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Title: Recommendations for sepsis management in resource-limited settings
Authors: 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
Karolinska University Hospital
University of Amsterdam
Keywords: Medicine
Issue Date: 1-Apr-2012
Citation: Intensive Care Medicine. Vol.38, No.4 (2012), 557-574
Abstract: 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.
ISSN: 14321238
Appears in Collections:Scopus 2011-2015

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