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.
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.
One comment on “Fast Facts-Critical Care”
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.
Hospital das Clínicas de Porto Alegre
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