ICS State of the Art Meeting - 2015

1. @SepsisUK
Sepsis. Process & scale
Dr Ron Daniels FFICM FRCA FRCPEd
CEO, UK Sepsis Trust
CEO, Global Sepsis Alliance

5. Breast cancer

6. Breast cancer

7. Breast cancer

8. Breast cancer

11. Iwashyna et al: Long-term cognitive impairment & functional disability among survivors of severe sepsis.
JAMA, 2010.
16.8
3.8
6.2
7.1
0 5 10 15 20
Moderate-severe
Mild
Before sepsis After sepsis
Cognitive impairment

12. Basics limit severity

13. Recognition 2014-16
@SepsisUK

14. Burns
Burns
Infection Sepsis
Severe
Sepsis
Septic
shock
Systemic Inflammatory Organ dysfunction Hypoperfusion
Response (SIRS)

15. Burns
Burns
Infection Sepsis
Severe
Sepsis
Septic
shock
Systemic Inflammatory Organ dysfunction Hypoperfusion
Response (SIRS)
<1% 10% 30% 50%

16. Funk and Kumar
Critical Care Clinics 2011 (in press)
‘For each hour’s delay in
administering antibiotics,
mortality increases by
7.6%’
Septic
shock

17. Burns
Burns
Infection Sepsis
Severe
Sepsis
Septic
shock

18. Burns
Burns
Infection Sepsis
Severe
Sepsis
Septic
shock
Systemic Inflammatory
Response (SIRS)
<1% 10% 35%

21. CVS SBP <90, MAP <70, or SBP decrease >40
SvO2 70% or ScvO2 <65%
Cardiac index <3.5 Lmin-1
Decreased capillary refill or mottling
Lactate >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 >60s
Platelets <100,000 x 106L-1
GI Ileus

22. Prehospital SepsisScreeningandActionTool
1. Areany2of thefollowingpresent?
Temperature > 38.30Cor < 360C
Respiratoryrate > 20per minute
Heart rate > 90per minute
Acuteconfusion/ reducedconsciouslevel
Glucose > 7.7mmol/l (unlessDM)
3. Isanyredflagpresent?
SystolicB.P< 90mmHg
Lactate> 2mmol/l
Heart rate> 130per minute
Respiratoryrate> 25per minute
Oxygensaturations< 91%
Respondsonlytovoiceor pain/ unresponsive
Purpuricrash
Sepsisnot present
Treat tostandardprotocols
RedFlagSepsis
Thisisatimecritical condition,
immediateactionisrequired.
Resuscitation:
250ml bolusescrystalloidtomaximum2000ml
(careinCHD)
Oxygen15L/minNRB (careinCOPD)
Intravenousantibiotics(ifavailable)
Recordlactate(ifavailable)
Communication:
Pre-alert receivinghospital ofRedFlagSepsis
Divert totheEmergencyDepartment
(or other agreeddestination)
Handover presenceofRedFlagSepsis
Y
Y
Y
Sepsispresent
Transport todesignated
destination.
Communicatepresenceof
sepsisat handover
N
N
N
Sepsisisatimecritical condition. Screening, earlyinterventionandimmediatetreatment saveslives.
Thistool shouldbeappliedtoall adult patientswhoarenot pregnant whohaveasuspected
infectionor their clinical observationsareoutsideofnormal limits
2. Couldthisbeasevereinfection?
For example:
Pneumonia
UrinaryTract Infection
Abdominal painor distension
Meningitis
Cellulitis/ septicarthritis/ infectedwound

23. 3. Is any red flag present?
Systolic B.P < 90 mmHg or MAP < 65 mmHg
Lactate > 2 mmol/l
Heart rate > 130 per minute
Respiratory rate > 25 per minute
Oxygen saturations < 91%
Responds only to voice or pain/ unresponsive
Purpuric rash
Red Flag Sepsis
This is a time critical
condition, immediate action
is required. Assume severe
sepsis present.
Sepsis Six
1 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 mins
Lactate should be repeated within 2 hours.
Perform a CXR and Urinalysis
Consider source control ( e.g. surgical
intervention)
Y

24. 3. Is any red flag present?
Systolic B.P <90 mmHg/MAP <65 mmHg
Lactate >2 mmol/l
Heart rate >130 per minute
Respiratory rate >25 per minute
Oxygen saturations <91%
Responds only to voice or
pain/unresponsive
Purpuric rash

25. NCEPOD 2015
@SepsisUK

28. At least
53% of
patients
had sepsis
prior to
arrival in
hospital

33. Fixing the system.
@SepsisUK

34. The Sepsis Six
1. Give oxygen as needed to target SpO2 > 94%
2. Take blood cultures consider source control
3. Give IV antibiotics according to local protocol
4. Start IV fluid resuscitation Hartmann’s or equivalent
5. Check lactate repeat within 2h
6. Monitor urine output consider catheterisation
within one hour
..plus Critical Care support to complete EGDT

42. Breast cancer

43. Mortality

44. Breast cancer

45. ron@sepsistrust.org
@SepsisUK
www.sepsistrust.org
www.world-sepsis-day.org