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Questions and Answers
What is the primary goal of using direct lung protective ventilation in septic shock patients?
Why is renal replacement therapy initiated in septic shock patients?
What is the consequence of sepsis-induced tissue hypoperfusion?
What is the potential benefit of early but short-term vasopressor treatment in septic shock patients?
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What is the primary reason for using mechanical ventilation in septic shock patients?
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What is the consequence of endothelial injury in septic shock patients?
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What is the potential drawback of using small bowel nutrition in critically ill patients?
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Why is providing organ support considered crucial in septic shock patients?
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What is the primary concern when inducing normotension too rapidly in patients not used to such conditions?
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What is the recommended tidal volume for mechanical ventilation in septic shock patients?
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What is the target for plateau pressure in mechanical ventilation?
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What is the recommended inspiratory to expiratory time ratio in mechanical ventilation?
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What is the recommended target for SpO2 in mechanical ventilation?
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What is the recommended approach to prevent ventilator-associated pneumonia?
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What is the preferred mode of renal replacement therapy at the beginning of treatment in septic shock patients?
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What is the recommended approach to achieve better circulatory effect in renal replacement therapy?
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What is the primary benefit of CRRT compared to IHD in septic shock patients?
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What is the recommended approach to prevent reabsorption atelectasis in mechanical ventilation?
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What is the primary concern when delivering RRT in septic shock patients?
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What is the primary role of RRT in septic shock patients?
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What is the indication for RRT in septic shock patients?
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What is the difference between the indication for RRT in septic shock patients and other diseases?
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What is the result of a recent RCT comparing IHD and CRRT in patients with acute kidney injury with sepsis?
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What is the purpose of disease severity scoring system or renal-specific scoring system in RRT?
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What is the primary reason for considering hemodialysis in patients with acute kidney injury with sepsis?
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What is the significance of 'timing of start' in RRT?
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Study Notes
Organ Support Strategies in Sepsis
- Organ support is crucial in septic shock patients, in addition to fluid and antimicrobial treatment.
- Septic shock can lead to tissue hypoperfusion, which causes anaerobic metabolism and mitochondrial dysfunction.
- Early vasopressor treatment may decrease tissue hypoperfusion and improve patient outcomes.
Mechanical Ventilation
- Complications of mechanical ventilation include:
- Increased intrathoracic pressure, which can impair the heart.
- Asynchronies may indicate the need for increased sedation or corrected ventilator settings.
- Ventilator settings:
- Low tidal volume (6-8 ml/kg-IBW).
- Low driving pressure and plateau pressure (≤ 30 cmH2O).
- Permissive hypercapnia (pH > 7.20).
- Respiratory rate (18-25).
- Inspiratory to expiratory time (1:2).
- Inspiratory flow rate (maximal without decelerating flow).
- FiO2 and PEEP combination titration.
- Monitoring oxygenation is essential, with a target SpO2 of 88-95%.
- PEEP should be titrated by equal proportion of FiO2 and PEEP.
- FiO2 should not exceed 0.6 to prevent reabsorption atelectasis.
Renal Replacement Therapy (RRT)
- Different modalities for RRT in septic shock patients:
- Continuous RRT (CRRT) is preferred for hemodynamic stability.
- Intermittent hemodialysis (IHD) can be performed in specific situations.
- Indications for RRT in septic shock:
- Accurate diagnosis of acute kidney injury.
- Choosing the optimal 'timing of start' as part of optimal RRT.
- Physician's individual preference.
- Disease severity scoring system or renal-specific scoring system.
- Clinical features of 'volume overload', 'acute kidney injury with azotemia or catabolism', and 'uremic symptoms'.
- Role of RRT in septic shock:
- RRT is a non-negligible organ support therapy to support, replace, or augment renal function.
- The indication for RRT is not different from other diseases, but the 'timing of start' and modality may vary.
- The main concern is how to deliver RRT effectively, avoiding the effect of 'hyperinflammatory phase in the early period of septic shock'.
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Description
Learn about the evidence-based treatment of organ support strategies in sepsis, including mechanical ventilation and lung-related alterations. Understand the challenges of treating infected patients with septic shock.
