Antonius Pudjiadi 2019

Pediatric Septic Shock Resuscitation: Taking out the Goals

Antonius H. Pudjiadi

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Antonius Pudjiadi 2019

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection

Definition of Sepsis

Singer M, et al. JAMA. 2016;315(8):801-810.

Janeway's Immunobiology, 8th Edition, Garland Science 2012, ISBN-13: 978-0815342434

Antonius Pudjiadi 2019

Infection Sepsis Septic Shock MODS MOF Death

HOSPITAL MORTALITY

>4 DAYS

HOSPITAL MORTALITY

Antonius Pudjiadi 2019 A. Leligdowicz and M. A. Matthay 2019 Antonius Pudjiadi 2019 Crit Care Med 2013; 41:580–637

(2012)

Antonius Pudjiadi 2019 Antonius Pudjiadi 2019 Crit Care Med 2017; 45:1061–1093

Antonius Pudjiadi 2019 Ames et al. Critical Care 2018;22:224 Antonius Pudjiadi 2019

Preload

Contractility

Afterload

Stroke Volume

Heart Rate

Cardiac Output

SVR

Blood Pressure

Hb

SpO2

DO2

ScvO2

Perfusion Pressure

Antonius Pudjiadi 2019

APP = MAP - IAP

AbdominalPerfusion Pressure

IntraAbdominalPressure

MeanArterialPressure

CPP = MAP - ICP

CerebralPerfusion Pressure

IntraCranialPressure

MeanArterialPressure

Optimal Preload

Antonius Pudjiadi 2019Marik P, Bellomo R. British Journal of Anaesthesia 2016;116: 339–49

Antonius Pudjiadi 2019 Antonius Pudjiadi 2019 CHEST 2008; 134:117–25

Antonius Pudjiadi 2019

Heart, Lung and Vessels. 2013; 5(3): 142-147

D. Lichtenstein

Antonius Pudjiadi 2019

Conclusion

• Early antibiotics and adequate resuscitation reduced pediatric sepsis mortality

• A meta-analysis of 44 studies revealed a significant reduction in mortality associated with improved compliance with the sepsis bundle

• Inadequate management influence the phenotype of the patient

• Some new bedside tools are able to give informations on hemodynamic more details than the surviving sepsis campaign goals

• It is suggested to modified of the sepsis bundle according to local situation , followed by an evaluation of the modified bundle