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SEPSIS
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PENGELOLAN LANJUTAN SEPSIS
Satriawan AbadiSatriawan Abadi
Pre and post-discharge
Hospitalization
24 hours
6 hours
Recognition
Resuscitation
Initial Management
Maintenance
Recovery
Reducing mortality due to severe sepsis requires an organized process that guarantees early recognition and consistent application of the evidence-based practices in the 2012 Surviving
Sepsis Campaign guidelines.
MAINTENANCE PHASEGOAL: Don’t kill him
•Avoid nosocomial complications
• Ventilator-induced lung injury
• Get tubes and lines out of him
• Clots and bleeding
•Avoid new infection
• Hand washing
• Semi-recumbent position
• Get tubes and lines out of him
•Minimize transfusions
RECOMMENDATIONSInitial Resuscitation,
Screening for Sepsis &
Performance
Improvement, Diagnosis,
Antimicrobial therapy,
Source control, &
Infection Prevention
Initial Resuscitation,
Screening for Sepsis &
Performance
Improvement, Diagnosis,
Antimicrobial therapy,
Source control, &
Infection Prevention
Blood Pr
oduc
t, Ig,
Se, r
hAPC,
Mec
. Ven
tilation
of Se
psis-
Indu
ced A
RDS, Se
dation
-
Analges
ia-Neu
rom
uscular
Blocka
de, G
lucose
Contro
l,
Bicarb
onat
e, DVT P
roph
ylaxis
,
Stre
ss U
lcer P
rophy
laxis,
Nutriti
on, Se
tting
Goa
ls of
Care
Blood Pr
oduc
t, Ig,
Se, r
hAPC,
Mec
. Ven
tilation
of Se
psis-
Indu
ced A
RDS, Se
dation
-
Analges
ia-Neu
rom
uscular
Blocka
de, G
lucose
Contro
l,
Bicarb
onat
e, DVT P
roph
ylaxis
,
Stre
ss U
lcer P
rophy
laxis,
Nutriti
on, Se
tting
Goa
ls of
Care
Fluid Therapy,
Vasopressors,
Inotropic Therapy,
CorticosteroidsFluid Therapy,
Vasopressors,
Inotropic Therapy,
Corticosteroids
11. BLOOD PRODUCT ADMINISTRATION
BLOOD PRODUCT ADMINISTRATION11. BLOOD PRODUCT ADMINISTRATION
12. IMMUNOGLOBULINS
Not using intravenous immunoglobulins in adult patients with severe sepsis or septic
shock (2B)
13. SELENIUM
Not using intravenous selenium for the treatment of severe sepsis (2C)
14. HISTORY OF RECOMMENDATIONS REGARDING USE OF RECOMBINANT
ACTIVATED PROTEIN C (RHAPC)
A history of the evolution of SSC recommendations as to rhAPC (no longer
available) is provided
15. MECHANICAL VENTILATION OF SEPSIS-INDUCED ARDS
15. MECHANICAL VENTILATION OF SEPSIS-INDUCED ARDS
15. MECHANICAL VENTILATION OF SEPSIS-INDUCED ARDS
15. MECHANICAL VENTILATION OF SEPSIS-INDUCED ARDS
15. MECHANICAL VENTILATION OF SEPSIS-INDUCED ARDS
16. SEDATION, ANALGESIA, AND NEUROMUSCULAR BLOCKADE IN SEPSIS
17. GLUCOSE CONTROL
18. RENAL REPLACEMENT THERAPY
19. BICARBONATE THERAPY
20. DEEP VEIN THROMBOSIS PROPHYLAXIS
DEEP VEIN THROMBOSIS PROPHYLAXIS
20. DEEP VEIN THROMBOSIS PROPHYLAXIS
21. STRESS ULCER PROPHYLAXIS
Coagulopathy, Mec. Ventilated at least 48 hr,
Possibly HypotensionPts should be periodically evaluated for the
continued need for prophylaxis
22. NUTRITION
Prevents bacterial
translocation ‘vs’ Risk
of ischemia
Better nutritional
strategy
22. NUTRITION
Parenteral nutrition has
no benefit & related to
higher infection
complicationParenteral nutrition has
no benefit & related to
higher infection
complication
Immune system
function can be
modifiedImmune system
function can be
modified
Arginine, Glutamine, EPA, GLAArginine, Glutamine, EPA, GLA
23. SETTING GOALS OF CARE
• Promote communication & understanding•Improves family understanding•Decrease stress, anxiety & depression•Shortens length of stay for pts who die in ICU
• Promote communication & understanding•Improves family understanding•Decrease stress, anxiety & depression•Shortens length of stay for pts who die in ICU
Summary• Selected therapies recommended by the 2012 Surviving
Sepsis Campaign:1. Blood Product Administration2. Maintain Adequate Glycemic Control3. Mechanical Ventilation of Sepsis-Induced ARDS
4. Sedation, Analgesia, and Neuromuscular Blockade 5. Deep Vein Thrombosis and Peptic Ulcer Disease Prophylaxis6. Nutrition
7. Setting Goals of Care
• The intention in applying the other selected therapies is to perform evidence-based treatments that will contribute to improving care of patients with severe sepsis and septic shock.
Thank You
