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    Bakteriemia, Sepsis Dan Syok Septik

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    diah stanya
    This document discusses sepsis, severe sepsis, septic shock, and their management. It defines the sepsis continuum and describes the normal systemic response to infection and injury. It explains the pathogenesis of severe sepsis, including the role of microbial products, cellular responses, coagulopathy, and multi-organ failure. It also discusses hemodynamic changes in septic shock, complications, management bundles, early goal-directed therapy, and strategies for minimizing inflammation in septic shock.

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    Bakteriemia, Sepsis Dan Syok Septik

    Uploaded by

    diah stanya
    14 views36 pages
    This document discusses sepsis, severe sepsis, septic shock, and their management. It defines the sepsis continuum and describes the normal systemic response to infection and injury. It explains the pathogenesis of severe sepsis, including the role of microbial products, cellular responses, coagulopathy, and multi-organ failure. It also discusses hemodynamic changes in septic shock, complications, management bundles, early goal-directed therapy, and strategies for minimizing inflammation in septic shock.

    Original Description:

    syok septik

    Original Title

    7.1 Sepsis-syok Septik 5-12-15

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    This document discusses sepsis, severe sepsis, septic shock, and their management. It defines the sepsis continuum and describes the normal systemic response to infection and injury. It explains the pathogenesis of severe sepsis, including the role of microbial products, cellular responses, coagulopathy, and multi-organ failure. It also discusses hemodynamic changes in septic shock, complications, management bundles, early goal-directed therapy, and strategies for minimizing inflammation in septic shock.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    14 views36 pages

    Bakteriemia, Sepsis Dan Syok Septik

    Uploaded by

    diah stanya
    This document discusses sepsis, severe sepsis, septic shock, and their management. It defines the sepsis continuum and describes the normal systemic response to infection and injury. It explains the pathogenesis of severe sepsis, including the role of microbial products, cellular responses, coagulopathy, and multi-organ failure. It also discusses hemodynamic changes in septic shock, complications, management bundles, early goal-directed therapy, and strategies for minimizing inflammation in septic shock.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    of 36

    Bakteriemia, sepsis dan

    syok septik
    dr Putra Hendra SpPD
    UNIBA

    Current Management of Severe Sepsis and Septic Shock l October 16, 2019 l 1
    Current Management of Severe Sepsis and Septic Shock l October 16, 2019 l 2
    Source
    (usually an endogenous source of
    • saluran usus infection)
    • orofaring
    • situs instrumentasi
    • terkontaminasi peralatan terapi inhalasi
    • cairan IV.
    • situs yang paling sering infeksi: Paru-paru, perut, dan
    saluran kemih.
    • Sumber-sumber lain termasuk kulit / jaringan lunak dan
    SSP.

    Angus DC, et al. Crit Care Med 2001, 29:1303-


    1310.
    Patients at increased risks of
    developing sepsis

    • penyakit yang mendasari: neutropenia, tumor padat,


    leukemia, dysproteinemias, sirosis hati, diabetes, AIDS,
    kondisi kronis yang serius.
    • Operasi atau instrumentasi: kateter.
    • Terapi sebelum obat: obat Immuno-penekan, terutama
    dengan antibiotik spektrum luas.
    • Umur: laki-laki, di atas 40 y; betina, 20-45 y.
    • kondisi Miscellaneous: melahirkan, aborsi septik, trauma dan
    luka bakar luas, ulserasi usus.
    Normal Systemic Response
    to Infection and Injury (1)
    • Leukocytosis Mobilizes neutrophils into the
    circulation
    • Tachycardia Increases cardiac output, blood flow
    to injuried tissue
    • Fever temperature central ↑ peripheral
    vasoconstriction shunts blood flow to
    injuried tissue

    Mandell et al. Principals and Practice of Infectious Diseases6th


    ed;906:906-926.
    Normal Systemic Response
    to Infection and Injury (2)
    • Acute-Phase Responses
    – Anti-infective
    • Increases synthesis of complement factors,
    microbe pattern-recognition molecules(mannose-
    binding lectin, LBP, CRP, CD14, Others)

    Mandell et al. Principals and Practice of Infectious Diseases6th


    ed;906:906-926.
    Normal Systemic Response
    to Infection and Injury (3)
    • Anti-inflammatory
    – anti-inflammatory neuroendocrine hormones ↑ (cortisol,
    ACTH, epinephrine, α-MSH)
    • Increases synthesis of proteins that help prevent
    inflammation within the systemic compartment
    • Cytokine antagonists (IL-1Ra, sTNF-Rs)
    • Anti-inflammatory mediators (e.g.,IL-4, IL-6, IL-6R, IL-10,
    IL-13, TGF-β)
    • Protease inhibitors (e.g.,α1-antiprotease)
    • Antioxidants (haptoglobin)
    Normal Systemic Response
    to Infection and Injury (4)
    • prokoagulan
    • Dinding infeksi, mencegah penyebaran sistemik
    • Meningkatkan sintesis atau pelepasan
    fibrinogen, PAI-1, C4b
    • Mengurangi sintesis protein C, anti-trombin III
    Current Management of Severe Sepsis and Septic Shock l October 16, 2019 l 9
    Current Management of Severe Sepsis and Septic Shock l October 16, 2019 l 10
    Current Management of Severe Sepsis and Septic Shock l October 16, 2019 l 11
    Current Management of Severe Sepsis and Septic Shock l October 16, 2019 l 12
    Patogenesis
    Current Management of Severe Sepsis and Septic Shock l October 16, 2019 l 14
    Pathogenesis of Severe
    Sepsis
    Infection

    Microbial Products
    (exotoxin/endotoxin)

    Cellular Responses
    Platelet Coagulation Kinins Cytokines
    Activation Activation Oxidases Complement TNF, IL-1, IL-6

    Coagulopathy/DIC
    Vascular/Organ System Injury

    Endothelial d h e l i al da mage
    amage Endot
    Multi-Organ Failure

    Death
    Current Management of Severe Sepsis and Septic Shock l October 16, 2019 l 16
    The Sepsis Continuum
    Severe Septic
    SIRS Sepsis Sepsis Shock

    • A clinical response
    arising from a SIRS with a Sepsis with Refractory
    nonspecific insult, presumed organ failure hypotension
    with  2 of the or confirmed
    following: infectious
    • T >38oC or <36oC process
    • HR >90 beats/min
    • RR >20/min SIRS = systemic inflammatory
    • WBC >12,000/mm3 or response syndrome
    <4,000/mm3 or >10%
    bands Chest 1992;101:1644.
    Severe Sepsis

    • Sepsis with organ hypoperfusion one of


    the followings :
    – SBP < 90 mmHg
    – Acute mental status change
    – PaO2 < 60 mmHg
    – Increased lactic acid/acidosis
    – Oliguria
    – DIC or Platelet < 80,000 /mm3
    – Liver enzymes > 2 x normal
    MODS
    (Multiple Organ Dysfunction Syndrome)
    Sepsis dengan hipoperfusi multiorgan
    Dua atau lebih dari yang berikut:
    SBP <90 mmHg
    perubahan status mental akut
    PaO2 <60 mmHg
    Peningkatan asam laktat / asidosis
    oliguria
    DIC atau trombosit <80.000 / mm3
    enzim hati> 2 x biasa
    Corticosteroid
    CNS disease, CS use
    Insufficiency in Acute
    Cytokine
    Illness
    +- •insufisiensi adrenal
    (serum kortisol basal
    rendah atau miskin
    Pituitary apoplexy, CS usemenanggapi
    cirticotropin) adalah
    umum di
    Cytokine,
    anesthetic, • pasien sakit kritis
    antiinfective (30%),
    -
    agents,
    hemorrhage,
    infection • syok septik (50-60%)

     CS-binding
    globulin
     Glucocorticoid
    The Cardiovascular
    System
    Septic Shock

    Decreased Decreased Abnormal


    Volume Pump Vessel
    Function Tone
    Definition of Shock

    • Inadequate tissue perfusion


    • Decreased oxygen supply
    • Anaerobic metabolism
    • Accumulation metabolic waste
    Complications
    • Dewasa sindrom gangguan pernapasan (ARDS)
    • Disebarluaskan Koagulasi intravaskular (DIC)
    • Gagal ginjal akut (ARF)
    • pendarahan usus
    • Gagal hati
    • disfungsi sistem saraf pusat
    • Gagal jantung
    • Kematian

    Angus DC, et al. Crit Care Med 2001, 29:1303-


    1310.
    Sepsis management bundle
    resusitasi cairan
    budaya yang tepat sebelum pemberian
    antibiotik, anti jamur
    Penghapusan sumber: kateter
    Penggunaan vasopressor / inotropik ketika
    cairan
    resusitasi dioptimalkan

    Surviving Sepsis Campaign Management Guidelines Committee. Crit Care Med 2004; 32:858-
    873.
    Sepsis management bundle
    • Evaluasi untuk insufisiensi adrenal: dopamin
    • Stres pemberian kortikosteroid dosis
    • Rekombinan manusia protein diaktifkan C
    (xigris) untuk sepsis berat
    • volume tidal ventilasi mekanis rendah untuk
    ARDS
    • kontrol glukosa ketat
    Surviving Sepsis Campaign Management Guidelines Committee. Crit Care Med 2004; 32:858-
    873.
    Early Goal-
    Directed Therapy

    CVP : central
    venous
    pressure

    MAP : mean
    arterial
    pressure

    ScvO2: central

    venous
    oxygen

    saturation

    NEJM 2001;345:1368-
    77.
    Current Management of Severe Sepsis and Septic Shock l October 16, 2019 l 33
    SEPTIC SHOCK
    MINIMIZING INFLAMMATION
    Rekombinan manusia protein diaktifkan C (Xigris)
    trombin menghambat
    menghambat apoptosis
    Meningkatkan kelangsungan hidup pada pasien dengan disfungsi
    multi-organ
    penekanan peradangan
    pencegahan mikrovaskuler koagulasi (DIC)
    pembalikan gangguan fibrinolisis
    Current Management of Severe Sepsis and Septic Shock l October 16, 2019 l 35
    Conclusion

    Current Management of Severe Sepsis and Septic Shock l October 16, 2019 l 36

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