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@SepsisUK
The changing face of sepsis.
Dr Ron Daniels FFICM FRCA FRCPEd
CEO, UK Sepsis TrustCEO, Global Sepsis Alliance
Bowel cancer Breast cancer
Annual UK sepsis deaths
Breast cancer
Iceberg?
Iceberg?
Annual UK sepsis deaths
NCEPOD 2015
Iwashyna et al: Long-term cognitive impairment & functional disability among survivors of severe sepsis. JAMA, 2010.
Cognitive impairment
Basics limit severity
Recognition 2014-16
@SepsisUK
BurnsBurns
Systemic Inflammatory Organ dysfunction Hypoperfusion Response (SIRS)
BurnsBurns
Systemic Inflammatory Organ dysfunction Hypoperfusion Response (SIRS)
<1% 10% 35% 50%
Funk and Kumar
Critical Care Clinics 2011 (in press)
‘For each hour’s delay in
administering antibiotics, mortality increases by 7.6%’
Septic shock
BurnsBurns
Systemic Inflammatory
<1% 10% 35% 50%
BurnsBurns
Systemic Inflammatory Organ dysfunction Hypoperfusion Response (SIRS)
<1% 10% 35% 50%
BurnsBurns
Systemic Inflammatory Organ dysfunction Hypoperfusion Response (SIRS)
CVS SBP <90, MAP <70, or SBP decrease >40 SvO2 70% or ScvO2 <65%Cardiac index <3.5 Lmin-1
Decreased capillary refill or mottlingLactate >2 mmolL-1
RS PaO2/FIO2 <300 or SpO2 <90%Renal Urine output <0.5 mLkg-1hr-1 for 2 hrs
Creatinine >177 micromolL-1
Hepatic Bilirubin >4 mgdL-1 or >70mmolL-1
Coagulation INR >1.5 or aPTT >60sPlatelets <100,000 x 106L-1
GI Ileus
3. Is any red flag present?
Systolic B.P < 90 mmHg or MAP < 65 mmHgLactate > 2 mmol/lHeart rate > 130 per minuteRespiratory rate > 25 per minuteOxygen saturations < 91%Responds only to voice or pain/ unresponsivePurpuric rash
Red Flag SepsisThis is a time critical condition, immediate action is required. Assume severe sepsis present.
Sepsis Six1 High-flow oxygen.2 Blood cultures and consider source control. 3 Intravenous antibiotics.4 Intravenous fluid resuscitation.5 Check haemoglobin and serial lactates.6 Hourly urine output measurement. Record the time each of these actions is completed. All actions should be completed as soon as possible but always within 60 minutes.
Communication:Inform senior clinician (e.g. registrar or above).
Additional: Bloods should include: FBC, U/E’s, LFT’s, clotting profile. Observations should be taken every 30 minsLactate should be repeated within 2 hours.Perform a CXR and UrinalysisConsider source control ( e.g. surgical intervention)
Y
3. Is any red flag present?
Systolic B.P < 90 mmHg or MAP < 65 mmHgLactate > 2 mmol/lHeart rate > 130 per minuteRespiratory rate > 25 per minuteOxygen saturations < 91%Responds only to voice or pain/ unresponsivePurpuric rash
Intervention.
@SepsisUK
The Sepsis Six
1. Give high-flow oxygen via non-rebreathe bag2. Take blood cultures and consider source
control3. Give IV antibiotics according to local
protocol4. Start IV fluid resuscitation Hartmann’s or
equivalent5. Check lactate6. Monitor urine output consider catheterisation
within one hour..plus Critical Care support to complete EGDT
Compliance,GHH (%)
Mortality
Cohort size (%)
Mortality % ‘RRR’ %(‘NNT’)
Total 567 (100) 34.7 -
Sepsis Six 347 (61.2) 44.0
Sepsis Six 220 (38.8) 20.0 46.6(4.16)
Fixing things.
@SepsisUK
Annual UK sepsis deaths
Annual UK sepsis deaths
#3andAhalf
bit.ly/SepsisNovel
Annual UK sepsis deaths
Annual UK sepsis deaths
[email protected] @SepsisUK
www.sepsistrust.orgwww.world-sepsis-day.org