现代急诊医学（张茂）感染性休克.pptVIP

Blood Product Administration 1、we recommend that red blood cell transfusion occur only when hemoglobin concentration decreases to 7.0 g/dL to target a hemoglobin concentration of 7.0 –9.0 g/dL in adults (grade 1B). Recommendations: Other Supportive Therapy of Severe Sepsis 2. Not using erythropoietin as a specific treatment of anemia associated with severe sepsis (grade 1B). 3. Fresh frozen plasma not be used to correct laboratory clotting abnormalities in the absence of bleeding or planned invasive procedures (grade 2D). 4. Not using antithrombin for the treatment of severe sepsis and septic shock (grade 1B). Blood Product Administration 5. In patients with severe sepsis, administer platelets prophylactically when counts are 10 x 109/L in the absence of apparent bleeding. We suggest prophylactic platelet transfusion when counts are 20 x 109/L if the patient has a significant risk of bleeding. Higher platelet counts (≥50 x 109/L) are advised for active bleeding, surgery, or invasive procedures (grade 2D). Blood Product Administration Recommendations: Other Supportive Therapy of Severe Sepsis 1. A protocolized approach to blood glucose management in ICU patients with severe sepsis commencing insulin dosing when 2 consecutive blood glucose levels are 180 mg/dL. This protocolized approach should target an upper blood glucose ≤180 mg/dL rather than an upper target blood glucose ≤ 110 mg/dL (grade 1A). 2. Blood glucose values be monitored every 1–2 hrs until glucose values and insulin infusion rates are stable and then every 4 hrs thereafter (grade 1C). Glucose Control 1. Continuous renal replacement therapies and intermittent hemodialysis are equivalent in patients with severe sepsis and acute renal failure (grade 2B). 2. Use continuous therapies to facilitate management of fluid balance in hemodynamically unstable septic patients (grade 2D). Renal Replacement Therapy Recommendations: Other Supportive Therapy of Severe Sepsis Bicarbonate Therapy Deep Vein Throm