Surviving sepsis guidelines Flashcards
Def sepsis - sepsis 3
Sepsis is life-threatening organ dysfunction caused by a dysregulated
host response to infection
Divide into 6 groups ?
What is guidelines - screening ?
What screening tool is best?
What is q SOFA SCORE
and SIRS SCORE ?
sofa score ?
Def of septic shock ?
Guidelines of the use of lactate?
With initial resus:
4.When to begin treatment ?
5. Patients with sepsis induced hypoperfusion or septic shocks?
6. Measures in adults to guide fluid resuss?
And name dynamic parameters
7. Use of lactate?
8. Use of cap refil time ?
Passive leg raised test?
In resource-limited regions where measurement
of CO or SV may not be possible, a>15% increase in pulse
pressure could indicate that the patient is fluid responsive
utilizing a passive leg-raise test for 60–90 seconds
OVERVIEW
Passive Leg Raise (PLR) transiently increases venous return in patients who are preload responsive, as such it is a diagnostic test not a treatment
it is a predictor of Fluid responsiveness (i.e. helps identify patients who are on the ascending portion of their Starling Curve, and will have an increase in stroke volume in response to fluid administration)
TECHNIQUE
sit patient at 45 degrees head up semi-recumbent position
lower patient’s upper body to horizontal and passively raise legs at 45 degrees up
maximal effect occurs at 30-90 seconds
assess for a 10% increase in stroke volume (cardiac output monitor) or using a surrogate such as pulse pressure (using an arterial line)
Guidelines of MAP ?
Admission to ICU ?
Infection sub groups ?
Diagnosis of infection
Time to antibiotics
Biomarkers to start antibiotics
Antimicrobial choice ?
Antifungal therapy ?
Antiviral therapy?
Delivery of AB ?
Pharmacokinetics and pharmacodynamics?
Source control ?
De escalation of treatment ?
Duration of AB?
Biomarkers to discontinue ?
Diagnosis sepsis ?
As a
best practice statement, we recommended that appropriate
routine microbiologic cultures (including blood)
should be obtained before starting antimicrobial therapy
in patients with suspected sepsis and septic shock if it
results in no substantial delay in the start of antimicrobials
(i.e.<45 min). “is recommendation has not been
updated in this version but remains as valid as before.
“e signs and symptoms of sepsis are nonspecific and
often mimic multiple other diseases [90–92]. Since there
is no “gold standard” test to diagnose sepsis, the bedside
provider cannot have a differential diagnosis of sepsis
alone in a patient with organ dysfunction. Indeed, a third
or more of patients initially diagnosed with sepsis turn
out to have non-infectious conditions [90, 93, 94]. Best
practice is to continually assess the patient to determine
if other diagnoses are more or less likely, especially since
a patient’s clinical trajectory can evolve significantly after
hospital admission, increasing or decreasing the likelihood
of a diagnosis of sepsis. With this uncertainty, there
can be significant challenges in determining when it is
“appropriate” to de-escalate or discontinue antibiotics
Time to AB?
- Adults with high possibility of shock or septic shock ?
13 and 14. Patients with possible sepsis without shock ?
What is rapid assessment?
And what time limit? - Patients without sepsis or shock ?
Biomarkers to start AB?
AB choice ?
MRSA ?
Risk factors MRSA?
Patient-related risk factors for MRSA include prior history
of MRSA infection or colonisation, recent IV antibiotics,
history of recurrent skin infections or chronic wounds,
presence of invasive devices, haemodialysis, recent hospital
admissions and severity of illness [136, 138–142].
MDR bacteria ?
19. For adults with sepsis or septic shock and high risk for multidrug
resistant (MDR) organisms?
20. For adults with sepsis or septic shock and low risk for MDR organisms?
21. For adults with sepsis or septic shock?
Antifungal and antiviral use ?
While patients with sepsis or septic shock may not in
general benefit from empiric antifungals, some patients
with particular risk factors for fungal infection may, for
example patients with febrile neutropenia who fail to
defervesce after 4–7 days of broad-spectrum antibacterial
therapy are at increased risk of having fungal disease
(Table 2) [175, 176]. “e risk of Candida sepsis or septic
shock for other immunosuppressed populations is highly
disease- and therapy-specific. Importantly, the decision
to start empiric antifungal therapy depends on the type
and number of risk factors, along with the local epidemiology
of fungal infections.
Accordingly, we suggest
Risk factors of fungal infections ?
Delivery of AB ?
Source control ?
Removing foreign objects ?
De escalation of AB ?
Duaration of AB ?
Biomarkers to discontinue ?
Fluid managment
32. First line treatment what fluid ?
33. NS vs RL ?
34. Albumin?
35.Starches ?
36. Gelatin
Vasopressors
37. What is best one to use ?
38. Vasopressin ?
Inotropes
What to use if cardiac dysfunction present ?
Monitoring
and IV access
Fluid balance ?
Oxygen targets?
High flow nasal O2 ?
NIV ?
Protective ventilation ARDS due to sepsis?
Plateau pressure aim?
Peep ?
Applying higher PEEP in patients with ARDS may
open lung units to participate in gas exchange and may
increase PaO2
TV in sepsis without ARDS ?
Recruitment ?
Proning
NM blockers ?
when to use and how?
Coticosteroids ?
RBC transfusion and triggers?
Stress ulcer prophylaxis ?
VTE ?
TYPE ?
Renal replacement ?
Glucose control?
Vit C ?
Bicarbonate therapy ?
Nutrition ?
