Vasopressors in septic shock
|
|
|
- Antony Simpson
- 6 years ago
- Views:
Transcription
1 Vasopressors in septic shock Prof. Jean-Louis TEBOUL Medical ICU Bicetre hospital University Paris-South France
2 Questions 1- Why do we use vasopressors in septic shock? 2- Which first-line agent? 3- When to start? 4- Which therapeutic target? 5- What to do in case of refractory hypotension?
3 Questions 1- Why do we use vasopressors in septic shock? 2- Which first-line agent? 3- When to start? 4- Which therapeutic target? 5- What to do in case of refractory hypotension?
4 Why do we use vasopressors in septic shock? Septic shock is characterized by a decreased vascular tone (inducible NO synthase activation, etc) Hypotension Hypoperfusion worsening
5 Autoregulation of organ blood flow organ blood flow mean arterial pressure
6 Why do we use vasopressors in septic shock? 1- Septic shock is characterized by a decreased vascular tone (inducible NO synthase activation, etc) 2- Profound hypotension worsens organ hypoperfusion and represents an independent risk of death
7 48 hrs 65 mmhg
8 mmhg Area under MAP 65 mmhg Time under MAP 65 mmhg Area under MAP 65 mmhg Best predictor of 30-day mortality
9 during the first 24 hours
10 Why do we use vasopressors in septic shock? 1- Septic shock is characterized by a decreased vascular tone (inducible NO synthase activation, etc) 2- Profound hypotension worsens organ hypoperfusion and represents an independent risk of death 3- Correction of hypotension with a vasopressor allows improving organ perfusion
11 Probable arterial pressure effect Urine flow (ml/h) Creatinine clearance Blood lactate (meq/l) * * * * * baseline 4 hrs 8 hrs 54 mmhg 73 mmhg 72 mmhg 0-2 hrs 4-6 hrs 54 mmhg 72 mmhg baseline 4 hrs 8 hrs 54 mmhg 73 mmhg 72 mmhg while cardiac output did not change
12 Autoregulation of renal blood flow renal blood flow mean arterial pressure
13 Why do we use vasopressors in septic shock? 1- Septic shock is characterized by a decreased vascular tone (inducible NO synthase activation, etc) 2- Profound hypotension worsens organ hypoperfusion and represents an independent risk of death 3- Correction of hypotension with a vasopressor allows improving organ perfusion and microcirculation
14
15 % 95 StO 2 StO 2 : 75 ± 9% p < 0.05 healthy volunteers ± 4 * 55 before NE with NE
16 NIRS technology
17 StO 2 (%) Vascular Occlusion Test Inflation of the pneumatic cuff Deflation of the pneumatic cuff AUC Start point : 0.98 x baseline StO 2 Desaturation slope End point : 0.85 x baseline StO 2 Recovery slope Index of recruitment of microvessels Start point : 1.05 x minimal StO 2 Occlusion time Time
18 (%/s) 3.5 StO 2 recovery slope Restoration of a good MAP with early introduction of NE resulted in recruitment 1.5 p < 0.05 of microvessels and better tissue oxygenation before NE with NE
19 Questions 1- Why do we use vasopressors in septic shock? 2- Which first-line agent? 3- When to start? 4- Which therapeutic target? 5- What to do in case of refractory hypotension?
20 Vasopressors Norepinephrine as the first choice vasopressor (grade 1B)
21
22
23
24
25 Questions 1- Why do we use vasopressors in septic shock? 2- Which first-line agent? 3- When to start? 4- Which therapeutic target? 5- What to do in case of refractory hypotension?
26
27 SAP MAP DAP vasodilatation reflects the vascular tone low DAP Consider vasopressors When to start vasopressors? when MAP is < 65 mmhg despite adequate fluid resuscitation or when MAP is < 65 mmhg and DAP is low even if the patient has not been yet fully fluid resuscitated
28 Questions 1- Why do we use vasopressors in septic shock? 2- Which first-line agent? 3- When to start? 4- Which therapeutic target? 5- What to do in case of refractory hypotension?
29 Autoregulation of organ blood flow organ blood flow? 65 mmhg? mean arterial pressure
30 MAP: 65 mmhg MAP: 75 mmhg MAP: 85 mmhg % urine output capillary flow red cell velocity tonometry PCO 2 gap
31 Autoregulation of organ blood flow organ blood flow Mean Arterial Pressure (mmhg)
32 Crit Care Med 2000; 28: Crit Care Med 2005; 33: increasing MAP above 65 mmhg results in little benefit
33 Crit Care Med 2000; 28: Crit Care Med 2005; 33: MAP target value: 65 mmhg
34 Vasopressors Vasopressor therapy initially to target a MAP of 65 mmhg (grade 1C) Probably higher target value if: History of chronic hypertension
35 10 patients none with history of severe hypertension MAP: 65 mmhg MAP: 75 mmhg MAP: 85 mmhg % urine output capillary flow red cell velocity tonometry PCO 2 gap
36 Organ Blood flow no prior hypertension with prior hypertension 65 mmhg Mean arterial pressure
37 MAP Base Line 0 hr 6 hrs after the start of therapy Standard therapy 76 ± 24 EGDT 74 ± ± ± 19 * 2/3 patients had chronic hypertension
38 80-85 mmhg mmhg
39 Asfar et al. N Engl J Med 2014
40
41 Vasopressors Vasopressor therapy initially to target a MAP of 65 mmhg (grade 1C) Probably higher target value if: History of chronic hypertension Elevated CVP
42 Vasopressors Vasopressor therapy initially to target a MAP of 65 mmhg (grade 1C) Probably higher target value if: History of chronic hypertension Elevated CVP Elevated abdominal pressure Initial renal impairment
43 Pts without AKI at H 72 Pts with AKI at H 6 (n =101) Pts with AKI at H 72 Hourly MAP (mmhg) from H 1 to H 24
44 Pts without AKI at H 72 Pts without AKI at H 6 (n =116) Pts with AKI at H 72 Hourly MAP (mmhg) from H 1 to H 24
45 Is it dangerous to target a MAP value up to normal values (around 85 mmhg) in septic shock?
46 6 pts with septic shock Perfused Vessel Density No worsening but improvement of microcirculation for MAP target up to 85 mmhg with NE Microvascular Flow Index
47 Highly variable response among patients 20 pts with septic shock
48 20 pts with septic shock Perfused capillary density improved in pts with an altered sublingual perfusion at baseline, and decreased in patients with preserved basal microvascular perfusion.
49 Questions 1- Why do we use vasopressors in septic shock? 2- Which first-line agent? 3- When to start? 4- Which therapeutic target? 5- What to do in case of refractory hypotension?
50 Vasopressors Vasopressor therapy initially to target a MAP of 65 mmhg (grade 1C) Norepinephrine (NE) as the first choice vasopressor (grade 1B) Epinephrine (added to and substituted for NE) when an additional agent is needed to maintain adequate blood pressure (grade 2B) Vasopressin (0.03 units/min can be added to NE) with intent of either raising MAP or decreasing NE dosage)
51 Conclusion 1- Why do we use vasopressors in septic shock? 2- Which first-line agent? 3- When to start? 4- Which therapeutic target? at least 65 mmhg probably higher value if: History of chronic hypertension Elevated CVP Elevated abdominal pressure Initial renal impairment mmhg seems to be a safe range Thank you
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
Fluid responsiveness and extravascular lung water
Fluid responsiveness and extravascular lung water Prof. Jean-Louis TEBOUL Medical ICU Bicetre hospital University Paris-South France Conflicts of interest Member of the Medical Advisory Board of Maquet/Pulsion
Actualités 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
How 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
Monitoring the microcirculation to guide resuscitation
Monitoring the microcirculation to guide resuscitation Daniel De Backer Head Dept Intensive Care, CHIREC hospitals, Belgium Professor of Intensive Care, Université Libre de Bruxelles President European
VOLUME RESPONSIVENESS IS DIFFERENT FROM NEED FOR FLUIDS BLOOD PRESSURE TARGETS IN SEPSIS
Department of Intensive Care Medicine VOLUME RESPONSIVENESS IS DIFFERENT FROM NEED FOR FLUIDS BLOOD PRESSURE TARGETS IN SEPSIS SEPTIC SHOCK : THE CLINICAL SCENARIO HYPOTENSION DESPITE ADEQUATE VOLUME RESUSCITATION
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
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
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%
Early 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
Cardiovascular 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
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,
(Peripheral) Temperature and microcirculation
(Peripheral) Temperature and microcirculation Prof. Jan Bakker MD, PhD Chair dept Intensive Care Adults jan.bakker@erasmusmc.nl www.intensivecare.me Intensive Care Med (2005) 31:1316 1326 DOI 10.1007/s00134-005-2790-2
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
6/5/2014. 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
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
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
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
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
Vasopressors 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:
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
Making 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
Controversies 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
Department 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
Sepsis 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
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
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
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.
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
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.
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
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
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
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
The 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
Sepsis care and the new core measures
Sepsis care and the new core measures Daniel S. Hagg, MD January 15, 2016 Outline What is sepsis? A brief history of sepsis care How should we take care of septic patients now? Core measures What strategies
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,
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
Endpoints of Resuscitation for Circulatory Shock: When Enough is Enough?
Endpoints of Resuscitation for Circulatory Shock: When Enough is Enough? Emanuel P. Rivers, MD, MPH, IOM Vice Chairman and Research Director Departments of Emergency Medicine and Surgery Henry Ford Hospital
SEPSIS UPDATE WHY DO WE NEED A CORE MEASURE CHAD M. KOVALA DO, FACOEP, FACEP
SEPSIS UPDATE WHY DO WE NEED A CORE MEASURE CHAD M. KOVALA DO, FACOEP, FACEP OBJECTIVES Arise, ProMISE, ProCESS Key points in sepsis management The CMS sepsis core measure COST OF SEPSIS CARE IN US Most
Objectives. 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
Fluid balance and clinically relevant outcomes
Fluid balance and clinically relevant outcomes Rui Moreno, MD, PhD, Professor UCINC, Hospital de São José Centro Hospitalar de Lisboa Central, E.P.E. INSULT PRIMARY MODS SIRS SECONDARY MODS OUTCOME RECOVERY
Sepsis Care and the New Core Measures. Daniel S. Hagg, MD January 15, 2016
Sepsis Care and the New Core Measures Daniel S. Hagg, MD January 15, 2016 Outline What is sepsis? A brief history of sepsis care How should we take care of septic patients now? Core measures What strategies
Pediatric 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
IABP to prevent pulmonary edema under VA-ECMO
IABP to prevent pulmonary edema under VA-ECMO Alain Combes Service de Réanimation ican, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris Université Pierre et Marie Curie,
การอบรมว 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
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
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
Update 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,
NE 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
Didier Payen, MD, Ph D DAR Lariboisière Université Paris 7 Unité INSERM 1160
Assessing response to therapy: SvO 2, lactate, PCO 2 gap, others Didier Payen, MD, Ph D DAR Lariboisière Université Paris 7 Unité INSERM 1160 dpayen1234@orange.fr How can we see the question? Some useful
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
Norepinephrine in septic shock
Norepinephrine in septic shock Prof. Zsolt Molnár zsoltmolna@gmail.com Department of Anaesthesia and Intensive Therapy University of Szeged, Hungary A few months ago should we give it earlier? (Courtesy
Sepsis 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
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
Titrating 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
Failure of the circulation to maintain Tissue cellular. Tissue hypoperfusion Cellular hypoxia SHOCK. Perfusion
Shock SHOCK Failure of the circulation to maintain Tissue cellular Perfusion Organs Syndrome RR
The 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
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
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
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
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
Management 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
THE KIDNEY IN HYPOTENSIVE STATES. Benita S. Padilla, M.D.
THE KIDNEY IN HYPOTENSIVE STATES Benita S. Padilla, M.D. Objectives To discuss what happens when the kidney encounters low perfusion To discuss new developments and clinical application points in two scenarios
Early Goal Directed Therapy in 2015: What Did the Big Trials Teach us?
Early Goal Directed Therapy in 2015: What Did the Big Trials Teach us? Mitchell M. Levy MD, FCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care Warren Alpert Medical School
AllinaHealthSystem 1
: Definition End-organ hypoperfusion secondary to cardiac failure Venoarterial ECMO: Patient Selection Michael A. Samara, MD FACC Advanced Heart Failure, Cardiac Transplant & Mechanical Circulatory Support
How to maintain optimal perfusion during Cardiopulmonary By-pass. Herdono Poernomo, MD
How to maintain optimal perfusion during Cardiopulmonary By-pass Herdono Poernomo, MD Cardiopulmonary By-pass Target Physiologic condition as a healthy person Everything is in Normal Limit How to maintain
Septic Acute Kidney Injury (AKI) Rinaldo Bellomo Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) Melbourne Australia
Septic Acute Kidney Injury (AKI) Rinaldo Bellomo Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) Melbourne Australia Things we really, honestly know about septic AKI AKI is common
The Hemodynamic Puzzle
The Hemodynamic Puzzle SVV NIRS O 2 ER Lactate Energy Metabolism (Oxygen Consumption) (Ml/min/m 2 ) Oxygen Debt: To Pay or Not to Pay? Full Recovery Possible Delayed Repayment of O 2 Debt Oxygen Deficit
BREAK 11:10-11:
1. Sepsis Tom Heaps 09:30-10:20 2. Oncological Emergencies Clare Pollard 10:20-11:10 ------------------------ BREAK 11:10-11:30 ------------------------ 3. Diabetic Ketoacidosis Tom Heaps 11:30-12:20 4.
Prof. Dr. Iman Riad Mohamed Abdel Aal
The Use of New Ultrasound Indices to Evaluate Volume Status and Fluid Responsiveness in Septic Shock Patients Thesis Submitted for partial fulfillment of MD degree in Anesthesiology, Surgical Intensive
PHYSIOLOGY AND MANAGEMENT OF THE SEPTIC PATIENT
PHYSIOLOGY AND MANAGEMENT OF THE SEPTIC PATIENT Melanie Sanchez, RN, MSNE, OCN, CCRN Clinical Nurse III City of Hope National Medical Center HOW THE EXPERTS TREAT HEMATOLOGIC MALIGNANCIES LAS VEGAS, NV
The changing face of
The changing face of sepsis. @SepsisUK Dr Ron Daniels B.E.M. CEO, UK Sepsis Trust CEO, Global Sepsis Alliance Special Adviser (maternal sepsis) to WHO Breast cancer Cognitive impairment Mild 3.8 7.1
Inflammatory 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
Sepsis. 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,
Diagnosis 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
Surviving 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
Core Measures SEPSIS UPDATES
Patricia Walker, RN-BC, BSN Evidence Based Practice Manager Quality Management Services UCLA Health System, Ronald Reagan Medical Center Core Measures SEPSIS UPDATES Severe Sepsis and Septic Shock Based
Sepsis: Management ANUPOL PANITCHOTE, MD. Division of Critical Care Medicine Department of Medicine, Khon Kaen University, Thailand
Sepsis: Management ANUPOL PANITCHOTE, MD. Division of Critical Care Medicine Department of Medicine, Khon Kaen University, Thailand Vital signs Symptoms LAB BT > 38.3 or < 36 ๐ C HR > 90 bpm RR > 20 /min
Patient 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
FLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL
FLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL COLLEGE NOVEMBER 10 TH 2017 TEXAS SCCM SYMPOSIUM Disclosures
Brain 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:
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
Dilemmas in Septic Shock
Dilemmas in Septic Shock William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center A 62 year-old female presents to the ED with fever,
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
When 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
4/4/2014. Of patients diagnosed with sepsis 50% will develop severe sepsis 25% will develop shock. SIRS Sepsis Severe Septic Sepsis Shock.
A summary of pathophysiology, therapeutics, and how the pharmacy TECHNICIAN can help improve OUTCOMES Anthony Nelson 2014 Pharm.D. Candidate Tricia Aggers, Pharm.D. Affiliate Faculty, ISU College of Pharmacy
Hemodynamic Support of Sepsis
Practice Parameters for Hemodynamic Support of Sepsis in Adult Patients Copyright by the SOCIETY OF CRITICAL CARE MEDICINE These guidelines can also be found in the March 1999 issue of Critical Care Medicine
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
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
UPMC Critical Care
UPMC Critical Care www.ccm.pitt.edu Shock and Monitoring Samuel A. Tisherman, MD, FACS, FCCM Professor Departments of CCM and Surgery University of Pittsburgh Shock Anaerobic metabolism Lactic acidosis
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
BC 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
What is. InSpectra StO 2?
What is InSpectra StO 2? www.htibiomeasurement.com What is InSpectra StO 2? Hemoglobin O 2 saturation is measured in three areas: 1) Arterial (SaO 2, SpO 2 ) Assesses how well oxygen is loading onto hemoglobin
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
Novel 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
CRRT: The Technical Questions Modality & Dose. Ashita J. Tolwani, MD, MSc University of Alabama at Birmingham 2018
CRRT: The Technical Questions Modality & Dose Ashita J. Tolwani, MD, MSc University of Alabama at Birmingham 2018 Case A 24YOM with HTN and OSA presents with acute pancreatitis. Despite aggressive fluid
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
Fluids in Sepsis Less is more. Dr Anand Senthi Joondalup Health Campus ED MBBS, MAppFin, GradCertPubHlth,
Fluids in Sepsis Less is more Dr Anand Senthi Joondalup Health Campus ED MBBS, MAppFin, GradCertPubHlth, FRACGP @drsenthi Summary Discussion of the evidence for/against fluid resuscitation in septic shock