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Journals / Türk Anestezi ve Reanimasyon Dergisi / 2007 / Cilt: 35 - Sayı: 6

Importance of early goal directed therapy in sepsis

Sepsis tedavisinde erken yaklaşımın önemi

Nihan YAPICI
İsmail CİNEL
Pages
379–392
Publication Date
2022-11-04
DOI
—
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Using protocolized care approaches widely to follow the objective criteria in critical care medicine, as accepted in science, is vital in sepsis treatment.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:The ability to identify sepsis patients early equilibrates to timely treatment and superior outcome.
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Key Findings & Data:Irrespective of its mechanism of formation, increased lactate levels remains an excellent prognostic marker in sepsis.
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Conclusion & Impact:Using protocolized care approaches widely to follow the objective criteria in critical care medicine, as accepted in science, is vital in sepsis treatment.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Domain Parameters

Abstract

The ability to identify sepsis patients early equilibrates to timely treatment and superior outcome. The treatment of severe sepsis includes three essential principles: eradication of the inciting infection using source control measure and empiric antibiotics, hemodynamic resuscitation of hypoperfusion to avoid acute life-threatening organ dysfunction, and sustained support of organ system dysfunction using interventions that minimize organ injury. Microcirculatory dysfunction causes impairment of tissue perfusion independent of global hemodynamics, and is hypothesized to be a critical factor in the development of sepsis-induced organ dysfunction, especially in the earliest phase of sepsis therapy. Irrespective of its mechanism of formation, increased lactate levels remains an excellent prognostic marker in sepsis. Increased heterogeneity of regional perfusion may be the first sign of organ dysfunction in sepsis. Effective resuscitation requires rapid identification of tissue hypoperfusion and timely interventions for the restoration of adequate tissue perfusion. Targeting microcirculatory failure and keep open microcirculation, like in “open the lung and keep it open” strategy in acute lung injury, could represent a cutting edge strategy to augment tissue perfusion with fluid resuscitation in sepsis treatment. Increasing awareness of early recognition and treatment can halt the progression of sepsis, improving outcomes. Using protocolized care approaches widely to follow the objective criteria in critical care medicine, as accepted in science, is vital in sepsis treatment.

Özet

Sepsiste sağkalım yararı olan tedavilerin çoğu zamana duyarlıdır. Tedavide altın standart erken tanı, erken antibiyoterapi ile birlikte hipoperfüzyonun önlenerek organ yetmezliklerinin önüne geçilmesidir. Makro hemodinamik göstergeleri iyi olan sepsis hastalarinda bile mikrosirkülasyonun bozulmuş olabileceğinin ve hipoperfüzyonun sürebildiğinin akılda tutulması gerekmektedir. Bu bağlamda erken hedefe yönelik tedavinin uygulanması ile birlikte laktat değerlerinin izlenmesi hipoperfüzyon açısından bizlere yol gösterici olabilir. Mikrosirkulasyondaki heterojenitenin artması, sepsiste zamanla gelişecek organ yetmezliklerinin ilk habercisidir. Hasarlanmış akciğerleri korumaya yönelik, alveolleri aç ve açık tut yaklaşımında “recruitment” ve PEEP uygulamasının değeri kadar, inflamasyon ve koagulasyonun aynı anda yoğun bir şekilde tetiklendiği sepsiste de, mikrosirkülasyonun açık tutulmasında sıvı resusitasyonunun önemi büyüktür. Protokol temelli yaklaşımlarla hem erken tanı, hem de tedavide sepsiste önemli ilerlemeler saptandığı gözlenmektedir. Yoğun bakım tıbbında protokol temelli yaklaşımların yaygın kullanılarak subjektifler yerine objektiflere daha fazla bağlı kalınması, bilimsel arenada olması gerektiği gibi, yaşamsal önem taşımaktadır.

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Cite This Article

YAPICI, N., CİNEL, İ. (2022). Importance of early goal directed therapy in sepsis. Türk Anestezi ve Reanimasyon Dergisi, Cilt: 35 - Sayı: 6, 379–392. https://ajindex.com/articles/620028

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