STOP Sepsis

6-hour Strategies to Timely Obviate the Progression of Sepsis

6-hour STOP Bundle

summarized by sun yaicheng http://decode-medicine.blogspot.com/

Early Goal-Directed Therapy in the Treatment of

Severe Sepsis and Septic Shock

Rivers E. N Engl J Med 2001;345:1368-77.

In-Hospital Mortality 28-Day Mortality 60-Day Mortality0%

10%

20%

30%

40%

50%

60%

46.50%49.20%

56.90%

30.50%33.30%

44.30%

STANDARD (N=133) EGDT (N=130)

SIRSTrauma

Burns

Pancreatitis

Other

BACTEREMIA

INFECTION SEPSIS Fungemia

Parasitemia

Viremia

Other

Systemic Inflammatory Response Syndrome • Temp < 36 ° C or > 38.3 ° C• HR > 90• RR > 20 or PCO2 < 32• WBC < 4K or > 12K or bands > 10%

SepsisSepsisSIRSSIRS Severe SepsisSevere Sepsis Septic ShockSeptic Shock

Bone et al. Chest 1992;101:1644

SepsisSIRS Severe Sepsis Septic Shock

Bone et al. Chest 1992;101:1644

SIRS with Infection

SepsisSIRS Severe Sepsis Septic Shock

Bone et al. Chest 1992;101:1644

Sepsis plus Organ Dysfunction• Elevated Creatinine (>2)• Elevated INR (DIC)• Altered Mental Status (GCS <12)• Elevated Lactate (>4)• Hypotension that responds to fluid

SepsisSIRS Severe Sepsis Septic Shock

Bone et al. Chest 1992;101:1644

Severe Sepsis and Hypotension• Hypotension that does NOT

respond to fluid (500 cc bolus)

Criteria to initiate the bundleSIRS plus source of

infection plus a

• SBP < 90 mmHg after a 20 mL/kg fluid bolus

• Lactate > 4 mmol/L• Organ dysfunction

SCCM 34th Critical Care Congress: Abstract 44. Presented Jan. 17,2005.

STOPSEPSIS

STOP Bundle Strategies

• Hemodynamic monitoring (CVP/ScvO2) within 2 hours

• Broad spectrum antibiotics administered within 4 hours

• EGDT achieved at 6 hours, including CVP ≧ 8 mmHg, MAP ≧65 mmHg, ScvO2 ≧70%

• Monitor for decreasing lactate; and administer steroid if on a vasopressor

Fever, general malaise, poor appetite for days

DM, HTN

70/40 mmHg, 39 ° C

CBC/DCWBC 20.0KHb 12.0Hct 36.0Platelet 30KSeg 75%Band 15%APPT 24.0PT 12.0INR 1.0ScvO2 60

BioBUN 25Creatinine 1.0Glucose 300Na 140K 4.0GOT 150GPT 100Alk-p 250CRP 20Lactate 40

Diagnosis

Liver Abscess with

Septic Shock

Next ?

What‘s the key point ?

summarized by sun yaichenghttp://decode-medicine.blogspot.com/