Albumina nel paziente critico. Savona 18 aprile 2007
|
|
|
- Mark Garrett
- 5 years ago
- Views:
Transcription
1 Albumina nel paziente critico Savona 18 aprile 2007
2 What Is Unique About Critical Care RCTs patients eligibility is primarily defined by location of care in the ICU rather than by the presence of a specific disease. many clinical entities in the ICU are often non specific constellations of physiologic and biological abnormalities forming syndromes. the pathologic processes affecting critically ill patients, resulting in homeostatic disturbances severe enough to result in ICU admission, are often in their late stages at the time of ICU admission.
3 What Is Unique About Critical Care RCTs
4 In hypovolaemia there is no evidence that albumin reduces mortality There is no evidence that albumin reduces mortality in critically ill patients with burns and hypoalbuminaemia and a suggestion that albumin may increase the risk of death.
5 Clinical Trials and Systematic Reviews Cardiovascular/Shock States Trauma. Septic shock. Perioperative shock states. Pulmonary Central Nervous System Ischemic brain injury. Subarachnoid hemorrhage.
6
7
8 SAFE
9 Admission pts judged to require fluids to maintain or increase IV. at least one of the following clinical signs: Heart rate greater than 90 beats per minute SBP < 100 mmhg or MAP < 75 mmhg or a 40 mmhg in SBP or MAP. Inotropes / vasopressors to maintain BP. Central venous pressure < 10 mmhg Pulmonary capillary wedge pressure < 12 mmhg Respiratory variation in SBP or MAP > 5 mmhg Capillary refill time greater than one second Urine output less than 0.5 ml/kg for one hour excluded cardiac surgery, liver transplant, burns pts.
10 treatments Two treatments 4% Albumin 0.9% Sodium Chloride (Saline) Allocated fluids are used for all fluid resuscitation during the first 28 days of the ICU stay. No control of fluids prior to a patient s admission or after discharge from the ICU
11 outcomes The primary outcome measure is 28-day allcause mortality. Secondary outcomes include length of stay in the ICU length of hospital stay organ dysfunction as measured by the SOFA score physiological measures of response to fluid therapy. Patients with the diagnostic criteria for severe sepsis and acute respiratory distress syndrome at study entry are identified to allow a priori subgroup analysis.
12 Kaplan Mayer Estimates
13
14
15 Relative risk of death
16 CCM 1999; 27, pp Crystalloids vs. colloids in fluid resuscitation: A systematic review Choi, PT et al
17
18 Relative risk of death
19
20
21
22 Relative risk of death
23
24
25
26
27
28
29
30 Ischemic brain injury hemodilution after acute ischemic stroke. Initial dextran trials: disability and survival large trials have failed to confirm these benefits. benefits with starch solutions have not been confirmed one trial stopped for worse outcomes in HES pts. crystalloid vs albumin, mortality and function not different. albumin survival and function in initially euvolemic patients crystalloids outcomes in volume-contracted patients While hemodilution decreases viscosity and optimizes circulatory volume, it may impair tissue oxygen delivery in hypovolemic patients.
31 Curr Opin Crit Care 2002, 8:
32 Subarachnoid hemorrhage During hypervolemic treatment is difficult to maintain the desired blood pressure, venous pressure, pulmonary capillary pressure, or whatever one is monitoring. particularly in young, fit people with normal renal function, and large volumes of fluid can lead to electrolyte disturbance (particularly hyponatremia), pulmonary edema, and other complications. Suggested measures to counteract this include fludrocortisone or albumin solution to minimize sodium and fluid loss.
33 Conclusions What does similar outcome mean? saline is as bad as albumin? albumin is as good as saline? Trauma patients caution (because of ICP) Septic patients investigation full blown ALI/ARDS and sepsis whith altered capillary permeability albumin just redistributes and its colloid osmotic action is decreased or lost patients with mild disease (no more permeability) albumin/furosemide accelerates the edema clearing and shortens the length of stay.
34 Grazie per l attenzione
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE In critically ill patients: too little fluid Low preload,
Presented by: Indah Dwi Pratiwi
Presented by: Indah Dwi Pratiwi Normal Fluid Requirements Resuscitation Fluids Goals of Resuscitation Maintain normal body temperature In most cases, elevate the feet and legs above the level of the heart
Fluids in ICU. JMO teaching 5th July 2016
Fluids in ICU JMO teaching 5th July 2016 Objectives Physiology of fluid infusion History of fluid resuscitation Physiology of fluid resuscitation Types of resuscitation fluid The ideal resuscitation fluid
Staging Sepsis for the Emergency Department: Physician
Staging Sepsis for the Emergency Department: Physician Sepsis Continuum 1 Sepsis Continuum SIRS = 2 or more clinical criteria, resulting in Systemic Inflammatory Response Syndrome Sepsis = SIRS + proven/suspected
Sepsis: Identification and Management in an Acute Care Setting
Sepsis: Identification and Management in an Acute Care Setting Dr. Barbara M. Mills DNP Director Rapid Response Team/ Code Resuscitation Stony Brook University Medical Center SEPSIS LECTURE NPA 2018 OBJECTIVES
How and why I give IV fluid Disclosures SCA Fluids and public health 4/1/15. Andrew Shaw MB FRCA FCCM FFICM
How and why I give IV fluid Andrew Shaw MB FRCA FCCM FFICM Professor and Chief Cardiothoracic Anesthesiology Vanderbilt University Medical Center 2015 Disclosures Consultant for Grifols manufacturer of
Index. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdominal compartment syndrome, as complication of fluid resuscitation, 331 338 abdominal perfusion pressure, 332 fluid restriction practice
Dr. F Javier Belda Dept. Anesthesiology and Critical Care Hospital Clinico Universitario Valencia (Spain) Pulsion MAB
State of the Art Hemodynamic Monitoring III CO, preload, lung water and ScvO2 The winning combination! Dr. F Javier Belda Dept. Anesthesiology and Critical Care Hospital Clinico Universitario Valencia
Sepsis Bundle Project (SEP) Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: April 2015 Most recent Revision: December 2018
Sepsis Bundle Project (SEP) Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: April 2015 Most recent Revision: December 2018 Objectives 1. To identify the symptom of severe sepsis and septic shock syndrome.
Initial Resuscitation of Sepsis & Septic Shock
Initial Resuscitation of Sepsis & Septic Shock Dr. Fatema Ahmed MD (Critical Care Medicine) FCPS (Medicine) Associate professor Dept. of Critical Care Medicine BIRDEM General Hospital Is Sepsis a known
Dr. Nai Shun Tsoi Department of Paediatric and Adolescent Medicine Queen Mary Hospital Hong Kong SAR
Dr. Nai Shun Tsoi Department of Paediatric and Adolescent Medicine Queen Mary Hospital Hong Kong SAR A very important aspect in paediatric intensive care and deserve more attention Basic principle is to
Evidence-Based. Management of Severe Sepsis. What is the BP Target?
Evidence-Based Management of Severe Sepsis Michael A. Gropper, MD, PhD Professor and Vice Chair of Anesthesia Director, Critical Care Medicine Chair, Quality Improvment University of California San Francisco
Nurse Driven Fluid Optimization Using Dynamic Assessments
Nurse Driven Fluid Optimization Using Dynamic Assessments 2016 1 WHAT WE BELIEVE We believe that clinicians make vital fluid and drug decisions every day with limited and inconclusive information Cheetah
HYPOVOLEMIA AND HEMORRHAGE UPDATE ON VOLUME RESUSCITATION HEMORRHAGE AND HYPOVOLEMIA DISTRIBUTION OF BODY FLUIDS 11/7/2015
UPDATE ON VOLUME RESUSCITATION HYPOVOLEMIA AND HEMORRHAGE HUMAN CIRCULATORY SYSTEM OPERATES WITH A SMALL VOLUME AND A VERY EFFICIENT VOLUME RESPONSIVE PUMP. HOWEVER THIS PUMP FAILS QUICKLY WITH VOLUME
Acute Liver Failure: Supporting Other Organs
Acute Liver Failure: Supporting Other Organs Michael A. Gropper, MD, PhD Professor of Anesthesia and Physiology Director, Critical Care Medicine University of California San Francisco Acute Liver Failure
Sepsis overview. Dr. Tsang Hin Hung MBBS FHKCP FRCP
Sepsis overview Dr. Tsang Hin Hung MBBS FHKCP FRCP Epidemiology Sepsis, severe sepsis, septic shock Pathophysiology of sepsis Recent researches and advances From bench to bedside Sepsis bundle Severe sepsis
What is the Role of Albumin in Sepsis? An Evidenced Based Affair. Justin Belsky MD PGY3 2/6/14
What is the Role of Albumin in Sepsis? An Evidenced Based Affair Justin Belsky MD PGY3 2/6/14 Microcirculation https://www.youtube.com/watch?v=xao1gsyur7q Capillary Leak in Sepsis Asking the RIGHT Question
R2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital
R2R: Severe sepsis/septic shock Surat Tongyoo Critical care medicine Siriraj Hospital Diagnostic criteria ACCP/SCCM consensus conference 1991 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
Nothing to disclose 9/25/2017
Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Nothing to disclose 1 Explain
Maria B. ALBUJA-CRUZ, MD ALBUMIN: OVERRATED. Surgical Grand Rounds
Maria B. ALBUJA-CRUZ, MD ALBUMIN: OVERRATED Surgical Grand Rounds ALBUMIN Most abundant plasma protein 1/3 intravascular 50% of interstitial SKIN Synthesized in hepatocytes Transcapillary escape rate COP
9/25/2017. Nothing to disclose
Nothing to disclose Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Explain
Shock and hemodynamic monitorization. Nilüfer Yalındağ Öztürk Marmara University Pendik Research and Training Hospital
Shock and hemodynamic monitorization Nilüfer Yalındağ Öztürk Marmara University Pendik Research and Training Hospital Shock Leading cause of morbidity and mortality Worldwide: dehydration and hypovolemic
SHOCK. Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital
SHOCK Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital 1 Definition Shock is an acute, complex state of circulatory dysfunction
IV fluid administration in sepsis. Dr David Inwald Consultant in PICU St Mary s Hospital, London CATS, London
IV fluid administration in sepsis Dr David Inwald Consultant in PICU St Mary s Hospital, London CATS, London The talk What is septic shock? What are the recommendations? What is the evidence? Do we follow
Impact of Fluids in Children with Acute Lung Injury
Impact of Fluids in Children with Acute Lung Injury Canadian Critical Care Forum Toronto, Canada October 27 th, 2015 Adrienne G. Randolph, MD, MSc Critical Care Division, Department of Anesthesia, Perioperative
Case year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50
Case 1 65 year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50 Case 1 65 year old female nursing home resident with
The Septic Patient. Dr Arunraj Navaratnarajah. Renal SpR Imperial College NHS Healthcare Trust
The Septic Patient Dr Arunraj Navaratnarajah Renal SpR Imperial College NHS Healthcare Trust Objectives of this session Define SIRS / sepsis / severe sepsis / septic shock Early recognition of Sepsis The
Managing Patients with Sepsis
Managing Patients with Sepsis Diagnosis; Initial Resuscitation; ARRT Initiation Prof. Achim Jörres, M.D. Dept. of Nephrology and Medical Intensive Care Charité University Hospital Campus Virchow Klinikum
Sepsis Management: Past, Present, and Future
Sepsis Management: Past, Present, and Future Benjamin Ferrell, MD Tennessee ACP Meeting October 28, 2017 Learning Objectives Identify the most updated definition and clinical criteria for sepsis Describe
Goal-directed vs Flow-guidedresponsive
Goal-directed vs Flow-guidedresponsive therapy S Magder Department of Critical Care, McGill University Health Centre Flow-directed vs goal directed strategy for management of hemodynamics S Magder Curr
Surviving Sepsis Campaign Guidelines 2012 & Update for David E. Tannehill, DO Critical Care Medicine Mercy Hospital St.
Surviving Sepsis Campaign Guidelines 2012 & Update for 2015 David E. Tannehill, DO Critical Care Medicine Mercy Hospital St. Louis Be appropriately aggressive the longer one delays aggressive metabolic
FLUIDS AND SOLUTIONS IN THE CRITICALLY ILL. Daniel De Backer Department of Intensive Care Erasme University Hospital Brussels, Belgium
FLUIDS AND SOLUTIONS IN THE CRITICALLY ILL Daniel De Backer Department of Intensive Care Erasme University Hospital Brussels, Belgium Why do we want to administer fluids? To correct hypovolemia? To increase
Fluid Treatments in Sepsis: Meta-Analyses
Fluid Treatments in Sepsis: Recent Trials and Meta-Analyses Lauralyn McIntyre MD, FRCP(C), MSc Scientist, Ottawa Hospital Research Institute Assistant Professor, University of Ottawa Department of Epidemiology
Update in Critical Care Medicine
Update in Critical Care Medicine Michael A. Gropper, MD, PhD Professor and Executive Vice Chair Department of Anesthesia and Perioperative Care Director, Critical Care Medicine UCSF Disclosure None Update
Vasoactive Medications. Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis
Vasoactive Medications Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis Objectives List components of physiology involved in blood pressure Review terminology related
Burn Resuscitation Formulas. John P. Sabra, MD Seton Surgical Group Department of Surgery Dell Medical School Austin, TX
Burn Resuscitation Formulas John P. Sabra, MD Seton Surgical Group Department of Surgery Dell Medical School Austin, TX BURN INJURY % Physiologic Change % TBSA burn Stasis BURN VASCULAR PERMEABILITY
INTENSIVE CARE MEDICINE CPD EVENING. Dr Alastair Morgan Wednesday 13 th September 2017
INTENSIVE CARE MEDICINE CPD EVENING Dr Alastair Morgan Wednesday 13 th September 2017 WHAT IS NEW IN ICU? (RELEVANT TO ANAESTHETISTS) Not much! SURVIVING SEPSIS How many deaths in England were thought
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Mitchell M. Levy MD, MCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care
4/5/2018. Update on Sepsis NIKHIL JAGAN PULMONARY AND CRITICAL CARE CREIGHTON UNIVERSITY. I have no financial disclosures
Update on Sepsis NIKHIL JAGAN PULMONARY AND CRITICAL CARE CREIGHTON UNIVERSITY I have no financial disclosures 1 Objectives Why do we care about sepsis Understanding the core measures by Centers for Medicare
Objectives. Epidemiology of Sepsis. Review Guidelines for Resuscitation. Tx: EGDT, timing/choice of abx, activated
Update on Surviving Sepsis 2008 Objectives Epidemiology of Sepsis Definition of Sepsis and Septic Shock Review Guidelines for Resuscitation Dx: Lactate, t cultures, SVO2 Tx: EGDT, timing/choice of abx,
Sepsis Early Recognition and Management. Therese Hughes, PhD, MPA, RN
Sepsis Early Recognition and Management Therese Hughes, PhD, MPA, RN 1 Sepsis a Deadly Progression Affects millions around the world each year, killing one in four Contributes to approximately 50% of all
Wet Lungs Dry lungs Impact on Outcome in ARDS. Charlie Phillips MD Division of PCCM OHSU 2009
Wet Lungs Dry lungs Impact on Outcome in ARDS Charlie Phillips MD Division of PCCM OHSU 2009 Today s talk Pathophysiology of ARDS The case for dry Targeting EVLW Disclosures Advisor for Pulsion Medical
John Park, MD Assistant Professor of Medicine
John Park, MD Assistant Professor of Medicine Faculty photo will be placed here park.john@mayo.edu 2015 MFMER 3543652-1 Sepsis Out with the Old, In with the New Mayo School of Continuous Professional Development
Sepsis Management Update 2014
Sepsis Management Update 2014 Laura J. Moore, MD, FACS Associate Professor, Department of Surgery The University of Texas Health Science Center, Houston Medical Director, Shock Trauma ICU Texas Trauma
Approach to Severe Sepsis. Jan Hau Lee, MBBS, MRCPCH. MCI Children s Intensive Care Unit KK Women s and Children's Hospital, Singapore
Approach to Severe Sepsis Jan Hau Lee, MBBS, MRCPCH. MCI Children s Intensive Care Unit KK Women s and Children's Hospital, Singapore 1 2 No conflict of interest Overview Epidemiology of Pediatric Severe
Fluid resuscitation in specific patient populations: sepsis and traumatic brain injury
Fluid resuscitation in specific patient populations: sepsis and traumatic brain injury John A Myburgh MBBCh PhD FCICM UNSW Professor of Critical Care Medicine The George Institute for Global Health University
DESIGNER RESUSCITATION: TITRATING TO TISSUE NEEDS
DESIGNER RESUSCITATION: TITRATING TO TISSUE NEEDS R. Phillip Dellinger MD, MSc, MCCM Professor and Chair of Medicine Cooper Medical School of Rowan University Chief of Medicine Cooper University Hospital
OHSU. Update in Sepsis
Update in Sepsis Jonathan Pak, MD June 1, 2017 Structure of Talk 1. Sepsis-3: The latest definition 2. Clinical Management - Is EGDT dead? - Surviving Sepsis Campaign Guidelines 3. A novel therapy: Vitamin
Evidence- Based Medicine Fluid Therapy
Evidence- Based Medicine Fluid Therapy Ndidi Musa M.D. Assosciate Professor of Pediatrics Medical College of Wisconsin/ Children s Hospital of Wisconsin Disclosures A. I have no relevant financial relationships
Updates in Sepsis 2017
Mortality Cases Total U.S. Population/1,000 Updates in 2017 Joshua Solomon, M.D. Associate Professor of Medicine National Jewish Health University of Colorado Denver Background New Definition of New Trials
Pediatric emergencies (SHOCK & COMA) Dr Mubarak Abdelrahman Assistant Professor Jazan University
Pediatric emergencies (SHOCK & COMA) Dr Mubarak Abdelrahman Assistant Professor Jazan University SHOCK Definition: Shock is a syndrome = inability to provide sufficient oxygenated blood to tissues. Oxygen
Sepsis Combine experience and Evidence. Eran Segal, MD Director General ICU, Sheba Medical Center, Israel
Sepsis Combine experience and Evidence Eran Segal, MD Director General ICU, Sheba Medical Center, Israel The Science of Sepsis A complex and diverse clinical entity Outcome is affected by: Infecting organism
Fluids and electrolytes: the basics
Fluids and electrolytes: the basics This document is based on the handout from the Surgery for Finals course. The notes provided here summarise key aspects, focusing on areas that are popular in clinical
Vasopressors in Septic Shock. Keith R. Walley, MD St. Paul s Hospital University of British Columbia Vancouver, Canada
Vasopressors in Septic Shock Keith R. Walley, MD St. Paul s Hospital University of British Columbia Vancouver, Canada Echocardiogram: EF=25% 57 y.o. female, pneumonia, shock Echocardiogram: EF=25% 57 y.o.
INTRAVENOUS FLUID THERAPY. Tom Heaps Consultant Acute Physician
INTRAVENOUS FLUID THERAPY Tom Heaps Consultant Acute Physician LEARNING OBJECTIVES 1. Crystalloids vs colloids 2. Balanced vs non-balanced solutions 3. Composition of various IV fluids 4. What is normal
What the ED clinician needs to know about SEPSIS - 3. Anna Morgan Consultant EM Barts Health
What the ED clinician needs to know about SEPSIS - 3 Anna Morgan Consultant EM Barts Health Aims: (1) To review the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) (2)
Sepsis Update: Focus on Early Recognition and Intervention. Disclosures
Sepsis Update: Focus on Early Recognition and Intervention Jessie Roske, MD October 2017 Disclosures I have no actual or potential conflict of interest in relation to this program/presentation. I will
Chapter 3 MAKING THE DECISION TO TRANSFUSE
Chapter 3 MAKING THE DECISION TO TRANSFUSE PRACTICE POINTS Determine the best treatment for the patient which may include transfusion. Treat the cause of cytopenia (anaemia or thrombocytopenia) or plasma
Full Disclosure. The case for why it matters. Goal-directed Fluid Resuscitation
Goal-directed Fluid Resuscitation Christopher G. Choukalas, MD, MS Department of Anesthesia and Perioperative Care University of California, San Francisco I own no stocks Full Disclosure The case for why
3/14/2017. Pediatric Sepsis: From Goal Directed Therapy to Protocolized Care. Objectives. Developmental Response to Sepsis
Pediatric Sepsis: From Goal Directed Therapy to Protocolized Care March 20, 2017 Reid WD Farris, MS MD Objectives Review the evolution & current state of the pediatric septic shock treatment guidelines
12/1/2009. Chapter 19: Hemorrhage. Hemorrhage and Shock Occurs when there is a disruption or leak in the vascular system Internal hemorrhage
Chapter 19: Hemorrhage Hemorrhage and Shock Occurs when there is a disruption or leak in the vascular system External hemorrhage Internal hemorrhage Associated with higher morbidity and mortality than
Blood Flow, Blood Pressure, Cardiac Output. Blood Vessels
Blood Flow, Blood Pressure, Cardiac Output Blood Vessels Blood Vessels Made of smooth muscle, elastic and fibrous connective tissue Cells are not electrically coupled Blood Vessels Arteries arterioles
-Cardiogenic: shock state resulting from impairment or failure of myocardium
Shock chapter Shock -Condition in which tissue perfusion is inadequate to deliver oxygen, nutrients to support vital organs, cellular function -Affects all body systems -Classic signs of early shock: Tachycardia,tachypnea,restlessness,anxiety,
SHOCK and the Trauma Victim. JP Pretorius Department of Surgery & SICU Steve Biko Academic Hospital.
SHOCK and the Trauma Victim JP Pretorius Department of Surgery & SICU Steve Biko Academic Hospital. Classification of Shock Cardiogenic - Myopathic Arrythmic Mechanical Hypovolaemic - Haemorrhagic Non-haemorrhagic
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Centre for Clinical Practice SCOPE Clinical guideline title: Intravenous fluid therapy in adults in hospital Quality standard title: Intravenous fluid
2. To provide an ethical, moral and practical framework for decision-making during a public health emergency.
November 2010 TABLE TOP EXERCISE PARTICIPANT GUIDE When Routine Critical Care Resources Are Not Available Time expectations for each session: SECTION ACTIVITY TIME I Introduction 5 minutes II Exercise
Fluid Resuscitation and Monitoring in Sepsis. Deepa Gotur, MD, FCCP Anne Rain T. Brown, PharmD, BCPS
Fluid Resuscitation and Monitoring in Sepsis Deepa Gotur, MD, FCCP Anne Rain T. Brown, PharmD, BCPS Learning Objectives Compare and contrast fluid resuscitation strategies in septic shock Discuss available
L uso appropriato dell albumina nel trattamento del paziente settico
Uso appropriato dell Albumina nella Cirrosi Epatica: le raccomandazioni AISF-SIMTI Istituto Superiore di Sanità, Roma Martedì 29 Marzo, 2016 L uso appropriato dell albumina nel trattamento del paziente
SEPSIS SYNDROME
INTRODUCTION Sepsis has been defined as a life threatening condition that arises when the body s response to an infection injures its own tissues and organs. Sepsis may lead to shock, multiple organ failure
Sepsis Story At Intermountain Healthcare Intensive Medicine Clinical Program
Sepsis Story At Intermountain Healthcare 2004-2012 Intensive Medicine Clinical Program The International Surviving Sepsis Campaign Was Organized In 2002 During The ESICM International Meeting In Barcelona,
Resuscitation Before Emergency Surgeries FEIRAN LOU SUNY DOWNSTATE MEDICAL CENTER KINGS COUNTY HOSPITAL
Resuscitation Before Emergency Surgeries FEIRAN LOU SUNY DOWNSTATE MEDICAL CENTER KINGS COUNTY HOSPITAL Case 73 yo woman h/o HTN three days abdominal pain and nausea. The pain was diffuse, cramp-like,
SEPSIS: Seeing Through the. W. Graham Carlos MD, MSCR, ATSF, FACP
SEPSIS: Seeing Through the W. Graham Carlos MD, MSCR, ATSF, FACP Objectives Forget everything you have known about sepsis Learn new things Objectives Define sepsis Explain why Early Goal Directed Therapy
SEPSIS: IT ALL BEGINS WITH INFECTION. Theresa Posani, MS, RN, ACNS-BC, CCRN M/S CNS/Sepsis Coordinator Texas Health Harris Methodist Ft.
SEPSIS: IT ALL BEGINS WITH INFECTION Theresa Posani, MS, RN, ACNS-BC, CCRN M/S CNS/Sepsis Coordinator Texas Health Harris Methodist Ft. Worth 1 2 3 OBJECTIVES Review the new Sepsis 3 definitions of sepsis
Early-goal-directed therapy and protocolised treatment in septic shock
CAT reviews Early-goal-directed therapy and protocolised treatment in septic shock Journal of the Intensive Care Society 2015, Vol. 16(2) 164 168! The Intensive Care Society 2014 Reprints and permissions:
Admissions with severe sepsis in adult, general critical care units in England, Wales and Northern Ireland
Admissions with severe sepsis in adult, general critical care units in England, Wales and Northern Ireland Question For all admissions to adult, general critical care units in the Case Mix Programme Database
Sepsis is an important issue. Clinician s decision-making capability. Guideline recommendations
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 Clinicians decision-making capability Guideline recommendations Sepsis is an important issue 8.7%
Fluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI)
Fluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI) Robert W. Schrier, MD University of Colorado School of Medicine Denver, Colorado USA Prevalence of acute renal failure in Intensive
12/29/2014. IV/IO Therapy & Fluid Administration. Objectives. Cleansing of the soul
IV/IO Therapy & Fluid Administration Gary Hoertz, EMT-P Spokane County EMS Indications for IV Access Types of Intravenous Access IV fluids Flow Rates Fluid resuscitation Objectives Cleansing of the soul
Shock. William Schecter, MD
Shock William Schecter, MD The Cell as a furnace O 2 1 mole Glucose Cell C0 2 ATP 38 moles H 2 0 Shock = Inadequate Delivery of 02 and Glucose to the Cell 0 2 Cell ATP 2 moles Lactic Acid Treatment of
Septic Shock. Rontgene M. Solante, MD, FPCP,FPSMID
Septic Shock Rontgene M. Solante, MD, FPCP,FPSMID Learning Objectives Identify situations wherein high or low BP are hemodynamically significant Recognize complications arising from BP emergencies Manage
Geriatric Trauma Resuscitation: Lessons from a Geriatric Trauma Surgeon
Geriatric Trauma Resuscitation: Lessons from a Geriatric Trauma Surgeon Aurelio Rodriguez, M.D., FACS Conemaugh Memorial Medical Center Trauma Center Johnstown, PA Demographics The fastest growing age
Subclinical Problems in the ICU:
Subclinical Problems in the ICU: Corticosteroid Insufficiency C. S. Cutillar, M.D., FPCP, FPSEM Associate Professor Cebu Institute of Medicine H-P-A Axis during Critical Illness CRH ACTH H-P-A Axis during
Fluids and Lactate. A/Prof Peter Morley
Fluids and Lactate A/Prof Peter Morley RCTs Other evidence 5 6 Plan Background information Crystalloids Which crystalloid? Colloids Crystalloids v colloids Once that s settled, how much fluid Plan Background
The syndrome formerly known as. Severe Sepsis. James Rooks MD. Coordinator of critical care education OU College of Medicine, Tulsa
The syndrome formerly known as Severe Sepsis James Rooks MD Coordinator of critical care education OU College of Medicine, Tulsa Disclosures I have no actual or practical conflicts of interest in relation
Physiological Response to Hypovolemic Shock Dr Khwaja Mohammed Amir MD Assistant Professor(Physiology) Objectives At the end of the session the
Physiological Response to Hypovolemic Shock Dr Khwaja Mohammed Amir MD Assistant Professor(Physiology) Objectives At the end of the session the students should be able to: List causes of shock including
What is sepsis? RECOGNITION. Sepsis I Know It When I See It 9/21/2017
Sepsis I Know It When I See It September 15, 2017 Matthew Exline, MD MPH Medical Director, Medical ICU What is sepsis? I shall not today attempt further to define the kinds of material [b]ut I know it
INTRAVENOUS FLUIDS. Ahmad AL-zu bi
INTRAVENOUS FLUIDS Ahmad AL-zu bi Types of IV fluids Crystalloids colloids Crystalloids Crystalloids are aqueous solutions of low molecular weight ions,with or without glucose. Isotonic, Hypotonic, & Hypertonic
EARLY GOAL DIRECTED THERAPY : seminaires iris. Etat des lieux en Daniel De Backer
EARLY GOAL DIRECTED THERAPY : Etat des lieux en 2017 Daniel De Backer Head Dept Intensive Care, CHIREC hospitals, Belgium Professor of Intensive Care, Université Libre de Bruxelles Past-President European
LeMone & Burke Ch 30-32
LeMone & Burke Ch 30-32 2 Right side- Low oxygenation Low pressure Light workload Goes toward the lungs Left side High oxygenation Thick walled high pressure Heavier workload Carries oxygenation blood
SEPSIS RAPID RESPONSE
SEPSIS RAPID RESPONSE Sepsis kills up to 50% of those infected. How many deaths will you prevent this year? 1 SEPSIS Back ground: According to the Institute for Health Improvement and the Surviving Sepsis
Use of Blood Lactate Measurements in the Critical Care Setting
Use of Blood Lactate Measurements in the Critical Care Setting John G Toffaletti, PhD Director of Blood Gas and Clinical Pediatric Labs Professor of Pathology Duke University Medical Center Chief, VAMC
SHOCK Susanna Hilda Hutajulu, MD, PhD
SHOCK Susanna Hilda Hutajulu, MD, PhD Div Hematology and Medical Oncology Department of Internal Medicine Universitas Gadjah Mada Yogyakarta Outline Definition Epidemiology Physiology Classes of Shock
Sepsis Wave II Webinar Series. Sepsis Reassessment
Sepsis Wave II Webinar Series Sepsis Reassessment Presenters Nova Panebianco, MD Todd Slesinger, MD Fluid Reassessment in Sepsis Todd L. Slesinger, MD, FACEP, FCCM, FCCP, FAAEM Residency Program Director
SHOCK. Pathophysiology
SHOCK Dr. Ahmed Saleem FICMS TUCOM / 3rd Year / 2015 Shock is the most common and therefore the most important cause of death of surgical patients. Death may occur rapidly due to a profound state of shock,
Sepsis the clinical syndrome
Sepsis the clinical syndrome João Gonçalves Pereira ICU director Vila Franca Xira Hospital Systemic Inflamatory Response 2 Temperature 38ºC or 36ºC bacteraemia other trauma HR 90/min INFECTION RR 20/min
Neurointensive Care of Aneurysmal Subarachnoid Hemorrhage. Alejandro A. Rabinstein Department of Neurology Mayo Clinic, Rochester, USA
Neurointensive Care of Aneurysmal Subarachnoid Hemorrhage Alejandro A. Rabinstein Department of Neurology Mayo Clinic, Rochester, USA The traditional view: asah is a bad disease Pre-hospital mortality
Reverse (fluid) resuscitation Should we be doing it? NAHLA IRTIZA ISMAIL
Reverse (fluid) resuscitation Should we be doing it? NAHLA IRTIZA ISMAIL 65 Male, 60 kg D1 in ICU Admitted from OT intubated Diagnosis : septic shock secondary to necrotising fasciitis of the R lower limb
FLUID RESUSCITATION SUMMARY
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
Getting smart with fluids in the critically ill. NOR AZIM MOHD YUNOS Jeffrey Cheah School of Medicine & Health Sciences Monash University Malaysia
Getting smart with fluids in the critically ill NOR AZIM MOHD YUNOS Jeffrey Cheah School of Medicine & Health Sciences Monash University Malaysia Isotonic Solutions and Major Adverse Renal Events Trial