Description
Sepsis is a life-threatening organ dysfunction caused by an unregulated response to infection. In septic shock, there will be an acute failure of multiple organs, critical reduction in tissue perfusion; including the lungs, kidneys, and liver.
The upcoming webinar with Dr Ankur Gupta, Head of Critical Care and Emergency will provide a better understanding regarding different Managing patterns of suspected Sepsis and Septic Shock in ICU
Résumé
- The speaker highlights key changes in the 2021 sepsis guidelines, emphasizing the personalized approach now required for treatment. The Q-SOFA score was removed due to its inaccuracy in identifying septic patients. Lactate levels are no longer considered a screening tool for sepsis, but rather a marker for resuscitation guidance in suspected cases.
- Fluid resuscitation recommendations have moved away from the "30 ml per kg" rule, urging clinicians to use their clinical judgment. Crystalloids and balanced solutions are both acceptable for resuscitation, but colloids are not recommended. Passive leg raising and systolic pulse pressure variation are suggested to assess fluid responsiveness.
- Antibiotics should be administered within one hour if a patient presents with shock, regardless of sepsis confirmation. In non-shock cases with suspected sepsis, antibiotics should be given within one hour. If an alternate cause is probable, clinicians can wait up to three hours. Procalcitonin is not recommended for initiating therapy, but can be useful for de-escalation.
- For gram-negative sepsis, the guidelines now recommend using two antibiotics from different groups. Beta-lactams and carbapenems should be given as prolonged infusions (around 3 hours) to enhance efficacy and reduce resistance. Source control should be implemented as early as possible (ideally within 6 hours), including the removal of infected intravascular devices.
- Shorter durations of antibiotic therapy are favored if the infection is effectively treated initially. Crystalloids and balanced solutions are the preferred fluids, with a trend towards balanced solutions to prevent hyperchloremic metabolic acidosis. Vasopressors should be started peripherally while securing a central line; norepinephrine is the preferred initial vasopressor.
- Ventilation strategies depend on the patient's respiratory status, and neuromuscular blockade agents can be used. Steroids should be initiated when vasopressor requirements start to increase. Transfusions are indicated at hemoglobin levels below seven. Thrombo-prophylaxis is recommended with low molecular weight heparin.
- Renal replacement therapy (RRT) should only be considered for fluid overload, persistent hyperkalemia, or uremic symptoms, not solely to correct acidosis. Insulin targets should be between 150-180. Good nutrition, starting with semi-elemental formulas, is essential. Detailed medication information should be included in discharge summaries for continuity of care.
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À propos des intervenants
Dr Ankur Gupta
Consultant Intensivist, Head Intensive Care & Emergency, Apollo Hospitals, Indore
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