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One–hour bundle: doporučení Surviving Sepsis Campaign
Michal Fedora
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Teorie:
• Sepsí indukovaná orgánová dysfunkce způsobena(alespoň částečně) hypoperfusí
• Hypoperfuse je výsledkem ↓CO a/nebo hypotense
• Tekutiny mohou zlepšit CO, TK a perfusi orgánů
(a tím i výsledek léčby)
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2004 2008 2012 2016 2018
Čas 3 – 6 h 3 – 6 h 3 – 6 h 3 – 6 h 1 h
Laktát
Hemokultura
Širokospektrá ATB
i.v. tekutiny (ml/kg) 20 20 30 30 začít 30
Vasopresory
PerfuseCíl CVP
Cíl ScvO2
Cíl CVPCíl ScvO2
Měřit CVPMěřit ScvO2
Posoudit perfusi
Opakovaně laktát
Změny v SCC Bundles – dospělí pacienti
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Crit Care Med 2008; 36:296–327
R. Phillip Dellinger, MD; Mitchell M. Levy, MD; Jean M. Carlet, MD et al
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Crit Care Med 2009; 37:666–688
Joe Brierley, MD; Joseph A. Carcillo, MD; Karen Choong, MD et al
Crit Care Med 2013; 41:580–637
R. Phillip Dellinger, MD; Mitchell M. Levy, MD; Andrew Rhodes, MB BS et al
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Alan L. Davis, MD, MPH, FAAP, FCCM; Joseph A. Carcillo, MD; Rajesh K. Aneja, MD et al
Crit Care Med 2017; 45:1061–1093
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1
23
4 567 8
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