medreg+1 loveridge acute medicine
TRANSCRIPT
Developing people for health and healthcare
Sepsis
Acute Medicine
24th July
The story behind sepsis management
Developing people forhealth and healthcare
OUTLINE
• To summarize the background behind sepsis management guidance
• To understand why simplified guidelines are being promoted
• • To consider briefly some of the possible
future trends in sepsis care
Developing people forhealth and healthcare
Developing people forhealth and healthcare
Developing people forhealth and healthcare
Developing people forhealth and healthcare
Developing people forhealth and healthcare
Developing people forhealth and healthcare
Developing people forhealth and healthcare
Developing people forhealth and healthcare
WHY WAS SIMPLIFICATION NEEDED?
• Poor compliance with bundles• Guidance involves some complex
measures• Mortality still stands at 30-35%• 36,800 lives lost annually in UK• Sepsis costs the NHS £2.5 billion
Developing people forhealth and healthcare
THE SEPSIS SIX
• Lactate• Blood cultures• Early antibiotic administration• Fluid resuscitation• Urine output monitoring• High flow oxygen
Developing people forhealth and healthcare
WHY THE SEPSIS SIX?
Developing people forhealth and healthcare
PREDICTED BENEFITS OF SEPSIS SIX
• Achieving 80% compliance with Sepsis Six expected to save 15,000 lives per year in UK
• …..and £170,000,000• (Extrapolated from unpublished data
relating to reduced length of stay)
Developing people forhealth and healthcare
Developing people forhealth and healthcare
THE PROCESS TRIAL
• Did not show statistically significant survival of patients treated with EGDT over and above less aggressive protocols or ‘usual care’
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WHAT NEXT?
• PROMISE & ARISE trials• NICE Guideline due 2016• Targeted in the National Outcomes
Framework for the NHS Commissioning Board
• Research into biomarkers, pathogen recognition, pathogenesis, targeted therapy
Developing people forhealth and healthcare
REFERENCES AND FURTHER READING
• Surviving sepsis campaign:International Guideline for Management of Severe Sepsis and Septic Shock 2012 http://www.sccm.org/Documents/SSC-Guidelines.pdf
• Surviving the first hours in sepsis: getting the basics right (an intensivist’s perspective) J Antimicrob Chemother 2011: 66 Suppl 2 ii11-1123
• A randomized trial of protocol-based care for early septic shock; The Process Investigators NEJM 2014; 370:1683-1693
• Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program; Critical care medicine; August 2014 (42) Issue 8: 1794-1755
Developing people forhealth and healthcare
References continued
• The Ombudsman report 2013
• http://www.ombudsman.org.uk/__data/assets/pdf_file/0004/22666/FINAL_Sepsis_Report_web.pdf
• The UK Sepsis Trust report 2013
• http://www.england.nhs.uk/wp-content/uploads/2013/12/spesis-brief.pdf