Practical. Septic shock resuscitation ไชยร ตน เพ มพ ก ล พบ. ภาคว ชาอาย รศาสตร คณะแพทยศาสตร ศ ร ราชพยาบาล
|
|
- Dwight Grant
- 5 years ago
- Views:
Transcription
1 Practical Septic shock resuscitation ไ ไชยร ตน เพ มพ ก ล พบ. ภาคว ชาอาย รศาสตร คณะแพทยศาสตร ศ ร ราชพยาบาล ประช มว ชาการ 101 ป อาย รศาสตร ศ ร ราช 6 ก มภาพ นธ 2561
2 Early recognition Early resuscitation Early goal achievement Early antibiotics Effective source control Optimal organ support Effective after shock care Important steps in sepsis resuscitation
3 why The story of sepsis Local infection. Local inflammation. Controlled If uncontrolled dissemination.. Generalized inflammation vascular effects.. Perfusion defect. end organ effects shock ischemic effect immune defect coag.defect... MODS death
4 Basic pathophysiology
5 The shock cascade Dutton RP. Anesthesiology Clin 25 (2007) 23 34
6 Strategy 1 Early recognition of sepsis Patient setting Fever, no other symptoms Fever, with symptoms and/ or signs Afebrile, with sepsis signs Shock etc ท าอย างไรจ งจะ ว น จฉ ยได แต ต น Vital signs Early warning scores eg. EWS, MEWS. SOS scores Quick SOFA or SOFA
7 Former definition of Sepsis ACCP/SCCM consensus conference 1992 Various stages of disease Bacteremia Systemic inflammatory response syndrome Sepsis syndrome Septic shock: early and refractory Systemic Inflammatory Response Syndrome Widespread inflammatory response to variety of severe clinical insults. Recognized by the presence of two or more of the followings: Temp > 38 o C or < 36 o C HR > 90/min RR > 20/min or PaCO2 < 32mmHg WBC > 12,000,000/ cu.mm. Or < 4000/cu.mm.
8 SOFA score
9
10 Influence of Systemic Inflammatory Response syndrome and Sepsis on Outcome of Critically Ill infected Patients Cumulative incidences of death of patients with infection (from date of infection to hospital discharge) according to sepsis stage : blue line for infection, red line for sepsis, green line for severe sepsis, black line for septic shock Septic Shock Severe sepsis sepsis infection Alberti, Brun-Buisson, Goodman, et al.: AJRCCM 2003:168;79 83
11 Strategy 2 Early resuscitation เป าหมายในการร กษา Mean arterial pressure > 65 mmhg Urine output > 0.5 ml/kg/hr Reversal of tissue hypoxia Fluid replacement Vasopressors if blood pressure (BP) goal is not reached Check and normalize tissue perfusion after BP goal Within 6 hours
12 Fluid replacement Fluid Bolus Initial fluid loading 30 ml/kg or more Isotonic crystalloids (0.9%NaCl, LRS or other balanced salt solution are recommended) Fluid challenge if BP goal is not reached CVP or other volume responsive tests Used as check point (ie. CVP 8 12 mmhg) Fluid maintenance After the goal is reached
13 Four Phases Fluid in the bolus Treatment of Shock Salvage Optimization Stabilization De-escalation Aggressive restoration of blood pressures Life saving measures Treat underlying causes Provide adequate oxygen delivery Optimize CO, ScvO2 and lactate Provide organ support Vasopressor weaning Achieve a negative balance Myburgh JA, Mythen MG. N Engl J Med 2013;369:
14 What fluid? Isotonic crystalloids NSS LRS or acetate Balance salt solution Albumin Synthetic colloids others Ann Intern Med 2014; 161(5):
15 Fluid Challenge When intravascular volume status is uncertain Static (pressure parameters) CVP, PAOP Dynamic (functional) parameters derived from heart lung interaction: PPV, SPV IVC Cardiac output Invasive Thermodilution Less invasive Indicator dilution Pulse contour Impedance PLR EEO Doppler Echo
16 If the BP target is not reached after adequate fluid เป แนวทางการร กษา าหมายในการร กษา Fluid replacement Mean arterial pressure > 65 Vasopressors if blood mmhg pressure (BP) goal is Urine not reached output > 0.5 ml/kg/hr Reversal Check and of tissue normalize hypoxia tissue perfusion after Within BP goal 6 hours Norepinephrine 0.1 2µg/kg/min First line agent Dopamine If NE contraindicated Arrhythmia, common complication Adrenaline If no response from the above agents
17 Can vasopressors be given earlier?
18 Early norepinephrine administration vs. standard treatment during severe sepsis/septic shock resuscitation: a randomized control trial Chairat Permpikul, Surat Tongyoo and Tanuwong Viarasilpa Division of Critical Care, Department of Medicine Siriraj Hospital, Mahidol University Bangkok THAILAND ESICM 2017, September 26
19 Outcomes Primary outcome Achieved target MAP + tissue perfusion goal within 6 hours no(%) Secondary outcomes Early Norepinephrine (N = 155) Standard Norepinephrine (N = 155) 118 (76.1) 75 (48.4) Mortality at 28 days no (%) 22 (14.2) 33 (21.3) Hospital mortality no (%) 33 (21.3) 37 (23.9) Time from initial treatment to achieve target MAP and tissue perfusion goal hr:min Outcomes Relative Risk (95% CI) 1.76 ( ) 0.77 ( ) 0.93 ( ) P value < :52±5:17 7:22±4: ESICM 2017, September 26
20 Detection and reversal of tissue hypoxia Adequacy of tissue perfusion Urine < 0.5 ml/kg/hr Low ScvO 2 < 70% Lactate > 2 mmol/l, or lactate clearance > 10% If perfusion goal is not reached Check afterload/ intense vasoconstriction Correct anemia Dobutamine, in those with low cardiac output Correct metabolic acidosis
21 Strategy 3,4 Early goal achievement Early antibiotics Hemodynamic restoration within 6 hours Macrocirculation mocrocirculation Antibiotics within 1 hour
22 Therapeutic goal achievements and their association with patients' outcomes during severe sepsis and septic shock resuscitation Milestone achievements during guideline implementation and their association with patients mortality were reported. These milestones include: 1. mean arterial > 65 mmhg 2. urine output > 0.5 ml/kg/hour 3. superior vena cava O 2 saturation > 70% or serum lactate clearance > 10%. Permpikul C. et al J Med Assoc Thai 2013
23 Main results Outcomes/ goal achievement No goal (n = 25) Blood pressure (n = 31) Blood pressure and urine output (n = 75) Blood pressure and urine output and lactate (n = 23) Urine output (n= 21) P value 28 days mortality (%) Hospital mortality (%) ICU LOS 48 pts (days) <0.001 Hospital LOS (days)
24 The influence of early hemodynamic optimization on biomarker patterns of severe sepsis and septic shock. The temporal patterns of inflammatory mediators were serially examined over the first 72 hrs of hospitalization after early hemodynamic optimization strategies of EGDT trial IL 1 ra TNF α Crit Care Med 2007;35:
25 Delayed initiation of antimicrobial therapy increases mortality. Kumar A Crit Care Med 2006;34(6): ;
26 Strategy 5 Effective source control Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 We recommend that a specific anatomic diagnosis of infection requiring emergent source control should be identified or excluded as rapidly as possible in patients with sepsis or septic shock, and that any required source control intervention should be implmented as soon as medically and logistically practical after the diagnosis is made (BPS). Crit Care Med 2017; 45:
27 Ease of removal of colonized devices Urinary catheter Increasing risk associated with removal Intravascular catheter Endotracheal tube Peritoneal dialysis catheter Prosthetic joint; orthopedic hardware Vascular graft Prosthetic heart valve Left ventricular assist device
28 Strategy 6 Optimal organ support Organ failure in sepsis and shock Hemodynamics Respiration Renal Coagulation system GI Metabolic Immune Etc.
29 Strategy 6 Effective after shock care Patients condition after shock Source controlled?? High risks hemodynamics Adequate/ inadequate volume Continued leakage Myocardial blood supply Organ failure/ recovery Anergy High risk of HAI or reactivation of silent infection
30 Early recognition Early resuscitation Early goal achievement Early antibiotics Effective source control Optimal organ support Effective after shock care Key success factors in sepsis resuscitation
31 ขอฝาก Guideline ง ายๆ
32
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
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 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 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 informationShock 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
More informationFluid 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
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 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 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 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 informationInitial 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
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 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 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 informationStaging 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
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 informationFLUID 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
More informationSepsis: 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
More informationL : Line and Tube อ นตรายป องก นได จากการให สารน า
L : Line and Tube อ นตรายป องก นได จากการให สารน า รศ.นพ.กว ศ กด จ ตตว ฒนร ตน ภาคว ชาศ ลยศาสตร คณะแพทยศาสตร มหาว ทยาล ยเช ยงใหม 3 rd Mini Conference: ความปลอดภ ยในผ ป วย ร วมด วย ช วยได ท กคน ว นท 13-14
More informationSepsis 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
More informationThe 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
More informationSepsis Awareness and Education
Sepsis Awareness and Education Meets the updated New York State Department of Health (NYSDOH) requirements for Infection Control and Barrier Precautions coursework Element VII: Sepsis Awareness and Education
More informationtowards early goal directed therapy
Paediatric Septic Shock- towards early goal directed therapy Elliot Long Paediatric Acute Care 2011 Conference Outline Emergency Department Rivers Protocol (EGDT) ACCM Sepsis Protocol Evidence Barriers
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 informationGoal-directed resuscitation in sepsis; a case-based approach
Goal-directed resuscitation in sepsis; a case-based approach Jorge A Guzman, MD, FCCM Head, Section Critical Care Medicine Respiratory Institute Cleveland Clinic Foundation The challenges to managing septic
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 informationNothing 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
More information9/25/2017. 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
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 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 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 informationCore 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
More informationTailored Volume Resuscitation in the Critically Ill is Achievable. Objectives. Clinical Case 2/16/2018
Tailored Volume Resuscitation in the Critically Ill is Achievable Heath E Latham, MD Associate Professor Fellowship Program Director Pulmonary and Critical Care Objectives Describe the goal of resuscitation
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 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 informationObjectives. 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,
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 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 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 information4/4/2014. 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
More informationSEPSIS: 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
More informationManaging 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
More informationUpdates 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
More informationPHYSIOLOGY 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
More informationSEPSIS 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
More informationKey Points. Angus DC: Crit Care Med 29:1303, 2001
Sepsis Key Points Sepsis is the combination of a known or suspected infection and an accompanying systemic inflammatory response (SIRS) Severe sepsis is sepsis with acute dysfunction of one or more organ
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 informationBREAK 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.
More informationIV 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
More informationSURVIVING SEPSIS: Early Management Saves Lives
SURVIVING SEPSIS: Early Management Saves Lives Pat Posa RN, BSN, MSA System Performance Improvement Leader St. Joseph Mercy Health System Ann Arbor, MI Patricia.posa@stjoeshealth.org Objectives a. Understand
More informationGoal-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
More informationHow 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
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 informationDr. İsa KILIÇASLAN Gazi University School of Medicine
Dr. İsa KILIÇASLAN Gazi University School of Medicine ystemic Inflammatory Response Syndrome (SIRS) Temp > 38.3 C or < 36 C HR > 90/min RR > 20 or PaCO2 < 32 WBC > 12 or < 4 or Bands > 10% TWO out of four
More informationNo conflicts of interest
Robert M. Rodriguez, MD FAAEM Clinical Professor of Medicine and Emergency Medicine, UCSF No conflicts of interest Major Points Most ICU patients start in ED Chain of critical care starting in field and
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 informationSepsis 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
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 informationPresented 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
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 informationEarly 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
More informationCurrent State of Pediatric Sepsis. Jason Clayton, MD PhD Pediatric Critical Care 9/19/2018
Current State of Pediatric Sepsis Jason Clayton, MD PhD Pediatric Critical Care 9/19/2018 Objectives Review the history of pediatric sepsis Review the current definition of pediatric sepsis Review triage
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 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 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 informationRounds in the ICU. Eran Segal, MD Director General ICU Sheba Medical Center
Rounds in the ICU Eran Segal, MD Director General ICU Sheba Medical Center Real Clinical cases (including our mistakes) Emphasis on hemodynamic monitoring Usually no single correct answer We will conduct
More informationUnderstand the scope of sepsis morbidity and mortality Identify risk factors that predispose a patient to development of sepsis Define and know the
Understand the scope of sepsis morbidity and mortality Identify risk factors that predispose a patient to development of sepsis Define and know the differences between sepsis, severe sepsis and septic
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 informationSepsis 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
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 informationSepsis and septic shock: can we win the battle against this hidden crisis?
REVIEW ARTICLE Sepsis and septic shock: can we win the battle against this hidden crisis? V.G. Dassanayake Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka Key words : Sepsis;
More informationEFFECT 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 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 informationSEPSIS: 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
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 informationRalph Palumbo, MD, FCCP
Ralph Palumbo, MD, FCCP Septic shock is the leading cause of mortality in patients admitted to the ICU In the United States alone there are over 750,000 cases of severe sepsis and septic shock annually
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 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 informationSepsis 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
More informationThe Management of Septic Shock
The Management of Septic Shock Anthony J. Courey, MD Assistant Professor of Medicine Associate Director, CCMU Pulmonary & Critical Care Medicine No conflicts No disclosures Conflicts & Disclosures Overview
More informationNo conflicts of interest to disclose
No conflicts of interest to disclose Introduction Epidemiology Surviving sepsis guidelines 2012 Updates Resuscitation protocols Map Goals Transfusion Sepsis-3 Bundle Management Questions Sepsis is a systemic,
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 informationSepsis 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,
More informationSEPSIS 2015 DISCLOSURES FINANCIAL DISCLOSURES 9/1/2015. William M. Johnson, MD Nebraska Pulmonary Specialties. William Johnson
SEPSIS 2015 William M. Johnson, MD Nebraska Pulmonary Specialties 1 DISCLOSURES William Johnson No financial interests related to this presentation 2 FINANCIAL DISCLOSURES I do however have 3 children
More informationSHOCK 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
More informationObligatory joke. The case for why it matters. Sepsis: More is more. Goal-Directed Fluid Resuscitation 6/1/2013
Obligatory joke Keep your eye on the food. Goal-Directed Fluid Resuscitation Christopher G. Choukalas, MD, MS Department of Anesthesia and Perioperative Care University of California, San Francisco The
More informationIDENTIFYING SEPSIS IN THE PREHOSPITAL SETTING
IDENTIFYING SEPSIS IN THE PREHOSPITAL SETTING Christopher Hunter, MD, PhD, FACEP Director, Health Services Department Associate Medical Director, Orange County EMS System Medical Director, Orlando Health
More informationWhat 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
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 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 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 informationSepsis or Severe Sepsis? Is there a right thing, and how do we do it?
Sepsis or Severe Sepsis? Is there a right thing, and how do we do it? Steven Q Simpson, MD, FCCP, FACP Professor of Medicine Division of Pulmonary and Critical Care University of Kansas Disclosures No
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 informationFluids 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
More informationSepsis 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.
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 informationFluid 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
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 informationDilemmas 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,
More information