Early Goal Therapy in Severe Sepsis Septic Shock严重脓毒症与感染性休克早期目标治疗.pptxVIP

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Early Goal Therapy in Severe Sepsis Septic Shock严重脓毒症与感染性休克早期目标治疗.pptx

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1 Early Goal Therapy in Severe Sepsis Septic Shock Nabil Abouchala, MD, FCCP, FACP Consultant, Pulmonary and Critical Care Medicine King Faisal Hospital Research Center Riyadh, Saudi Arabia 2 Sepsis: Defining a Disease Continuum A clinical response arising from a nonspecific insult, including ? 2 of the following: Temperature ?38oC or ?36oC HR ?90 beats/min Respirations ?20/min WBC count ?12,000/mm3 or ?4,000/mm3 or 10% immature neutrophils SIRS = Systemic Inflammatory Response Syndrome SIRS with a presumed or confirmed infectious process Sepsis SIRS Infection/Trauma Severe Sepsis Adapted from: Bone RC, et al. Chest 1992;101:1644 Opal SM, et al. Crit Care Med 2000;28:S81 3 Sepsis: Defining a Disease Continuum Bone et al. Chest 1992;101:1644; Wheeler and Bernard. N Engl J Med 1999;340:207 Sepsis SIRS Infection/Trauma Severe Sepsis Sepsis with ?1 sign of organ failure Cardiovascular (refractory hypotension) Renal Respiratory Hepatic Hematologic CNS Metabolic acidosis 4 Mortality Incidence Balk, R.A. Crit Care Clin 2000;337:52 Mortality Increases in Septic Shock Patients Serum Lactate Measured Blood Culture Obtained Prior to Antibiotic Administration Broad-Spectrum Antibiotics Administered within 1 Hour of ED Admission Fluid Resuscitation (30 ML/Kg) for Hypotension or Lactate 4mmol/L Vasopressors for Ongoing Hypotension Maintain Adequate Central Venous Pressure (CVP ≥ 8) Maintain Adequate Central Venous Oxygen Saturation (ScvO2 ≥ 70%) Resuscitation Bundle Sepsis Bundle 5 Re-measure Serum Lactate A. Initial Resuscitation Early Goal-directed Therapy in the Treatment of Severe Sepsis and Septic Shock To Examine whether Early Goal Directed Therapy (EGDT) before admission to the ICU is superior to standard hemodynamic therapy in patients with sever sepsis and septic shock N Engl J Med, 2001;345:1368-77 #Citing articles 2469 Central venous and arterial catheterization CVP 8 -12 mm Hg MAP 365 and ￡90 mm Hg ScvO2 370% Goals achieved Hospital admission Protocol for