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SEPSIS

SURVIVING SEPSIS CAMPAIGN


SEPSIS BUNDLE
Therapy Across the Sepsis Continuum

Infection SIRS Sepsis Severe Sepsis Septic Shock

Microorganism  A clinical response SIRS with a Sepsis with Refractory


invading sterile arising from a presumed organ failure hypotension
tissue nonspecific insult, or confirmed Vascular collapse
with 2 of the infectious
Renal
following: process
Hemostasis
 T >38oC or
<36oC Lung
 HR >90 LA
beats/min
 RR >20/min
 WBC
>12,000/mm3 or
<4,000/mm3 or
>10% bands

Chest 1992;101:1644
Sepsis Syndromes
1992: SCCM/ACCP

Parasite

Virus
Infection Severe SIRS
Sepsis Sepsis
Fungus
Shock
Trauma
BSI
Bacteria
Burns
• Kejadian sepsis dari tahun ke tahun semakin
meningkat dan banyak terjadi resistensi
bakteri terhadap antibiotik

• MAKA........
Deklarasi sepsis sedunia
• Menempatkan sepsis sbg kedaan serius shg
perlu mndpt perhatian dgn peningkatan
anggaran dan kemampuan kedokteran
• Meningkatkan fasilitas keshdan SDM untuk
pengelolaan sepsis
• Mendukung berlakunya SSC dgn menekankan
pada deteksi dini, pengobatan yang efektif dan
pencegahan infeksi
• Memobilisir “stakeholder”
Summary of the 2012 Surviving Sepsis Recommendations
• Delinger et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and
Septic Shock: 2012. Crit Care Med. 2013;41(2): 580‐637
• Annotated by George Chen, DO MPH (January 25, 2013)

Definition & Diagnostic Triggers for starting “Initial Resuscitation Bundle” (meeting
any of the 3 bolded definitions)
• (Sepsis = infection + systemic manifestations of infection)
• Severe sepsis = sepsis + sepsis‐induced organ dysfunction or tissue hypoperfusion
(with any of the below signs)
• 1. Sepsis induced hypotension = SBP < 90 mmHg or MAP < 70mmHg or SBP
decrease > 40 mmHg or less than 2
• standard deviation below normal for age in the absence of other cause for
hypotension
• 2. Lactate above the upper limit of normal
• 3. UoP < 0.5 mL/Kg/hr for more than 2 hours despite adequate fluid resuscitation
• 4. Acute lung injury with PaO2/FiO2 < 250 in the absence of PNA as infection source
• 5. Acute lung injury with PaO2/FiO2 < 200 in the presence of PNA as infection
source
• 6. Cr > 2 mL/dL
• 7. TBili > 2mg/dL
• 8. Platelet < 100K
• 9. INR
• Septic shock = persistent sepsis‐induced
hypotension despite adequate fluid
resuscitation.
• Sepsis‐induced tissue hypoperfusion =
Sepsis‐induced hypotension despite fluid
challenge, or, Blood Lactate > 4mmol/L
2012 INITIAL RESUSCITATION BUNDLE

1. Completed within 3 hours of diagnosis


a. Draw Lactate
b. 2 sets of Blood cultures (best done within 45
minutes)
c. Broad spectrum antimicrobials (best done
within 1 hour)
d. At least 30 mL/Kg crystalloid fluid challenge
2. Complete within 6 hours of diagnosis
a. Vasopressor to keep MAP ≥ 65mmHg if goals not
met by fluid challenge, Norepinephrine is first
choice
b. If persistent hypotension despite fluid resuscitation
or initial lactate ≥ 4 mmol/L:
i. CVP: goal 8‐12 mmHg; 12‐15 mmHg for patients
with mechanically‐ventilation or ↑
intraabdominal pressure (due to cardiac filling
impediment)
ii. ScvO2: goal ≥ 70% (or, SvO2 ≥ 65%)
c. Re‐measure lactate: goal is normalizing lactate
d. (Other targets: UoP ≥ 0.5 mL/Kg/hr, normalizing
lactate as a marker for improved tissue
VASOPRESSORS
PROCEDURE