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  • Severe Sepsis Resuscitation Protocol: Invasive WHO

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    Okram Kulla
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    Patients with severe sepsis / septic shock may require at least 6 liters of fluid during their acute resuscitation (first 6 hours of care) If MAP is 65 after adequate fluid loading, start vasopressors. If lactate hasn't cleared by >= 10% AND ScvO2 >= 70%, go to disposition.

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    Patients with severe sepsis / septic shock may require at least 6 liters of fluid during their acute resuscitation (first 6 hours of care) If MAP is 65 after adequate fluid loading, start vasopressors. If lactate hasn't cleared by >= 10% AND ScvO2 >= 70%, go to disposition.

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    20 views1 page

    Severe Sepsis Resuscitation Protocol: Invasive WHO

    Uploaded by

    Okram Kulla
    Patients with severe sepsis / septic shock may require at least 6 liters of fluid during their acute resuscitation (first 6 hours of care) If MAP is 65 after adequate fluid loading, start vasopressors. If lactate hasn't cleared by >= 10% AND ScvO2 >= 70%, go to disposition.

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    SevereSepsisResuscitationProtocol:Invasive WHO INITIAL RESUSCITATION

    SepticPatientwithLactate4mmol/LorMAP<65after2literscrystalloid AND Goalsofcarearecurative Administer2030ml/kgisotoniccrystalloidbolusover20minutes Sendculturesofalllikelysourcesofinfection Thinkofsourcecontrol(Infectedcatheter?Operativeinterventionforinfection?Drainablepus?) Administerantibioticstocoveralllikelysourcesofinfection PlacefullsterilecentrallineintheIJ(preferablywithultrasound)orsubclavianvein IfpatientsO2saturationis<90%onhighfiO supplementaloxygen(nonrebreathermask),consider:
    2

    SpO2

    Intubation(Beware,thepatientmaydroptheirbloodpressureprecipitously) Placeonlungprotectiveventilation Placeonpaincontrolregimen,administersedationafterpaincontrolled Choose1Strategy DynamicIVCUltrasoundKeepgiving5001000mlbolusesofisotoniccrystalloiduntilthereis<30% changeinIVCsizeifnotintubatedor>12%ifintubated. CVPAdministerfluidsuntilCVP>10mmHginnonintubatedpatientsand>14mmHginintubated patients. EmpiricFluidLoadingPatientswithseveresepsis/septicshockmayrequireatleast6litersoffluid duringtheiracuteresuscitation(first6hoursofcare). IfMAPis<65afteradequatefluidloading,startvasopressors. TitratevasopressorstoachieveaMAP65.

    FLUIDS

    RECHECKING MAP

    TISSUE OXYGENATION

    DISPOSITION

    SendrepeatlactateANDScvO2 Iflactatehasclearedby10%ANDScvO270%,gotodisposition IfScvO2<70ORlactatehasntclearedby10%,choose1Option: IfHb<7:transfuse1unitofPRBC or AdditionalFluids:ifusingCVPtodeterminefluidstatus,administeranadditionalliterof isotoniccrystalloid or Inotropes:especiallyifheartappearshypodynamiconecho.Ifcalciumislow,repletethat first.Ifnot,administerdobutamine520mcg/kg/min. or Intubate:todecreasepulmonarymetabolicload or IfHb710:considertransfusion.Especiallyinelderlypatientsorpatientswithcoronary arterydisease SendrepeatlactateandScvO2.IfScvO2<70oriflactatestillhasnotclearedby10%,continue withtheabove,trendinglactatesandScvO2every1houruntilthesetwogoalsaremet. PatientsshouldgetICUconsultation.IfnotanICUcandidate,shouldgotoappropriatelymonitored bed. PeriodicallyrecheckpatientforMAP65,goodmentalstatus,andgoodurineoutput. ConsidertrendinglactateeveryQ24hours.Ifitstartsrisingagain,restartprotocol.

    GNYHAandUHFherebydisclaimallwarranties,expressorimplied,astotheaccuracyofanyoftheinformationcontainedherein,orits fitness for any particular use or purpose. These materials are intended to provide you with information and resources that may assist yourorganizationandshouldnotbeusedasasubstituteforclinicalormedicaljudgment.

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