6. SIRS
• Two or more of the following conditions:
– Fever or hypothermia
– Tachypnea
– Tachycardia
– Leukocytosis or leukopenia or >10% bands
• Infectious / Noninfectious
6
8. Severe sepsis
• Sepsis with signs of one or more organ dysfunction
– Cardiovascular: hypotension that responds to
administration of IV fluids
– Renal
– Respiratory
– Hematologic
– Unexplained metabolic acidosis
8
9. Septic shock
• Sepsis with
– Hypotension, for at least 1 h, despite adequate fluid
resuscitation
– Need for vesopressor
9
22. Immunocompetent patient
• Any of the following
– Piperacillin-tazobactam
– Imipenem-cilastin or meropenem
– Cefepime
• If allergic to ß lactam agents
– Ciprofloxacin or levofloxacin plus clindamycin
• Vancomycin should be added to each of
the above regimen 22
23. Neutropenic patient
• Imipenem-cilastin or meropenem or cefepime
• Piperacillin-tazobactam plus tobramycin
• Vancomycin should be added if indicated
• Empirical antifungal therapy if hypotensive or
has been receiving broad spectrum antibiotic
23
24. Other special situations
• Splenectomy
– Cefotaxime or Ceftriaxone
– Vancomycin plus either moxifloxacin or
levofloxacin or aztreonam
• IV drug user
– Vancomycin
24
25. Other special situations: cont
• AIDS
– Cefepime or peperacillin-tazobactam
plus tobramycin
– Ciprofloxacin or levofloxacin
plus vancomycin
plus tobramycin
25
27. Management of hypotension
• Fluid challenge over 30 min
• 500–1000 ml crystalloid
• 300–500 ml colloid
• Repeat based on response and tolerance
27
28. Management of hypotension
• Vasopressor therapy
– Titrating dose of norepinephrine or dopamine
– Dobutamine if myocardial dysfunction
28
29. Steroid
• CIRCI: inadequate corticosteroid activity for the
severity of the illness
• Hypotension that does not respond to fluid
replacement therapy
• Hydrocortisone, 50 mg IV q6h
• If clinical improvement, continue for 5-7 days,
slowly taper
• Hastens recovery from septic shock
• No increase in long term survival
29
30. Activated protein C
• Approved by USFDA
• Indicated for
– Very sick patient (APACHE II)
– Low risk of hemorrhage
• Complex anti-inflammatory, anti-apoptotic,
anticoagulant effect
• Trials going on 30
31. Glucose control
– Insulin to lower blood glucose to 100-120
mg/dl is potentially harmful
– Needed only to maintain blood glucose below
150 mg/dl
31