Early Detection Pada Pasien

SEPSIS
• Philip Purworahyono, S.Kep

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2014 Clinical Pediatric Emergency Medicine .000/year in the US • Mortality • Severe Sepsis: 15-30% • Septic Shock: 20-60% • PEDIATRICS • 40.Incidence.000/year in the US • Mortality • Severe Sepsis: 4-7% • Septic Shock: 13-34% Wang et. Noah. Critical Care Medicine. Al 2007.10th Leading Cause of Death • ADULTS • 571.

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Rp. 325 Jt – Rp. 550 jt .

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2000 .PETER JD: NEMJ.343.

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NEMJ.ARTHUR PW. 340. 1999 .

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SEPSIS 3 .

neutrophils Bone et al.000/mm3 or >10% immature SIRS = systemic inflammatory response syndrome.101:1644.Sepsis: Defining a Disease Continuum Infection/ Trauma SIRS Sepsis Severe Sepsis A clinical response arising SIRS with a from a nonspecific insult. including presumed or 2 of the following: confirmed • Temperature ≥38oC or ≤36oC infectious process • HR ≥90 beats/min • Respirations ≥20/min 1992 • WBC count ≥12. 1992. Chest.000/mm3 or ≤4. .

Sepsis: Defining a Disease Continuum Infection/ Trauma SIRS Sepsis Severe Sepsis • Sepsis with ≥1 sign of organ failure – Cardiovascular (refractory hypotension) – Renal Shock – Respiratory – Hepatic 1992 – Hematologic – CNS – Unexplained metabolic acidosis Bone et al. Chest. 1992. 1999.340:207. N Engl J Med. .101:1644. Wheeler and Bernard.

1992 Parasite Virus Severe Infection Sepsis SIRS Sepsis Fungus shock Severe SIRS Trauma Bacteria BSI Burns Adapted from SCCM ACCP Consensus Guidelines .

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MAP < 70 mmHg.5mg/dL or 44.5 or aPTT > 60s) 24 hr) • Hyperglycemia (plasma glucose > 7. 41(2): 21 580-637. or an • WCC SBP decrease > 40 mmHg in adults or less than two SD below normal for age) Surviving Sepsis Campaign .International Guidelines for Management of Severe Sepsis and Septic Shock. Diagnostic criteria for sepsis General variables • Fever (> 38.3°C) Organ dysfunction variables • Hypothermia (core temperature < 36°C) • Arterial hypoxaemia (PaO2/FiO2 < 300) • Heart rate > 90/min–1 or more than two SD above the normal • Acute oliguria (urine output < 0.7 mmol/L) in the absence • Ileus (absent bowel sounds) of diabetes • Thrombocytopenia (platelet count < 100.000 μL–1) Inflammatory variables • Hyperbilirubinaemia (plasma total bilirubin > 4mg/dL or 70 μmol/L) • Leucocytosis (WBC count > 12.5 mL/kg/hr for at least value for age 2 hrs despite adequate fluid resuscitation) • Tachypnoea • Altered mental status • Creatinine increase > 0. .000 μL–1) • Leucopenia (WBC count < 4000 μL–1) • Normal WBC count with greater than 10% immature forms Tissue perfusion variables Plasma C-reactive protein more than two SD above the normal value • Hyperlactatemia (> 1 mmol/L) • Decreased capillary refill or mottling Haemodynamic variables • Arterial hypotension (SBP < 90mm Hg.2 μmol/L • Significant oedema or positive fluid balance (> 20 mL/kg over • Coagulation abnormalities (INR > 1. Crit Care Med 2013.

.International Guidelines for Management of Severe Sepsis and Septic Shock. Surviving Sepsis Campaign . 41(2): 22 580-637. Septic shock Septic shock is defined as sepsis-induced tissue hypoperfusion persisting after resuscitation with 30mls/kg intravenous isotonic crystalloid fluid as evidenced by: – Systolic blood pressure < 90 mmHg or MAP < 65 mmHg – Decrease in systolic blood pressure by 40mmHg from baseline and/or – Lactate > 4 mmol/l. Crit Care Med 2013.

2016 THE DEFINITION OF SEPSIS Life Threatening ORGAN DYSFUNCTION caused by a DYSREGULATED HOST RESPONSE to infection .

Life Threatening ORGAN DYSFUNCTION caused by a DYSREGULATED HOST RESPONSE to infection SOFA score : Sequential Organ atau Failure Assesmen .

Digunakan untuk pasien Non ICU INFEKSI ( Suspect ) + 2 atau lebih dari kriteria mengalami organ dysfunction dan diduga SEPSIS ------.315(8):801-810.2016.0287 . 2016.Harus ditranfer ke ruang intensif Tidak diperlukan pemeriksaan laboratorium JAMA.1001/jama. doi:10.

Sepsis Management National Clinical Guideline No.European Society of Intensive Care Medicine Annual Congress in September 2014. 2014 . 6.

Copyright © 2016 American Medical Date of download: 5/9/2016 Association. All rights reserved. .

Diindikasikan adanya kecurigaan infeksi dan gagal organ ..SOFA Score • Direkomendasikan untuk pasien yang dirawat di ICU • Peningkatan SCORE 2 (dua) atau lebih .

. SEPTIC SHOCK • Septic shock is a severe type of sepsis wherein circulatory and cellular metabolism abnormalities are extreme and substantially increase the risk of death • In-hospital mortality is >40%.

SEPTIC SHOCK • MAP <65 dengan SEPSIS penggunaan Vasopressor • Lactat serum > 2mmol/L • Tidak ada tanda HIPOVOLEMI .

Monitor kondisi klinis Pasien SEPSIS masih reevaluasi untuk diduga No No dinilai ulang bila ada INFEKSI qSOFA ≥ 2 diduga indikasi Yes Yes Assesment adanya kejadian disfungsi ORGAN qSOFA : • Pernafasan >22 x/menit Yes • Kesadaran Menurun • Tekanan Darah Sistolik < 100 mmHg .

Monitor kondisi klinis SOFA ≥ 2 No reevaluasi untuk dinilai ulang bila ada indikasi Yes SEPSIS MAP < 65 dengan penggunaan Vasopresor SOFA Variable : • PaO2/FiO2 Ratio Level serum Lactat > 2 mmol/L • GCS • MAP ( Tidak ada hipovolemia) • Penggunaan vasopresor (jenis dan Yes dosisnya) • Serum creatinin dan urine output • Billirubin SEPTIC SHOCK • Trombosit .

Tapi “ severe sepsis” tidak digunakan dalam klasifikasi baru (SEPSIS 3) • qSOFA direkomendasikan untuk mendeteksi secara dini adanya Sepsis • Hipotensi dan level LACTAT menjadi poin penting dalam kriteria Shock Septic yang baru . SUMMARY • SIRS Masih digunakan untuk GIUDE klinisi dalam mendeteksi adanya infeksi.

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