VOLUME RESPONSIVENESS IS DIFFERENT FROM NEED FOR FLUIDS BLOOD PRESSURE TARGETS IN SEPSIS
|
|
- Chester Pearson
- 6 years ago
- Views:
Transcription
1 Department of Intensive Care Medicine VOLUME RESPONSIVENESS IS DIFFERENT FROM NEED FOR FLUIDS BLOOD PRESSURE TARGETS IN SEPSIS
2 SEPTIC SHOCK : THE CLINICAL SCENARIO HYPOTENSION DESPITE ADEQUATE VOLUME RESUSCITATION or ON VASOPRESSORS TO AVOID HYPOTENSION
3 OPEN QUESTIONS/ MAJOR CONTROVERSIES Sepsis-3 «need for vasopressors» Ö definition of blood pressure targets «adequate fluid resuscitation» JAMA. 2016;315(8): doi: /jama
4 THE HEMODYNAMIC TARGET BLOOD PRESSURE! Sevransky JE et al, Critical Care 2007, 11:R67 Takala et al, Intensive Care Med 2008 Aug;34: Epub 2008 Apr 3 Torgersen et al, Eur J Anaesthesiol 2011;28:284-90
5 BLOOD PRESSURE TARGETS: a consensus mean arterial pressure in sepsis: mmhg...but we do not do what we say...
6 BLOOD PRESSURE MANAGEMENT IN CLINICAL TRIALS 100 mean arterial blood pressure (mmhg) target MAP actual MAP at 24 hrs based on trials cited in Sevransky JE et al: Hemodynamic goals in randomized clinical trials in patients with sepsis: a systematic review of the literature. Critical Care 2007, 11:R67
7 high blood pressures in clinical trials on hemodynamic management Asfar et al, N Engl J Med 2014, epublished on March 18 Russell JA et al: Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 2008;358: De Backer D et al: Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 2010;362: Annane D et al: Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial. Lancet :
8 A CLOSER LOOK AT TRIALS WITH STRICT HEMODYNAMIC MANAGEMENT PROTOCOLS: the CATS trial Annane D et al: Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial. Lancet :
9 TARGET MEAN ARTERIAL BLOOD PRESSURE at least 70 mmhg, thereafter stepwise vasopressor withdrawal Annane D et al Lancet 2007; 370:
10 TIME TO VASOPRESSOR WITHDRAWAL
11 A CLOSER LOOK: the VASST study Russell JA et al: Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 2008;358:877-87
12 MAP >85 mmhg safety limit for hypertension, rapid tapering of open label vasopressors and the study drug, if considered necessary An initial target mean arterial pressure of 65 to 75 mm Hg was recommended; however, the attending ICU physician could modify the target blood pressure of each patient Russell et al, N Engl J Med 2008;358:877-87
13 A CLOSER LOOK: the norepi vs dopa study De Backer D et al: Comparison of dopamine and norepinephrine in the treatment of shock N Engl J Med 2010;362:779-89
14 The target blood pressure was determined by the doctor in charge for each individual patient De Backer et al, N Engl J Med 2010;362:779-89
15 A CLOSER LOOK: the SEPSISPAM study Asfar P et al High versus low blood-pressure target in patients with septic shock N Engl J Med 2014;370:
16 recommendation: reduce vasopressors hourly, if MAP above target Asfar et al N Engl J Med 2014;370:
17 BLOOD PRESSURE IN LARGE CLINICAL TRIALS a dissociation between actual and targeted blood pressure deviation towards higher blood pressure regardless of strict protocols or recommendations
18 PRECISION MEDICINE or PERSONALIZED MEDICINE?
19 PLoSONE 12(1): e
20 FAILURE TO TITRATE (REDUCE) VASOPRESSORS Lamontagne et al, PLoSONE 12(1): e
21 FAILURE TO TITRATE (REDUCE) VASOPRESSORS Lamontagne et al, Intensive Care Med 2016;42:
22 80 % not clinically justified
23 DO HIGHER BLOOD PRESSURES MATTER? MAP-levels of mmhg do not hurt and higher levels offer no mortality benefits Ö Ö Varpula M et al: Hemodynamic variables related to outcome in septic shock. Intensive Care Med 2005; 31: retrospective analysis of 111 patients Dünser MW et al: Arterial blood pressure during early sepsis and outcome. Intensive Care Med. 2009;35: Epub 2009 Feb 3 retrospective analysis of 274 patients
24 DO HIGHER BLOOD PRESSURES MATTER? increased catecholamine load at MAP>70 mmhg may harm retrospective analysis of the control group in the L-NMMA phase III trial Ö adjusted for age, chronic arterial hypertension mean vasopressor load, SAPS II, geographic region, center MAP levels above 70 mmhg were not associated with 28- day mortality Dünser MW et al: Association of arterial blood pressure and vasopressor load with septic shock mortality: a post hoc analysis of a multicenter trial. Crit Care. 2009;13:R181. [Epub ahead of print]
25 MEAN VASOPRESSOR LOAD was associated with INCREASED RISK OF 28-DAY MORTALITY (P<.001) occurrence of disease-related adverse events Dünser MW et al: Association of arterial blood pressure and vasopressor load with septic shock mortality: a post hoc analysis of a multicenter trial. Crit Care. 2009;13:R181. [Epub ahead of print]
26 DO HIGHER BLOOD PRESSURES MATTER? any further increases in blood pressure above 70 mmhg achieved by catecholamine vasopressors may increase the risk of mortality
27 HIGH DOSE OF NOREPINEPHINE: independently associated with risk of death Martin et al, Shock 2015;44,:
28 HIGH DOSE OF NOREPINEPHINE: independently associated with risk of death Martin et al, Shock 2015;44,:
29 L-NMMA MAP RESPONSE IN PHASE II SUPERIMPOSED ON PHASE III L-NMMA phase III control phase III Takala J, Crit Care Med 2010; 38[Suppl.]:S613 S619
30 L-NMMA SURVIVAL CURVE OF PHASE II SUPERIMPOSED ON PHASE III data points for 28-day survival curve for L-NMMA in the phase II study lower MAP higher MAP control phase III L-NMMA phase III blood pressure more relevant to outcome than the drug(s)? Takala J, Crit Care Med 2010; 38[Suppl.]:S613 S619
31 REDUCING CATECHOLAMINE VASOPRESSORS? benefit for less severe septic shock in the VASST trial NE 5-14 µg/min protection from unnecessary exposure to catecholamines?
32 ADVERSE EFFECTS OF CATECHOLAMINES? excess vasoconstriction impaired microcirculation increased metabolic demands altered immune response increased myocardial oxygen demand risk of myocardial ischemia etc.
33 DISSOCIATION BETWEEN BLOOD FLOW AND BLOOD PRESSURE
34 39 Septic Patients (15,836 pulmonary artery catheter measurements) r²=0.003
35 TREATMENT TARGETS TO RESTORE HEMODYNAMIC STABILITY? A. Jarisch: Fortschritte der gesamten Medizin Dtsch Med Wochenschr 1928;28: A. Jarisch Fortschritte der gesamten Medizin IT HAS BEEN A CERTAIN DISASTER FOR THE DEVELOPMENT OF THE SCIENCE OF CIRCULATION THAT BLOOD FLOW IS SO DIFFICULT TO Dtsch MEASURE Med IN Wochenschr CONTRAST TO 1928;28: THE EASE OF MEASURING BLOOD PRESSURE THEREFORE, BLOOD PRESSURE MANOMETER ACHIEVED ITS EVEN FASCINATING IMPACT, DESPITE THE FACT THAT MOST ORGANS DO NOT NEED BLOOD PRESSURE THEY NEED BLOOD FLOW Rev. S. Hales ???
36 CONCERNS TO BE ADDRESSED: does accepting lower MAP risk the kidney? do patients with hypertension profit from higher MAP?
EFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK. Alexandria Rydz
EFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK Alexandria Rydz BACKGROUND- SEPSIS Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated
More informationVasopressors 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.
More informationVasopressors in septic shock
Vasopressors in septic shock Prof. Jean-Louis TEBOUL Medical ICU Bicetre hospital University Paris-South France Questions 1- Why do we use vasopressors in septic shock? 2- Which first-line agent? 3- When
More informationShould we use steroids in sepsis? J.G. van der Hoeven
Should we use steroids in sepsis? J.G. van der Hoeven Why I don t like it It is boring.. It usually results in emotional outcries in the audience If any, the effects on outcome are very small You are not
More information4/5/2018. 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
More informationControversies in Hospital Medicine: Critical Care. Vasopressors, Steroids, and Insulin Therapy
Controversies in Hospital Medicine: Critical Care Vasopressors, Steroids, and Insulin Therapy Douglas Fish, Pharm.D. Professor of Pharmacy, University of Colorado Denver Clinical Specialist in Critical
More informationEvidence-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
More informationVasopressors for shock
Vasopressors for shock Background Reviews and Observational Studies Holler 2015. Nontraumatic Hypotension and Shock in the Emergency Department and Prehospital Setting Prevalence, Etiology and Mortality:
More informationActualités de la prise en charge hémodynamique initiale Daniel De Backer
Actualités de la prise en charge hémodynamique initiale Daniel De Backer Head Dept Intensive Care, CHIREC hospitals, Belgium Professor of Intensive Care, Université Libre de Bruxelles Past- President European
More informationCardiovascular Management of Septic Shock
Cardiovascular Management of Septic Shock R. Phillip Dellinger, MD Professor of Medicine Robert Wood Johnson Medical School/UMDNJ Director, Critical Care Medicine and Med/Surg ICU Cooper University Hospital
More informationTiming of Vasopressors in Septic Shock: How Soon is Too Soon?
Timing of Vasopressors in Septic Shock: How Soon is Too Soon? Anand Kumar, MD Sections of Critical Care Medicine and Infectious Diseases Professor of Medicine, Medical Microbiology and Pharmacology University
More informationEfficacy and Outcomes After Vasopressin Guideline Implementation in Septic Shock
669163AOPXXX10.1177/1060028016669163Annals of PharmacotherapyWu et al research-article2016 Research Report Efficacy and Outcomes After Vasopressin Guideline Implementation in Septic Shock Annals of Pharmacotherapy
More informationWhen options matter. Vasopressor Reloaded. Balance in Haemodynamics - Only Survival Matters
When options matter Vasopressor Reloaded Balance in Haemodynamics - Only Survival Matters Vasopressin Synthesis and Release Physiologic Importance in Septic Shock Hypothalamus Brain Vasopressin deficiency
More informationSepsis and Hemodynamic Support in September 15, 2017 Carleen Risaliti
Sepsis and Hemodynamic Support in 2017 September 15, 2017 Carleen Risaliti Objectives Review fluid resuscitation guidelines in septic shock Discuss volume assessment v. fluid responsiveness Evaluate pros
More informationFluid 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
More informationDepartment of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS
Department of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS a mismatch between tissue perfusion and metabolic demands the heart, the vasculature
More information6/5/2014. Sepsis Management and Hemodynamics. 2004: International group of experts,
Sepsis Management and Hemodynamics Javier Perez-Fernandez, M.D., F.C.C.P. Medical Director Critical Care Services, Baptist t Hospital of Miamii Medical Director Pulmonary Services, West Kendall Baptist
More informationHow to resuscitate the patient in early sepsis? A physiological approach. J.G. van der Hoeven, Nijmegen
How to resuscitate the patient in early sepsis? A physiological approach J.G. van der Hoeven, Nijmegen Disclosure interests speaker (potential) conflict of interest Potentially relevant relationships with
More informationResuscitation Symposium Resuscitation Literature Update. Abdullah Al Reesi, MD, MSc, FACEP, FRCPC Sr. Consultant and HoD SQUH
Resuscitation Symposium Resuscitation Literature Update Abdullah Al Reesi, MD, MSc, FACEP, FRCPC Sr. Consultant and HoD SQUH Objectives Review recent articles in sepsis New sepsis definition High versus
More informationSepsis 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
More informationDESIGNER 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
More informationCardiogenic shock: Current management
Cardiogenic shock: Current management Janine Pöss Universitätsklinikum des Saarlandes Klinik für Innere Medizin III Kardiologie, Angiologie und internistische Intensivmedizin Homburg/Saar I have nothing
More informationIn-hospital Care of the Post-Cardiac Arrest Patient. David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine
In-hospital Care of the Post-Cardiac Arrest Patient David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine Disclosures I have no financial interest, arrangement,
More informationObjectives. Management of Septic Shock. Definitions Progression of sepsis. Epidemiology of severe sepsis. Major goals of therapy
Objectives Management of Septic Shock Review of the Evidence and Implementation of Pediatric Guidelines at Christus Santa Rosa Manish Desai, M.D. PL 5 2 nd year Pediatric Critical Care Fellow Review of
More informationWhat works in sepsis. Topics. EGDT: Severe Sepsis/ Shock. Sepsis
What works in sepsis Eric Schmidt, MD Denver Health Medical Center University of Colorado School of Medicine Topics Understanding and implemen@ng early goal directed therapy (EGDT) Ac@vated Protein C should
More informationSepsis: 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
More informationMaking vasopressors safer
Making vasopressors safer Requirements for safe vaspressor use In an ideal world 1. Knowledge of what constitutes optimal vasopressor dosing 2. A culture of cautiousness regarding vasopressors What do
More informationSepsis and septic shock Practical hemodynamic consequences. Intensive Care Training Program Radboud University Medical Centre Nijmegen
Sepsis and septic shock Practical hemodynamic consequences Intensive Care Training Program Radboud University Medical Centre Nijmegen Septic cardiomyopathy Present in > 50% and often masked by low vascular
More informationUpdate in Sepsis. Conflicts of Interest: None. Bill Janssen, M.D.
Update in Sepsis Bill Janssen, M.D. Associate Professor of Medicine National Jewish Health University of Colorado Denver Conflicts of Interest: None A 62 year-old female presents to the ED with fever,
More informationEarly Goal-Directed Therapy
Early Goal-Directed Therapy Where do we stand? Jean-Daniel Chiche, MD PhD MICU & Dept of Host-Pathogen Interaction Hôpital Cochin & Institut Cochin, Paris-F Resuscitation targets in septic shock 1 The
More informationSurviving 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
More informationBrain under pressure Impact of vasopressors
Brain under pressure Impact of vasopressors Brain dysfunction in sepsis Incidence: - Varying nomenclature: sepsis-associated encephalopathy, delirium, brain dysfunction - Consistently recognized as frequent:
More informationTitrating Critical Care Medications
Titrating Critical Care Medications Chad Johnson, MSN (NED), RN, CNCC(C), CNS-cc Clinical Nurse Specialist: Critical Care and Neurosurgical Services E-mail: johnsoc@tbh.net Copyright 2017 1 Learning Objectives
More informationSurviving Sepsis. Brian Woodcock MBChB MRCP FRCA FCCM
1 Surviving Sepsis Brian Woodcock MBChB MRCP FRCA FCCM 2 Disclosures No conflicts of interest 3 Sepsis Principles of management of septic shock in the operating room "Surviving Sepsis" guidelines 4 Add-on
More informationHeart Rate Control in sepsis and septic shock
Heart Rate Control in sepsis and septic shock Antonia Koutsoukou Associate Professor of Intensive Care Medicine University of Athens/ Sotiria General Chest Diseases Hospital Introduction Sepsis, is a clinical
More informationINTENSIVE 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
More informationThe 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
More informationSurviving 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
More informationOHSU. 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
More informationCase 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
More informationInflammatory Statements
Inflammatory Statements Using ETCO 2 Analysis in Sepsis Syndromes George A. Ralls M.D. Orange County EMS System Sepsis Sepsis Over 750,000 cases annually Expected growth of 1.5% per year Over 215,000 deaths
More informationSepsis 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%
More informationCORTICOSTEROID USE IN SEPTIC SHOCK THE ONGOING DEBATE DIEM HO, PHARMD PGY1 PHARMACY RESIDENT VALLEY BAPTIST MEDICAL CENTER BROWNSVILLE
CORTICOSTEROID USE IN SEPTIC SHOCK THE ONGOING DEBATE DIEM HO, PHARMD PGY1 PHARMACY RESIDENT VALLEY BAPTIST MEDICAL CENTER BROWNSVILLE 1 ABBREVIATIONS ACCP = American College of Chest Physicians ARF =
More informationPediatric Sepsis Treatment:
Disclosures Pediatric Sepsis Treatment: (treat) Early & (reevaluate) Often None June 11, 2018 Leslie Dervan, MD MS Pacific Northwest Sepsis Conference 1 Agenda Sepsis: pathophysiology at-a-glance Pediatric
More informationBC Sepsis Network Emergency Department Sepsis Guidelines
The provincial Sepsis Clinical Expert Group developed the BC, taking into account the most up-to-date literature (references below) and expert opinion. For more information about the guidelines, and to
More informationVasopressor hormones in shock noradrenaline, vasopressin or angiotensin II: which one will make the race?
Editorial Vasopressor hormones in shock noradrenaline, vasopressin or angiotensin II: which one will make the race? Martin W. Dünser 1, Jens Meier 2 1 Department of Critical Care, University College of
More informationDr Nick Taylor Visiting Emergency Specialist Teaching Hospital Karapitiya
Dr Nick Taylor Visiting Emergency Specialist Teaching Hospital Karapitiya Senior Specialist and Director ED Training Clinical Lecturer, Australian National University Canberra Hospital, Australia Inotropes
More informationSepsis and septic shock
Sepsis and septic shock Practical hemodynamic consequences Intensive Care Training Program Radboud University Medical Centre Nijmegen Septic cardiomyopathy Present in > 50% and often masked by low vascular
More informationPercutaneous Mechanical Circulatory Support for Cardiogenic Shock. 24 th Annual San Diego Heart Failure Symposium Ryan R Reeves, MD FSCAI
Percutaneous Mechanical Circulatory Support for Cardiogenic Shock 24 th Annual San Diego Heart Failure Symposium Ryan R Reeves, MD FSCAI The Need for Circulatory Support Basic Pathophysiologic Problems:
More informationFluids 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,
More informationSepsis 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
More informationThe Ever Changing World of Sepsis Management. Laura Evans MD MSc Medical Director of Critical Care Bellevue Hospital
The Ever Changing World of Sepsis Management Laura Evans MD MSc Medical Director of Critical Care Bellevue Hospital COI Disclosures No financial interests to disclose Learning Objectives Review the evolution
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for
More informationTaiwan Crit. Care Med.2009;10: C 1. CVP 8~12 mmhg 2. MAP 65 mmhg 1. 1B
6 24 1C 1. CVP 8~12 mmhg 2. MAP 65 mmhg 3. 0.5 ml 4. 70% 65% 1 colloid crystalloid 1B SAFE albumin 2 813 386 07-346-8278 07-350-5220 E-mail shoalin01@.gmail.com 21 p=0.09 prospective meta-analysis 3-5
More informationUpdate 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
More informationLooking for sepsis. Sepsis: Update. Prevalence of High Profile Dzs. Screening and risk stratification. Mortality of High Profile Diseases
Sepsis: Update Prevalence of High Profile Dzs Edward A. Panacek, MD, MPH Professor and Chair, Emergency Medicine USA Medical Center, Mobile, AL NDAFP Conference Big Sky. 2016 Syllabus Angus Crit Care Med
More informationBack to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill
Back to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill Joe Palumbo PGY-2 Critical Care Pharmacy Resident Buffalo General Medical Center Disclosures
More informationSepsis is a complicated infectious process that propagates. Use of Vasopressors in Septic Shock. Clinical review
Use of Vasopressors in Septic Shock Megan A. Rech, PharmD, Megan Prasse, PharmD, and Gourang Patel, PharmD, MSc Abstract Objective: To review the latest findings on the use of vasopressor agents in septic
More informationGuidelines are the Future of Sepsis Management Pro
Guidelines are the Future of Sepsis Management Pro R. Phillip Dellinger MD, MCCM Professor and Chair of Medicine Director Adult Health Institute Senior Critical Care Attending Camden NJ USA Objectives
More informationSHOCK. 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
More informationNE refractoriness: From Definition To Treatment... Prof. Alain Combes
NE refractoriness: From Definition To Treatment... Prof. Alain Combes Service de Réanimation ican, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris Université Pierre
More informationJAMA. 2016;315(8): doi: /jama
JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287 SEPSIS 3 life-threatening organ dysfunction caused by a dysregulated host response to infection organ dysfunction: an increase in the SOFA
More informationAcute 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
More informationPediatric Septic Shock. Geoffrey M. Fleming M.D. Division of Pediatric Critical Care Vanderbilt University School of Medicine Nashville, Tennessee
Pediatric Septic Shock Geoffrey M. Fleming M.D. Division of Pediatric Critical Care Vanderbilt University School of Medicine Nashville, Tennessee Case 4 year old male with a history of gastroschesis repaired
More informationการอบรมว ทยาศาสตร พ นฐานทางศ ลยศาสตร เร อง นพ.ส ณฐ ต โมราก ล ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร โรงพยาบาลรามาธ บด มหาวทยาลยมหดล
การอบรมว ทยาศาสตร พ นฐานทางศ ลยศาสตร เร อง นพ.ส ณฐ ต โมราก ล ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร โรงพยาบาลรามาธ บด มหาวทยาลยมหดล Distributive shock Severe sepsis and Septic shock Anaphylactic shock Neurogenic
More informationNovel Sepsis Therapies
RSEM-GSA 17 Novel Sepsis Therapies Khaled Ahmed Alghamdi, MD, ABEM, FACEP, FAAEM Consultant Emergency Medicine Deputy program director Medical Director of Emergency Medical Services King Faisal Specialist
More informationSeptic AKI in ICU patients
Septic AKI in ICU patients Prof. Achim Jörres, M.D. Dept. of Nephrology and Medical Intensive Care Charité University Hospital Campus Virchow Klinikum Berlin, Germany achim.joerres@charite.de Agenda Epidemiology
More informationGIAPREZA (angiotensin II) Update
Corporate Presentation GIAPREZA (angiotensin II) Update NASDAQ: LJPC December 2017 0 Forward Looking Statement These slides contain forward-looking statements as that term is defined in the Private Securities
More informationSepsis. From EMS to ER to ICU. What we need to be doing
Sepsis From EMS to ER to ICU What we need to be doing NEHAL BHATT, MD ATHENS PULMONARY, CRITICAL CARE AND SLEEP Objectives 1. Define the changes to the definition of Sepsis 2. Describe the assessment,
More informationNorepinephrine (Levophed )
Norepinephrine (Levophed ) Scope C3IFT CCT Generic Name: Norepinephrine Trade Name: Levophed Chemical Class: Therapeutic Class: Actions: Pharmacokinetics: Vasopressor Vasopressor Mechanism of Action: Norepinephrine
More informationThe Art and Science of Infusion Nursing John M. Allen, PharmD, BCPS. Understanding Vasoactive Medications
The Art and Science of Infusion Nursing John M. Allen, PharmD, BCPS Understanding Vasoactive Medications Focus on Pharmacology and Effective Titration ABSTRACT In the care of the critically ill patient,
More informationFull 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
More informationJohn 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
More informationThe Use of Metabolic Resuscitation in Sepsis
The Use of Metabolic Resuscitation in Sepsis Jennifer M. Roth, PharmD, BCPS, BCCCP Critical Care Clinical Specialist - Surgical Trauma ICU Baylor University Medical Center Disclosures No conflicts of interest
More informationEarly-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:
More informationHow can the PiCCO improve protocolized care?
How can the PiCCO improve protocolized care? Azriel Perel Professor and Chairman Department of Anesthesiology and Intensive Care Sheba Medical Center, Tel Aviv University, Israel ESICM, Vienna 2009 Disclosure
More informationThe Pharmacology of Hypotension: Vasopressor Choices for HIE patients. Keliana O Mara, PharmD August 4, 2018
The Pharmacology of Hypotension: Vasopressor Choices for HIE patients Keliana O Mara, PharmD August 4, 2018 Objectives Review the pathophysiology of hypotension in neonates Discuss the role of vasopressors
More informationThe subject of the best vasopressor drug for the initial
Implementation of a Norepinephrine-based Protocol for Management of Septic Shock: A Pilot Feasibility Study Glenn Hernandez, MD, Alejandro Bruhn, MD, Carlos Romero, MD, Francisco Javier Larrondo, MS, Rene
More informationThe 2016 Surviving Sepsis Guidelines have arrived, a
A Users Guide to the 2016 Surviving Sepsis Guidelines R. Phillip Dellinger, MD, MCCM Christa A. Schorr, RN, MSN, FCCM Cooper University Health and Cooper Medical School of Rowan University Camden, NJ Mitchell
More informationIntroduction. Invasive Hemodynamic Monitoring. Determinants of Cardiovascular Function. Cardiovascular System. Hemodynamic Monitoring
Introduction Invasive Hemodynamic Monitoring Audis Bethea, Pharm.D. Assistant Professor Therapeutics IV January 21, 2004 Hemodynamic monitoring is necessary to assess and manage shock Information obtained
More informationSeptic 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
More informationSwans and Pressors. Vanderbilt Surgery Summer School Ricky Shinall
Swans and Pressors Vanderbilt Surgery Summer School Ricky Shinall Shock, Swans, Pressors in 15 minutes 4 Reasons for Shock 4 Swan numbers to know 7 Pressors =15 things to know 4 Reasons for Shock Not enough
More informationDr. 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
More informationSwans and Pressors. Vanderbilt Surgery Summer School Ricky Shinall
Swans and Pressors Vanderbilt Surgery Summer School Ricky Shinall SHOCK Hypotension SHOCK Hypotension SHOCK=Reduction of systemic tissue perfusion, resulting in decreased oxygen delivery to the tissues.
More informationSepsis: Mitigating Denials Amid Definition Disparity
Sepsis: Mitigating Denials Amid Definition Disparity White Paper - April 2017 Sepsis Criteria at a Glance The Society of Critical Care Medicine (SCCM) met in 2016 to update the definition of sepsis. During
More informationLJPC-501 Market Opportunity
LJPC-501 Market Opportunity NASDAQ: LJPC July 2015 Forward-Looking Statements These slides contain "forward-looking" statements within the meaning of the Private Securities Litigation Reform Act of 1995.
More informationHemodynamic Monitoring Using Switching Autoregressive Dynamics of Multivariate Vital Sign Time Series
Hemodynamic Monitoring Using Switching Autoregressive Dynamics of Multivariate Vital Sign Time Series Li-Wei H. Lehman, MIT Shamim Nemati, Emory University Roger G. Mark, MIT Proceedings Title: Computing
More informationDiagnosis and Management of Sepsis and Septic Shock. Martin D. Black MD Concord Pulmonary Medicine Concord, New Hampshire
Diagnosis and Management of Sepsis and Septic Shock Martin D. Black MD Concord Pulmonary Medicine Concord, New Hampshire Financial: none Disclosures Objectives: Identify physiologic principles of septic
More informationObjectives. Outline. Sepsis Incidence and Outcomes. Definitions
Objectives Evaluate recent literature on the management of sepsis Apply new and potentially controversial recommendations from the Surviving Sepsis Guidelines to patient cases. Surviving Sepsis Campaign
More informationSurviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview
Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview Mechanical Ventilation of Sepsis-Induced ALI/ARDS ARDSnet Mechanical Ventilation Protocol Results: Mortality
More informationSepsis 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
More informationManagement of Severe Sepsis:
Management of Severe Sepsis: Update from the Surviving Sepsis Campaign Barbara Birriel, MSN, ACNP-BC, FCCM The Pennsylvania State University NONE Disclosures Review evidence-based international sepsis
More informationSurviving Sepsis Campaign
Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview By professor Ahmad Alaysh BMC-MICU 1 Surviving Sepsis A global program to Reduce mortality rates in severe
More informationPrehospital treatment of sepsis Christopher W. Seymour, MD MSc
Prehospital treatment of sepsis Christopher W. Seymour, MD MSc The CRISMA Center Assistant Professor of Critical Care Medicine & Emergency Medicine University of Pittsburgh School of Medicine Disclosures
More informationRed Cell Transfusion triggers: A moving target When, who, and how much?
Red Cell Transfusion triggers: A moving target When, who, and how much? Tim Walsh Professor of Critical Care, Edinburgh University A transfusion threshold of 70 g/l or below, with a target Hb range of
More informationPatient Safety Safe Table Webcast: Sepsis (Part III and IV) December 17, 2014
Patient Safety Safe Table Webcast: Sepsis (Part III and IV) December 17, 2014 Presenters Mark Blaney, RN Regional Nurse Educator CHI Franciscan Health Karen Lautermilch Director, Quality & Performance
More informationR2R: 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
More informationWhen Fluids are Not Enough: Inopressor Therapy
When Fluids are Not Enough: Inopressor Therapy Problems in Neonatology Neonatal problem: hypoperfusion Severe sepsis Hallmark of septic shock Secondary to neonatal encephalopathy Vasoplegia Syndrome??
More informationSpecial features of cardiogenic failure in sepsis. Krisztina Madách
Special features of cardiogenic failure in sepsis Krisztina Madách The problem in focus Incidence of sepsis is increasing Severe sepsis and septic shock are leading cause of death in ICU Septic patients
More informationJarisch A. Kreislauffragen, Dünser et al. Critical Care 2013, 17:326 Sunday, March 30, 14
It was fatal for the development of our understanding of circulation that blood flow is relatively difficult while blood pressure so easy to measure: This is the reason why the sphygmomanometer has gained
More information