Sepsis and septic shock: Guideline-based management

Abstract

Sepsis is a life-threatening organ dysfunction that results from the body's response to infection. It requires prompt recognition, appropriate antibiotics, careful hemodynamic support, and control of the source of infection. With the trend in management moving away from protocolized care in favor of appropriate usual care, an understanding of sepsis physiology and best practice guidelines is critical. KEY POINTSTools such as the Systemic Infl ammatory Response Syndrome criteria and the quick version of the Sequential Organ Failure Assessment can help with early diagnosis and triage.The initial antibiotic should be broad-spectrum, based on local sensitivity patterns, with daily assessment of appropriate antibiotic de-escalation and cessation.Resuscitation with initial fl uid boluses should be followed by weighing benefi ts and risks of additional fl uid administration based on dynamically assessed volume status, and then aggressive fl uid removal during recovery.During resuscitation, a goal mean arterial pressure of 65 mm Hg is preferred, using norepinephrine (with vasopressin if needed) to achieve it.Glucocorticoids are not recommended if fl uid resuscitation and vasopressors are suffi cient to restore hemodynamic stability.

Evaluation and management of shock in patients with COVID-19

“…2 An initial goal of MAP above 65 mmHg, which is later individualized based on a dynamic assessment of perfusion using capillary refill time, mentation and urine output, is a reasonable approach. 17,18 ■ CARDIOGENIC SHOCK…”

Hidrotoraks Masif Dekstra dengan Penyulit ARDS Akibat Komplikasi Pemasangan Kateter Vena Sentral Jugular Interna

“…Skor qSOFA ≥2 dengan kecurigaan infeksi atau sudah ada infeksi yang pasti diusulkan untuk memberikan terapi yang agresif, termasuk monitoring yang sering dan perawatan di ICU. 16 Pada studi prelinik, ternyata sepsis dapat menyebabkan injuri langsung pada paru diawali dengan kerusakan pada epitel paru, namun injuri secara tidak langsung juga dapat terjadi yang bermula dari kerusakan endotelial sistemik akibat mediator inflamatori. 6 Unit pertukaran gas di paru dibatasi oleh barier alveolar-kapilar yang tipis yang memelihara hubungan antara udara dan cairan.…”

Management of Septic Shock

“…(Marik & Taeb, 2017) Sepsis erat kaitannya dengan vasodilatasi, kebocoran kapiler, dan penurunan efektivitas sirkulasi darah dalam tubuh. Gangguan hemodinamik ini kemudian akan mengganggu perfusi jaringan pada sepsis (Dugar, Choudhary, & Duggal, 2020). Tujuan terapi pada sepsis dan syok septik ialah untuk mengembalikan volume intravaskular, eradikasi infeksi, meningkatkan distribusi okigen ke jaringan, dan mengembalikan disfungsi organ (Dugar et al, 2020).…”