beyond surviving epsis guidline

1. Dr Riyas A
MD Anaesthesia

2.  Severe sepsis and septic shock are major
health care problems

3.  Sepsis:presence of infection with systemic
manifestation of infection
 Severe sepsis;presence of sepsis with
evidence of sepsis induced organ dysfunction
or tissue hypoperfusion
 Septic shock:sepsis induced hypotension
persisting despite fluid resucitation

4.  A)initial resuscitation
 B)screening
 C)diagnosis
 D)antimicrobial therapy
 E)source control
 F)infective prevention
 G)fluid therapy
 H) Vasopressor
 I) Corticosteroid

5.  J) supportive therapy
 a) blood products administration
 b) immunoglobulins
 c) selenium
 d) recombinant activated protein c
 e) sedation,analgesia,NMB
 f) glucose control
 g)RRT

6.  H)bicarbonate therapy
 i)DVT prophylaxis
 J)stress ulcer prophylaxis
 K)nutrtion support

7.  Central venous pressure 8 to 12 mm Hg
(grade 1C)
 Mean arterial pressure (MAP) ≥65 mm Hg
(grade 1C)
 Urine output ≥0.5 mL/kg/hour (grade 1C)
 Superior vena cava oxygenation saturation
(Scvo2) 70%
 mixed venous oxygen saturation (Svo2) 65%

10.  Obtain blood culture
 Measure lactate level
 Broad spectrum antibiotis
 30ml/kg fluid for hypoension or lactate level

11.  Vasopressors
 Remeasure lactate level

13.  Crystalloids as first choice for initial fluid
resuscitation (grade 1B)
 Initial minimum crystalloid challenge of 30
mL/kg (grade 1C)

14.  10 ml of blood
 From two site percutaneous and insitu
catheter
 Other culture samples

15.  within 1 hour of recognition of
septic shock (grade 1B) and severe sepsis
without septic shock (grade 1C)
 Broad spectrum
 7-10 days
 Recently used one should be avoided
 Combination therapy

16.  Selective oral as well as digestive
decontamination
 Others include
hand hygeine
nursing care
elevated head end of the table
Sub glottic suctioning

17.  Norepinephrine as first choice
 NE+Epn
 Vasopressin 0.03u/min
 Phenylephrine not recommended

18.  Dobutamine infusion trial up to 20
µg/kg/minute administered or added to
vasopressor in the case
of myocardial dysfunction or ongoing signs
of hypoperfusion

19.  No corticosteroids in the absence of
refractory shock (grade 1D)

20. 

21.  PRBC transfusion when Hb ≤ 7gm%
 target hemoglobin concentration of 7.0–9.0
g/dL in adults (grade 1B)

22.  No role

23.  No role

24.  ARDS protocol

25.  CONTINOUS OR INTERMITTENT SEDATION
 CONTINOUS OR INTERMITTENT UNDER TRAIN
OF FOUR MONITORING

26.  ≤180 MG%
 To be monitored every 1 or 2 hr

27.  RRT
 Stress ulcer prophlyalxis
 Dvt prophylaxis
 Nutrition support

28.  THANK YOU