Sepsis

Question 1

Drivers of hyperglycemia in inflammatory states: (3)

Answer 1

1) sympathoadrenal response: increase in counter-regulatory hormones
2) systemic inflammatory response, driven by TNF-alpha + IL1 => increase ACTH release -> cortisol release
- intereference with GLUT synthesis and membrane expression
3) Hyperglycemia persists beyond inflammation due to cytokine persistence e.g. resistin

Question 2

How does Hct affect whole blood glucose measurement?

Answer 2

• Hemoconcentration -> erythrocytosis: spuriously low glucose
• Anemia -> over-estimation of glucose can occur

Question 3

What does surviving sepsis recommend for glycemic control?

Answer 3

Insulin initiated in adult patients with BG > 180mg/dL (10mmol/L)
Generally literature shows liberal glycaemic control better than no control or intensive control.

Question 4

Definition of hospital-associated infections

Answer 4

an infectious event that is diagnosed > 48 hours after hospital admission, or more specifically, on or after the third hospital day without proven prior incubation.

Question 5

Risk factors for HAI in the ICU:

Answer 5

1. Prolonged length of hospital stay
2. Mechanical ventilation
3. Indwelling devices
4. Trauma
5. Surgical procedures
6. Antimicrobials other than perioperatively
7. Anti-ulcer medications

Question 5

Definition of sepsis (Sepsis-3)

Answer 5

life-threatening organ dysfunction caused by a dysregulated host response to infection.

Question 6

Definition of septic shock

Answer 6

= Subset of sepsis, in which underlying circulatory and cellular or metabolic abnormalities are profound enough to substantially increase mortality
Clinical construct: persisting hypotension requiring vasopressors to maintain MAP of 65mmHg or above, and having a serum lactate level > 2mmol/L despite adequate volume resuscitation.

Question 7

Surviving Sepsis 2021 hour-1 bundle

Answer 7

1) Measure lactate level.
a. Repeat measurement of lactate if initial lactate is elevated (>2mmol/L)
2) Obtain blood cultures prior to administering antibiotics
3) Administer broad-spectrum antibiotics
4) Begin rapid administration of 30mL/kg crystalloid for hypotension or lactate ≥ 4mmol/L
5) Vasopressors if hypotensive during or after fluid resuscitation to maintain a mean arterial pressure of ≥ 65mmHg