TreatmentofSepsis：脓毒症的治疗.pptVIP

Treatment of Sepsis JoeBob Kirk D.O. Southcrest Hospital Tulsa, OK Sepsis All patients with severe sepsis require appropriate antimicrobial agents immediately. Antimicrobial therapy is often an empiric choice because of the time required for culture and sensitivity results. Many patients do not have a pathogen identified. Empiric antifungal therapy is necessary in some cases. Anti-infectives and source control Appropriate anti-infectives and source control are critical in treating severe sepsis. Treating and eradicating infection does not necessarily arrest the disease’s progression. A large number of patients develop septic shock, multiple organ dysfunction(MODS), and eventually die. Standard supportive care alone may not adequately treat sever sepsis which rates of 28-50%. The best chance for patient survival includes therapy targeted to the microvasculature, in addition to supportive care, because of the underlying progression that occurs in severe sepsis. Examples of supportive care therapy for patients with severe sepsis are : Cardiovascular support Respiratory support Renal replacement therapy Glucose control Other supportive care Cardiovascular Support Hypotension is a hallmark of severe sepsis. Patients with severe sepsis have intravascular volume deficits as a result of hemodynamic alterations. The first step in reversing hypotension is rapid fluid resuscitation with natural or artificial colloids or crystalloids Early goal-directed therapy to optimize cardiac preload, afterload, and contractility has proven beneficial in some cases. Cardiovascular Support When appropriate fluid challenge fails to improve blood pressure, patients usually require vasopressors. Even when fluid challenge is in progress and hypovolemia has not been corrected, vasopressor therapy may be required transiently if hypotension is life-threatening. Low-dose corticosteroids may improve outcomes in patients with septic shock. Respiratory Support Oxygenation and ventilation problems ar