Description
Sepsis is a potentially fatal condition brought on by your body's reaction to an infection. Your immune system defends you against a variety of diseases and infections, but it has the potential to overreact in the face of an infection. The Centers for Disease Control and Prevention (CDC) estimates that there are roughly 1.7 million instances of sepsis each year. Over the past 40 years, sepsis patient survival has increased. However, other from antibiotic therapy, we still don't have a specific molecular therapy for this illness.
Summary Listen
- World Heart Day is celebrated, and a presentation on sepsis is given. Sepsis is a disregulated host response, where the body's immune response, not just the offending organism, causes organ dysfunction and hypoperfusion. Individuals with hyperimmune responses tend to have poorer outcomes.
- The heart's function involves pumping blood to the lungs for oxygenation, then circulating oxygenated blood throughout the body. Oxygen delivery depends on cardiac output, hemoglobin levels, and oxygen saturation. In sepsis, oxygen extraction by tissues increases, leading to anaerobic metabolism and inflammatory mediator production.
- Tissue oxygen consumption is indicated by the oxygen returning to the right side of the heart, typically 70%. In severe sepsis, this value may be higher (80-90%) due to tissues being unable to extract oxygen properly because of mitochondrial death. The balance between oxygen delivery and consumption determines disease progression.
- Organ perfusion depends on mean arterial pressure, which is determined by cardiac output and systemic vascular resistance. Cardiac output relies on preload, contractility, afterload, and heart rate. Systemic vascular resistance depends on vascular tone, catecholamines, and blood viscosity.
- Sepsis involves severe inflammation, leading to vasodilation, capillary leakage, and hypovolemia. This results in less perfusion to vital organs, tissue hypoxia, and the release of inflammatory mediators like cytokines, which damage normal tissues. Early intervention is vital in sepsis management.
- Early sepsis management protocols are important. Previously, 6 hours was allocated, but now 1 hour is the target for resuscitation strategies. Mortality rates are high in sepsis, especially in septic shock. Specific populations, such as immunocompromised, geriatric, and those with metabolic disorders, are more vulnerable.
- Sepsis is defined as a life-threatening condition with organ dysfunction caused by a disregulated host response. Inflammatory mediators attack microorganisms and the body's own organs, leading to vasodilation, myocardial dysfunction, respiratory failure, renal failure, and cerebral dysfunction.
- Symptoms and signs of sepsis include altered mental status, hyperglycemia/hypoglycemia, elevated C-reactive protein, hypotension, acute kidney injury, coagulopathy, thrombocytopenia, and liver dysfunction. Delaying treatment increases mortality risk, with a Q-SOFA score used for quick assessment.
- Septic shock is characterized by inadequate organ perfusion, requiring vasopressors, and elevated lactate levels despite fluid resuscitation. Lactate levels can indicate hyperimmune response. Serial lactate measurements and early goal-directed therapy are important for managing sepsis.
- Fluid management focuses on crystalloids, with limited use of albumin and avoidance of hydroxyethyl starch. Balanced crystalloid solutions are preferred. Norepinephrine is the first-choice vasopressor. Maintaining a mean arterial pressure of 65-70 mmHg is the goal.
- High-flow nasal oxygen or non-invasive ventilation can be used for hypoxic patients. Low tidal volume ventilation is recommended for ARDS. Ancillary treatments like vitamin C are not recommended. Corticosteroids can be used in vasopressor-resistant cases. Early enteral nutrition is preferred.
- Blood and blood products should be used judiciously. Glucose control should target 140-180 mg/dL. Bicarbonate therapy is not routinely recommended. Continuous renal replacement therapy may be beneficial. Low molecular weight heparin can be used for DVT prophylaxis.
- Setting goals of care, clear communication, handovers, and cognitive therapies are vital in sepsis management. Post-discharge follow-up is important. The focus is on early recognition, rapid resuscitation, source control, and multi-disciplinary care.
Sample Certificate
About the Speakers
Dr Aklesh Tandekar
Consultant - Non Invasive Cardiology at Fortis Memorial Research Institute Gurgaon, India
Comments
Comments
You must be logged in to leave a comment.