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Sepsis (3rd nov_2011)[1]
- 1. SEPSIS 3rd November 2011 Dr. Vimal Desai
- 2. ∗ What is sepsis? ∗ Why should we be worried? ∗ How to assess ∗ How to manage AIMS
- 4. ∗ Body’s response to infection What is sepsis?
- 5. Why is it important?
- 6. ∗ Sepsis is common ∗ SEPSIS KILLS!!! (36,800 deaths in UK in 2005) ∗ Early intervention saves lives (in a study of over 15,000 patients across 30 countries over 2 years, mortality fell by 20%) Why is it important?
- 7. SIRS
- 8. ∗ 2 or more of... ∗ Temp >38o C or < 36o C ∗ HR > 90 ∗ WCC >12 or <4 ∗ RR > 20 or PaCO2 < 4.2 SIRS
- 10. Sites of infection ∗ Chest ∗ Urine / reproductive♀ ∗ GI ∗ Biliary ∗ Cannula site ∗ Bone / joint / disc ∗ CNS ∗ Endocarditis ∗ ENT ∗ Prosthesis ∗ Skin / soft tissue / wound ∗ Other
- 11. SIRS + Infection = SEPSIS
- 12. Other causes of SIRS
- 13. ∗ Trauma ∗ Major surgery ∗ Blood transfusion ∗ Pancreatitis ∗ PE ∗ ACS Other causes of SIRS
- 15. First hour care in sepsis or ‘sepsis six’
- 16. ∗ High flow oxygen ∗ Peripheral blood cultures ∗ IV antibiotics (as per local policy) ∗ Fluid resuscitate ∗ Serum lactate ∗ Measure hour fluid balance (?catheterise) First hour care in sepsis or ‘sepsis six’
- 17. Next step...
- 18. Evidence of organ dysfunction
- 19. ∗ SBP < 90 / MAP < 65 / fall of 40mmHg ∗ Urine output < 0.5 ml / kg / h for adults ∗ INR > 1.5 ∗ Bilirubin > 34 ∗ Lactate > 2 ∗ O2 needed to keep SaO2 > 90% (new) ∗ Platelets < 100 ∗ Creatinine > 177 ∗ Evidence of organ dysfunction
- 20. Sepsis + Organ Dysfunction = SEVERE SEPSIS Mortality = 35%
- 21. ∗ PaO2 < 8 or SaO2 < 85% on 100% O2 or PaCO2 > 7 (>9 if chronic) or exhaustion ∗ Stridor, tracheal tug or see-saw chest ∗ SBP < 90mmHg despite resuscitation ∗ pH < 7.15 or lactate > 6 (>4 after resus.) ∗ Seizures ∗ GCS < 9 ∗ Arrest ∗ EES > 8 Consider ITU referral if...
- 22. If severe sepsis results in SBP < 90 / MAP < 65 / a fall of 40mmHg or lactate > 4 ↓ SEPTIC SHOCK Mortality = 50%
- 23. Six hour resuscitation bundle
- 24. ∗ Further fluid resuscitation if indicated ∗ Ensure Hb > 7 g / dl ∗ If still shocked (low BP / urine output / high↓ lactate) insert central line and ensure CVP = 8- 12mmHg; consider noradrenaline or dopamine ∗ Check ScvO2; consider dobutamine if <70% Six hour resuscitation bundle
- 25. ∗ APACHE II score ∗ ?Low tidal volume ventilation ∗ Ventilation care bundle ∗ Hydrocortisone ∗ ?vasopressin ∗ ?Activated protein C ITU
- 26. ∗ Assessment of sepsis ∗ Management of sepsis Summary