Sepsis (Septic Shock) Prognosis Prevention TREATMENT

Sepsis (Septic Shock) Prognosis Prevention TREATMENT

TREATMENT Sepsis (Septic Shock)

  • Admit in ICU
  • Treat local site of infection
  • Monitor hemodynamics.
  • Sepsis is a clinical syndrome characterized by systemic inflammation due to infection.
  • There is a continuum of severity ranging from sepsis to severe sepsis and septic shock.

Sepsis (Septic Shock) 2

Sepsis (Septic Shock) Prognosis Prevention TREATMENT


Antimicrobial therapy in Sepsis (Septic Shock)

  • Ceftriaxone 2gjday
  • Ticarcillin – Clavulanate 3.1g 6 hrly
  • Piperacillin – Tazobactam 3.375g 6 hrly
  • Imipenem – Cilastatin 0.5g 6 hrly
  • Meropenem – 19 8 hrly
  • Cefepime – 2g 12 hrly
  • Gentamycin, Tobramycin + any of the above Ciprofloxacin 400mg 12 hrly + Clindamycin 600mg 8 hrly
  • Levofloxacin 500mg 12 hrly + Clindamycin 600mg 8 hrly
  • Vancomycin 19 12 hrly for MRSA infections -(Methicillin resistant Staph aureus)
  • Cefotaxime 2g 8 hrly
  • Ceftriaxone 2g 12 hrly
  • Covers gram positive and gram negative organisms till results of culture arrive.
  • Give IV only, for at least 1 week.
  • Adjust dose and drug for renal impairment.
  • Removal of source of infection – Drainage of site Removal of catheters; and the tip is rolled over blood — agar plate for culture.
  • New catheter is put in.
  • Foley’s or drainage catheter replaced.
  • In nasal intubation, look for paranasal sinusitis. In neutropenia, look for red tender sites.
  • Look for ulcers, ureteral obstruction, perinephric ab­scess, renal abscess.
  • CT and MRI of different regions is done. Hemodynamic, respiratory and metabolic support is given.
  • Oxygen therapy is given.
  • Organ perfusion should be adequate.
  • IV fluids for hypotension – 1-2 litre of saline in 1-2 hours is given.
  • CVP (Central venous pressure) or PWP (Pulmonary wedge pressure) should be monitored specially in refractory shock, renal or cardiac disease.
  • CVP should be 10-12 cm water.
  • PWP should be 12-16 mmHg
  • Urine output should be more than 30 ml per hour Diuretics like Frusemide and spirinolactone can be used.
  • Maintain systolic blood pressure more than 90 mmHg and cardiac index more than 4 litre per minute/m2 by volume infusion.
  • Inotropic therapy – Dopamine, dobutamine Vasopressors –:
  • IV vasopressin
  • For adrenal insufficiency and if hypotension persists IV hydrocortisone 50 mg 6 hourly is given.
  • Circulatory adequlcy is seen clinically by assessment of mentation, skinPerfusion, urine output, SP02
  • Ventilator Therapy is often needed for hypoxaemia, hypercapnia, muscular failure, neurological distur­bance.
  • Respiratory rate more than 30/minute means impend­ing ventricular collapse.
  • Mechanical ventilation is given at this stage for ad­equate oxygenation, to divert blood from respiratory muscles, prevent aspiration, decrease afterload.
  • If Hb is less than 8 mg/dl blood transfusion or RBC concentrate is given.
  • For metabolic acidosis, give bicarbonate if arterial pH less than 7.2
  • DIC with bleeding treated with transfusion of FFP (Fresh Frozen Plasma) and platelets.
  • Acidosis and DIC is reversed only if infection treated

General Support for Sepsis (Septic Shock)

  • In sepsis more than 3 days, nutritional supplementa­tion reqUired by central route.
  • Prevent skin infection, DVT (Deep vein thrombosis), nosocomial infection etc.

Patient Care:

  • Specimens of blood and body fluids are collected and cultured.
  • Two or three consecutive blood cultures are obtained while the patient is febrile.

Critical Care for Sepsis (Septic Shock)

  • Invasive hemodynamic monitoring in patients with sepsis typically reveals an elevated cardiac index, decreased systemic vascular resistance, decreased oxygen delivery to tissues, and decreases in mixed venous oxygen saturation
  • Fluid resuscitation with crystalloid or colloid:
  • Initial therapy with fluid bolus (at least 20 mL/kg or 2 liters of crystalloid or 300–500 mL of colloid over 30 minutes)
  • Use central venous pressure (CVP) of 8–12 mm Hg (12–15 mm Hg if on mechanical ventilation) as initial target of resuscitation
  • Use caution in the presence of CHF.
  • Vasopressors:
  • Norepinephrine or dopamine
  • Low-dose dopamine for renal protection is not recommended

Other measures

  • · Anti endotoxin agents
  • · Anti lipid A agents
  • · Anti mediator agents
  • · Methyl prednisolone
  • · Recombinant IL-1ra
  • · Anti TNFa
  • · New drug – Anticoagulant agent recombinant activated protein C (aPe) may be used in severe.
  • sepsis or septic shock. It may improve survival but may cause serious bleeding specially if plate­let count is less than 30,000/111 or there is men­ingitis. Dose is 24 119/kg/hr for four days.

Prognosis of Sepsis (Septic Shock)

  • 60% patients die in 30 days to 6 months.

Prevention of Sepsis (Septic Shock)

  • · Treat sepsis early
  • · Avoid invasive procedures
  • · Limit use of catheters
  • · Avoid indiscriminate use of antimicrobials, glu­cocorticoids
  • · Control of infections.