R. Phillip Dellinger, MD, MCCM, FCCP

Slides:

Advertisements

Similar presentations

“Surviving Sepsis” Barcelona declaration (ESICM congress, 2002)

Advertisements

A Practical Guide to Prescribing on Day 1! Dr. Liz Gamble

Faculty Mitchell M. Levy, MD, FCCM

Pediatric Septic Shock

GUIDELINES UPDATED Dr. Akhil Taneja

The New Surviving Sepsis Bundles: From Time Zero to Tomorrow

Surviving Sepsis Campaign Database: Revision based on the 2012 Guidelines Christa A. Schorr RN, MSN, FCCM.

Audience Participation

Participating in the Surviving Sepsis Campaign: How It Can Help You! Laura Evans, MD MSc Medical Director of Critical Care Bellevue Hospital NYU School.

Rogers Kyle, MD Medical University of South Carolina 5/21/13

Wes Theurer, DO.  Recognize sepsis early  Understand therapeutic principles  Cultures before antibiotics  Crystalloid fluid resuscitation  Antimicrobials.

Compliance with Severe Sepsis Protocol: Impact on Patient Outcomes Lisa Hurst RN BSN CCRN and Kim Raines RN CCRN References The purpose of this study is.

Shock and Sepsis 2 of 2 William Whitehead, M.D., Ph.D. Department of Anesthesiology.

Severe Sepsis Initial recognition and resuscitation

GAPP Coaching Call Sepsis Working Session August 14, 2014 Jan Ratterree Lynne Hall Jean Allred.

Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock CR 杜宜霖.

FROM CEM SEPSIS TOOLKIT PAPERS TO COVER NGUYEN EARLY LACTATE CLEARANCE IS ASSOCIATED WITH IMPROVED OUTCOME IN SEVERE SEPSIS AND SEPTIC SHOCK P Single.

In 2001, the European Society of Intensive Care Medicine (ESICM), Society of Critical Care Medicine (SCCM), and the International Sepsis Forum (ISF) developed.

Septic Shock Daniel Henning, MD, MPH Acting Instructor Harborview Medical Center Division of Emergency Medicine.

Early Goal Therapy in Severe Sepsis & Septic Shock

Judy Bedard RN, MSN/ED. I do not have any affiliation with Laerdal Corporation that offers financial support for this educational activity.

A REVIEW OF FUNCTIONAL HAEMODYNAMIC MONITORING AJ van den Berg.

Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock Dellinger RP, Levy MM, Rhodes A, Annane D, Carcillo JA, Gerlach H,

SEPSIS Early recognition and management. Aims of the talk Understand the definition of sepsis and severe sepsis Understand the clinical significance of.

Management of Neutropenic Sepsis Rebecca Frewin Consultant Haematologist Gloucestershire Hospitals NHS Foundation Trust.

Sepsis: Evidence Based Controversies

Applying the Surviving Sepsis Campaign Guidelines to Clinical Practice

Monitoring Fluid Responsiveness Murat Sungur, MD Erciyes University Medical School Department of Medicine Division of Critical Care Medicine.

Early Goal-Directed Therapy in Pediatric Sepsis Derek S. Wheeler, MD, FAAP, FCCP, FCCM Associate Professor of Clinical Pediatrics University of Cincinnati.

Reducing Sepsis Mortality

Vasopressors and Inotropes in Canadian Emergency Departments

™ Guidelines for Management of Severe Sepsis/Septic Shock Bekele Afessa, MD.

Sepsis and Early Goal Directed Therapy

Sepsis course – VI: Surviving Sepsis Campaign Zsolt Molnár University of Szeged 2009.

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 A Guide To The Guidelines … Nabil Abouchala,

Pediatric Septic Shock

Reducing Sepsis Mortality Richard Crowell, MD Chief Quality Officer UNM Health System Professor, Dept of Internal Medicine.

Sepsis – What matters David Johnson Traditional care Early recognition Antibiotics Fluids Vasopressors Source control.

SEPSIS & SEPTIC SHOCK Jaime Palomino, MD Pulmonary & Critical Care Medicine Tulane University Health Sciences Center New Orleans, Louisiana.

The Surviving Sepsis Campaign: The Sepsis Epidemic: How to Win.

Prof. Jean-Louis TEBOUL Medical ICU Bicetre hospital University Paris-South France Optimal blood pressure target in septic shock.

Djillali Annane Université de Versailles SQY Université de Paris Saclay Hôpital Raymond Poincaré - APHP.

Copyright 2008 Society of Critical Care Medicine

EXPLORING END USERS’ SYSTEM REQUIREMENTS TO A HANDHELD COMPUTER SUPPORTING BOTH SEPSIS TEST WORKFLOW AND CURRENT IT SOLUTIONS Medinfo /08/2013 Lasse.

National Sepsis Audit National Registrar Research Collaborative Audit Project 2013 Nationally led by SPARCS (Severn and Peninsula Audit and Research Collaborative.

Vasopressors in shock Diane J Lum, PharmD, BCACP Stony Brook University Hospital 9/30/15 1.

Sepsis Management in the Emergency Department Bryon K. Frost, MD, FACEP September 13, 2010 Medical Staff Meeting.

The (Surviving) Sepsis Campaign at Cork University Hospital

United States Statistics on Sepsis

Tiffany M. Osborn, MD University of Virginia ACEP Chair Critical Care Section ACEP Representative Surviving Sepsis Campaign.

Steroid Therapy.

R. Phillip Dellinger, MD Professor of Medicine Robert Wood Johnson Medical School/UMDNJ Director Critical Care Medicine Cooper University Hospital Camden,

The ‘SEPSIS 6’ <insert date> Faculty: <insert faculty>

Bela Patel MD Associate Professor of Medicine UT Health Science Center Houston Memorial Hermann Hospital – Texas Medical Center.

Update in Critical Care Medicine Ann Intern Med 2007;147:

Updated guidelines in septic shock Philippe Montravers Anaesthesia and Surgical ICU, CHU Bichat Claude Bernard, Assistance Publique Hopitaux de Paris,

Code Sepsis: Current Evidence Based Guidelines and the CMS Sepsis Core Measure Adult Patients - Abbreviated Updated May 26, 2017.

Yadegarynia, D. MD..

CALS Instructor Update July 14, 2016

Sepsis Surgeon Champions Talking Points

Rural Emergency Quality Series

Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock Dellinger RP, Levy MM, Rhodes A, Annane D, Carcillo JA, Gerlach.

Early Goal Directed Therapy Fondazione Ospedale Maggiore

Advances in Vasodilatory Shock:

Improving Outcomes for Severe Sepsis and Septic Shock: Tools for Early Identification of At-Risk Patients and Treatment Protocol Implementation Emanuel.

Rural Emergency Quality Series

Activated endothelial cells

Presentation transcript:

R. Phillip Dellinger, MD, MCCM, FCCP Acting Chair & Chief of Department of Medicine Head, Division of Critical Care Medicine Cooper University Hospital Camden, New Jersey Professor of Medicine Cooper Medical School of Rowan University

What’s new with the 2012 guidelines and associated changes in the database R. Phillip Dellinger MD, MCCM Christa A. Schorr RN, MSN, FCCM Cooper Medical School Rowan University Cooper University Hospital Camden, NJ

Potential Conflicts of Interest Neither has direct or indirect potential financial conflict of interest as to any material presented in this presentation As to potential intellectual conflict of interest both hold leadership positions in Surviving Sepsis Campaign

management of severe sepsis and septic shock: 2012 Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2012 R. Phillip Dellinger, Mitchell M. Levy, Andrew Rhodes, Djillali Annane, Herwig Gerlach, Steven M. Opal, Jonathan E. Sevransky, Charles L. Sprung, Ivor S. Douglas, Roman Jaeschke, Tiffany M. Osborn, Mark E. Nunnally, Sean R. Townsend, Konrad Reinhart, Ruth M. Kleinpell, Derek C. Angus, Clifford S. Deutschman, Flavia R. Machado,Gordon D. Rubenfeld, Steven A. Webb, Richard J. Beale, Jean-Louis Vincent, Rui Moreno, and the Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Crit Care Med 2013; 41:580-637 Intensive Care Medicine 2013; ..

Currently Funded with a Gordon and Betty Moore Foundation Grant No direct or indirect industry support for guidelines revision

Grading Quality of Evidence GRADE System A- high quality B- intermediate C- low D- very low Case series or expert opinion Upgrade capability Ungraded (UG) recommendation

Grading Strength of Recommendation GRADE System 1- strong recommendation We recommend 2- weak recommendation We suggest

Early Screening and a Performance Improvement Program

Antibiotic Therapy We recommend that intravenous antibiotic therapy be started as early as possible and within the first hour of recognition of septic shock (1B) and severe sepsis without septic shock (1C). (Best Practice versus Stand of Care)

Resuscitation of Sepsis Induced Tissue Hypoperfusion Recommend MAP 65 mm Hg

FLUID THERAPY

Fluid therapy We recommend crystalloids be used in the initial fluid resuscitation of severe sepsis (Grade 1B).

Fluid therapy We suggest the use of albumin in the fluid resuscitation of severe sepsis and septic shock when patients require substantial amounts of crystalloids (Grade 2C).

Fluid challenge Initial fluid challenge in sepsis-induced tissue hypoperfusion (hypotension or elevated lactate) A minimum of 30ml/kg of crystalloids (a portion of this may be albumin equivalent). (1B)

Vasopressors

Vasopressors We recommend norepinephrine as the first choice vasopressor (Grade 1 B).

Vasopressors 2. We suggest epinephrine (added to and potentially substituted for norepinephrine) when an additional agent is needed to maintain blood pressure (Grade 2B).

Vasopressors 3. Vasopressin .03 units/min can be added to norepinephrine with the intent of raising MAP to target or decreasing or decreasing norepinephrine dosage. (UG)

Phenylephrine Pure vasopressor and in general not recommended

Sepsis Induced Tissue Hypoperfusion (Recommend Quantitative Resuscitation) Requirement for vasopressors after fluid challenge or Lactate ≥ 4 mg/dL The initial resuscitation of the patient is of utmost importance and frequently occurs in the emergency department or on hospital wards.

Initial Resuscitation of Sepsis Induced Tissue Hypoperfusion Recommend Insertion central venous catheter Central venous pressure: 8–12 mm Hg Higher with altered ventricular compliance or increased intrathoracic pressure Grade 1C

Arterial Systolic Pressure Variation Parry-Jones, et al. Int J Respir Crit Care Med 2003;2:67

Effect on Stroke Volume Part A Once the initial Arterial thermodilution Cardiac Output is obtained the system is now calibrated to do the PCCO measurement. PCCO is the measurement of Continuous Cardiac Output which is measured beat to beat. How many of you look at the arterial line wave form to determine if the patient has adequate vascular volume ? Tall narrow and peaked waveform may be an indication of possible hypovolemia. Wide and Fat may be an indication of low vascular volume. The truth is that the area under the arterial wave form is proportional to stroke volume. We determine the stroke volume and multiply it buy the heart rate and get Cardiac Output. t

Effect on Stroke Volume

Effect on Cardiac Filling

Initial Resuscitation of Sepsis Induced Tissue Hypoperfusion Recommend Insertion central venous catheter ScvO2 saturation (SVC)  70% Grade 1C

Lactate Clearance In patients with elevated lactate levels as a marker of tissue hypoperfusion we suggest targeting resuscitation to normalize lactate as rapidly as possible (grade 2C).