Professional Documents
Culture Documents
Lynn Choo
ICU Pharmacist
DEFINITIONS
COMPLEX
INTERACTIO
N
HR
RR
> 90
> 20 or PaCO2
< 32
Infection
SIRS
Sepsis
Brain
Heart
confusion, delirium
SBP < 90 (> 40
decrease)
Lungs
Liver
Gut ileus
Kidneys
Blood
Lactate
organ dysfunction , tissue hypoperfusion
CRT
Severe Sepsis
Vasopressors +/Inotropes
and more
SEPTIC SHOCK
Multi-organ failure
Levy et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31
(4): 1250 56.
Bone et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. CHEST 1992;101: 1644 55.
Pinsky. Septic shock. Medscape Reference: Drugs, Diseases & Procedures updated Oct 25, 2011. Available on www.medscape.com [Accessed
29 March 2012]
SEPTIC SHOCK
Septic shock
intravascular volume
SVR
( CO)
BP +
perfusion
leaky capillaries
vasodilation
compensatory
(by HR)
Antibiotics
Fluid resuscitation
intravascular volume BP
Vasopressors
SVR BP
Oxygenation
organ perfusion
T 35.6C
BP 130/66
Na 141
K4
Ur 12.4
21
left lower lobe consolidation
HR 98 RR
Cr 188
HNE RESOURCES
http://www.cec.health.nsw.gov.au/programs/sepsis
NEW GUIDELINES
2012
www.survivingsepsis.org
Dellinger et al. Surviving Sepsis Campaign: international guidelines for the management of severe sepsis and septic
shock 2012.
Crit Care Med 2013; 41: 580 637
Dellinger et al. Surviving Sepsis Campaign: international guidelines for the management of severe sepsis and septic shock 2012. Crit Care
ScvO2 70%
Inotropic therapy
Corticosteroids
PHARMACOLOGICAL THERAPIES
ANTIBIOTICS
Antibiotics
Timing
Antibiotics
Loading dose
LD = V x Cp
Volume of distribution (V):
lipophillic
hydrophillic
increase in sepsis
increase in obese
McKenzie. Antibiotic dosing in critical illness. J Antimicrob Chemother 2011; 66 Supp 2: ii25 ii31
Antibiotics
SEPSIS
Increased
cardiac output
Leaky
capillaries
Multi-organ
failure
Increased
clearance
Increased
volume of
distribution
Decreased
clearance
Low plasma
High plasma
concentrations
concentrations
Adequate
initial dosing
important
Reassess and
adjust
McKenzie. Antibiotic dosing in critical illness. J Antimicrob Chemother 2011; 66 Supp 2: ii25 ii31