Fast Facts-Critical Care

November 22, 2006

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
    • pressors
    • PRBCs (for Hct <30)
    • inotropes
  • 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.

Rivers E., et.al.Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock
N Engl J Med 2001; 345:1368-1377, Nov 8, 2001.

Russell J. A. Drug Therapy: Management of Sepsis N Engl J Med 2006; 355:1699-1713, Oct 19, 2006.

 

One Response to Fast Facts-Critical Care

  1. nasi on July 7, 2007 at 3:43 pm

    In my institution (a general university hospital with 700 beds) the early goal therapy does not represent a significant change in mortality of septic shock (60%). We dont use activated protein C.
    We are looking fore interpretation for this findings.
    Thank you
    Emergency Department
    Hospital das Clínicas de Porto Alegre
    Brazil

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