GUIDELINE FOR SEPTIC

SHOCK
AHMAD RAMADHAN (17777022)
 BACKGROUND - BASIC DEFINITIONS

• Sepsis = known or suspected infection plus

systemic manifestations of infection (SIRS and
others)
• Severe Sepsis = Sepsis + either
• Acute organ dysfunction thought to be due to
sepsis
• Acute tissue hypoperfusion thought to be due to
sepsis
• Hypotension
• Elevated lactate
• Oliguria
• (Altered mental status)
• Severe Sepsis Organ Dysfunctions
• Acute lung injury
• Acute kidney injury
• Coagulopathy
• Thrombocytopenia
• Increased INR
• Liver Dysfunction
• (Cardiovascular)
• Septic Shock
• Vasopressors +/- organ dysfunction
KLASIFIKASI
 SOURCE CONTROL

• We recommend that a specific

anatomic diagnosis of infection
requiring emergent source control be
identified or excluded as rapidly as
possible in patients with sepsis or septic
shock, and that any required source
control intervention be implemented
as soon as medically and logistically
practical after the diagnosis is made.
ANTIBIOTICS THERAPY
 FLUID THERAPY

• We recommend crystalloids as the fluid of choice

for initial resuscitation and subsequent intravascular
volume replacement in patients with sepsis and
septic shock
(Strong recommendation, moderate quality of
evidence).

• We suggest using albumin in addition to crystalloids

when patients require substantial amounts of
crystalloids
(weak recommendation, low quality of evidence).
 VASOPRESSORS

1. We recommend norepinephrine as the first choice

vasopressor (Grade 1 B).
2. We suggest epinephrine (added to and
potentially substituted for norepinephrine) when
an additional agent is needed to maintain blood
pressure (Grade 2B).
3. Vasopressin .03 units/min can be added to
norepinephrine with the intent of raising MAP to
target or decreasing or decreasing
norepinephrine dosage.
(UG)
 CORTICOSTEROIDS

• We suggest against using intravenous

hydrocortisone to treat septic shock patients
if adequate fluid resuscitation and
vasopressor therapy are able to restore
hemodynamic stability. If this is not
achievable, we suggest intravenous
hydrocortisone at a dose of 200 mg per day.
MECHANICAL VENTILATION
 REFRENCES

• - Surviving Sepsis Campaign: International

Guidelines for Management of Sepsis and Septic
Shock: 2016 (ppt)
• - Jurnal Anestesiologi Indonesia, Sepsis dan Tata
Laksana Berdasar Guideline Terbaru (jornal)
• - Septic Shock: Current Management and New
Therapeutic Frontiers, R. Phillip Dellinger, MD
Professor of Medicine Robert Wood Johnson
Medical School/UMDNJ Director Critical Care
Medicine Cooper University Hospital Camden, New
Jerse (ppt)