Sepsis and Septic shock - Part 2 Flashcards
Fluid therapy for sepsis:
- crystalloids are initial fluids of choice
- albumin is recommended when patients required substantial amounts of crystalloids
- Initial fluid challenge 30 mL/kg of crystalloids during first 3 hours
- Hemodynamic improvement measured by stroke volume, arterial pressure, heart rate, urine output, respiratory rate
SvO2 =
central venous oxygen saturation
Initial resuscitation:
- If ScvO2<70% persist:
- Dobutamine infusion
- Transfusion of packed red blood cells to achieve hematocrit equal or greater than 30%
How is it when it comes to antimicrobial treatment and sepsis?
- Administration of IV antimicrobials should be initiated as soon as possible after recognition and no later than within one hour for both sepsis and septic shock
- Each hour delay in administration of appropriate antimicrobials is associated with a measurable increase in mortality
Dobutamine (google):
- Dobutamine is a sympathomimetic drug used in the treatment of heart failure and cardiogenic shock.
- Its primary mechanism is direct stimulation of β1 receptors of the sympathetic nervous system.
Antimicrobial therapy:
- Spectrum activity likely to treat the responsible pathogen
- Bolus drugs might have advantage
- Penetrate in adequate concentrations into the tissues suspected to be the source of infection
- In emergency situations if vascular and intraosseous access is unavailable some β-lactams, including imipenem/cilastatin, cefepime, ceftriaxone, and ertapenem can also be effectively administered intramuscularly
Antimicrobial initial therapy general suggestions:
- carbapenem (e.g. meropenem, imipenem/cilastatin or doripenem)
- extended-range penicillin/β-lactamase inhibitor combination (piperacillin/tazobactam or ticarcillin/clavulanate)
- third- or higher-generation cephalosporins
What medication do we give a patient with suspected candidemia?
If candidemia is suspected echinocandin is preferred in patients with severe illness
Text that you should know.. About combination therapy:
- Combination therapy (using at least two antibiotics of different antimicrobial classes) aimed at the most likely bacterial pathogen(s)
- Usually a β-lactam with a fluoroquinolone, aminoglycoside, or macrolide)
- For a single pathogen expected to be sensitive to both, particularly for purposes of accelerating pathogen clearance.
- The term combination therapy is not used where the purpose of a multidrug strategy is to strictly broaden the range of antimicrobial activity
- de-escalation with discontinuation of combination therapy within the first few days in response to clinical improvement and/or evidence of infection resolution
Empirical antimicrobial therapy in sepsis summary:
- Fast
- Effective
- Large doses
- As soon as possible
- Reach its destination
De-escalation of antimicrobial therapy:
- As soon as the causative agent is identified and susceptibility profile is known
- Covers the pathogen
- Safe
- Cost effective
- Narrowing the spectrum of antimicrobial coverage
What is the duration of the antimicrobial therapy?
typically 7-10 days
When shouldn’t you use antimicrobial agents?
Antimicrobial agents not to be used in patients with severe inflammatory states of noninfectious cause
Sought, diagnosed or excluded as rapidly as possible -
examples:
- Intraabdominal abscesses,
- gastrointestinal perforation,
- ischemic bowel or volvulus,
- cholangitis, cholecystitis, pyelonephritis associated with
obstruction or abscess, - necrotizing soft tissue infection,
- other deep space infection (e.g., empyema or septic arthritis),
- implanted device infections
Empyema def (google):
the collection of pus in a cavity in the body, especially in the pleural cavity.
