Sepsis and septic shock
Pavel Suk
Intensive Care Unit
St. Anne’s University Hospital

Mervyn Singer, JAMA 2016
R. Phillip Dellinger, Crit Care Med 2012


Definition I.
•Sepsis = life-threatening organ dysfunction caused by a dysregulated host response to infection
•organ dysfunction
–SOFA ≥ 2
–Quick SOFA  (qSOFA) ≥ 2
•Respiratory rate > 22/min
•Altered mentation (GCS < 15)
•Systolic blood pressure < 100 mmHg
•mortality > 10 %

SOFA = Sequential [Sepsis-Related] Organ Failure Assessment Score
•


Definition II.
•Septic shock
–hypotension despite adequate fluid resuscitation
–vasopressors to maintain MAP > 65mmHg
–serum lactate level > 2 mmol/L
–mortality > 40 %
•

Initial Resuscitation
•haemodynamics - signs
–tachycardia
–hypotension
–tissue hypoperfusion
•elevated lactate (> 2 mmol/l)
•low SvO2 / ScvO2
•skin mottling
•low urine output
•altered mental status
Výsledek obrázku pro skin mottling

•heamodynamics - monitoring
–clinical signs
–urine output
–lactate dynamics, SvO2/ScvO2
–echocardiography
–cardiac output measurement
–invasive blood pressure
•
Výsledek obrázku pro invasive blood pressure Výsledek obrázku pro arterial blood gases

•haemodynamics – therapy
–correct hypovolaemia
•rapid crystalloid infusion (fluid challenge)
–maintain MAP > 65 mmHg
•vasopressors – titrate norepinephrine
–serial lactate levels / ScvO2 trend monitoring
–iontropic support
–transfusion trigger as ussual
•

Microbial diagnostics
•cultures from relevant sites (urine, throat, sputum, tracheal aspirate, wounds, abscess, bile,…)
•at least 2 sets of blood cultures
• (aerobic/anaerobic)
•all before administration of AB
•
–
Výsledek obrázku pro blood culture

Antimicrobial therapy
•intravenous antimicrobials within the 1st hour
•activity against all likely pathogens (based on [likely] source of sepsis)
–usually broad-spectrum antibiotics
•daily reassessment (change, de-escalation)
•duration of therapy typically 7 to 10 days
–based on clinical course, PCT
•

Source control
•dignostics (imaging, puncture, surgery) to diagnose and control source of sepsis (ASAP, within 12
hrs) •mini-invasive approach preferred (CT guided drainage)
•if catheters are possible source → remove/exchange
•
Výsledek obrázku pro x ray pneumonia Výsledek obrázku pro ct abscess Výsledek obrázku pro us
cholecystitis