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SIRS Criteria ≥2 of the following:
- Temp >38 or <36
- HR >90
- RR >20 or PaCO2 <32
- WBC >12k, <4k or >10% bands
Identifies severe sepsis & significant risk of death organ dysfunction
Organ dysfunction signs 1. Lactate above ULN
2. Renal insuff:
- UO <0.5 mL/kg/h for >2h despite IVFs
- SCr >2
3. Acute lung injury: PaO2/FIO2 <200
4. Hepatic insufficiency: bili >2
Most common cause of death in patients with severe sepsis multisystem organ failure
(probability of death increases and number of failing organs increases)
Organ failure: Carry the highest independent risk of death in septic shock liver & renal
Determinants of Mortality in Sepsis
(Management of these risks = SOC) 1. Early recognition
2. Appropriate abx tx w/in 1h of hypotension
3. Source control
4. Resuscitation, reestablishing perfusion w/in 6h of onset of hypotensive shock
, lactate of how much that does not correct in 6h correlates with mortality? >4
Initial fluid resuscitation for sepsis
- how much?
- for who? - crystalloids 30mL/kg bolus
- lactate >2, hypotensive
[Sepsis]: Assessing volume status after initial bolus Repeat PE
2 of the following assessments of perfusions:
- CVP (goal = 8-12)
- SCVO2 >70%
- CV US & IVC measurement (goal diameter 1.5-2.5cm or <50% collapse during inspiration)
- Assessment of fluid responsiveness (passive leg raise testing)
[Sepsis] Ultimate goal for IVF resuscitation response MAP >65
Normalizing lactate
[Sepsis] Consider for double coverage of GN organisms Neutropenia
Multidrug resistant GN organisms
[Sepsis] Biomarker that may aid in stopping empiric abx if no infection source is identified
procalcitonin
[Sepsis] Pressor associated with increased adverse events (increased mortality)
dopamine
(vs. levo)
SIRS Criteria ≥2 of the following:
- Temp >38 or <36
- HR >90
- RR >20 or PaCO2 <32
- WBC >12k, <4k or >10% bands
Identifies severe sepsis & significant risk of death organ dysfunction
Organ dysfunction signs 1. Lactate above ULN
2. Renal insuff:
- UO <0.5 mL/kg/h for >2h despite IVFs
- SCr >2
3. Acute lung injury: PaO2/FIO2 <200
4. Hepatic insufficiency: bili >2
Most common cause of death in patients with severe sepsis multisystem organ failure
(probability of death increases and number of failing organs increases)
Organ failure: Carry the highest independent risk of death in septic shock liver & renal
Determinants of Mortality in Sepsis
(Management of these risks = SOC) 1. Early recognition
2. Appropriate abx tx w/in 1h of hypotension
3. Source control
4. Resuscitation, reestablishing perfusion w/in 6h of onset of hypotensive shock
, lactate of how much that does not correct in 6h correlates with mortality? >4
Initial fluid resuscitation for sepsis
- how much?
- for who? - crystalloids 30mL/kg bolus
- lactate >2, hypotensive
[Sepsis]: Assessing volume status after initial bolus Repeat PE
2 of the following assessments of perfusions:
- CVP (goal = 8-12)
- SCVO2 >70%
- CV US & IVC measurement (goal diameter 1.5-2.5cm or <50% collapse during inspiration)
- Assessment of fluid responsiveness (passive leg raise testing)
[Sepsis] Ultimate goal for IVF resuscitation response MAP >65
Normalizing lactate
[Sepsis] Consider for double coverage of GN organisms Neutropenia
Multidrug resistant GN organisms
[Sepsis] Biomarker that may aid in stopping empiric abx if no infection source is identified
procalcitonin
[Sepsis] Pressor associated with increased adverse events (increased mortality)
dopamine
(vs. levo)
