surviving sepsis campaign - latest guideline.pptx

surviving sepsis campaign

1. Society of Critical Care Medicine & European Society of Intensive Care Medicine Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 The Surviving Sepsis Campaign Bundle: 2018 Update Surviving Sepsis Campaign

2. WHAT IS SEPSIS ? D e fine S E PSIS ? Septic shock ?

3. Sepsis c a u sed by Life threatening organ dysfunction dysregulated host response to infection

4. Septic shock ? Subset of sepsis with : Circulatory & Cellular / metabolic dysfunction A s s oc i at e d w i t h h i gher r i sk o f m o r t a l i t y C an be clinically identified by to maintain a mean arterial pressure of 65 mm Hg or greater serum lactate level greater than 2 mmol /L (>18 mg/ dL ) in the absence of hypovolemia The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

5. We  recommend against  using qSOFA compared with SIRS, NEWS, or MEWS as a single screening tool for sepsis or septic shock.  Strong recommendation, moderate-quality evidence.

6. (Quick Sequential Organ Failure Assessment) (REMEMBER ---- HAT) 1) Hypotensive (systolic ≤ 100) 2) Altered conscious level (GCS <15) 3) Tachypnea Respiratory rate ≥ 22 2 out of 3 criteria = SEPSIS predicted mortality of ≥10% > specific qSOFA

7. SIRS (Systemic inflammatory response syndrome) 2 out of 4 criteria = SEPSIS

8. Sepsis & septic shock are medical emergencies & we recommend that treatment & resuscitation begin immediately.

9. Surviving Sepsis Campaign : Recommendation for initial resuscitation : A t least 30 mL/kg of IV crystalloid fluid should be given within the first 3 hours of resuscitation . (balanced crystalloids instead of normal saline for resuscitation .) G uiding resuscitation to decrease serum lactate in patients with elevated lactate level. A dults with septic shock, use capillary refill time to guide resuscitation as an adjunct to other measures of perfusion Use dynamic measures to guide fluid resuscitation over physical examination or static parameters alone . -passive leg raise or a fluid bolus - stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV), or echocardiography, where available.

10. Initial resuscitation Septic 1 hour bundle : Measure lactate level. Re – measure if initial lactate is > 2 mmol/L Obtain blood cultures prior to administration of antibiotics Administer broad spectrum antibiotics Begin rapid administration of 30 ml / kg crystalloid for hypotension or if lactate > 4 mmol/L ( within t h e fi rs t 3 h o u rs ) Apply vasopressors if patient is hypotension during or after fluid resuscitation to maintain MAP > 65 mm Hg Additional fluids be guided by frequent reassessment of haemodynamic status

11. Source control We recommend that a specific diagnosis of infection requiring emergent source control be identified or excluded rapidly To obtain culture Antibiotics We recommend that administration of IV antimicrobials be initiated as soon as possible after recognition & within 1 hour for both sepsis & septic shock We recommend empiric broad spectrum therapy with one or more antimicrobials to cover all likely pathogens Antibiotics Stewardship

12. Antibiotics Stewardship Do not start antibiotics when there is no evidence of infection Narrowed the antibiotics once pathogen identification & sensitivities are established Antimicrobial duration of 7 – 10 days is adequate for most serious infection

13. Fluid therapy Crystalloids : as the fluid of choice for initial resuscitation balanced crystalloids instead of normal saline for resuscitation Subsequent intravascular volume replacement in patients with sepsis & septic shock Using albumin in addition to crystalloids when patient require substantial amounts of crystalloid Aim MAP of > 65 mm Hg in patients with septic shock requiring vasopressors

14. Vasoactive agents Noradrenaline as the 1 st choice Intent of raising MAP to the target value If shock is not resolving quickly …….. Further haemodynamic assessment (such as assessing cardiac function) To determine the type of shock if the clinical examination does not lead to a clear diagnosis

15. Lactate ??? Can help to guide resuscitation Marker of tissue hypoperfusion Suggest guiding resuscitation to normalize lactate levels Aim <2.0mmol /L