UPDATES IN SEPSIS MANAGEMENT Shannon Fry, Pharm.D. Critical Care Pharmacy Specialist St. Joseph Medical Center
|
|
- Allyson Johnston
- 5 years ago
- Views:
Transcription
1 UPDATES IN SEPSIS MANAGEMENT Shannon Fry, Pharm.D. Critical Care Pharmacy Specialist St. Joseph Medical Center DISCLOSURE I have no financial relationships to disclose OBJECTIVES At the completion of this program, the participant will be able to: Describe the 2012 Sepsis Campaign Guidelines List new sepsis management trials Cite evidence for recent updates to the 2012 Surviving Sepsis Campaign Guidelines Critically analyze new evidence regarding sepsis management and its place in therapy guidance 1
2 SELF-ASSESSMENT QUESTIONS What guideline updates have been released by the Surviving Sepsis Campaign Committee? How have the ProCESS, ARISE and ProMISe studies influenced the 2012 Surviving Sepsis Campaign Guidelines? What have the conclusions been of recent trials regarding early goal-directed therapy in sepsis management? How does the newest evidence in sepsis management influence the use of the current Surviving Sepsis Campaign Guidelines? SURVIVING SEPSIS GUIDELINE REVIEW SEPSIS Definitions The presence of infection together with systemic manifestations of infection SIRS plus infection Severe sepsis is sepsis associated with organ dysfunction or tissue hypoperfusion Septic shock is sepsis-induced hypotension persisting despite adequate fluid resuscitation Sepsis-induced tissue hypoprofusion is hypoperfusion persisting after initial fluid challenge or blood lactate 4 2
3 GRADING Quality of evidence A- high quality B- intermediate C- low D- very low Case series or expert opinion Strength of recommendation 1- strong recommendation We recommend 2- weak recommendation We suggest SURVIVING SEPSIS CAMPAIGN 1 A collaboration between the U.S. Society of Critical Care Medicine (SCCM), the European Society of Intensive Care Medicine, and the International Sepsis Forum Consensus committee of 65 international experts representing 26 international organizations Last updated 2012 Continues to recommend early goal-directed therapy INITIAL RESUSCITATION, SCREENING AND DIAGNOSIS Goals for resuscitation (1C): CVP 8-12 MAP 65 UOP 0.5 ml/kg/hr ScvO2 70% or SvO2 65% Resuscitation should target normalization of lactate levels in facilities that do not have the capability to target central venous oxygenation saturation (2C) Screening processes should occur to assist in early sepsis identification (1C) Cultures should be obtained before antimicrobial therapy initiation (1C) Diagnostic assays could be utilized in patients at risk for fungal sepsis (2B-C) 3
4 INFECTION ISSUES: ANTIMICROBIAL THERAPY Administration of effective IV antimicrobial within the first hour of recognition of septic shock and severe sepsis (1C) Regimen should be assessed daily for potential de-escalation (1B) Empiric combination therapy should be considered in neutropenic patients, or those with risk factors for MDROs (2B) Typical duration of therapy 7-10 days (2C) Procalcitonin should not be used as a diagnostic tool for severe sepsis (2C) Low procalcitonin levels can be used as a marker for discontinuation of empiric antibiotics INFECTION ISSUES: SOURCE CONTROL AND INFECTION PREVENTION Recommends rapid diagnosis and intervention as appropriate for source control (1C) Digestive tract and oropharyngeal decontamination may be investigated to reduce VAP (2B) Oral chlorhexidine gluconate FLUID THERAPY The use of crystalloids for initial fluid resuscitation is recommended (1B) Albumin may be added to the initial fluid resuscitation (2C) Hydroxyethyl startches (hetastarches) with molecular weight greater than 200 daltons or a degree of substitution more than 0.4 should not be used (1B) The initial fluid challenge in suspected hypovolemic patents should be 1 L or more to achieve a minimum of 30 ml/kg (1C 4
5 VASOPRESSORS AND INOTROPIC THERAPY Norepinephrine is identified as the first-choice vasopressor (1B) Epinephrine may be added or substituted (2B) Vasopressin 0.03 units/minute may be added (UG) Dopamine is identified as an alternative vasopressor in patients at very low risk of arrhythmias, and with a low cardiac output and/or heart rate (2C) Dobutamine may be started or added to a vasopressor in the presence of myocardial dysfunction or ongoing signs of hypoperfusion (1C) STEROIDS IV corticosteroids should not be used if fluid resuscitation or vasopressor therapy is able to restore hemodynamic stability (2C) When hemodynamic stability cannot be achieved, hydrocortisone 200 mg daily as a continuous infusion is recommended (2C-D) No value to ACTH stimulation testing (2B) OTHER SUPPORTIVE THERAPIES Blood product administration based on labs (1B-2D) Mechanical ventilation of sepsis-induced ARDS Higher levels of PEEP are recommended (2C) Recruitment maneuvers may be used in patients with severe hypoxemia on high PEEP and FiO2 (2C) Prone position can be considered for patients with PaO2/FiO2 ratios < 100 (2B) Conservative fluid use when tissue hypoprofusion is not present (1C) Recommend against beta 2-agonist use without indication (1B) Glycemic control to goal glucose levels 180 (1A) Recommends enteral feeding over parenteral nutrition for first 7 days (2B) 5
6 SURVIVING SEPSIS CAMPAIGN BUNDLES To be completed within 3 hours Measure lactate level Obtain blood cultures prior to administration of antibiotics Administer broad spectrum antibiotics Administer 30 ml/kg crystalloids for hypotension or lactate 4 To be completed within 6 hours Initiate vasopressors for hypotension not responsive to initial fluid resuscitation to maintain a MAP 65 If persistent arterial hypotension despite volume resuscitation, or initial lactate 4, measure CVP and ScvO2 Remeasure lactate if initial was elevated RECENT RESEARCH EARLY GOAL-DIRECTED THERAPY IN THE TREATMENT OF SEVERE SEPSIS AND SEPTIC SHOCK 2 Primary basis for EGDT 2001 randomized study enrolling 263 patients Patients received either 6 hour EGDT or standard therapy Primary outcome: hospital mortality Results: EGDT mortality 30.5%; standard therapy 46.5% P=0.009 Significant decrease in mortality seen with EGDT 6
7 PROCESS TRIAL randomized study enrolling 1341 patients Patients randomized to one of three groups for comparison Protocol-based EGDT Protocol-based standard therapy Usual care Primary outcome: 60-day in-hospital mortality Results: EGDT mortality 21%, PBST mortality 18.2%, UC mortality 18.9% Found no significant difference in outcomes between groups ARISE TRIAL randomized study enrolling 1600 patients Patients randomized to received either EGDT or usual care Primary outcome: 90-day all-cause mortality Results: EGDT mortality 18.6%, UC mortality 18.8% Found mortality benefit from EGDT META-ANALYSIS review Effect of goal-directed therapy on mortality 13 trials including 2,525 patients Did not include the ARISE Trial GDT significantly reduced overall mortality RR 0.83 (95% CI ) Subgroup analysis Only EGDT (within first 6 hours) had mortality benefit RR 0.77 (95% CI ) VS RR 0.92 (95% CI ) 7
8 PROMISE TRIAL randomized trial enrolling 1260 English patients Patients randomized to 6-hour EGDT protocol or usual care Primary outcome: 90-day all-cause mortality Results: EGDT mortality 29.5%, UC mortality 29.2% Found no significant mortality benefit with EGDT EGDT was associated with increased costs IMPRESS STUDY prospective, observational, quality improvement study Examined the effects of compliance with the 3- hour and 6-hour Surviving Sepsis Campaign bundles on outcomes 1,794 patients from 62 countries Overall compliance with all 3 hour bundle metrics was 19% Associated with improved hospital mortality (20 vs 31%, p<0.001) 6 hour bundle matric compliance was 36% Associated with improved hospital mortality (22 vs 32%, p< 0.001) Compliance with bundles significantly decreased mortality APPLYING THE LITERATURE 8
9 SURVIVING SEPSIS CAMPAIGN BUNDLES UPDATES To be completed within 3 hours Measure lactate level Obtain blood cultures prior to administration of antibiotics Administer broad spectrum antibiotics Administer 30 ml/kg crystalloids for hypotension or lactate 4 To be completed within 6 hours Initiate vasopressors for hypotension not responsive to initial fluid resuscitation to maintain a MAP 65 If persistent arterial hypotension despite volume resuscitation, or initial lactate 4, reassess volume status and tissue perfusion by either: Repeat focused exam by provider, including vital signs, cardiopulmonary review, capillary refill, pulse, and skin findings, OR Two of the following: measure CVP, measure ScvO2, bedside cardiac echo, or dynamic assessment of fluid responsiveness via passive leg raise for fluid challenge Remeasure lactate if initial was elevated EGDT- WHERE DO WE GO NOW? Is EGDT debunked? Critically review the literature What is usual care? Has this changed? External validity APACHE II scores Mortality rates ROLE OF EGDT Beneficial elements that are now part of usual care Early detection Antibiotics within 1 hour Adequate fluid resuscitation Elements that may not be necessary Oximetric monitoring Inotropes Others? 9
10 CMS REQUIREMENTS CMS REQUIREMENTS Implemented October 1, 2015 Within 3 hours of severe sepsis presentation Lactate level Blood cultures drawn prior to antibiotics Broad spectrum antibiotics Administer 30 ml/kg crystalloid fluids for hypotension or lactate 4 Within 6 hours Repeat lactate if initial level >2 IF persistent hypotension after fluids Vasopressors to maintain MAP 65 mmhg Repeat volume status and tissue perfusion assessment Also required if initial lactate was 4 CMS REQUIREMENTS The terms severe sepsis or septic shock must be used to clearly define time zero Any delineation from protocol must be supported by patient or family refusal of treatment For patients with septic shock, repeat volume status and tissue perfusion assessment can be done in 2 ways: Focused provider exam documenting vital signs, cardiopulmonary exam, capillary refill, peripheral pulses, skin color and circulation Two of the following: CVP measurement, ScvO2 measurement, bedside cardiac echo, passive leg raise or fluid challenge 10
11 SUMMARY SUMMARY Guidelines recommend early goal-direct therapy New data may suggests lack of benefit from EGDT Confounded by the definition of standard of care CMS requirements follow EGDT SELF-ASSESSMENT QUESTIONS What guideline updates have been released by the Surviving Sepsis Campaign Committee? How have the ProCESS, ARISE and ProMISe studies influenced the 2012 Surviving Sepsis Campaign Guidelines? What have the conclusions been of recent trials regarding early goal-directed therapy in sepsis management? How does the newest evidence in sepsis management influence the use of current Surviving Sepsis Campaign Guidelines? 11
12 QUESTIONS? REFERENCES 1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, Intensive Care Med Feb;39(2): Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med Nov 8;345(19): ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC. A randomized trial of protocol-based care for early septic shock. N Engl J Med May 1;370(18): ARISE Investigators; ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, Webb SA, Williams P. Goal-directed resuscitation for patients with early septic shock. N Engl J Med Oct 16;371(16): Gu WJ, Wang F, Bakker J, Tang L, Liu JC. The effect of goal-directed therapy on mortality in patients with sepsis - earlier is better: a meta-analysis of randomized controlled trials. Crit Care Oct 20;18(5): Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM; ProMISe Trial Investigators. Trial of early, goaldirected resuscitation for septic shock. N Engl J Med Apr 2;372(14): Rhodes A, Phillips G, Beale R, Cecconi M, Chiche JD, De Backer D, Divatia J, Du B, Evans L, Ferrer R, Girardis M, Koulenti D, Machado F, Simpson SQ, Tan CC, Wittebole X, Levy M. The Surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study). Intensive Care Med Sep;41(9):
6/5/2014. Sepsis Management and Hemodynamics. 2004: International group of experts,
Sepsis Management and Hemodynamics Javier Perez-Fernandez, M.D., F.C.C.P. Medical Director Critical Care Services, Baptist t Hospital of Miamii Medical Director Pulmonary Services, West Kendall Baptist
More informationRalph Palumbo, MD, FCCP
Ralph Palumbo, MD, FCCP Septic shock is the leading cause of mortality in patients admitted to the ICU In the United States alone there are over 750,000 cases of severe sepsis and septic shock annually
More informationSurviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Mitchell M. Levy MD, MCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care
More informationSepsis Management Update 2014
Sepsis Management Update 2014 Laura J. Moore, MD, FACS Associate Professor, Department of Surgery The University of Texas Health Science Center, Houston Medical Director, Shock Trauma ICU Texas Trauma
More informationSurviving Sepsis Campaign Guidelines 2012 & Update for David E. Tannehill, DO Critical Care Medicine Mercy Hospital St.
Surviving Sepsis Campaign Guidelines 2012 & Update for 2015 David E. Tannehill, DO Critical Care Medicine Mercy Hospital St. Louis Be appropriately aggressive the longer one delays aggressive metabolic
More informationSepsis is an important issue. Clinician s decision-making capability. Guideline recommendations
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 Clinicians decision-making capability Guideline recommendations Sepsis is an important issue 8.7%
More informationSepsis: Identification and Management in an Acute Care Setting
Sepsis: Identification and Management in an Acute Care Setting Dr. Barbara M. Mills DNP Director Rapid Response Team/ Code Resuscitation Stony Brook University Medical Center SEPSIS LECTURE NPA 2018 OBJECTIVES
More informationBC Sepsis Network Emergency Department Sepsis Guidelines
The provincial Sepsis Clinical Expert Group developed the BC, taking into account the most up-to-date literature (references below) and expert opinion. For more information about the guidelines, and to
More informationManagement of Severe Sepsis:
Management of Severe Sepsis: Update from the Surviving Sepsis Campaign Barbara Birriel, MSN, ACNP-BC, FCCM The Pennsylvania State University NONE Disclosures Review evidence-based international sepsis
More informationSeptic Shock. Rontgene M. Solante, MD, FPCP,FPSMID
Septic Shock Rontgene M. Solante, MD, FPCP,FPSMID Learning Objectives Identify situations wherein high or low BP are hemodynamically significant Recognize complications arising from BP emergencies Manage
More informationWhy does it matter? Sepsis
Sepsis 2015 Mitchell M. Levy MD, FCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care Warren Alpert Medical School of Brown University Providence, RI Sepsis Why does it matter?
More informationSepsis Management: Past, Present, and Future
Sepsis Management: Past, Present, and Future Benjamin Ferrell, MD Tennessee ACP Meeting October 28, 2017 Learning Objectives Identify the most updated definition and clinical criteria for sepsis Describe
More informationUpdates On Sepsis Updates based on 2016 updates on sepsis from The International Surviving Sepsis Campaign
Updates On Sepsis Updates based on 2016 updates on sepsis from The International Surviving Sepsis Campaign Dr. Joseph K Erbe, DO Medical Director Hospitalist Division of Medicine Objectives 1. Review the
More informationNothing to disclose 9/25/2017
Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Nothing to disclose 1 Explain
More information9/25/2017. Nothing to disclose
Nothing to disclose Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Explain
More informationSepsis and Hemodynamic Support in September 15, 2017 Carleen Risaliti
Sepsis and Hemodynamic Support in 2017 September 15, 2017 Carleen Risaliti Objectives Review fluid resuscitation guidelines in septic shock Discuss volume assessment v. fluid responsiveness Evaluate pros
More informationSepsis: Getting to ZERO Probable or Impossible?
Sepsis: Getting to ZERO Probable or Impossible? Carol A Rauen, RN-BC, MS, CCRN, PCCN, CEN Independent Clinical Nurse Specialist & Education Consultant. Burn Trauma ICU, Sentara Norfolk General, VA Sepsis
More informationEFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK. Alexandria Rydz
EFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK Alexandria Rydz BACKGROUND- SEPSIS Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated
More informationUpdate in Sepsis. Conflicts of Interest: None. Bill Janssen, M.D.
Update in Sepsis Bill Janssen, M.D. Associate Professor of Medicine National Jewish Health University of Colorado Denver Conflicts of Interest: None A 62 year-old female presents to the ED with fever,
More informationTroubleshooting Audio
Welcome! Audio for this event is available via ReadyTalk Internet Streaming. No telephone line is required. Computer speakers or headphones are necessary to listen to streaming audio. Limited dial-in lines
More informationThe Ever Changing World of Sepsis Management. Laura Evans MD MSc Medical Director of Critical Care Bellevue Hospital
The Ever Changing World of Sepsis Management Laura Evans MD MSc Medical Director of Critical Care Bellevue Hospital COI Disclosures No financial interests to disclose Learning Objectives Review the evolution
More informationDiagnosis and Management of Sepsis. Disclosures
Diagnosis and Management of Sepsis David Shimabukuro, MDCM Medical Director, 13 ICU Physician Lead, UCSF Sepsis Bundle Compliance and Mortality Reduction I have no disclosures Disclosures 1 The following
More informationSepsis Bundle Project (SEP) Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: April 2015 Most recent Revision: December 2018
Sepsis Bundle Project (SEP) Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: April 2015 Most recent Revision: December 2018 Objectives 1. To identify the symptom of severe sepsis and septic shock syndrome.
More informationEARLY GOAL DIRECTED THERAPY : seminaires iris. Etat des lieux en Daniel De Backer
EARLY GOAL DIRECTED THERAPY : Etat des lieux en 2017 Daniel De Backer Head Dept Intensive Care, CHIREC hospitals, Belgium Professor of Intensive Care, Université Libre de Bruxelles Past-President European
More informationSEPSIS UPDATE WHY DO WE NEED A CORE MEASURE CHAD M. KOVALA DO, FACOEP, FACEP
SEPSIS UPDATE WHY DO WE NEED A CORE MEASURE CHAD M. KOVALA DO, FACOEP, FACEP OBJECTIVES Arise, ProMISE, ProCESS Key points in sepsis management The CMS sepsis core measure COST OF SEPSIS CARE IN US Most
More informationStaging Sepsis for the Emergency Department: Physician
Staging Sepsis for the Emergency Department: Physician Sepsis Continuum 1 Sepsis Continuum SIRS = 2 or more clinical criteria, resulting in Systemic Inflammatory Response Syndrome Sepsis = SIRS + proven/suspected
More informationSepsis 2015: You say you wanted a revolution
Thomas Jefferson University Jefferson Digital Commons Pulmonary and Critical Care Medicine, Presentations and Grand Rounds Division of Pulmonary and Critical Care Medicine 6-10-2015 Sepsis 2015: You say
More informationObjectives. Management of Septic Shock. Definitions Progression of sepsis. Epidemiology of severe sepsis. Major goals of therapy
Objectives Management of Septic Shock Review of the Evidence and Implementation of Pediatric Guidelines at Christus Santa Rosa Manish Desai, M.D. PL 5 2 nd year Pediatric Critical Care Fellow Review of
More informationFluid Resuscitation and Monitoring in Sepsis. Deepa Gotur, MD, FCCP Anne Rain T. Brown, PharmD, BCPS
Fluid Resuscitation and Monitoring in Sepsis Deepa Gotur, MD, FCCP Anne Rain T. Brown, PharmD, BCPS Learning Objectives Compare and contrast fluid resuscitation strategies in septic shock Discuss available
More informationCore Measures SEPSIS UPDATES
Patricia Walker, RN-BC, BSN Evidence Based Practice Manager Quality Management Services UCLA Health System, Ronald Reagan Medical Center Core Measures SEPSIS UPDATES Severe Sepsis and Septic Shock Based
More informationSepsis. From EMS to ER to ICU. What we need to be doing
Sepsis From EMS to ER to ICU What we need to be doing NEHAL BHATT, MD ATHENS PULMONARY, CRITICAL CARE AND SLEEP Objectives 1. Define the changes to the definition of Sepsis 2. Describe the assessment,
More informationSepsis and septic shock: can we win the battle against this hidden crisis?
REVIEW ARTICLE Sepsis and septic shock: can we win the battle against this hidden crisis? V.G. Dassanayake Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka Key words : Sepsis;
More informationSEPSIS 2015 DISCLOSURES FINANCIAL DISCLOSURES 9/1/2015. William M. Johnson, MD Nebraska Pulmonary Specialties. William Johnson
SEPSIS 2015 William M. Johnson, MD Nebraska Pulmonary Specialties 1 DISCLOSURES William Johnson No financial interests related to this presentation 2 FINANCIAL DISCLOSURES I do however have 3 children
More informationSurviving Sepsis Campaign
Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview By professor Ahmad Alaysh BMC-MICU 1 Surviving Sepsis A global program to Reduce mortality rates in severe
More informationSurviving Sepsis. Brian Woodcock MBChB MRCP FRCA FCCM
1 Surviving Sepsis Brian Woodcock MBChB MRCP FRCA FCCM 2 Disclosures No conflicts of interest 3 Sepsis Principles of management of septic shock in the operating room "Surviving Sepsis" guidelines 4 Add-on
More informationSepsis overview. Dr. Tsang Hin Hung MBBS FHKCP FRCP
Sepsis overview Dr. Tsang Hin Hung MBBS FHKCP FRCP Epidemiology Sepsis, severe sepsis, septic shock Pathophysiology of sepsis Recent researches and advances From bench to bedside Sepsis bundle Severe sepsis
More informationOHSU. Update in Sepsis
Update in Sepsis Jonathan Pak, MD June 1, 2017 Structure of Talk 1. Sepsis-3: The latest definition 2. Clinical Management - Is EGDT dead? - Surviving Sepsis Campaign Guidelines 3. A novel therapy: Vitamin
More informationThe syndrome formerly known as. Severe Sepsis. James Rooks MD. Coordinator of critical care education OU College of Medicine, Tulsa
The syndrome formerly known as Severe Sepsis James Rooks MD Coordinator of critical care education OU College of Medicine, Tulsa Disclosures I have no actual or practical conflicts of interest in relation
More informationDiagnosis and Management of Sepsis and Septic Shock. Martin D. Black MD Concord Pulmonary Medicine Concord, New Hampshire
Diagnosis and Management of Sepsis and Septic Shock Martin D. Black MD Concord Pulmonary Medicine Concord, New Hampshire Financial: none Disclosures Objectives: Identify physiologic principles of septic
More informationEvidence-Based. Management of Severe Sepsis. What is the BP Target?
Evidence-Based Management of Severe Sepsis Michael A. Gropper, MD, PhD Professor and Vice Chair of Anesthesia Director, Critical Care Medicine Chair, Quality Improvment University of California San Francisco
More information6-horas 24 horas Coleta de lactato Hemoculturas. Corticosteróides. Controle glicêmico. Fluidos/vasopressores. Otimização de SvO 2
Novas diretrizes da Surviving Sepsis Campaign 2012 o que foi atualizado? Os pacotes da sepse 6-horas 24 horas Coleta de lactato Hemoculturas Corticosteróides Antibióticos Proteína C ativdada Fluidos/vasopressores
More informationSteps to Success in Sepsis ASHNHA Quality Webinar. Maryanne Whitney, RN, CNS, MSN Improvement Advisor, Cynosure Health
1 Steps to Success in Sepsis ASHNHA Quality Webinar Maryanne Whitney, RN, CNS, MSN Improvement Advisor, Cynosure Health Goals for Today State the Problem: Create Awareness & Will Unravel the mysteries
More informationDESIGNER RESUSCITATION: TITRATING TO TISSUE NEEDS
DESIGNER RESUSCITATION: TITRATING TO TISSUE NEEDS R. Phillip Dellinger MD, MSc, MCCM Professor and Chair of Medicine Cooper Medical School of Rowan University Chief of Medicine Cooper University Hospital
More informationInitial Resuscitation of Sepsis & Septic Shock
Initial Resuscitation of Sepsis & Septic Shock Dr. Fatema Ahmed MD (Critical Care Medicine) FCPS (Medicine) Associate professor Dept. of Critical Care Medicine BIRDEM General Hospital Is Sepsis a known
More informationThe Septic Patient. Dr Arunraj Navaratnarajah. Renal SpR Imperial College NHS Healthcare Trust
The Septic Patient Dr Arunraj Navaratnarajah Renal SpR Imperial College NHS Healthcare Trust Objectives of this session Define SIRS / sepsis / severe sepsis / septic shock Early recognition of Sepsis The
More informationEarly Goal-Directed Therapy
Early Goal-Directed Therapy Where do we stand? Jean-Daniel Chiche, MD PhD MICU & Dept of Host-Pathogen Interaction Hôpital Cochin & Institut Cochin, Paris-F Resuscitation targets in septic shock 1 The
More informationActualités de la prise en charge hémodynamique initiale Daniel De Backer
Actualités de la prise en charge hémodynamique initiale Daniel De Backer Head Dept Intensive Care, CHIREC hospitals, Belgium Professor of Intensive Care, Université Libre de Bruxelles Past- President European
More informationSepsis or Severe Sepsis? Is there a right thing, and how do we do it?
Sepsis or Severe Sepsis? Is there a right thing, and how do we do it? Steven Q Simpson, MD, FCCP, FACP Professor of Medicine Division of Pulmonary and Critical Care University of Kansas Disclosures No
More informationSepsis Update: Focus on Early Recognition and Intervention. Disclosures
Sepsis Update: Focus on Early Recognition and Intervention Jessie Roske, MD October 2017 Disclosures I have no actual or potential conflict of interest in relation to this program/presentation. I will
More informationGuidebook for ED and Inpatient Sepsis Order Set Initiatives 2018
Background The leadership of the Surviving Sepsis Campaign (SSC) believes, since its inception, that both the SSC Guidelines and the SSC performance improvement indicators (1) will evolve as new evidence
More informationFluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE In critically ill patients: too little fluid Low preload,
More informationNQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE. Measure Information Form Collected For: CMS Only
Last Updated: Version 5.2 NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE Measure Set: Sepsis Set Measure ID #: Measure Information Form Collected For: CMS Only Performance Measure Name: Early
More informationPediatric Sepsis Treatment:
Disclosures Pediatric Sepsis Treatment: (treat) Early & (reevaluate) Often None June 11, 2018 Leslie Dervan, MD MS Pacific Northwest Sepsis Conference 1 Agenda Sepsis: pathophysiology at-a-glance Pediatric
More informationGuidelines are the Future of Sepsis Management Pro
Guidelines are the Future of Sepsis Management Pro R. Phillip Dellinger MD, MCCM Professor and Chair of Medicine Director Adult Health Institute Senior Critical Care Attending Camden NJ USA Objectives
More informationThe 2016 Surviving Sepsis Guidelines have arrived, a
A Users Guide to the 2016 Surviving Sepsis Guidelines R. Phillip Dellinger, MD, MCCM Christa A. Schorr, RN, MSN, FCCM Cooper University Health and Cooper Medical School of Rowan University Camden, NJ Mitchell
More informationPatient Safety Safe Table Webcast: Sepsis (Part III and IV) December 17, 2014
Patient Safety Safe Table Webcast: Sepsis (Part III and IV) December 17, 2014 Presenters Mark Blaney, RN Regional Nurse Educator CHI Franciscan Health Karen Lautermilch Director, Quality & Performance
More information2016 Sepsis Update: Pearls, Pitfalls, and Core Measure Quicksand
2016 Sepsis Update: Pearls, Pitfalls, and Core Measure Quicksand Jack Perkins, MD FACEP, FAAEM, FACP Assistant Professor of Emergency and Internal Medicine Virginia Tech Carilion School of Medicine Why
More informationSepsis Update Disclosures. Definitions. Objectives. Diagnosis. Diagnosis 9/21/15
Sepsis Update 2015 Nathaniel D. Curl, MD FACEP UnityPoint Health-Trinity Disclosures I received an all-expenses paid trip in March 2011 from Edwards, the manufacturer of the PreSep catheter, to attend
More information9/9/15. Sepsis Update: Early identification and management. Objectives. Incidence & Mortality. Blaizie Goveas, MS, APRN, AGACNP- BC
Sepsis Update: Early identification and management Blaizie Goveas, MS, APRN, AGACNP- BC Objectives Understanding what is sepsis and the severity of the disease process. Epidemiology of sepsis Identifying
More information4/4/2014. Of patients diagnosed with sepsis 50% will develop severe sepsis 25% will develop shock. SIRS Sepsis Severe Septic Sepsis Shock.
A summary of pathophysiology, therapeutics, and how the pharmacy TECHNICIAN can help improve OUTCOMES Anthony Nelson 2014 Pharm.D. Candidate Tricia Aggers, Pharm.D. Affiliate Faculty, ISU College of Pharmacy
More informationUpdate of Sepsis: Recent Evidences about Early Goal Directed Therapy
REVIEW http://dx.doi.org/10.4046/trd.2015.78.3.156 ISSN: 1738-3536(Print)/2005-6184(Online) Tuberc Respir Dis 2015;78:156-160 Update of Sepsis: Recent Evidences about Early Goal Directed Therapy Woo Hyun
More informationINTENSIVE CARE MEDICINE CPD EVENING. Dr Alastair Morgan Wednesday 13 th September 2017
INTENSIVE CARE MEDICINE CPD EVENING Dr Alastair Morgan Wednesday 13 th September 2017 WHAT IS NEW IN ICU? (RELEVANT TO ANAESTHETISTS) Not much! SURVIVING SEPSIS How many deaths in England were thought
More informationJawad Nazir, MD, FACP Medical Director, Infection Prevention and Control Avera Health and Avera McKennan Hospital Clinical Associate Professor of
Jawad Nazir, MD, FACP Medical Director, Infection Prevention and Control Avera Health and Avera McKennan Hospital Clinical Associate Professor of Medicine Sanford School of Medicine, Univ of South Dakota
More informationA Critical Review of Early Goal Directed Therapy and Government Endorsement
A Critical Review of Early Goal Directed Therapy and Government Endorsement Charles Natanson M.D. Critical Care Medicine Department Clinical Center National Institutes of Health Clinical Center None Conflicts
More informationThe Management of Septic Shock
The Management of Septic Shock Anthony J. Courey, MD Assistant Professor of Medicine Associate Director, CCMU Pulmonary & Critical Care Medicine No conflicts No disclosures Conflicts & Disclosures Overview
More informationSepsis Review. Angela Craig APN,MS,CCNS Clinical Nurse Specialist Intensive Care Unit Cookeville Regional Medical Center
Sepsis Review Angela Craig APN,MS,CCNS Clinical Nurse Specialist Intensive Care Unit Cookeville Regional Medical Center acraig@crmchealth.org Discuss the Updated International Guidelines Discuss how you
More informationSUCCESS IN SEPSIS MORTALITY REDUCTION. Maryanne Whitney RN MSN CNS Improvement Advisor, Cynosure Health HRET HEN AK Webinar
SUCCESS IN SEPSIS MORTALITY REDUCTION Maryanne Whitney RN MSN CNS Improvement Advisor, Cynosure Health HRET HEN AK Webinar Got Sepsis? Now What?- Alerts & Bundles Maryanne Whitney RN, MS, CNS Improvement
More informationTaiwan Crit. Care Med.2009;10: C 1. CVP 8~12 mmhg 2. MAP 65 mmhg 1. 1B
6 24 1C 1. CVP 8~12 mmhg 2. MAP 65 mmhg 3. 0.5 ml 4. 70% 65% 1 colloid crystalloid 1B SAFE albumin 2 813 386 07-346-8278 07-350-5220 E-mail shoalin01@.gmail.com 21 p=0.09 prospective meta-analysis 3-5
More informationThe Surviving Sepsis Campaign: Where have we been and where are we going?
MEDICAL GRAND ROUNDS EDUCATIONAL OBJECTIVE: Readers will consider the recommendations of the Surviving Sepsis Campaign when treating patients with sepsis R. PHILLIP DELLINGER, MD, MSc, MCCM Professor and
More informationSurviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012
Intensive Care Med (2013) 39:165 228 DOI 10.1007/s00134-012-2769-8 GUIDELINES R. P. Dellinger Mitchell M. Levy Andrew Rhodes Djillali Annane Herwig Gerlach Steven M. Opal Jonathan E. Sevransky Charles
More informationWhere did it all begin?
EXPLORE Healthcare Summit Sepsis: Can We Finally Just Relax on the SOFA? Mark Keuchel, D.O. Background: 1. Sepsis is a wide-spectrum disease process that remains poorly understood 2. Early-goal directed
More informationSepsis - A Year in Transition
Sepsis - A Year in Transition Todd L. Allen, MD, FACEP Chair, Emergency Department Development Team; Assistant Quality Officer, Institute for Healthcare Leadership Russell R. Miller, III, MD, MPH, FCCM
More informationSEPSIS: IT ALL BEGINS WITH INFECTION. Theresa Posani, MS, RN, ACNS-BC, CCRN M/S CNS/Sepsis Coordinator Texas Health Harris Methodist Ft.
SEPSIS: IT ALL BEGINS WITH INFECTION Theresa Posani, MS, RN, ACNS-BC, CCRN M/S CNS/Sepsis Coordinator Texas Health Harris Methodist Ft. Worth 1 2 3 OBJECTIVES Review the new Sepsis 3 definitions of sepsis
More informationFLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL
FLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL COLLEGE NOVEMBER 10 TH 2017 TEXAS SCCM SYMPOSIUM Disclosures
More informationEarly goal-directed therapy Where to from here? Rinaldo Bellomo ANZIC Research Centre Melbourne, Australia
Early goal-directed therapy Where to from here? Rinaldo Bellomo ANZIC Research Centre Melbourne, Australia Early goal-directed therapy in septic shock 2001 Proof-of-concept EGDT trial published NEJM 16%
More informationShould Roids Be the Rage in Septic Shock? Lauren Powell, MSN, RN, CCRN, AGACNP-BC CHI Baylor St. Luke s Medical Center, Houston, TX
Should Roids Be the Rage in Septic Shock? Lauren Powell, MSN, RN, CCRN, AGACNP-BC CHI Baylor St. Luke s Medical Center, Houston, TX Learning Objectives 1. Review the mechanism of action for the use of
More informationDr. İsa KILIÇASLAN Gazi University School of Medicine
Dr. İsa KILIÇASLAN Gazi University School of Medicine ystemic Inflammatory Response Syndrome (SIRS) Temp > 38.3 C or < 36 C HR > 90/min RR > 20 or PaCO2 < 32 WBC > 12 or < 4 or Bands > 10% TWO out of four
More informationSevere Sepsis/ Septic Shock. Fereshte Sheybani, MD. Assistant Professor in Infectious Diseases
Severe Sepsis/ Septic Shock Fereshte Sheybani, MD. Assistant Professor in Infectious Diseases Sepsis is one of the oldest and most elusive syndromes in medicine. Hippocrates claimed that sepsis (σήψις)
More informationtowards early goal directed therapy
Paediatric Septic Shock- towards early goal directed therapy Elliot Long Paediatric Acute Care 2011 Conference Outline Emergency Department Rivers Protocol (EGDT) ACCM Sepsis Protocol Evidence Barriers
More informationCase year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50
Case 1 65 year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50 Case 1 65 year old female nursing home resident with
More informationJohn Park, MD Assistant Professor of Medicine
John Park, MD Assistant Professor of Medicine Faculty photo will be placed here park.john@mayo.edu 2015 MFMER 3543652-1 Sepsis Out with the Old, In with the New Mayo School of Continuous Professional Development
More informationCardiovascular Management of Septic Shock
Cardiovascular Management of Septic Shock R. Phillip Dellinger, MD Professor of Medicine Robert Wood Johnson Medical School/UMDNJ Director, Critical Care Medicine and Med/Surg ICU Cooper University Hospital
More informationCurrent State of Pediatric Sepsis. Jason Clayton, MD PhD Pediatric Critical Care 9/19/2018
Current State of Pediatric Sepsis Jason Clayton, MD PhD Pediatric Critical Care 9/19/2018 Objectives Review the history of pediatric sepsis Review the current definition of pediatric sepsis Review triage
More informationBillion
Surviving : Are we? The 7th National Emergency Medicine Congress Antalya, Turkey Alexander L. Eastman, MD, MPH Department of Surgery UTSW Severe : A Significant Healthcare Challenge Major cause of morbidity
More informationGUIDELINES AND APPLICATION TO SEPSIS MANAGEMENT
GUIDELINES AND APPLICATION TO SEPSIS MANAGEMENT Sven Van Poucke, MD ZOL GENK Goals Sepsis Overview and Guidelines The Importance of a System-based Approach The Experience of Other Institutions The Acute
More informationR2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital
R2R: Severe sepsis/septic shock Surat Tongyoo Critical care medicine Siriraj Hospital Diagnostic criteria ACCP/SCCM consensus conference 1991 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
More informationSEPSIS MANAGEMENT. Abdulhadi Tashkandi, MD, FRCP(c) Assistant Prof. Of Medicine Head of E.D. PMBAH-National Guard hospital Al-Madinah Al-Munawarah
SEPSIS MANAGEMENT Abdulhadi Tashkandi, MD, FRCP(c) Assistant Prof. Of Medicine Head of E.D. PMBAH-National Guard hospital Al-Madinah Al-Munawarah goals Treatment of pts. with septic shock consists of
More informationTITLE: Early Identification of Sepsis: A Review of the Evidence for Clinical Indicators and Guidelines for Management
TITLE: Early Identification of Sepsis: A Review of the Evidence for Clinical Indicators and Guidelines for Management DATE: 01 June 2010 CONTEXT AND POLICY ISSUES: Sepsis syndrome covers a broad array
More informationTailored Volume Resuscitation in the Critically Ill is Achievable. Objectives. Clinical Case 2/16/2018
Tailored Volume Resuscitation in the Critically Ill is Achievable Heath E Latham, MD Associate Professor Fellowship Program Director Pulmonary and Critical Care Objectives Describe the goal of resuscitation
More informationObjectives. Epidemiology of Sepsis. Review Guidelines for Resuscitation. Tx: EGDT, timing/choice of abx, activated
Update on Surviving Sepsis 2008 Objectives Epidemiology of Sepsis Definition of Sepsis and Septic Shock Review Guidelines for Resuscitation Dx: Lactate, t cultures, SVO2 Tx: EGDT, timing/choice of abx,
More informationUnderstand the scope of sepsis morbidity and mortality Identify risk factors that predispose a patient to development of sepsis Define and know the
Understand the scope of sepsis morbidity and mortality Identify risk factors that predispose a patient to development of sepsis Define and know the differences between sepsis, severe sepsis and septic
More informationSepsis Early Recognition and Management. Therese Hughes, PhD, MPA, RN
Sepsis Early Recognition and Management Therese Hughes, PhD, MPA, RN 1 Sepsis a Deadly Progression Affects millions around the world each year, killing one in four Contributes to approximately 50% of all
More informationSepsis: Management ANUPOL PANITCHOTE, MD. Division of Critical Care Medicine Department of Medicine, Khon Kaen University, Thailand
Sepsis: Management ANUPOL PANITCHOTE, MD. Division of Critical Care Medicine Department of Medicine, Khon Kaen University, Thailand Vital signs Symptoms LAB BT > 38.3 or < 36 ๐ C HR > 90 bpm RR > 20 /min
More information4/5/2018. Update on Sepsis NIKHIL JAGAN PULMONARY AND CRITICAL CARE CREIGHTON UNIVERSITY. I have no financial disclosures
Update on Sepsis NIKHIL JAGAN PULMONARY AND CRITICAL CARE CREIGHTON UNIVERSITY I have no financial disclosures 1 Objectives Why do we care about sepsis Understanding the core measures by Centers for Medicare
More informationSurviving Sepsis: A CRASH Course. Justin Jones, PharmD Sanford Medical Center, Fargo Staff Education 2015
Surviving Sepsis: A CRASH Course Justin Jones, PharmD Sanford Medical Center, Fargo Staff Education 2015 Disclosures No financial conflicts of interest Abbreviations ULN Upper limit of normal SVCO2 Central
More informationObjectives. Outline. Sepsis Incidence and Outcomes. Definitions
Objectives Evaluate recent literature on the management of sepsis Apply new and potentially controversial recommendations from the Surviving Sepsis Guidelines to patient cases. Surviving Sepsis Campaign
More informationAdvancements in Sepsis
Objectives Advancements in Sepsis Brian Gilbert, PharmD PGY-1 Pharmacy Resident Jackson Memorial Hospital 3/13/2016 www.fshp.org Pharmacist objectives Review recent updates in resuscitation strategies
More informationEarly-goal-directed therapy and protocolised treatment in septic shock
CAT reviews Early-goal-directed therapy and protocolised treatment in septic shock Journal of the Intensive Care Society 2015, Vol. 16(2) 164 168! The Intensive Care Society 2014 Reprints and permissions:
More informationBasics from anatomy and physiology classes Local tissue reactions
Septicaemia & SIRS Septicaemia is a life-threatening condition that arises when the physical reaction to an infection, causes damage to tissue and organs Basics from anatomy and physiology classes Local
More information