SEPSIS – What is Sepsis? <insert date> Surviving Sepsis – ‘Recognise and Act’ <insert date> Faculty: <insert faculty>

Sepsis Aims: To improve the recognition, assessment and management of septic patients To drive improvements in patient outcomes from episodes of sepsis Objectives: To learn the terminology associated with sepsis To increase knowledge of the sepsis 6 To be aware of special circumstances © SaIL Centre 2015

What is sepsis? 26 year old female Complaining of abdominal pain Fevers, chills, rigors Temperature 39.4ºC Heart rate 120 BP 130/70 RR 18 Sats 98% on air Is this sepsis? Why? © SaIL Centre 2015

SIRS Criteria What are the SIRS criteria? Temp <36 or >38 HR >90 RR >20/min or PaCO2 <32mmHg WCC <4 or >12; >10% immature Forms Acutely Altered Mental State Hyperglycaemia; BM >7.7 in absence Of Diabetes Mellitus © SaIL Centre 2015

SIRS Criteria What support do we have to identify SIRS criteria and hence Septic patients? © SaIL Centre 2015

© SaIL Centre 2015

The NEWS scoring actually reflects the latest evidence on identification of septic patients with poor outcomes. High respiratory rate, low blood pressure and confusion are the strongest markers of poor outcome and are more sensitively detected in NEWS than in PAR scoring. © SaIL Centre 2015

GSTT version

What is sepsis? 66 year old with known Systemic Lupus Erythematosis On steroids Presents with muscle aches and pains Noted to have fevers HR 95 Temperature 37.8ºC RR 16 BP 150/90 WCC 16 Is this sepsis? Why? © SaIL Centre 2015

What is sepsis? 45 year old male Known heavy alcohol intake Presents with severe epigastric pain HR 120 BP 155/80 Temp 37.4 RR 28 Sats 95% on air Is this sepsis? Why? © SaIL Centre 2015

SIRS + SEPSIS Sepsis is the combination of an infection (purple circle) and SIRS – the systemic inflammatory response syndrome. There are other causes of SIRS (see circles on right) and not all infections cause sepsis (where specific infection circles don’t overlap into the central pink sepsis area)

Sepsis © SaIL Centre 2015

Organ Dysfunction in Severe Sepsis Systolic blood pressure <90 mmHg or >40 mmHg fall from baseline, or mean arterial pressure <65 mmHg. Bilateral pulmonary infiltrates with new need for oxygen to maintain saturations >90%, or with PaO2/FiO2 ratio<300 (mmHg) or 39.9 (kPa). Lactate >2.0 mmol/l. Serum creatinine >176.8 μmol/l or urine output <0.5 ml/kg/hr for 2 successive hours. INR (international normalisation ratio) >1.5 or aPTT (activated partial thromboplastin time) >60 s. Platelet count <100x109/l. Bilirubin >34.2 μmol/l. © SaIL Centre 2015

Sepsis ≥2 SIRS Criteria Temp <36 or >38 HR >90 RR >20/min or PaCO2 <32mmHg WCC <4 or >12 >10% immature Forms Acutely Altered Mental State Hyperglycaemia BM >7.7 in absence Of Diabetes Mellitus ≥2 SIRS Criteria Hyperglycaemia (>7.7) in the absence of DM Septic shock is when sepsis (infection + SIRS) becomes unresponsive to fluid resuscitation © SaIL Centre 2015

Sepsis In the UK it is estimated that sepsis kills 37,000 patients per year. © SaIL Centre 2015

Sepsis Original Article Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock Emanuel Rivers M.D et al N Engl J Med 2001; 345:1368-1377 November 8, 2001 © SaIL Centre 2015

Sepsis In order to target sepsis, an international campaign was launched. This led to the development of the Sepsis Bundle concept.. Which was shown to significantly improve mortality Sepsis consumes at least 50% of critical care resources The Surviving Sepsis Campaign created evidence-led guidelines (2008, updated 2012) which led to the concept of the resuscitation bundle. © SaIL Centre 2015

Sepsis © SaIL Centre 2015

Sepsis But…… In a survey in 2009, only 14% of patients were receiving the complete Sepsis bundle… In recognition of this, the Sepsis 6 was developed. 6 key, early interventions Previously identified as poorly performed Use of the Sepsis 6 reduced mortality 20.0% vs 44.1% (p <0.001) What are the Sepsis 6…? © SaIL Centre 2015

The Sepsis 6 High flow Oxygen Cultures Antibiotics IV fluids Lactate & Hb Hourly Urine output All within 1 hour… © SaIL Centre 2015

SEPSIS NPSA Alert September 2014 NPSA alert in September 2014 – More to be done to identify and treat sepsis quickly. © SaIL Centre 2015

Sepsis – horizon scanning Coming in 2015-2016… © SaIL Centre 2015

Sepsis – horizon scanning Sepsis Guidelines coming July 2016 © SaIL Centre 2015

GSTT version The new GSTT Sepsis Screening Tool Flow from identification (Pt unwell or via NEWS), to identifying SIRS, to asking ?infection. This leads to identification of organ hypo-perfusion, advises the administration of the Sepsis 6 and early call for senior support.

Sepsis The Sepsis 6 Video © SaIL Centre 2015