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Sepsis - in children - Þórólfur Guðnason

Sepsis - in children - Þórólfur Guðnason. Sepsis - definitions -. Bacteremia Septicemia Sepsis - (SIRS) systemic response to an infection ; localized, in the blood or focus not found Sepsis syndrome - severe sepsis Septic shock MODS. Sepsis - definitions -. Infectious agent.

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Sepsis - in children - Þórólfur Guðnason

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  1. Sepsis- in children - Þórólfur Guðnason

  2. Sepsis- definitions - • Bacteremia • Septicemia • Sepsis - (SIRS) • systemic response to an infection; localized, in the blood or focus not found • Sepsis syndrome - severe sepsis • Septic shock • MODS

  3. Sepsis- definitions - Infectious agent Localized In the blood Sepsis

  4. Sepsis- definitions - • Sepsis • infection + Two or more of the following: • temperature >38C or <36 C • tachycardia (>2 SD above nl) • tachypnea (>2 SD above nl) • WBC >12.000, <4.000, or >10% band forms

  5. Sepsis- definitions - Infectious agent Localized In the blood Sepsis Sepsis syndrome / severe sepsis

  6. Sepsis- skilgreiningar - • Sepsis syndrome / severe sepsis • - sepsis • + • at least one of the following: • - acute CNS changes • - hypoxemia • - elevated lactate in plasma • - oliguria

  7. Sepsis- definitions - Infectious agent Localized In the blood Sepsis Sepsis syndrome Septic shock

  8. Sepsis- definitions - • Septic shock • sepsis syndrome / severe sepsis • + • progressive hypotension / hypoperfusion • Multiorgan dysfunction syndrome (MODS) • DIC, ARDS, renal failure, hepatic failure, CNS dysfunction, • myocardial dysfunction

  9. Sepsis- definitions - Infectious agent Localized In the blood Sepsis Sepsis syndrome Septic shock Death

  10. Sepsis- pathophysiology - Infectious agents or parts of... Hormones Cytokines Enzymes Immune system Coagulation system Endothelium damage Sepsis/Sepsis syndrome

  11. Sepsis- clinical symptoms - • Age <3 months • - non-specific, sometimes afebrile, NBfever !!!! • - mottled skin, irritability • Age >3 months • - fever, tachypnea, tachycardia • - poor perfusion • - petechial rash • - irritability

  12. Sepsis- epidemiology - • 700.000 cases per year in USA (all ages) • 20-70% positive blood cultures (all ages). • Mortalitet • - sepsis/sepsis syndrome • 35% all ages • children 10% • - septic shock/MODS • >90%

  13. Sepsis- treatment - • Consider:Age, circumstances, origin of infection • 0-1 mo. • gram neg. bacteria • gr. B streptococci • enterococci • Listeria • staph. aureus • Herpes simplex • Ampicillin • and • aminoglycosides • or • 3rd gen. cephalosporins • ?? Acyclovir

  14. Sepsis- treatment - • 1-3 mo. • meningococci • pneumococci • gram neg. bacteria • gr. B streptococci • enterococci • Listeria • staph. aureus • Ampicillin • and • 3rd gen. Cephalosporins • or • Aminoglycosides

  15. Sepsis- treatment - • >3 mo. • meningococci • pneumococci • (gram neg. bacteria) • 3rd gen. cephalosporins Children at hospitals staph. aureus, gram neg. bacteria, fungi Immune deficiency gram neg. bacteria, staph. aureus, fungi Foreign bodies staphylococci

  16. Sepsis- immunomodulating treatment - Infection Parts of microorganism ACTH / endorphins TNF, IL-1, IFN complement activation Increased coagulation Activation of endothelial cells and WBC. Kallikrein - kinin stimulation Stimulation of PMN´s Secondary mediators IL, PAF o. fl endothelial damage vasodilation SHOCK endothelial damage capillary leak Death

  17. Sepsis- immunomodulating treatment - • Protein C • Tissue factor • Polyclonal IgG • anti-LPS (anti-lipid A) • Steroids • anti-TNF • anti-IL-1 • Nitric oxide • Naloxon • CD-18 monoclonal Ab • pentoxyfyllin

  18. Sepsis- treatment - - fluids - vasopressors - oxygen - acid-base - respirator - platelets - plasma - plasma exchange ?? - nutrition

  19. How can outcome be improved ? • Outcome not improved for several years ? • Improve diagnosis • clinical • laboratory • Preventive measures • vaccinations

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