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What Is Sepsis

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Husni Ajaj
Husni Ajaj
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What is Sepsis? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Approach Scenario 1 ,[object Object],[object Object]
  The Sepsis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is meant by SIRS, sepsis and septic shock? ,[object Object],[object Object],[object Object],[object Object],[object Object]
ACCP/SCCM Consensus Conference Definitions (3) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sepsis ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is Sepsis?  Inflammation A Description of the Inflammatory Cascades ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
Vascular Injuries ,[object Object],[object Object],[object Object],[object Object]
Nitric Oxide ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Coagulopathy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
What is Sepsis?  Multi-Organ Failure                   How does sepsis effect the various organs of the body?
Autoregulated Organs ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Gut Origin Theory ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
 
 
 
 
Lung Origin Theory ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000; 342(18):1301-1308.
What is Sepsis?  Activated Protein C ,[object Object],[object Object]
 
 
Activated Protein C (APC) Inactive Protein C Active Protein C Pro-inflammatory cytokines Thrombin/ thrombomodulin Anti-thrombotic Anti-inflammatory Pro-fibrinolytic ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Concerns: Bleeding, single study, cost, severity of illness
Treating Septic Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Stages ABC: Immediate Stabilization ,[object Object]
[object Object]
Stage C: re-establishing the circulation ,[object Object],[object Object],[object Object]
Clinical Scenario ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
 
Individual Agents ,[object Object],[object Object]
Proposed Algorithm for the Management of Hyperdynamic Shock Hypotension/Hypoperfusion Cardiac Index Cardiac Index (CI<4.5 l/min/m ) (CI>4.5 L/min/m ) 2 2 Preload (EDV) Preload Preload Preload (PAOP<15 mmHg) (PAOP>15) (PAOP<15) (PAOP>15) Volume Inotrope Volume Inotrope Vasopressor
Dopamine ,[object Object],[object Object],[object Object],[object Object],[object Object]
Dobutamine ,[object Object],[object Object]
Noradrenaline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
adrenaline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other Vasoactive Drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Step D: Detective work - history, physical, immediate investigation ,[object Object],[object Object]
What symptoms do you have? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Scenario 1 ,[object Object],[object Object],[object Object]
Step E: Empiric Therapy - Antibiotics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Frequency of Source of Infection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
In intensive care units approximately ,[object Object],[object Object],[object Object],[object Object]
Of the gram negative organisms, the organisms in order of likelihood are ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Of the gram positive infections, by far the most common is ,[object Object],[object Object],[object Object],[object Object],[object Object]
A 75 year old male presents with hypotension, pyrexia and leucocytosis. Presumed diagnosis - sepsis, cause unknown. ,[object Object],[object Object],[object Object]
Step E: Empiric Therapy: Activated Protein C ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Step F: Find the site and control the source ,[object Object]
But, what if the patient is behaving as if he has sepsis, but there is no obvious source? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Step G:  Feed the Gut ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Step H - Hemodynamics: assess adequacy of resuscitation and prevention of organ failure. ,[object Object],[object Object],[object Object]
Step I – Iatrogenic injuries and complications ,[object Object]
Step J - Justify your therapeutic plan ,[object Object]
Step MN – Metabolic and Neuroendocrine Control ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusion ,[object Object]
Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock Dellinger, et al Crit Care Med 32:858-73, 2004. Recommendations (not based on expert opinion): Human activated protein C is recommended in patients with a high risk of death. After resolution of hypoperfusion and in the absence of CAD, acute hemorrhage or lactic acidosis, transfusion of rbc’s should only be done to maintain hemoglobin > 7 gm/dl.
Vasopressors Volume Expansion Inotropes “ It’s déjà vu all over again!” Therapy of Shock
Key Points ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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What Is Sepsis

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  • 17. What is Sepsis?  Multi-Organ Failure                   How does sepsis effect the various organs of the body?
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  • 45. Proposed Algorithm for the Management of Hyperdynamic Shock Hypotension/Hypoperfusion Cardiac Index Cardiac Index (CI<4.5 l/min/m ) (CI>4.5 L/min/m ) 2 2 Preload (EDV) Preload Preload Preload (PAOP<15 mmHg) (PAOP>15) (PAOP<15) (PAOP>15) Volume Inotrope Volume Inotrope Vasopressor
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  • 69. Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock Dellinger, et al Crit Care Med 32:858-73, 2004. Recommendations (not based on expert opinion): Human activated protein C is recommended in patients with a high risk of death. After resolution of hypoperfusion and in the absence of CAD, acute hemorrhage or lactic acidosis, transfusion of rbc’s should only be done to maintain hemoglobin > 7 gm/dl.
  • 70. Vasopressors Volume Expansion Inotropes “ It’s déjà vu all over again!” Therapy of Shock
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