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Sepsis Treatment

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Sepsis Treatment Members of the Midwest Critical Care Collaborative Led by: W. Christopher Bandy, MD Katie Burenheide, PharmD
Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is a Bundle? ,[object Object],[object Object]
Bundle Examples ,[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]
Adapted from Univ of Ks. Hospital
Early Goal Directed Therapy: Adequate Resuscitation The Key to Hypoperfusion/Hypotension Management due to Sepsis!
EARLY GOAL DIRECTED THERAPY (within 6 hours of diagnosis) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Optimization Of Central Venous Pressure (CVP) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Continue to OPTIMIZATION OF MAP
Optimization of Mean Arterial Pressure (MAP) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],When goal MAP of > 65 mmHg is achieved continue to OPTIMIZATION OF SvO2.
Optimization of Mean Arterial Pressure (MAP) ,[object Object],[object Object],[object Object]
Optimization of SvO2 (Mixed venous O2 Sat) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EARLY GOAL DIRECTED THERAPY (within 6 hours of diagnosis) ,[object Object],[object Object],[object Object]
Monitoring Lactate Levels During Resuscitation
Lactate Measurements ,[object Object],[object Object],[object Object]
Lactate Measurements ,[object Object],[object Object],[object Object]
Bundle Management: ARDSnet Ventilator Management
Rationale ,[object Object],[object Object],[object Object]
Ventilator Settings ,[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]
Other Respiratory Management Measures ,[object Object],[object Object],[object Object],[object Object],[object Object]
Bundle Management: Broad-Spectrum Antibiotics
[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],[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]
Bundle Management: Blood Glucose Control
Rationale: Adequate blood sugar management reduces ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
American College Of Endocrinology And American Diabetes Association Consensus Statement ,[object Object],[object Object]
American College Of Endocrinology And American Diabetes Association Consensus Statement ,[object Object],[object Object]
Surviving Sepsis Campaign Recommends Following initial stabilization of patients with severe sepsis, blood glucose should be maintained < 150 mg/dL (8.3 mmol/L).
Bundle Management Corticosteroids
Steroids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cortisol Levels – Draw Baseline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Discontinue steroids once patient is off vasopressors
Bundle Management: Stress Ulcer Prophylaxis
Stress Ulcer Prophylaxis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bundle Management: Deep Vein Thrombosis Prophylaxis
Deep Vein Prophylaxis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bundle Management: Drotrecogin alpha (Xigris  )
Drotrecogin- α Mechanism of Action ,[object Object],[object Object],[object Object]
Drotrecogin alpha (Xigris  ) Criteria for use ,[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]
Contraindications ,[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],[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]
Drotrecogin- α Dosing ,[object Object],[object Object],[object Object],[object Object]
Trouble Shooting ,[object Object],[object Object],[object Object],[object Object]
Treating Sepsis Management Time is Crucial – Just like……… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
References – Cont’d ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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