Professional Documents
Culture Documents
International
SEPSIS
Infection
International
Sepsis =
infection plus systemic inflammatory
response syndrome (SIRS)
Sepsis berat =
sepsis yang disertai disfungsi organ
atau juga hipoperfusi jaringan
Syok septik =
sepsis berat disertai dengan hipotensi
yang tidak berespons dengan
pemberian cairan
Infection
International
INFLAMASI
Respon awal
tubuh
Tujuan :
menghancurkan
dan
menetralisasi
Infection
International
1. Mengisolasi
2. Mendilusi
3. Menghancurkan
4. membersihkan
Infection
International
Infection
International
PEMBUL
UH
DARAH
BEKUAN
O2
ALBUMIN →
PEMBUL
UH INTERST. SEL
SPACE
DARAH PLASMA →
CO2
MENGGANGGU PERTUKARAN O2
Infection
JENIS SEPSIS
International
Sepsis
T > 38 or < 36
o o
Sepsis +
PR > 90 bpm
+ Hypotension and
RR > 20/min or hypoperfusion
Invasion of Infection Organ
PaCO2 < 32 despite adequate
microorganisms dysfunction,
L > 12,000/uL + hypoperfusion or volume
or < 4,000/uL SIRS hypotension replacement
Infection
International
Bacteremia
Othe
Infection r
SIRS
Fungemi Sepsis Trauma
a
Parasite
Virus Burns
other
Pancreatitis
Severe Sepsis
• Sepsis with organ hypoperfusion one of
the followings :
– SBP < 90 mmHg
– Acute mental status change
– PaO2 < 60 mmHg on RA (PaO2 /FiO2 < 250)
– Increased lactic acid/acidosis
– Oliguria
– DIC or Platelet < 80,000 /mm3
– Liver enzymes > 2 x normal
Infection
Microbial Products
(exotoxin/endotoxin)
Cellular Responses
Platelet Coagulation Kinins Cytokines
Activation Activation Oxidases Complement TNF, IL-1, IL-6
Coagulopathy/DIC
Vascular/Organ System Injury
ial
Endothelial Endothel
damage damage
Multi-Organ Failure
Death
Infection
International
Angka kejadian dan mortalitas
akibat sepsis
Incidenc Mortality
e
Approximately total
200,000 death/year
Sepsis
400,000 7-17%
PCT AS A TOOL TO
International
KENDALI
SUMBER TERAPI CAIRAN Vasopressors
INFEKSI
Recombinant
Inotropic Therapy Corticosteroids Human Activated
Protein C (rhAPC)
TRANSFUSI
DARAH
Sepsis Guidelines 2008
Infection
International Tatalaksana sepsis (2013)
A. Initial resuscitation
B. Screening for sepsis and performance improvement
C. Diagnosis
D. Antimicrobial therapy
E. Source control
F. Infection prevention
G. Fluid therapy for severe sepsis
H. Vasopressor
I. Inotropic therapy
J. Corticosteroids
K. Blood production administration
L. Immunoglobulin
M. Selenium
N. History of recommendations regarding use of recombinant activated protein C
O. Mechanical ventilation of sepsis induced Acute Respiratory Distress Syndrome
(ARDS)
P. Sedation, analgesia and neuromuscular blockade
Q. Glucose control
R. Renal replacement therapy
S. Bicarbonate therapy
T. Deep vein thrombosis prophylaxis
U. Stress ulcer prophylaxis
V. Nutrition
W. Setting goals of care Sepsis Guidelines 2013
Infection
International
4 transfusio Cannula
n Mask
Mechanical
ventilation
2 3
fluid Preloa Afterloa vasoactiv
d d e
Contractility inotrop 5
e Dobutamine
Infection
International
40
33.3%
30
20
10
0
Standard Therapy EGDT
n =133 n=130
*Key difference was in sudden CV collapse, not MODS
Terapi antibiotik
International
Terapi antibiotik
Terapi Empiris
Kombinasi antibiotik satu atau lebih yang dapat meng-
cover berbagai jenis bakteri dan/atau jamur yang
dicurigai, serta memiliki kemampuan penetrasi jaringan
yang baik
G. Terapi cairan
• Transfusi TC jika :
– < 10,000/mm3 tanpa adanya
perdarahan
– < 20,000/mm3 with dengan risiko
kejadian perdarahan
Pasien sepsis
Terapi pendukung
Infection
International
Infection
International
TERIMA KASIH