system from 0 to 4 evaluating the severity of organ dysfunction using a variety of clinical findings and laboratory data i. Respiration (Pao2 /Fio2 mm Hg) ii. Coagulation (platelets, x 103 /mm3 ) iii. Liver function (bilirubin, mg/dL) iv. Cardiovascular function (mean arterial pressure [MAP] or vasopressor requirement) v. Central nervous system function (Glasgow Coma Scale) vi. Renal function (creatinine, mg/dL and/or urinary output, mL/day)
In screening for sepsis, increased risk would be an acute increase in the SOFA score of 2 points or higher and a suggestion of infection. d. SOFA scoring is primarily used in the ICU setting
QSOFA score
One point is given for each of the criteria, and a score of 2 or higher is considered positive. i. Low blood pressure (systolic blood pressure 100 mm Hg or less) ii. High respiratory rate (22 breaths/minute or greater) iii. Altered mental status (Glasgow Coma Scale score less than 15)
Septic shock definition
Patients with septic shock have sepsis with (1) persistent hypotension requiring vasopressors to main- tain a MAP of 65 mm Hg or greater and (2) a serum lactate concentration greater than 2 mmol/L.
Sepsis fluid recommendations
Fluid therapy a. At least 30 mL/kg of intravenous crystalloid fluid Ringer solution) given within the first 3 hours
additional fluids should be guided by frequent assessment of hemodynamic status.
Target a MAP of 65 mm Hg, especially in those also receiving vasopressor therapy. iii. Target returning serum lactate concentrations to normal (less than 2 mmol/L)
Sepsis pressor recommendations
Norepinephrine is recommended first line. (a) Can be used as monotherapy, or additional agents (epinephrine, vasopressin) may be added to reach a MAP target of 65 mm Hg
Phenylephrine is a pure α-adrenergic agonist that should be reserved for those who have not
achieved their goal MAP with other agents and combinations.
Dobutamine may be initiated in patients with evidence of persistent hypoperfusion despite
fluid resuscitation and vasopressor therapy.
Sepsis steroids recs
Corticosteroids should only be used in patients with septic shock if adequate fluid resuscitation and vaso- pressor therapy do not restore hemodynamic stability.
Recommended dose is 200 mg daily by continuous or intermittent infusion; however, may result in an
increased risk of hyperglycemia
hydrocortisone can be initiated in patients with septic shock when fluid resuscitation and vasopressor therapy have failed to restore hemodynamic stability.
Use until hemodynamic stability has been restored. a. Use as short a course as possible. b. Taper hydrocortisone over 3 days or more when vasopressors are no longer require
Insulin in sepsis
Insulin should be initiated when two consecutive blood glucose concentrations are greater than 180 mg/dL. b. Target glucose concentrations should be less than 180 mg/dL and greater than 110 mg/dL.
PK changes in sepsis
Increased volume of distribution of drugs leads to decreased serum concentrations of hydrophilic drugs.
Augmented renal clearance a. Occurs in 30%–85% of critically ill patients b. Renal elimination of antibiotics may be increased, leading to subtherapeutic concentrations.
