विवरण
Sepsis is a life-threatening condition caused by the body's response to an infection. Early recognition and management of sepsis and septic shock are critical to improving patient outcomes. The initial steps in managing sepsis and septic shock include resuscitation and stabilization of the patient. The management of sepsis and septic shock also involves identifying and treating the underlying infection. Antibiotic therapy is a key component of the management of sepsis and septic shock. The choice of antibiotics should be based on the suspected source of infection and the patient's individual characteristics. Inappropriate use of antibiotics can lead to the development of antibiotic-resistant bacteria. The goal of fluid resuscitation is to achieve adequate tissue perfusion while avoiding fluid overload. Vasopressor therapy may be required in patients with septic shock who are not responding to fluid resuscitation.
सारांश
- Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, not merely a condition. Early screening and treatment programs in hospitals are critical for acutely ill, high-risk patients, especially those with comorbidities or undergoing operative procedures.
- Q sofa score, incorporating blood pressure, mental status, and respiratory rate, can be used. Any score above two suggests a higher risk of poor outcome, but it is not diagnostic. Another tool is the modified early warning score (MEWS) utilizing a color-coded system based on respiratory parameters, pulse rate, blood pressure, temperature, and alertness.
- Blood lactate levels should be measured due to their value as indicators of hypoperfusion. Initial fluid resuscitation with 30 ml/kg of IV crystalloid fluid is advised, although this recommendation has low-quality evidence. Dynamic parameter monitoring, such as passive leg raising and stroke volume variation, is preferred over physical examination or static parameters.
- Antibiotics should be administered within the first hour of recognizing sepsis or septic shock. This should not be delayed for blood cultures. Procalcitonin can be used to de-escalate antibiotics but not to start them.
- Antimicrobial choices should consider the risk of MRSA. Patients at high risk require empiric antibiotics that cover MRSA. Also, fungal infections should be addressed when appropriate.
- Rapid source control is crucial alongside antibiotic therapy. Intravascular devices suspected as infection sources should be removed.
- For fluid therapy, crystalloids are the first-line choice. Albumin may be considered for patients who have received large volumes of crystalloids. Norepinephrine is the preferred initial vasopressor.
- Ventilatory strategies for sepsis-induced hypoxemic respiratory failure include high-flow nasal cannula over non-invasive ventilation. For ARDS, protective ventilation with low tidal volume and plateau pressures below 30 cm of mercury is advised, potentially using high PEEP, recruitment maneuvers, and prone ventilation.
- Corticosteroids can be added for patients requiring persistent vasopressor support. However, glucose control is important due to the risk of hyperglycemia. Restrictive red blood cell transfusion strategies should target a hemoglobin level of around 7 g/dL, guided by the patient's overall clinical status.
- Stress ulcer prophylaxis and thromboprophylaxis are also recommended. Renal replacement therapy should be considered for AKI. Target blood sugar levels should range from 140 to 180 mg/dL.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
टिप्पणियाँ
टिप्पणियाँ
टिप्पणी करने के लिए आपको लॉगिन होना होगा।