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SEPSIS

RESIDEN BEDAH UMUM 1.0


dr Fathir Yunarfan Fatahaddin
dr Reza Arif Fadillah
dr Ali Akbar Rahmani
dr Dian Sulastri
dr Cytra Givani Rossy
dr Elvira Caesarena
dr Muhammad Ahlidin Firdaus
dr So Zanolo Krisna Payana
Pendahuluan

Brunicardi, F Charles. Schwartz's principles of surgery. 11th edition.: 2018. United States. New York : McGraw-Hill.
Antonelli, M. The Surviving Sepsis Campaign: Internasional Guidelines for Management of Sepsis and Septic Shock: 2017.
SSC Guideline

19 International Association

59 Panel Member
SSC
Guidelines
Process

Rhodes A et al. The Surviving Sepsis Campaign: Internasional Guidelines for Management of Sepsis and Septic Shock:
2016. Intensive Care Medicine. 2017; Vol. 43: 304-77.
Revisi SSC Guideline
Revisi pada tahun 2018
tetap mengacu pada
publikasi SSC Guideline
tahun 2016

1 HOUR BUNDLE

Q SOFA
Rhodes A et al. The Surviving Sepsis Campaign: Internasional Guidelines for Management of Sepsis and Septic Shock:
2016. Intensive Care Medicine. 2017; Vol. 43: 304-77.
.
Definisi Baru Sepsis: Sepsis-3

1991 1991 - 2001 DEFINISI


• Definisi sepsis • gejala dan • SIRS
pertama kali tanda • SEVERE
dikembangkan • clinical bedside SEPSIS
experience • SEPTIC
SHOCK

international task force dengan 19 participant  revisi 


menyingkirkan kriteria SIRS  mengembangkan Sepsis 3
• Levy MM ; Evans LE ; Rhodes A . The Surviving Sepsis Campaign Bundle: 2018 Updates. Critical Care Medicine. June 2018; Vol. 46, No. 6:
997-1000.
• Napolitano, Lena M. Sepsis 2018: Definition and Guideline Changes. Surgical Infection Journal. 2018; Vol. 19, No. 2: 117-25.
Napolitano, Lena M. Sepsis 2018: Definition and Guideline Changes. Surgical Infection Journal. 2018; Vol. 19, No. 2: 117-25.
.
Perkembangan
definisi sepsis

Makic MBF, Bridges Elizabeth. Managing Sepsis and Septic Shock: Current Guidelines and Definitions. Recent Updates
Emphasize Early Recognition and Prompt intervention. AJN February 2018; Vol. 118, No. 2: 34-9.
SOFA
SCORE

• Makic MBF, Bridges Elizabeth. Managing Sepsis and Septic Shock: Current Guidelines and Definitions. Recent Updates Emphasize Early
Recognition and Prompt intervention. AJN February 2018; Vol. 118, No. 2: 34-9.
• Singer, Mervin et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), JAMA. 2016;315(8):801-810.
Quick SOFA

• Makic MBF, Bridges Elizabeth. Managing Sepsis and Septic Shock: Current Guidelines and Definitions. Recent Updates Emphasize Early
Recognition and Prompt intervention. AJN February 2018; Vol. 118, No. 2: 34-9.
• Singer, Mervin et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), JAMA. 2016;315(8):801-810.
Hour 1

• Levy MM ; Evans LE ; Rhodes A . The Surviving Sepsis Campaign Bundle: 2018 Updates. Critical Care Medicine. June 2018; Vol. 46,
No. 6: 997-1000.
• Napolitano, Lena M. Sepsis 2018: Definition and Guideline Changes. Surgical Infection Journal. 2018; Vol. 19, No. 2: 117-25.
• Makic MBF, Bridges Elizabeth. Managing Sepsis and Septic Shock:
Current Guidelines and Definitions. Recent Updates Emphasize Early
Recognition and Prompt intervention. AJN February 2018; Vol. 118,
No. 2: 34-9.
• Napolitano, Lena M. Sepsis 2018: Definition and Guideline Changes.
Surgical Infection Journal. 2018; Vol. 19, No. 2: 117-25.
2018

Same as 2016

Hour-1 Bundle, the most important change in


2018
the revision of SSC is 3-hour and 6-hour
bundle has been combined into “hour-1
bundle” with explicit intention of beginning
highlight
rescucitation and management immidately,
especially in patient hypotension.
Rapidly administered 30 ml/kg crystalloid for
hypotension or lactate >= 4 mmol/L

Same as 2016

• Rhodes A et al. The


Same as 2016
Surviving Sepsis Campaign:
Obtain blood cultures prior to Internasional Guidelines for
administration of antibiotics Management of Sepsis and
Septic Shock: 2016.
Broad spectrum same as 2016 Intensive Care Medicine.
2017; Vol. 43: 304-77.
Same as 2016 • Levy MM ; Evans LE ;
Rhodes A . The Surviving
Same as 2016 Sepsis Campaign Bundle:
2018 Updates. Critical Care
Medicine. June 2018; Vol. 46,
No. 6: 997-1000.
Sebelumnya menggunakan 3 hour and 6 hour checklist

Q SOFA &
1 HOUR BUNDLE
• Levy MM ; Evans LE ; Rhodes A . The Surviving Sepsis Campaign
Bundle: 2018 Updates. Critical Care Medicine. June 2018; Vol. 46, No. 6:
997-1000.
• Napolitano, Lena M. Sepsis 2018: Definition and Guideline Changes.
Surgical Infection Journal. 2018; Vol. 19, No. 2: 117-25.
Penjelasan SSC Sebelumnya
Surviving Sepsis Campaign telah direvisi dalam bundle
penanganan 3 jam dan 6 jam

Yang perlu didapatkan dalam 3 jam untuk Severe Sepsis :


• a. Pemeriksaan Laktat Inisial
• b. Kultur darah dan resistensi antibiotic
• c. pemberian obat obatan antibiotik broad spectrum

Yang perlu didapatkan dalam 6 jam untuk Severe sepsis :


• - Pengulangan pemeriksaan laktat jika laktat >2
Pada SSC 2018

• Surviving Sepsis Campaign telah direvisi dalam bundle


penanganan 3 jam dan 6 jam berubah menjadi 1 jam yang
disebut 1-Hour Bundle dengan tujuan explisit adalah cepat
memulai resusitasi cairan dan beri pengobatan segera
terutama pasien dengan hipotensi

• Berikan secara cepat 30 ml/kg crystalloid untuk hipotensi atau


pada laktat >= 4 mmol/L
Sepsis and septic shock
are medical emergencies
and we recommend that
treatment and
resuscitation begin
immediately.
Best Practice Statement
• Rhodes A et al. The Surviving Sepsis Campaign: Internasional Guidelines for Management of Sepsis and Septic Shock: 2016.
Intensive Care Medicine. 2017; Vol. 43: 304-77.
• Antonelli, M. The Surviving Sepsis Campaign: Internasional Guidelines for Management of Sepsis and Septic Shock: 2017.
The Sepsis 3 App includes the most practical and up-to-date Sepsis Calculators & Data (from the ESICM and the
SCCM 3rd International Consensus (Sepsis-3, 2016)
SOFA, qSOFA, LODS, Sepsis Ward, Sepsis ICU, Sepsis Pro, Septic Shock (with integrated Calculator panels &
Dynamic Tables for visual efficiency).
Sepsis 3 is part of MediCalc®, "The standard for clinical calculations and analytics in Medicine™".
MediCalc® is the best and most comprehensive "Medical Calculator System™" in the world. It performs automatic
computation of more than 450 clinical formulas, equations & scores "commonly used" in medical practice.
REFERENCE
• Brunicardi, F Charles. Schwartz's principles of surgery. 11th edition.: 2018. United States.
New York : McGraw-Hill.
• Makic MBF, Bridges Elizabeth. Managing Sepsis and Septic Shock: Current Guidelines
and Definitions. Recent Updates Emphasize Early Recognition and Prompt intervention.
AJN February 2018; Vol. 118, No. 2: 34-9.
• Levy MM ; Evans LE ; Rhodes A . The Surviving Sepsis Campaign Bundle: 2018 Updates.
Critical Care Medicine. June 2018; Vol. 46, No. 6: 997-1000.
• Napolitano, Lena M. Sepsis 2018: Definition and Guideline Changes. Surgical Infection
Journal. 2018; Vol. 19, No. 2: 117-25.
• Rhodes A et al. The Surviving Sepsis Campaign: Internasional Guidelines for Management
of Sepsis and Septic Shock: 2016. Intensive Care Medicine. 2017; Vol. 43: 304-77.
• Antonelli, M. The Surviving Sepsis Campaign: Internasional Guidelines for Management of
Sepsis and Septic Shock: 2017.
• Singer, Mervin et al. The Third International Consensus Definitions for Sepsis and Septic
Shock (Sepsis-3), JAMA. 2016;315(8):801-810.

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