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SEPSIS & SEPTIC SHOCK 10.15. 2009

SEPSIS & SEPTIC SHOCK 10.15. 2009. Jaime Palomino, MD Pulmonary & Critical Care Medicine Tulane University Health Sciences Center New Orleans, Louisiana. Epidemiology. Sepsis yearly incidence  50 – 95 cases / 100,000 Increasing by 9% each year 2% hospital admissions

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SEPSIS & SEPTIC SHOCK 10.15. 2009

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  1. SEPSIS & SEPTIC SHOCK 10.15. 2009 Jaime Palomino, MD Pulmonary & Critical Care Medicine Tulane University Health Sciences Center New Orleans, Louisiana

  2. Epidemiology • Sepsis yearly incidence  50 – 95 cases / 100,000 • Increasing by 9% each year • 2% hospital admissions • 9% sepsis  severe sepsis • 3% severe sepsis  septic shock • 10% of ICU admissions

  3. Annane D et al. Lancet 2005;365:63-78

  4. Russell J. NEJM 2006;355:1699-713

  5. Russell J. NEJM 2006;355:1699-713

  6. Russell J. NEJM 2006;355:1699-713

  7. Septic Shock – Treatment • Initial Resuscitation

  8. Rivers E et al. NEJM 2001;345:1368-1377

  9. Rivers E et al. NEJM 2001;345:1368-1377

  10. Septic Shock – Treatment • What are the recommended vasopressors in septic shock patients? • MAP ≥ 65 mmHg • Norepinephrine and Dopamine  initial vasopressors of choice • Epinephrine  first alternative when BP is poorly responsive to Norepinephrine or Dopamine

  11. Annane D et al. Lancet 2007;370:676-84

  12. Septic Shock – Treatment • Vasopressors • Vasopressin • May be subsequently added to Norepinephrine (Dose: 0.03units/min) with anticipation of an effect equivalent to Norepinephrine alone.

  13. Russell J et al. NEJM 2008;358:877-887

  14. Russell J et al. NEJM 2008;358:877-887

  15. Russell J et al. NEJM 2008;358:877-887

  16. Povoa P et al. CCM 2009;37:410-416

  17. Septic Shock – Treatment • Vasopressors • Comparison of Dopamine and Norepinephrine as the First Vasopressor Agent in the Management of Shock • De Backer D. NCT00314704 • Primary Outcome Measures: 28 day survival • Estimated Enrollment: 1600 • Study Start Date: December 2003 • Estimated Study Completion Date: December 2010

  18. Septic Shock – Treatment • Steroids

  19. Sprung et al. NEJM 2008;358:111-24

  20. Sprung et al. NEJM 2008;358:111-24

  21. Sprung et al. NEJM 2008;358:111-24

  22. Sprung et al. NEJM 2008;358:111-24

  23. Sprung et al. NEJM 2008;358:111-24

  24. Relative Adrenal Insufficiency Diagnosis Thomas Z et al. Ann Pharmacother 2007;41:1456-65

  25. Dellinger R et al. Crit Care Med 2008; 36:296-327

  26. Annane et al. JAMA 2009;301:2362-2375

  27. Annane et al. JAMA 2009;301:2362-2375

  28. Annane et al. JAMA 2009;301:2362-2375

  29. Annane et al. JAMA 2009;301:2362-2375

  30. Septic Shock – Treatment • Glucose Control

  31. Van Den Berghe G et al. NEJM 2001;345:1359-1367

  32. Van Den Berghe G et al. NEJM 2001;345:1359-1367

  33. Van Den Berghe G et al. NEJM 2006;354:449-461

  34. Van Den Berghe G et al. NEJM 2006;354:449-461

  35. Brunkhorst FM et al. NEJM 2008;358:125-139

  36. Brunkhorst FM et al. NEJM 2008;358:125-139

  37. NEJM 2009;360:1283-97

  38. NEJM 2009;360:1283-97

  39. NEJM 2009;360:1283-97

  40. NEJM 2009;360:1283-97

  41. NEJM 2009;360:1283-97

  42. NEJM 2009;360:1283-97

  43. Septic Shock– Treatment • Activated Protein C

  44. Bernard GR et al. NEJM 2001;344:699-709

  45. Bernard GR et al. NEJM 2001;344:699-709

  46. Abraham E et al. NEJM 2005;353:1332-1341

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