T7 - Sépsis e MODS (2)

Question 1

Ionotropes?

Answer 1

➢ A trial of dobutamine infusion up to 20 microg / kg / min be administered or added to vasopressor in the presence of:
– (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output
– (b) ongoing signs of hypoperfusion, despite achieving adequate intravascular volume and adequate MAP
➢ Not using a strategy to increase cardiac index to predetermined supranormal levels

Question 2

Therapy Targets?

Answer 2

➢ Target a MAP of >65 mmHg
– suggest a higher MAP in septic patients with history of hypotension and in patients that show clinical improvement with higher blood pressure

➢ Mental status
➢ Urinary output >0,5 ml/kg/h
➢ Skin appearance / Capillary perfusion time < 3 sec

➢ Lactate <2 mmol/L
➢ SVO2 >70% / CO2 Gap <6 mmHg

Question 3

Steroids?

Answer 3

➢ We suggest against using intravenous hydrocortisone to treat septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability
➢ If this is not achievable, we suggest intravenous hydrocortisone at a dose of 200 mg per day

Question 4

Conclusions?

Answer 4

➢ Reconhecimento precoce da sepsis e choque séptico
➢ Dx do foco provável de infeção
➢ Exames microbiológicos e terapêutica antibiótica adequada
➢ Controlo de foco, sempre que necessário e possível
➢ Adequação da entrega de oxigénio aos tecidos: VIP
➢ Monitorização seriada da resposta (decidir se extrategia boa ou se precisamos de a mudar)
➢ Terapêutica adjuvante??