Sepsis_ACS_CardiacSurgery_AKI_Presentation.pptx

Sepsis

1. Sepsis, Abdominal Compartment Syndrome, Cardiac Surgery, Causes of Acute Kidney Failure Мо Имран 513А

2. Sepsis: Definition & Importance Sepsis = life-threatening organ dysfunction due to dysregulated host response to infection. WHO: major cause of global mortality. Progression: infection → sepsis → septic shock → multi-organ failure.

3. Sepsis: Pathogenesis Entry of pathogens → systemic inflammation. Release of cytokines (TNF-α, IL-1, IL-6). Endothelial dysfunction → capillary leakage. Coagulation cascade activation → microthrombosis.

4. Sepsis: Clinical Features Fever, tachycardia, tachypnea. Hypotension unresponsive to fluids. Altered sensorium, oliguria. SOFA score used for diagnosis.

5. Sepsis: Diagnosis Blood cultures, CBC, CRP, Procalcitonin. Lactate levels for tissue hypoperfusion. Imaging: CT, ultrasound to locate infection source.

6. Sepsis: Management Early broad-spectrum antibiotics. Source control (drain abscess, remove infected devices). IV fluids, vasopressors (norepinephrine). Organ support: ventilation, dialysis if needed.

7. Abdominal Compartment Syndrome: Definition ACS = sustained intra-abdominal pressure (IAP) >20 mmHg with new organ dysfunction. Causes: trauma, massive fluid resuscitation, pancreatitis, burns.

8. Abdominal Compartment Syndrome: Pathophysiology ↑ IAP → ↓ venous return → ↓ cardiac output. Compression of kidneys → oliguria/AKI. Diaphragm elevation → respiratory compromise.

9. Abdominal Compartment Syndrome: Clinical Features Abdominal distension, tense abdomen. ↓ urine output, hypotension. ↑ airway pressures on ventilation.

10. Abdominal Compartment Syndrome: Diagnosis Measurement of IAP via bladder pressure (gold standard). Ultrasound, CT for intra-abdominal fluid/gas.

11. Abdominal Compartment Syndrome: Management Conservative: sedation, analgesia, gastric/colonic decompression, diuretics. Surgical: decompressive laparotomy. Supportive care: fluids, vasopressors, dialysis if renal failure.

12. Cardiac Surgery: Overview Types: CABG, valve repair/replacement, congenital heart surgery, heart transplant. Used for ischemic heart disease, valvular disorders, heart failure.

13. Cardiac Surgery: Preoperative Considerations Risk stratification (EuroSCORE). Control of comorbidities: diabetes, hypertension. Anticoagulation management.

14. Cardiac Surgery: Intraoperative Management Cardiopulmonary bypass machine → oxygenates blood. Hypothermia to reduce metabolic demand. Myocardial protection with cardioplegia.

15. Cardiac Surgery: Postoperative Complications Bleeding, infection, arrhythmias. Myocardial infarction, low cardiac output syndrome. Stroke, renal dysfunction.

16. Cardiac Surgery: Advances & Future Trends Minimally invasive surgery. Robotic-assisted procedures. Transcatheter interventions (TAVR, MitraClip).

17. Acute Kidney Failure: Definition Sudden decline in kidney function → inability to maintain fluid, electrolyte, and acid-base balance. KDIGO criteria: ↑ serum creatinine or ↓ urine output.

18. Acute Kidney Failure: Prerenal Causes Hypovolemia (hemorrhage, dehydration). Heart failure, shock. Renal artery stenosis.

19. Acute Kidney Failure: Intrinsic Renal Causes Acute tubular necrosis (ischemia, nephrotoxins). Glomerulonephritis. Interstitial nephritis (drugs, infections).

20. Acute Kidney Failure: Postrenal Causes Obstruction of urinary outflow: stones, tumors, prostate enlargement, strictures. Leads to hydronephrosis and renal damage.

21. Acute Kidney Failure: Management Correct underlying cause. Optimize fluid balance. Stop nephrotoxic drugs. Dialysis if severe (uremia, hyperkalemia, pulmonary edema).

22. Thank You For your attention