Nonpharmacologic Therapy

^ Evaluate septic patients for the presence of a localized infection amenable to source control measures. Common source control measures include drainage and

debridement, device removal, and prevention. - Implementation of source control methods should be instituted as soon as possible following initial fluid resuscitation. The selection of optimal source control methods must weigh benefits and risks of the intervention. Source control measures may cause complications (bleeding, fistulas,

and organ injury), therefore the method with the least risk should be employed. Prognosis

There are various factors that influence outcome. Gramnegative bacteria are more likely to produce septic shock than gram-positive bacteria (50% versus 25%) and have a higher mortality than other pathogens. This may be related to the severity of the underlying condition. Patients with rapidly fatal conditions, such as leukemia, aplastic anemia, and burn patients have a worse prognosis than patients with nonfatal underlying conditions, such as diabetesme llitus or chronicrenal insufficiency. Other factors that worsen the prognosis of septic patients are: advanced age, malnutrition, resistant bacteria, utilization of medical devices, and immunosuppression. Data for long-term mortality are lacking (it is estimated that the mortality for sepsis survivors within the first year is 20%).5 Patients may have prolonged physical disability related to muscle weakness and posttraumatic stress.

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