SEPSISEarly recognition and management

Aims of the talk

• Understand the definition of sepsis and severe sepsis • Understand the clinical significance of a diagnosis of sepsis and

severe sepsis• Understand the potential outcomes of sepsis and severe sepsis• Understand the SEPSIS SIX and management of sepsis and

severe sepsis• Know that without prompt recognition of sepsis appropriate

management of the patient will be inevitably delayed and therefore survival chances also

• Be empowered to know that YOU can make a difference

Surviving sepsis

• Sepsis is defined as the presence (probable or documented) of infection together with systemic manifestations of infection.

• Severe sepsis is defined as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion.

Is sepsis important?

• Risen by 329% in 20 years (likely to rise 1.5%/yr)

• Worldwide 18 million die from Sepsis each yr.

• 1, 400 die per day

• Most common cause of death in ICU

• 30% of patients in UK ICU have it

• Cost implication

• UK Sepsis Trust: 37,000 people are estimated to die of sepsis each year in the UK

• Sepsis is a more common reason for hospital admission than heart attack – and has a higher mortality

• Most common causes of severe sepsis:– Pneumonia– Bowel perforation– Urinary infection– Severe skin infection– ……infection complicating childbirth although less common

overall, leading cause of direct maternal death

Does early recognition and management of patients with sepsis matter?

• Strong relationship between delay in receiving first dose of effective antimicrobial and mortality– adjusted odds ratio 1.119 per hour delay (CI 1.103-1.136,

p<0.0001)– each hour delay in first 6 hours increases mortality by

7.6%

‘Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock’ – Kumar A, Roberts D, Wood KE et al. Critical Care Medicine (2006); 34: 1589-1596

How can we improve management of patients with sepsis?

THE SEPSIS SIX

SEPSIS SIX

Six elements of care to be delivered to the patient within the first hour following the time at which severe sepsis is first present (or at admission to hospital)

The SEPSIS SIX empowers non-specialist staff to be able to contribute to the delivery of essential and life-saving treatments rapidly

SEPSIS SIX

1. Give high flow oxygen via non-rebreathe bag

2. Take blood cultures

3. Give IV antibiotics

4. Start IV fluid resuscitation Hartmann’s or equivalent

5. Check haemoglobin and lactate

6. Monitor accurate hourly urine output may require catheter

Does the SEPSIS SIX approach work?

UK hospital 2007-2008 575 patients treated for severe sepsis

200 patients received Sepsis Six within one hour 25% mortality

375 patients did not receive within one hour 40% mortality

Striking mortality reduction of nearly 40% For every six patients successfully treated an

extra life is saved (urgent angioplasty for acute coronary syndrome requires over 40 patients to be treated to save an extra life)

You can make a difference