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Sepsis & Syok Sepsis

Dr. Sunto
Departemen Perawatan Kritis
Eka Hospital Pekanbaru
Most sepsis-associated deaths were unlikely to be
preventable through better hospital-based care
Outline
• Definisi
• Syok, sepsis dan syok sepsis
• Diagnosis
• Quick SOFA dan SOFA score
• Gangguan metabolik dan disfungsi organ
• Platelet, Lekositosis, Albumin, Elektrolit, Laktat
• Tatalaksana
• Resusitasi cairan
• Vasopresor
• Antibiotik
• Lainnya: Ventilasi mekanik, kortikosteroid, renal support
BANGSAL

Manusia biasa INFEKSI SEPSIS

• Sepsis: Disfungsi organ yang


mengancam nyawa disebabkan karena SYOK
disregulasi respons imun karena infeksi
• Syok sepsis: Sepsis + hipotensi yg butuh
SEPSIS
ICU,
vasopressor utk pertahankan MAP >65 BUKAN
mmHg dan laktat serum 2mmol/L HCU ya
nyong
SOFA difficult aahh?
No need to worry lah
uncle aunty,
we create
quick SOFA
Disfungsi organ & metabolik
• Paru : shunting pulmonal pneumonia
• Koagulasi: Low platelet
• Liver: kondisi syok, perfusi terganggu
• Kardiovaskuler: Hipotensi
• Neurologis: Penurunan kesadaran
• Renal: Acute Kidney Injury
• Albumin status
• Hiponatremia, hypokalemia/hiperkalemia
Hoaks laktat
Siklus Krebs  Siklus Cori
Global anaerobic threshold dewasa
4mls/kgBW/min, sama dgn Hb 4 dan
Cardiac Index 1 L/min/m2
↑ glukosa Stres hiperglikemia

Hepar ↑
glikogenolisis
↑ Laktat
Hiperlaktatemia

Aktivasi B2 adrenergik ↑ Laktat


dehidrogenase

Otot ↑
↑ Pyruvate
glikogenolisis

↑ Piruvat
dehidrogenase

↑ Acetyl-CoA Siklus Krebs


This review presents clear evidence that there is no biochemical support for
lactate production causing acidosis. Lactate production retards, not causes,
acidosis.

…..Thus increased lactate production coincides with cellular acidosis and


remains a good indirect marker for cell metabolic conditions that induce
metabolic acidosis. If muscle did not produce lactate, acidosis and muscle
fatigue would occur more quickly and exercise performance would be
severely impaired
Tatalaksana

1. Resusitasi cairan
2. Vasopresor
3. Antibiotik, kultur darah, sputum, urin
4. Lainnya: Ventilasi mekanik, kortikosteroid, renal support
Outdated?
2012 Recommendation for
Initial Resuscitation.
We recommend the protocolized, quantitative resuscitation of
patients with sepsis- induced tissue hypoperfusion. During the
first 6 hours of resuscitation, the goals of initial resuscitation
should include all of the following as a part of a treatment
protocol:
a) CVP 8–12 mm Hg
b) MAP ≥ 65 mm Hg
c) Urine output ≥ 0.5 mL/kg/hr
d) Scvo2 ≥ 70%.
CVP 8–12 mm Hg as a target for fluid resus?

Marik, 2008
Mau ikut siapa?
Fluid responsiveness
Antibiotik
• Nuke them with M-bomb (meropenem)?
• Variabel lain yang perlu jadi pertimbangan?
• Berapa lama?
• Kultur urin, darah, sputum
Terapi lain
• Ventilasi mekanik
• Renal support
• Kortikosteroid
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