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Protocol Based Approacment in Severe Sepsis: One Year Experience

Protocol Based Approacment in Severe Sepsis: One Year Experience. Zuhal Karakurt , Tülay Yarkın, Nalan Adıgüzel, Gökay Güngör, Özlem Soğukpınar, Eylem Acartürk Süreyyapaşa Chest Diseases and Thoracic Surgery Teaching Hospital, Respiratory Intensive Care Unit, İstanbul, Türkiye. Aim.

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Protocol Based Approacment in Severe Sepsis: One Year Experience

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  1. Protocol Based Approacment in Severe Sepsis: One Year Experience Zuhal Karakurt, Tülay Yarkın, Nalan Adıgüzel, Gökay Güngör, Özlem Soğukpınar, Eylem Acartürk Süreyyapaşa Chest Diseases and Thoracic Surgery Teaching Hospital, Respiratory Intensive Care Unit, İstanbul, Türkiye

  2. Aim We evaluated the efficacy of protocol based approach including the interventions mentioned above (except APC) in the patients with severe sepsis admitted to our respiratory intensive care unit (RICU) in one year period.

  3. Methods • Study design: Prospektive clinic study • Place: Tertiary Teaching Hospital 10 bed medikal ICU • Study period: 1 January 2006 – 31 December 2006 • Patients: ARF patients with severe sepsis stayed more than 24 h in ICU • Evaluations: patients’ characteristic and nutrition, cathetarization, mechanical ventilation were recorded.

  4. Methods Patients with severe pepsis: SIRS:systemic inflamatuar response sendrome 1.Fever: < 36 or >38 C 2. Heart rate > 90/m 3.Respiratory rate >20 or PaCO2 <32mmHg 4.WBC: < 4000 or >12000 or 10% band Severe Sepsis: Sepsis with organ disfunction (hypoperfusion, changed mental status, oliguria etc). Sepsis Shock: Sepsis related hypotension refractory to fluid resusitation ( need vasopressor to gain optimal arterial tention)

  5. Methods Sepsis Protocols: • Early Goal Directed Therapy: fluid resussitation (MAP>65mmHg) and emprical antibiotics • Low Tidal Volume: 6ml/kg • Tight Glucose Control: Insulin infusion to obtain blood glucose equal 80-140mg/L • Moderate Dose Steroid: Methyl prednisolon 20mg 3 times daily for 7 days

  6. Results 176 patients 119 severe sepsis 38 (49) Septic shock 29 death

  7. Death unrelated to sepsis: 17 (%14) 1) Myocardial Infarction 2) Lung cancer 3) IPF (end stage) 4) Serebro vascular accident (SVA) Death related to sepsis: 12 (%10) 1) Resistant pathogen 2) Inappropriate empirical antibiotics 3) Multiple organ failure ICU mortality rate: 24%

  8. Results of Sepsis Protocols

  9. Results

  10. Risk factors for sepsis related mortality

  11. Sepsis related mortality reducing studies

  12. Conclusions • Mortality rates in severe sepsis varied from 28% to 50% in the literature. • In this study, we demonstrated that sepsis related mortality can be decreased by using protocol based management including EGDT, LVT, TGC and MDS in such patients.

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