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

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Presentation transcript:

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

SURGICAL - “SEPTIC” ICU (01/ /2008) 307 patients severe sepsis/septic shock 195 patients 66 Severe sepsis 129 Septic shock 112 excluded: - cirrhosis waiting list OLT - OLT - Pediatrics ICU ( ) severe sepsis/septic shock

I. Management of Severe Sepsis Initial Resuscitation Initial Resuscitation Diagnosis Diagnosis Antibiotic therapy Antibiotic therapy Source Control Source Control Fluids Fluids Vasopressor Vasopressor Inotropic Therapy Inotropic Therapy Steroids Steroids rhAPC rhAPC Blood Product adiministartion Blood Product adiministartion 50 Strong Recommendations (1 A-C) 19 Weak Recommendations (2 B-D) II. Supportive Therapy of Sepsis Mechanical Ventilation Mechanical Ventilation Sedation Sedation Glucose control Glucose control Renal replacement Renal replacement Bicarbonate Therapy Bicarbonate Therapy Deep Vein Thrombosis Prophylaxis Deep Vein Thrombosis Prophylaxis Stress Ulcer Prophylaxis Stress Ulcer Prophylaxis SDD SDD Limitation of Support Limitation of Support III. Pediatric Consideration in severe sepsis GUIDELINES

SEPSIS BUNDLES

ICU ( ) severe sepsis/septic shock BUNDLES COMPLIANCE Jan 05 Jun 05 July 05 Dec 05 July 06 Dec 06 Jan 06 Jun 06 Jan 07 Jun 07 % patients 6-Hours 24-Hours All bundles EDUCATION PROCESS CHANGES

ICU ( ) severe sepsis/septic shock BUNDLES COMPLIANCE 6H bundle 24 H bundle n =195 Percentage of patients

GIViTI Septic Shock yearSAPS IIMort.H ±1862, ±1859,0 SAPS II 50±1658±2764±2456±1661±1656±2166±2253±1460±1657±17 EDUCATION SEPSIS TEAM SAPS II hospital 30 days TI ( ) severe sepsis/septic shock BUNDLES COMPLIANCE ICU ( ) severe sepsis/septic shock MORTALITY Septic shock n = 129

TI ( ) severe sepsis/septic shock BUNDLES COMPLIANCE ICU ( ) severe sepsis/septic shock MORTALITY (f) BUNDLES

Multivariate Logistic Regression 30-d Mortality Confounders: age, sex, SAPS II, SOFA, Shock, Semester Independent: 9 sepsis interventions* + IgGAM n =129 ICU ( ) severe sepsis/septic shock mortality (f) sepsis interventions Hosmer-Lemeshow = 0,565 * sepsis Interventions 1.Blood Cultures 2.Antibiotic < 3h 3.Source control 4.Fluids 5.SvO2> 70% 6.Glycamia 7.Steroids 8.rhAPC 9.PIP<30cmH20 OR95% CIp Source Control 0,2450,069-0,8710,030 Antibiotic 0,1190,024-0,5920,009 Fluids 5,0071,260-19,900,022 6 H Bundles 0,2740,065-1,1520,077 Steroids 4,2381,13-15,820,032 rhAPC 0,2260,064-0,8030,021 IgGAM 0,0940,019-0,7740,014

77 Spanish ICUs 2804 patients severe sepsis/septic shock Before and after 2 months educational program WHICH INTERVENTION ?