Recommendations for sepsis management in resource-limited settings
Purpose: To provide clinicians prac ticing in resource-limited settings with a framework to improve the diagnosis and treatment of pediatric and adult patients with sepsis. Methods: The medical literature on sepsis management was reviewed. Specific attention was paid to identify clinical evidence on...
Saved in:
Main Authors: | , , , , , , , , |
---|---|
Other Authors: | |
Format: | Article |
Published: |
2018
|
Subjects: | |
Online Access: | https://repository.li.mahidol.ac.th/handle/123456789/14890 |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
Institution: | Mahidol University |
id |
th-mahidol.14890 |
---|---|
record_format |
dspace |
spelling |
th-mahidol.148902018-06-11T12:14:02Z Recommendations for sepsis management in resource-limited settings Martin W. Dünser Emir Festic Arjen Dondorp Niranjan Kissoon Tsenddorj Ganbat Arthur Kwizera Rashan Haniffa Tim Baker Marcus J. Schultz St. Johanns-Spital Mayo Clinic in Jacksonville, Florida Mahidol University The University of British Columbia Central State University Hospital Makerere University UCL Karolinska University Hospital University of Amsterdam Medicine Purpose: To provide clinicians prac ticing in resource-limited settings with a framework to improve the diagnosis and treatment of pediatric and adult patients with sepsis. Methods: The medical literature on sepsis management was reviewed. Specific attention was paid to identify clinical evidence on sepsis management from resource-limited settings. Results: Recommendations are grouped into acute and post-acute interventions. Acute interventions include liberal fluid resuscitation to achieve adequate tissue perfusion, normal heart rate and arterial blood pressure, use of epinephrine or dopamine for inadequate tissue perfusion despite fluid resuscitation, frequent measurement of arterial blood pressure in hemodynamically unstable patients, administration of hydrocortisone or prednisolone to patients requiring catecholamines, oxygen administration to achieve an oxygen saturation[90%, semi-recumbent and/or lateral position, non-invasive ventilation for increased work of breathing or hypoxemia despite oxygen therapy, timely administration of adequate antimicrobials, thorough clinical investigation for infectious source identification, fluid/tissue sampling and microbiological workup, removal, drainage or debridement of the infectious source. Post-acute interventions include regular reassessment of antimicrobial therapy, administration of antimicrobials for an adequate but not prolonged duration, avoidance of hypoglycemia, pharmacological or mechanical deep vein thrombosis prophylaxis, resumption of oral food intake after resuscitation and regaining of consciousness, careful use of opioids and sedatives, early mobilization, and active weaning of invasive support. Specific considerations for malaria, puerperal sepsis and HIV/AIDS patients with sepsis are included. Conclusion: Only scarce evidence exists for the management of pediatric and adult sepsis in resourcelimited settings. The presented recommendations may help to improve sepsis management in middle- and low-income countries. © Copyright jointly held by Springer and ESICM 2012. 2018-06-11T05:14:02Z 2018-06-11T05:14:02Z 2012-04-01 Article Intensive Care Medicine. Vol.38, No.4 (2012), 557-574 10.1007/s00134-012-2468-5 14321238 03424642 2-s2.0-84862535428 https://repository.li.mahidol.ac.th/handle/123456789/14890 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84862535428&origin=inward |
institution |
Mahidol University |
building |
Mahidol University Library |
continent |
Asia |
country |
Thailand Thailand |
content_provider |
Mahidol University Library |
collection |
Mahidol University Institutional Repository |
topic |
Medicine |
spellingShingle |
Medicine Martin W. Dünser Emir Festic Arjen Dondorp Niranjan Kissoon Tsenddorj Ganbat Arthur Kwizera Rashan Haniffa Tim Baker Marcus J. Schultz Recommendations for sepsis management in resource-limited settings |
description |
Purpose: To provide clinicians prac ticing in resource-limited settings with a framework to improve the diagnosis and treatment of pediatric and adult patients with sepsis. Methods: The medical literature on sepsis management was reviewed. Specific attention was paid to identify clinical evidence on sepsis management from resource-limited settings. Results: Recommendations are grouped into acute and post-acute interventions. Acute interventions include liberal fluid resuscitation to achieve adequate tissue perfusion, normal heart rate and arterial blood pressure, use of epinephrine or dopamine for inadequate tissue perfusion despite fluid resuscitation, frequent measurement of arterial blood pressure in hemodynamically unstable patients, administration of hydrocortisone or prednisolone to patients requiring catecholamines, oxygen administration to achieve an oxygen saturation[90%, semi-recumbent and/or lateral position, non-invasive ventilation for increased work of breathing or hypoxemia despite oxygen therapy, timely administration of adequate antimicrobials, thorough clinical investigation for infectious source identification, fluid/tissue sampling and microbiological workup, removal, drainage or debridement of the infectious source. Post-acute interventions include regular reassessment of antimicrobial therapy, administration of antimicrobials for an adequate but not prolonged duration, avoidance of hypoglycemia, pharmacological or mechanical deep vein thrombosis prophylaxis, resumption of oral food intake after resuscitation and regaining of consciousness, careful use of opioids and sedatives, early mobilization, and active weaning of invasive support. Specific considerations for malaria, puerperal sepsis and HIV/AIDS patients with sepsis are included. Conclusion: Only scarce evidence exists for the management of pediatric and adult sepsis in resourcelimited settings. The presented recommendations may help to improve sepsis management in middle- and low-income countries. © Copyright jointly held by Springer and ESICM 2012. |
author2 |
St. Johanns-Spital |
author_facet |
St. Johanns-Spital Martin W. Dünser Emir Festic Arjen Dondorp Niranjan Kissoon Tsenddorj Ganbat Arthur Kwizera Rashan Haniffa Tim Baker Marcus J. Schultz |
format |
Article |
author |
Martin W. Dünser Emir Festic Arjen Dondorp Niranjan Kissoon Tsenddorj Ganbat Arthur Kwizera Rashan Haniffa Tim Baker Marcus J. Schultz |
author_sort |
Martin W. Dünser |
title |
Recommendations for sepsis management in resource-limited settings |
title_short |
Recommendations for sepsis management in resource-limited settings |
title_full |
Recommendations for sepsis management in resource-limited settings |
title_fullStr |
Recommendations for sepsis management in resource-limited settings |
title_full_unstemmed |
Recommendations for sepsis management in resource-limited settings |
title_sort |
recommendations for sepsis management in resource-limited settings |
publishDate |
2018 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/14890 |
_version_ |
1763488348577464320 |