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

Slides:

Advertisements

Similar presentations

R. Phillip Dellinger, MD, MCCM, FCCP

Advertisements

The golden hour(s) for severe sepsis and septic shock treatment

GUIDELINES UPDATED Dr. Akhil Taneja

The New Surviving Sepsis Bundles: From Time Zero to Tomorrow

Copyright Wigfull 2013 The Sepsis Timebomb James Wigfull Critical Care and Anaesthesia Sheffield Teaching Hospitals.

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.

Sepsis Protocol Go Live December 1, 2009 Hendricks Regional Health.

Severe Sepsis Initial recognition and resuscitation

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.

Early Goal Therapy in Severe Sepsis & Septic Shock

MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?

Goal-Directed Resuscitation for Patients with Early Septic Shock NEJM October 2014 ARISE.

Surviving Sepsis Michael Stewart CT2 EM

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.

Department of Anesthesiology and Critical Care Medicine Hadassah Medical Center Steroids: Benefits vs. Risks Risk/Benefit: Where are we now? Charles L.

Sepsis: Evidence Based Controversies

Severe sepsis and septic shock Zsolt Molnár University of Szeged AITI

Surviving Sepsis 2008 Guidelines Early Goal Directed Therapy MAZEN KHERALLAH, MD, FCCP INFECTIOUS DISEASE AND CRITICAL CARE MEDICINE.

Applying the Surviving Sepsis Campaign Guidelines to Clinical Practice

Sepsis course – II. The „debt” which can kill Zsolt Molnár SZTE, AITI.

SEPSIS Where are the goal posts now?. What is the new evidence? RCTs: Trilogy of EGDT trials ( ) RCT: SEPSIS-PAM (2014) RCT: ALBIOS (2014) Observational.

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

Sepsis and Early Goal Directed Therapy

Albumin Safety and Efficacy as a Resuscitative Therapy in the ICU: Are all ICU patients the same? Gary R. Haynes, M.D., Ph.D. Professor, Department of.

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

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.

Severe Sepsis and Septic Shock Abdullah Alsakka EM.Consultant.

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

SIRS Dr. Jonathan R. Goodall M62 Coloproctology Course 31 st March 2006.

QUALI RISULTATI VORRESTI E QUALI HAI Journal Club ‘Sopravvivere alla Sepsi: i primi 5 anni’ 2 dicembre 2010.

Sepsis course – IV: Organ support in sepsis Zsolt Molnár SZTE, AITI.

ITU Journal Club: Dr. Clinton Jones. ST4 Anaesthetics.

COMBINED USE OF TRANSPULMONARY THERMODILUTION (TPTD) TECHNIQUE IN FLUID MANAGEMENT FOR SEPSIS PATIENTS 1 St. Marianna University School of Medicine, Kanagawa,

Jay Green, PGY-4 Dr. Jason Lord August 20,  Dr. Jason Lord  Dr. Dan Howes  Dr. Trevor Langhan  Dr. Aric Storck.

Early goal directed therapy in the treatment of sepsis Nouf Y.Akeel General surgery demonstrator Saudi board trainee R3.

Septic Shock Stuart Forman MD, FAAFP Contra Costa Regional Medical Center June 2009.

United States Statistics on Sepsis

Priyank Desai, MD Ryan Griffin, RN. HOW COMMON? DEFINITION PATHOGENESIS CLINICAL FEATURES MANAGEMENT CORE Measures!!

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

Dr Alex Hieatt, EM Consultant MEHT Dr Ron Daniels, Chair of the UK Sepsis Trust and Global Sepsis Alliance (Slides with permission.)

Risk Factors and Outcome of Changes in Adrenal Response to ACTH in the Course of Critical Illness Margriet Fleur Charlotte de Jong, MD, PhD, Albertus Beishuizen,

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y j 내과 R2 이지영.

Surviving Sepsis 2008 Guidelines Therapy Across the Sepsis Continuum MAZEN KHERALLAH, MD, FCCP INFECTIOUS DISEASE AND CRITICAL CARE MEDICINE.

Anything else? Glucose – tight control must be better NICE-SUGAR study investigators. Intensive versus conventional glucose control in critically ill.

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

UNC Hospitals Sepsis Mortality Reduction Initiative General CMS Compliant Sepsis Training Updated Code Sepsis.

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

Yadegarynia, D. MD..

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

A Randomised Trial of Protocol-Based Care for Early Septic Shock

Code Sepsis: Current Evidence Based Guidelines and the CMS Sepsis Core Measure Adult Patients - Abbreviated Updated August 30, 2017.

Sepsis Surgeon Champions Talking Points

the official training programme of the Surviving Sepsis Campaign

Code Sepsis: Current Evidence Based Guidelines and the CMS Sepsis Core Measure Adult Patients - Abbreviated Updated August 30, 2017.

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

the official training programme of the Surviving Sepsis Campaign

Early Goal Directed Therapy Fondazione Ospedale Maggiore

Advances in Management of Perioperative Hypotension: It Takes a Team

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

Infections in Surgical Patients: Intensive Care Unit

Presentation transcript:

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

Question of the ‘90s Friedman G, Silva E, Vincent JL: Has the mortality of septic shock changed with time? Crit Care Med 1998; 26:

Surviving Sepsis Campaign – 2008 Dellinger RP et al. Intensive Care Med 2008; 34: 17-60

Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Quality of evidence: A: high (RCT) B: moderate (small RCT, excellent observational study) C: low (observational study) D: very low (case series or expert opinion) Strength of recommendation: 1: strong „ recommend” 2: weak „suggest” Dellinger RP et al. Intensive Care Med 2008; 34: 17-60

EGDT –CVP:8-12, MAP>65, UO>0.5ml/kg/h, ScvO 2 >70% (1C) –Christalloid or colloid (1B) Diagnosis –2 or more blood cultures (1C) –Immediate radiology (1C) Antibiotic treatment –<1 h in severe sepsis (1D), septic shock (1B) –Broad spectrum AB (1B) –De-escalation (2D) –Stop AB immediately if there is no infection (1D) Resuscitation and infection

Vasopressors, inotropes –First choice: noradrenalin v. dopamin (1C) –Adrenalin, phenylephrin, vazopresszin: not recommended (2C) –„Renal dose dopamine”: No (1A) –IABP (1D) –First choice inotrope: dobutamine (1C) Blood products –Don’t give: erythropoietin (1B), FFP if there’s no bleeding (2D), antithrombin (1B) –Give platelets: <5000/mm 3, vérzési rizikó esetén, <50000 műtétekhez (2D) Hemodynamics

Activated protein C (rhAPC) –PROWESS (n=1690) 6.1 % reduction in mortality 19.4 % relative risk reduction NNT = 16 –ADDRESS (n=2613) 1.5 % higher mortality in the APC group Postop + 1 organ failure: 6.6 % higher mortality –ENHANCE (n=2378) Give early Recommendation: –Sepsis + high risk (APACHE II>25, MOF): „suggest” (2B, 2C postop) –Severe sepsis + small risk (APACHE II<20, 1 organ failure): not recommended (1A) Adjuvant and supportive care

Glucose control –i.v. inzulin (1B) –„Sliding scale” target: 8.3 mmol/l (2C) Brunkhorst FM, et al: NEJM 2008; 358: Finfer S, et al: NICE-Sugar Study NEJM 2009; 360: Steroids –Therapy resistant hypotension (2C) Sprung CL, et al: NEJM 2008; 358: And many more… (85 all together) Adjuvant and supportive care

Evidence and outcome

Economic implications of an evidence-based sepsis protocol: Can we improve outcome and lower cost? Shorr AF et al. Crit Care Med 2007; 35: 1257 Methods Retrospective post-hoc analysis Pre-protocol: (n=60) Protocol: (n=60) –Surviving Sepsis Campaign: Early AB EGDT Vasopressor/inotrope Transzfusion rhAPC Corticosteroids

Economic implications of an evidence-based sepsis protocol: Can we improve outcome and lower cost? Shorr AF et al. Crit Care Med 2007; 35: 1257 Mortality: 48 vs. 30% (p=0.04)

Finance

1995 (n= ) Mortality: 28.6% LOS: 19.6 nap Cost (S): $ Cost (NS): $ 2005 (n=60) APACHE II: 22.5 ± 8.3 Mortality: 48.3% Cost: $ Cost 2006 (n=44) SAPS II: 46.4 Mortality: 34% LOS: 15.8 nap Income: $ Expense: $ Summary >5000 $ Reason: salary, numbers? USA Hungary (Pécs) Angus DC et al. Crit Care Med 2001; 29: Shorr AF et al. Crit Care Med 2007; 35: 1257 PTE, AITI: „Trauma”-ICU (Csontos Cs, Varga Sz)

Személyi feltételek és a túlélés

Influence of the number of nurses on survival in MSOF Data shown as median (min., max.) and mean ± standard deviation *: p<0.05 compared to Year No of patients on ICU No of patients with MSOF AgeSex (M/F)SAPS IIICU LOS Mortality of all patients on ICU Mortality of MSOF No of nurses on the unit Ratio of qualified nurses Lowest nurse:patient ratio (21,87)69/4249 ± 246 (1,52)22,5%92,8%1457%1: (21,80)44/2545 ± 219 (1,58)25,5%89,9%1546%1: (18,85)68/3851 ± 225 (1,51)30,6%84%1656%1: (20,88)63/2248 ± 218 (1,48)25,8%75,3%*3155%1: (21,87)37/4151 ± 225 (1,61)23,1%65,4%*3059%1:2 Total (18,88)281/16849 ± 227 (1,61)25,3%82,2% Mikor A, et al. Crit Care 2008; 12: S166

Influence of the number of nurses on survival in MSOF Independent predictors of outcome Mikor A, et al. Crit Care 2008; 12: S166

Severe sepsis – mortality can be reduced! Think about it! –Adequate clinical and biochemical investgations Prevention = early resuscitation –Oxygen + fluid + monitoring (ScvO 2 ) Treatment: –ICU Sepsis Less of a diagnosis… …more of a concept Summary

Motto The question isn’t about whether you’ve done the right thing, but whether you’ve done everything to do the right thing. Diagnosis can wait, but cells can’t!