抗生素PPT课件（英文精品）Surviving .ppt

Surviving Sepsis Eloise Harman The Sepsis Continuum A clinical response arising from a nonspecific insult, with ?2 of the following: T 38oC or 36oC HR 90 beats/min RR 20/min WBC 12,000/mm3 or 4,000/mm3 or 10% bands Sepsis: A Major Cause of ICU Death More than 750,000 cases of severe sepsis in the US each year Mortality about 20% (recent decline) Economic cost of $17 billion each year Incidence is projected to increase by 1.5% yearly Although prognosis has improved, because of increased incidence, actual deaths will increase Surviving Sepsis Campaign Launched in Fall 2002 as a collaborative effort of European Society of Intensive Care Medicine, the International Sepsis Forum, and the Society of Critical Care Medicine Goal: reduce sepsis mortality by 25% in the next 5 years Guidelines revealed at SCCM in Feb 2004 Critical Care Medicine March 2004 32(3):858-87. Website: survivingsepsis . org Key Components Fluid resuscitation Appropriate cultures prior to antibiotic administration Early targeted antibiotics and source control Use of vasopressors/inotropes when fluid resuscitation optimized Key Components Evaluation for adrenal insufficiency Stress dose corticosteroid administration Recombinant human activated protein C (xigris) for severe sepsis Low tidal volume mechanical ventilation for ARDS Tight glucose control Key Components: Prevent Complications of Critical Illness Prophylaxis for DVT Stress ulcer prophylaxis Prevention of nosocomial pneumonia by elevation of head to 45 degrees Facilitate extubation by daily interruption of sedation and early SBT Narrowing of antibiotic spectrum when appropriate Key Components: Infection Control Appropriate cultures prior to antibiotic administration Early targeted antibiotics and source control Early Appropriate Antibiotics and Source Control Gram positive organisms have surpassed gram negatives as the most common source of sepsis Therapy targeted to the suspected site (eg, CAP, intra-abdominal source) Drainage, debridemen