Surviving Sepsis, Evidence Based Medicine

Surviving Sepsis, Evidence Based Medicine - Surviving...

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Unformatted text preview: Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview Surviving Sepsis A global program to: Reduce mortality rates in severe sepsis Phase 1 Barcelona declaration Phase 2 Evidence based guidelines Phase 3 Implementation and education Surviving Sepsis Phase 1 Barcelona declaration Phase 2 Evidence based guidelines Phase 3 Implementation and education Surviving Sepsis Sponsoring Organizations American Association of Critical Care Nurses American College of Chest Physicians American College of Emergency Physicians American Thoracic Society Australian and New Zealand Intensive Care Society European Society of Clinical Microbiology and Infectious Diseases European Society of Intensive Care Medicine European Respiratory Society International Sepsis Forum Society of Critical Care Medicine Surgical Infection Society Guidelines Committee* Dellinger (RP) Carlet Masur Gerlach Levy Vincent Calandra Cohen Gea-Banacloche Keh Marshall Parker Harvey Hazelzet Hollenberg Jorgensen Maier Maki Marini Opal Osborn Parrillo Rhodes Sevransky Ramsay Zimmerman Beale Bonten Brun-Buisson Carcillo Cordonnier Dellinger (EP) Dhainaut Finch Finfer Fourrier Sprung Torres Vendor Bennet Bochud Cariou Murphy Nitsun Szokol Trzeciak Visonneau *Primary investigators from recently performed positive trials with implications for septic patients excluded from committee selection. Surviving Sepsis Campaign (SSC) Guidelines for Management of Severe Sepsis and Septic Shock Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM and the SSC Management Guidelines Committee Crit Care Med 2004;32:858-873 Intensive Care Med 2004;30:536-555 available online at www.springerlink.com www.sccm.org www.sepsisforum.com Sackett DL. Chest 1989; 95:2S–4S Sprung CL, Bernard GR, Dellinger RP. Intensive Care Medicine 2001; 27(Suppl):S1-S2 Clarifications Recommendations grouped by category and not by hierarchy Grading of recommendation implies literature support and not priority of importance Initial Resuscitation Figure B, page 948, reproduced with permission from Dellinger RP. Cardiovascular management of septic shock. Crit Care Med 2003;31:946-955. The Importance of Early Goal-Directed Therapy for Sepsis Induced Hypoperfusion Adapted from Table 3, page 1374, with permission from Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345:1368-1377 In-hospital mortality (all patients) 10 20 30 40 50 60 Standard therapy EGDT 28-day mortality 60-day mortality NNT to prevent 1 event (death) = 6-8 Mortality (%) Initial Resuscitation In the presence of sepsis-induced hypoperfusion Hypotension Lactic acidosis MAP Urinary output (mL) 49 + 18 56 + 21 43 + 13 .60/.71 Capillary blood flow (mL/min/100 g) 6.0 + 1.6 5.8 + 11 5.3 + 0.9 .59/.55....
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Surviving Sepsis, Evidence Based Medicine - Surviving...

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