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Sepsis. Bundle Approach to Therapy. 2004 Guidelines SSC. Dellinger et al Crit Care Med 2004; 32:858. 2008 Guidelines SSC. Dellinger et al Crit Care Med 2008; 36:296. Sepsis. Resuscitative Phase. Rivers et al N Engl J Med 2001; 345:1368. Sepsis Resuscitation Bundle – IHI/SSC.

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sepsis

Sepsis

Bundle Approach to Therapy

2004 guidelines ssc
2004 Guidelines SSC

Dellinger et al Crit Care Med 2004; 32:858

2008 guidelines ssc
2008 Guidelines SSC

Dellinger et al Crit Care Med 2008; 36:296

sepsis1

Sepsis

Resuscitative Phase

sepsis resuscitation bundle ihi ssc
Sepsis Resuscitation Bundle – IHI/SSC
  • Measure serum lactate
  • Obtain blood cultures, prior to antibiotic administration
  • Administer broad spectrum antibiotics within 3 hrs ED admission, or 1 hr non-ED sepsis
  • Treat hypotension and/or elevated lactate with fluids:
    • Initial minimum 20 mL/kg crystalloid or equivalent
    • Apply vasopressors for hypotension not responsive to initial fluids. Maintain MAP > 65 mmHg
    • Continue vasopressors for ongoing hypotension
  • For persistent hypotension despite fluids, and/or lactate > 4 mmol/L:
    • Achieve central venous pressure > 8 mmHg
    • Achieve ScvO2 > 70% or SvO2 > 65%

http://www.ihi.org/IHI/Topics/CriticalCare/Sepsis/

compliance with early sepsis bundle and mortality
Compliance with early Sepsis Bundle and Mortality

Gao et al Crit Care 2005; 9(6):764

bundle management of early severe sepsis and outcome
Bundle Management of Early Severe Sepsis and Outcome

% Mortality

Nguyen et al Crit Care Med 2007: 35:1105

slide13

Protocol for Early Goal-Directed Therapy

Rivers E et al. N Engl J Med 2001;345:1368-1377

sepsis2

Sepsis

Management Phase

sepsis management bundle ihi ssc
Sepsis Management Bundle – IHI/SSC
  • Administer low-dose steroids for septic shock in accordance with a standardized ICU policy
  • Administer drotecogin alfa (activated) in accordance with a standardized ICU policy
  • Maintain glucose control: > LLN and < 180 mg/dL
  • Maintain inspiratory plateau pressure < 30 cmH2O for mechanically ventilated patients

http://www.ihi.org/IHI/Topics/CriticalCare/Sepsis/

pediatric considerations
Pediatric Considerations
  • Guide fluid resuscitation by clinical parameters: HR, UOP, capillary refill, LOC
  • Dopamine as first vasopressor of choice
  • Dobutamine for low cardiac output state (as determined clinically)
  • Hydrocortisone reserved for children with catecholamine resistance and suspected/proven adrenal insufficiency
  • No rhAPC
  • ? Glycemic control
  • Consider IVIG

Dellinger et al Crit Care Med 2008; 36:296

pediatric considerations1
Pediatric Considerations

Dellinger et al Crit Care Med 2008; 36:296