Traumacast EAST/AAST/AAST-AMC: SCC Review Series - Surgical Infections I
Jul 31, 2025
Scott Brakenridge, a renowned sepsis researcher at the University of Washington, joins surgical critical care fellow Erin White to tackle crucial topics in managing surgical infections. They discuss the early management of septic shock and the importance of following the Surviving Sepsis guidelines. The conversation dives into ventilator-associated pneumonia, highlighting preventive measures and treatment protocols. They also explore the complexities of managing C. diff infections and the innovative use of monoclonal antibodies in treating recurrent cases, offering fresh insights into critical care practices.
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Prefer Early Enteral Nutrition
- Start enteral nutrition early rather than early parenteral nutrition and consider feeds even when patients are on vasopressors if tolerated.
- Titrate feeds for patients emerging from shock rather than pushing full feeds immediately.
Targeted Measures For Persistent VAP Rates
- Consider selective digestive decontamination in ICUs with low antibiotic resistance to lower VAP rates, using topical agents plus short IV antibiotics.
- Use subglottic secretion drainage tubes and consider early tracheostomy or postpyloric feeding selectively in high-risk patients.
Old ICU Practices Persist Despite Weak Evidence
- Many once-routine prevention measures (e.g., chlorhexidine oral care) show inconsistent benefit and may be de-emphasized.
- Practices persist because they carry little harm and are entrenched in unit routines despite weak evidence.