Pengelolan lanjutan sepsis satriawan abadi
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Transcript of Pengelolan lanjutan sepsis satriawan abadi
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PENGELOLAN LANJUTAN SEPSIS
Satriawan AbadiSatriawan Abadi
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Pre and post-discharge
Hospitalization
24 hours
6 hours
Recognition
Resuscitation
Initial Management
Maintenance
Recovery
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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.
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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
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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
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11. BLOOD PRODUCT ADMINISTRATION
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BLOOD PRODUCT ADMINISTRATION11. BLOOD PRODUCT ADMINISTRATION
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12. IMMUNOGLOBULINS
Not using intravenous immunoglobulins in adult patients with severe sepsis or septic
shock (2B)
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13. SELENIUM
Not using intravenous selenium for the treatment of severe sepsis (2C)
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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
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15. MECHANICAL VENTILATION OF SEPSIS-INDUCED ARDS
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15. MECHANICAL VENTILATION OF SEPSIS-INDUCED ARDS
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15. MECHANICAL VENTILATION OF SEPSIS-INDUCED ARDS
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15. MECHANICAL VENTILATION OF SEPSIS-INDUCED ARDS
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15. MECHANICAL VENTILATION OF SEPSIS-INDUCED ARDS
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16. SEDATION, ANALGESIA, AND NEUROMUSCULAR BLOCKADE IN SEPSIS
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17. GLUCOSE CONTROL
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18. RENAL REPLACEMENT THERAPY
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19. BICARBONATE THERAPY
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20. DEEP VEIN THROMBOSIS PROPHYLAXIS
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DEEP VEIN THROMBOSIS PROPHYLAXIS
20. DEEP VEIN THROMBOSIS PROPHYLAXIS
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21. STRESS ULCER PROPHYLAXIS
Coagulopathy, Mec. Ventilated at least 48 hr,
Possibly HypotensionPts should be periodically evaluated for the
continued need for prophylaxis
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22. NUTRITION
Prevents bacterial
translocation ‘vs’ Risk
of ischemia
Better nutritional
strategy
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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
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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
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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.
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Thank You