Contenu connexe
Similaire à Sirs Mods (20)
Sirs Mods
- 9. SIRS Continuum Source: Bone et al. Chest 1992;101:1644 SIRS OTHER INFECTION PANCREATITIS BURNS TRAUMA SEPSIS SEVERE SEPSIS SEPTIC SHOCK
- 15. Mortality Increases in Septic Shock Patients Mortality Incidence Source: Balk, R.A. Crit Care Clin 2000;337:52 Approximately 200,000 patients including 70,000 Medicare patients have septic shock annually Septic Shock 53-63% 20-53% Severe Sepsis 300,000 7-17% Sepsis 400,000
- 20. Pathogenesis of Severe Sepsis Infection Microbial Products (exotoxin/endotoxin) Cellular Responses Oxidases Platelet Activation Kinins Complement Coagulopathy/DIC Vascular/Organ System Injury Multi-Organ Failure Death Endothelial damage Endothelial damage Coagulation Activation Cytokines TNF, IL-1, IL-6
- 34. Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock Dellinger RP, et al. Crit Care Med 2004; 32:858-873.
- 40. Early Goal-Directed Therapy CVP : central venous pressure MAP : mean arterial pressure ScvO 2 : central venous oxygen saturation NEJM 2001;345:1368-77 .
- 41. Early Goal-Directed Therapy Results 49.2% 33.3% 0 10 20 30 40 50 60 Standard Therapy n=133 EGDT n=130 P = 0.01* *Key difference was in sudden CV collapse, not MODS 28-day Mortality NEJM 2001;345:1368-77.
- 52. Inflammatory mediators priming SIRS leading to MODS Vascular permeability ↑ + PMN chemotaxis Mono / Macrophage PMN elastase PLA2 oxygen free radicals TNF IL - 8 IL - 1 IL - 6 Liver : acute phase Remote organ injury Tissue injury Endothelium Injury factors PMN PAF Adhensive molecules DIC
- 53. Common Manifestations of MODS DIC Coagulation CNS failure Brain Acute hepatic failure Liver Stress ulcer/enteroparalysis Gastro-intestine ARF Kidney ALI /ARDS Lung Shock Peripheral circulation Acute heart failure Heart Symptoms Organ