VA MICU Conference 11/22/06
56 y.o. male with PMH ETOH abuse and COPD presented with a LUL PNA and BCx positive for penicillin-resistant pneumococcus.
Early Goal-Directed Therapy in Severe Sepsis and Septic Shock
- Early broad spectrum antibiotics.
- Goal directed hemodynamic resuscitation with
- IV fluids
- PRBCs (for Hct <30)
- To maintain:
- Central Venous Pressure 8-12 mm Hg
- Arterial Pressure: MAP >65 mm Hg but <90 mm Hg
- Central Venous Oxygen Saturation >70%
- Consider cosyntropin stimulation to evaluate for relative adrenal insufficiency.
- Consider Recombinant Activated Protein C in patients with an APACHE II score >25.