Introduction:
Epidemiology:
Sepsis is a significant public health burden with increasingly high incidence and mortality rates. In 2010, an estimated 5.1% of deaths were attributed to sepsis in the United Kingdom. Consequently, it is a leading cause of admission to intensive care units (ICU), delays in hospital discharge and a significant cost to the economy. Therefore, it is imperative to raise awareness and prepare clinicians with the knowledge and guidance to embark on the global movement towards improving quality of care and outcomes for patients with severe sepsis and septic shock.
Defining Sepsis:
In 1991, The Society of Critical Care Medicine and The American College of Chest Physicians held a meeting with the aim of establishing distinct …show more content…
Initial Resuscitation:
The principle approach to managing a patient with sepsis is to perform vigorous fluid resuscitation. As stated previously severe sepsis occurs when the patient exhibits signs of widespread tissue hypoperfusion (i.e. having elevated blood lactate concentration, sepsis-induced hypotension or oliguria). Therefore, aiming to correct such physiological parameters is the mainstay of the initial treatment in these patients. In particular, the guidelines focus on achieving the following targets during the first 6 hours of resuscitation:
1. Central venous pressure (CVP) (8-12mmHg),
2. Mean arterial pressure (MAP) (65mm Hg or higher),
3. Urine output (≥ 0.5/kg/hour) and,
4. Superior vena cava oxygenation saturation (the percentage of oxygen being returned to the right atrium) or mixed venous oxygen saturation (of 70% or 65% respectively).
In order to achieve these goals, a minimum of 30ml/kg of isotonic crystalloid fluid is required for sufficient volume resuscitation. Aiming for haemodynamic stability warrants continued administration of fluids until this is deemed futile. Moreover, patients with hypotension unresponsive to the initial fluid challenge (i.e. septic shock) should receive additional cardiovascular support in the form of vasopressors (i.e. Norepinephrine as first choice vasopressor followed by Epinephrine) to maintain a MAP of 65mm Hg or
Epidemiology:
Sepsis is a significant public health burden with increasingly high incidence and mortality rates. In 2010, an estimated 5.1% of deaths were attributed to sepsis in the United Kingdom. Consequently, it is a leading cause of admission to intensive care units (ICU), delays in hospital discharge and a significant cost to the economy. Therefore, it is imperative to raise awareness and prepare clinicians with the knowledge and guidance to embark on the global movement towards improving quality of care and outcomes for patients with severe sepsis and septic shock.
Defining Sepsis:
In 1991, The Society of Critical Care Medicine and The American College of Chest Physicians held a meeting with the aim of establishing distinct …show more content…
Initial Resuscitation:
The principle approach to managing a patient with sepsis is to perform vigorous fluid resuscitation. As stated previously severe sepsis occurs when the patient exhibits signs of widespread tissue hypoperfusion (i.e. having elevated blood lactate concentration, sepsis-induced hypotension or oliguria). Therefore, aiming to correct such physiological parameters is the mainstay of the initial treatment in these patients. In particular, the guidelines focus on achieving the following targets during the first 6 hours of resuscitation:
1. Central venous pressure (CVP) (8-12mmHg),
2. Mean arterial pressure (MAP) (65mm Hg or higher),
3. Urine output (≥ 0.5/kg/hour) and,
4. Superior vena cava oxygenation saturation (the percentage of oxygen being returned to the right atrium) or mixed venous oxygen saturation (of 70% or 65% respectively).
In order to achieve these goals, a minimum of 30ml/kg of isotonic crystalloid fluid is required for sufficient volume resuscitation. Aiming for haemodynamic stability warrants continued administration of fluids until this is deemed futile. Moreover, patients with hypotension unresponsive to the initial fluid challenge (i.e. septic shock) should receive additional cardiovascular support in the form of vasopressors (i.e. Norepinephrine as first choice vasopressor followed by Epinephrine) to maintain a MAP of 65mm Hg or