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The golden hours. Akut Infektionsmedicin Initial behandling af sepsis Dansk Selskab for Infektionsmedicin Overlæge Merete Storgaard. Dansk Selskab for Intern Medicin. Årsmødet den 3. marts 2006. SIRS systemisk inflammatorisk respons syndrom mindst 2 af 4 kriterier skal være opfyldt :

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Akut InfektionsmedicinInitial behandling af sepsisDansk Selskab for InfektionsmedicinOverlæge Merete Storgaard

Dansk Selskab for Intern Medicin.

Årsmødet den 3. marts 2006

sepsis definitioner
SIRS

systemisk inflammatorisk respons syndrom

mindst 2 af 4 kriterier skal være opfyldt:

Temperatur større end 38,0 eller mindre end 36,0.

Puls > 90/min.

Respirationsfrekvens > 20/min.

Leukocytter > 12,0 x 109 eller < 4,0 x 109

eller venstreforskydning med > 10 % stavkernede eller andre umodne former.

Sepsis

SIRS med dokumenteret infektion.

Alvorlig sepsis:

Sepsis med hypotension eller

tegn til organ hypoperfusion.

Septisk shock:

Sepsis med hypotension

trods adækvat volumensubstitution eller med behov for pressorstøtte.

Sepsis definitioner

Hypotension: systolisk BT < 90 mm Hg eller et vedvarende systolisk BT-fald > 40 mm Hg i mere end 1 time

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Epidemiology of sepsis in Norway in 1999.

Hans Flaatten  Critical Care 2004, 8: R180-R184

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Proportion of survivors according to systemic response

N= 339

Valles, J. et al. Chest 2003;123:1615-1624

Community-Acquired Bloodstream infection in Critically ill Adult patients

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Survival rate according to the presence of shock and empiric antibiotic treatment (log-rank test, p < 0.001)

Valles, J. et al. Chest 2003;123:1615-1624

Community-Acquired Bloodstream Infection in Critically ill Adult Patients

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Duration of hypotension prior to antimicrobial administration is a critical determinant of outcome in human septic shock K-415/ ICAAC 2004

2100 pt with septic shock.

Overall mortality 53,3 %.

Median time to effective anti-microbial therapy was 6,25 hours.

Odds ratio of death increased progressively with delays in initiation of appropriate therapy with 5-10% decrease in survival with every hour of delay over the first 6 hours.

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Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic ShockEmanuel Rivers, M.D., M.P.H., Bryant Nguyen, M.D., Suzanne Havstad, M.A., Julie Ressler, B.S., Alexandria Muzzin, B.S., Bernhard Knoblich, M.D., Edward Peterson, Ph.D., Michael Tomlanovich, M.D., for the Early goal-Directed Therapy Collaborative Group

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Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock, by Rivers 2001

mortality
Mortality

Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock, by Rivers 2001, NEJM 2001

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

Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock, by Rivers 2001, NEJM 2001

optimering af behandling af sepsis
Optimering af behandling af sepsis
  • Hurtig identifikation af sepsis patienter.
  • Målrettet strategi med fokus både på effekt mål og tidsfaktor.
  • Initial behandling bestående af 3 elementer:
    • Bredspektret antibiotika ved ukendt fokus
    • Volumenterapi
    • Udredning med henblik på fokus
antibiotika behandling
Antibiotika behandling
  • Antibakterielle spektrum
  • Pharmakokinetik / pharmakodynamik
  • Kliniske studier
  • Økologi