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SEPSIS
Infection
International
Sepsis =
infection plus systemic inflammatory
response syndrome (SIRS)
Infection
International
PERJALANAN INFEKSI
KEMATIAN
Infection
International
ANGKA KEJADIAN DAN MORTALITAS AKIBAT SEPSIS
Incidence Mortality
Approximately total
Sepsis 200,000 death/year
400,000 7-17%
INFLAMASI
Respon awal
tubuh
Tujuan :
menghancurkan
dan
menetralisasi
Infection
International
1. Mengisolasi
2. Mendilusi
3. Menghancurkan
4. membersihkan
Infection
International
Infection
International
PEMBULUH
DARAH
BEKUAN
O2
ALBUMIN
PLASMA
CO2
MENGGANGGU PERTUKARAN O2
Infection
International
TINGKATAN SEPSIS
T > 38o or < 36o Sepsis
PR > 90 bpm Sepsis +
RR > 20/min or +
PaCO2 < 32 Hypotension and
Invasion of Infection Organ hypoperfusion
L > 12,000/uL or despite adequate
microorganisms dysfunction,
< 4,000/Ul + volume
hypoperfusion or
Or > 10% immatur SIRS hypotension replacement
neutrofil
Infection
International
Infection
International
Infection
International
MATERNITY PATIENT
Infection
Tatalaksana
MANAGEMENT sepsis
OF SEVERE
International
berat
SEPSIS
KENDALI SUMBER
TERAPI CAIRAN Vasopressors
INFEKSI
Recombinant
Inotropic Therapy Corticosteroids Human Activated
Protein C (rhAPC)
TRANSFUSI
DARAH
Infection Tatalaksana Sepsis (2013)
International
A. Initial resuscitation
B. Screening for sepsis and performance improvement
C. Diagnosis
D. Antimicrobial therapy
E. Source control
F. Infection prevention
G. Fluid therapy for severe sepsis
H. Vasopressor
I. Inotropic therapy
J. Corticosteroids
K. Blood production administration
L. Immunoglobulin
M. Selenium
N. History of recommendations regarding use of recombinant activated protein C
O. Mechanical ventilation of sepsis induced Acute Respiratory Distress Syndrome
(ARDS)
P. Sedation, analgesia and neuromuscular blockade
Q. Glucose control
R. Renal replacement therapy
S. Bicarbonate therapy
T. Deep vein thrombosis prophylaxis
U. Stress ulcer prophylaxis
V. Nutrition
W. Setting goals of care
Infection
International
Tujuan resusitasi
• CVP 8–12 mm Hg
• MAP ≥ 65 mm Hg
• Produksi urine ≥ 0.5 mL/kg/jam
• SvO2 ≥ 70%
OPTIMALISASI
Infection PENGIRIMAN OKSIGEN
International
Packed red cell
Cannula Mask
4 transfusion Mechanical ventilation
Oxygenation/ mech.
ventilation vent.
HR x SV MAP < 65mmHg Vasopressor
(norepinephrine) MAP > 90mmHg Vasodilator
(NTG)
2 3
fluid Preload Afterload vasoactive
Contractility inotrope 5
Dobutamine
EARLY
Infection GOAL DIRECTED THERAPY
International
Infection
International
Early Goal-Directed Therapy Results
28-day Mortality
60
49.2%
50 P = 0.01*
40
33.3%
30
20
10
0
Standard Therapy EGDT
n =133 n=130
*Key difference was in sudden CV collapse, not MODS
Rivers E. N Engl J Med 2001;345:1368-77.
Infection
Terapi antibiotik
International
Terapi antibiotik
G. Terapi cairan
• Transfusi TC jika :
3
– < 10,000/mm tanpa adanya
perdarahan
3
– < 20,000/mm with dengan risiko
kejadian perdarahan
Summary
Resusitasi Terapi Kendali
Diagnosis
awal antibiotik sumber
Terapi pendukung
Infection
International
TERIMA KASIH