Paediatric Sepsis Frm Sinéad Hrgan SSWHG Sepsis Lead www.hse.ie/sepsis
Definitin A life-threatening rgan dysfunctin due t a dysregulated hst respnse t infectin N cnfirmatry test Bld cultures are psitive in 40% cases Presentatin is variable Infectin Acute rgan dysfunctin
Incidence Number f Paediatric Sepsis Cases 820 800 780 Number f cases 760 740 Series1 720 700 1 2 3 4 5 6 Year 2011-2016
Mrtality rate Mrtality Sepsis-assciated Crude Hspital Mrtality 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 2012 2013 2014 2015 2016 Year
Paediatric Sepsis Frm
Epidemilgy 80% arise in the cmmunity 78% ccur in children with c-mrbidities Cngenital heart disease Neurlgical disrders Surce Site 57% cmmunity acquired 43% healthcare factrs antibitics in preceding 7 days Respiratry tract Abdminal 53% pathgen was islated
Brain Lungs Heart Kidneys Skin Clinical signs f rgan Acute cnfusin Flppy, pr feeding, weak r absent cry Altered functinal state Leg pain, unable t weight bear Requiring xygen r respiratry supprt Hypxia Inapprpriate tachycardia r bradycardia Prlnged central capillary refill Lactate >2mml/L Hyptensin a late sign Oligurea < 1ml/kg/hr Creatinine dubled Purpuric rash Mttling dysfunctin
Clinical aims Recgnise the unwell child with infectin Identify risk factrs and deteriratin Cmplete the sepsis 6 bundle within 1 hur f recgnitin Escalate the patient wh requires rgan supprt t critical care Surce cntrl
Purpse Prevent r abrt the sepsis respnse by: Aiding the hst in killing the infecting rganism Apprpriate antimicrbial therapy Surce cntrl Restring hmestasis Supplementary O2 t achieve sats 94% (ECJ) May require ventilatry supprt Restring tissue perfusin with fluid resuscitatin +/- pressrs Invasive mnitring Serial lactate measurement Urinary utput measurement Renal replacement therapy
Sepsis diagnsis Pattern recgnitin Multiple variables Each variable can be caused by ther cnditins Data available at different time pints Minutes, hurs, days Easier t recgnise as clinical curse prgresses But harder t treat! Effective treatment is time-dependant Sepsis is a medical emergency!
Sepsis Screening Infectin Nn-specific eg SIRS Lcalising ie t site f infectin Unwell Alteratin in functinal status
YOU, THE PATIENT AND THE RELEVANT SITUATION FOR SCREENING Identify
Risk Factrs 78% OF SEPSIS CASES HAD RISK FACTORS
Unwell Parents/caregivers knw the nrmal functin status f patients with disability/ chrnic disease listen t them
What t d Screen is psitive if there is a suspicin f infectin (including gastrenteritis) and the patient has risk factrs and/r presents with ne f the characteristic presentatins listed. When referring ensure yu cmmunicated the infrmatin yu have gathered and say COULD THIS BE SEPSIS? Make sure the frm is accessible fr the dctr.
Medical Review
Sepsis 6
Sepsis Frm Cmpletin Recrd if: Sepsis Nt sepsis Septic Shck
Sign and file If signed it can be cded 60% adult sepsis cases identified Prtects yu, yur hspital and yur cmmunity
Audit results 2016 n= 1489 Diagnsis made and dcumented Risk stratificatin crrect With frm 87% 44% 74% 24% Withut frm 1 st dse antimicrbials within 1 hur 74.5% 46.5% Only 56% f sepsis cases were dcumented as sepsis in the case ntes
Sepsis Pilt Phase 1 Jint prject with Natinal Paediatric Prgramme and Natinal Sepsis Prgramme. Paediatric sepsis frm designed by expert multidisciplinary team Paediatric SPR, Lead Paediatric Nurse frm Clinical Advisry Grup, Practice Nurse, Dr Vida Hamiltn, Sepsis ADON. Signed ff by Paediatric Clinical Advisry Grup. 1 st Pilt Spring 2018. Feedback t Expert multidisciplinary grup April 2018. 2 nd Pilt Summer 2018. Plan fr Educatin prgramme and rll ut in Autumn.
ANY QUESTIONS? www.hse.ie/sepsis