1. Surviving Sepsis Michael Stewart CT2 EM
Definition agreed 1992, revised SSC launched 2002 – aim 25% RR by 2009 (10% absolute reduction)
Michael Stewart
CT2 EM

2. Mortality severe sepsis – 30-50%; in septic shock >50%.

3. SIRS + Sepsis Systemic Inflammatory Response Syndrome:
Temp<36/>38.3
HR > 90
RR >20
WCC <4/>12; >10% immature
Acutely altered mental state
BM > 6.6 in absence of diabetes
Sepsis: SIRS caused by infection
SIRS – 2 or more criteria met

4. Severe Sepsis
Severe sepsis – sepsis leading to organ hypoperfusion or hypotension
Septic shock – hypoperfusion persists after adequate fluid resuscitation
Markers – Lactate>2, MAP<65, Cr>177, Bili>34, Plt<100, INR>1.5, APTT>60, UO<0.5ml/kg/hr for 2 hours, increased oxygen requirement to keep SpO2>90%
Septic shock – MAP<65/Lac>4/Lac>4 initially still >2

5. Early Goal Directed Therapy
Fluids (CVP 8-12)
Vasopressors (MAP > 65)
Optimise ScvO2:
Transfusion (Hct > 30%)
Inotropes (ScvO2 > 70%)
CVP if ventilated
ARR 15% in some studies (at 28 days)

6. Sepsis Six Oxygen Cultures IV Antibiotics IV fluid resuscitation
Blood tests, including Lactate
Fluid balance monitoring
Catheter. Aim abx <1hr if direct admission, <3hrs if A+E
20ml/kg IVI if severe sepsis