Severe sepsis and septic shock

.
.

1. (severe sepsis)
(septic shock)
2. severe sepsis septic shock
(sepsis)
(severe sepsis)
(septic shock)

Diagnosis
SIRS : Systemic Inflammatory Response Syndrome
2 4
1)
>38oC <36oC
2)
>90
3)
>20 PaCO2 <32 mmHg
4)
>12,000 cells L-1 <4,000 L-1
Sepsis SIRS
Severe sepsis sepsis tissue hypoperfusion
(1)
- (Sepsis induced hypotension: systolic blood
pressure <90 mmHg mean arterial pressure <70 mmHg SBP >40 mmHg)
- (Lactate) upper normal limits (>4 mmol/L)
- (urine output) <0.5 mL/kg/h 2
-Acute lung injury PaO2/FiO2 <250
-Acute lung injury PaO2/FiO2 <200
- (Creatinine) >2.0 mg/dL (176.8 mol/L)

- (Bilirubin) >2 mg/dL (34.2 mol/L)

- (Platelet count) <100,000 L
-Coagulopathy INR: international normalized ratio >1.5
1 Diagnosis criteria for sepsis ( Levy et al. (1))

Septic shock sepsis

inotropic vasopressor agents

SIRS criteria


SIRS (2)
Management of severe sepsis and septic shock
Early goal-directed therapy severe sepsis and septic shock
2 Protocol for Early goal-directed therapy ( (3))

A. Resuscitation
6 (4)
Central venous pressure 8-12 mmHg

 (Fluid therapy) crystalloid

30 mL/kg crystalloid albumin

Mean arterial pressure (MAP) 65 mmHg

Vasopressor MAP 65 mmHg Norepinephrine
Dopamine septic shock
vasopressor hemodynamic instability
Hydrocortisone 200 mg per day
Central venous or mixed venous oxygen saturation 70%
SvO2 Dobutamine
(maximum 20 g/kg/min) packed red cell (PRC) Hematocrit 30%
Urine output 0.5 mL/kg/hr
B. (Diagnosis)
(culture)
(Hemoculture) 2


C. (Antibiotic therapy)
1 septic
shock severe sepsis (Empirical antinfective therapy) 3-5
7-10
S. aureus

D. (Source control)


12 (5)

 Surviving Sepsis Campaign bundles

sepsis

3 Surviving Sepsis Campaign Care Bundles ( (5))

Reference
1. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001
SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med April
2003. 2003;31(4):12506.
2. Wester AL, Dunlop O, Melby KK, Dahle UR, Wyller TB. Age-related differences in symptoms,
diagnosis and prognosis of bacteremia. BMC Infect Dis. 2013 Jul 24;13:346.
3. Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock NEJM
[Internet]. New England Journal of Medicine. [cited 2014 May 2]. Available from:
http://www.nejm.org/doi/full/10.1056/NEJMoa010307
4. Surviving Sepsis Campaign | Guidelines [Internet]. [cited 2014 May 2]. Available from:
http://www.survivingsepsis.org/Guidelines/Pages/default.aspx
5. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis
Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit
Care Med January 2008. 2008;36(1):296327.