Early Goal Directed

Therapy
Acara Ilmiah Residen Bedah Umum
SELASA, 24 JUNI 2014
Introduction

National Center for Health Statistics, 2001.

American Cancer Society, 2001. *American Heart Association.

2000.

Angus DC et al. Crit Care Med. 2001;29(7):1303-1310.

AIDS* Colon Breast
Cancer

CHF

Severe
Sepsis

C
a
s
e
s
/
1
0
0
,
0
0
0

0
50
100
150
200
250
300
Incidence of Severe Sepsis Mortality of Severe Sepsis
0
50,000
100,000
150,000
200,000
250,000
D
e
a
t
h
s
/
Y
e
a
r
AIDS*

Severe
Sepsis

AMI

Breast
Cancer


Summary of the 2012 Surviving Sepsis Recommendations
Delinger et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis an
d Septic Shock: 2012. Crit Care Med. 2013;41(2): 580637

A clinical response arising
from a nonspecific insult,
with 2 of the following:
T >38
o
C or <36
o
C
HR >90 beats/min
RR >20/min
WBC >12,000/mm
3
or
<4,000/mm
3
or >10%
bands SIRS = systemic inflammatory response
syndrome
SIRS with a
presumed
or confirmed
infectious
process
Mortality :0-10%

Chest 1992;101:1644.
Sepsis SIRS
Severe
Sepsis
Septic
Shock
Sepsis with
organ disfunct
Or tissue
hipoperfusion
Refractory
Hypotension
Mortality
30-60%

Sepsis and
Severe Sepsis
based on
International
Sepsis
Definitions
Conference
Adapted from Levy MM, Fink MP, Marshall JC, et al: 2001
SCCM/ESICM/ACCP/ATS/SIS International Sepsis
Definitions Conference. Crit Care Med 2003; 31: 1250
1256.
Sepsis and Severe Sepsis based on
International Sepsis Definitions
Conference
Adapted from Levy MM, Fink MP, Marshall JC, et al: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31: 12501256.
Initial Resusitation in Severe Sepsis
2012
Introduction
Definition
EGDT is a sepsis cardiovascular support protocol aimed
at early hemodynamic optimization
The protocol is initiated as soon as sepsis -- induced
hypoperfusion is identified
Targets end points of resuscitation derived from
hemodynamic monitoring (central venous pressure
[CVP], mean arterial pressure [MAP], and central venous
oxygen saturation [Scvo2]).

Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345:13681377
EGDT Protocol
Rivers E, Nguyen B, Havstad
S, et al. Early goal-directed
therapy in the treatment of
severe sepsis and septic
shock. N Engl J Med 2001;
345:13681377

DONT FORGET !
SOURCE CONTROL
TERIMA KASIH


Surviving Sepsis Campaign 2012