@SepsisUK

The changing face of sepsis.

Dr Ron Daniels FFICM FRCA FRCPEd

CEO, UK Sepsis TrustCEO, Global Sepsis Alliance

Bowel cancer Breast cancer

Annual UK sepsis deaths

Breast cancer

Iceberg?

Iceberg?

Annual UK sepsis deaths

NCEPOD 2015

Iwashyna et al: Long-term cognitive impairment & functional disability among survivors of severe sepsis. JAMA, 2010.

Cognitive impairment

Basics limit severity

Recognition 2014-16

@SepsisUK

BurnsBurns

Systemic Inflammatory Organ dysfunction Hypoperfusion Response (SIRS)

BurnsBurns

Systemic Inflammatory Organ dysfunction Hypoperfusion Response (SIRS)

<1% 10% 35% 50%

Funk and Kumar

Critical Care Clinics 2011 (in press)

‘For each hour’s delay in

administering antibiotics, mortality increases by 7.6%’

Septic shock

BurnsBurns

Systemic Inflammatory

<1% 10% 35% 50%

BurnsBurns

Systemic Inflammatory Organ dysfunction Hypoperfusion Response (SIRS)

<1% 10% 35% 50%

BurnsBurns

Systemic Inflammatory Organ dysfunction Hypoperfusion Response (SIRS)

CVS SBP <90, MAP <70, or SBP decrease >40 SvO2 70% or ScvO2 <65%Cardiac index <3.5 Lmin-1

Decreased capillary refill or mottlingLactate >2 mmolL-1

RS PaO2/FIO2 <300 or SpO2 <90%Renal Urine output <0.5 mLkg-1hr-1 for 2 hrs

Creatinine >177 micromolL-1

Hepatic Bilirubin >4 mgdL-1 or >70mmolL-1

Coagulation INR >1.5 or aPTT >60sPlatelets <100,000 x 106L-1

GI Ileus

3. Is any red flag present?

Systolic B.P < 90 mmHg or MAP < 65 mmHgLactate > 2 mmol/lHeart rate > 130 per minuteRespiratory rate > 25 per minuteOxygen saturations < 91%Responds only to voice or pain/ unresponsivePurpuric rash

Red Flag SepsisThis is a time critical condition, immediate action is required. Assume severe sepsis present.

Sepsis Six1 High-flow oxygen.2 Blood cultures and consider source control. 3 Intravenous antibiotics.4 Intravenous fluid resuscitation.5 Check haemoglobin and serial lactates.6 Hourly urine output measurement. Record the time each of these actions is completed. All actions should be completed as soon as possible but always within 60 minutes.

Communication:Inform senior clinician (e.g. registrar or above).

Additional: Bloods should include: FBC, U/E’s, LFT’s, clotting profile. Observations should be taken every 30 minsLactate should be repeated within 2 hours.Perform a CXR and UrinalysisConsider source control ( e.g. surgical intervention)

Y

3. Is any red flag present?

Systolic B.P < 90 mmHg or MAP < 65 mmHgLactate > 2 mmol/lHeart rate > 130 per minuteRespiratory rate > 25 per minuteOxygen saturations < 91%Responds only to voice or pain/ unresponsivePurpuric rash

Intervention.

@SepsisUK

The Sepsis Six

1. Give high-flow oxygen via non-rebreathe bag2. Take blood cultures and consider source

control3. Give IV antibiotics according to local

protocol4. Start IV fluid resuscitation Hartmann’s or

equivalent5. Check lactate6. Monitor urine output consider catheterisation

within one hour..plus Critical Care support to complete EGDT

Compliance,GHH (%)

Mortality

Cohort size (%)

Mortality % ‘RRR’ %(‘NNT’)

Total 567 (100) 34.7 -

Sepsis Six 347 (61.2) 44.0

Sepsis Six 220 (38.8) 20.0 46.6(4.16)

Fixing things.

@SepsisUK

Annual UK sepsis deaths

Annual UK sepsis deaths

#3andAhalf

bit.ly/SepsisNovel

Annual UK sepsis deaths

Annual UK sepsis deaths

ron@sepsistrust.org @SepsisUK

www.sepsistrust.orgwww.world-sepsis-day.org