ICN Victoria: Pilcher on "Plummeting Mortality of ICU Sepsis"
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Intensive Care Network Victoria presents Associate Professor David Pilcher talking on the reducing mortality associated with sepsis in Australian and New Zealand ICUs.
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ICN Victoria: Pilcher on "Plummeting Mortality of ICU Sepsis"
- 1. Sepsis in Australian and New Zealand ICUs Getting better but………….. The view from the ANZICS CORE Registry David Pilcher @IntensiveDave The Alfred Hospital ANZICS Centre for Outcome and Resource Evaluation
- 3. Resources & CLABSI Adult Patient Database Paediatric Intensive Care Registry 13,000Sepsis 130,000 admissions annually 1.4 million adult ICU episodes
- 4. Small differences Incidence and prevalence What you do, not what you should do 0 1 2 3 4 35 37 39 41 AdjustedOddsRatiosforDeath Temperature
- 5. Comparisons can be difficult Michael
- 6. Michael 65yrs 83kg 174cm Sepsis Age 15% Diagnosis 13% Mechanical Ventilation 3% Elective surgical status 5% Source of admission 8% Chronic health 8% Treatment limitations 9% Biochemical values 15% Acute Physiology 24% Relative contributions to a patient’s risk of death
- 7. Michael 65yrs 83kg 174cm Sepsis Sepsis admissions to ICU are common.
- 8. MedicalSurgical Cardiothoracic Neurological Sepsis Sepsis is common in ICU Septic shock is common in sepsis admissions
- 9. MedicalSurgical Cardiothoracic Neurological Sepsis Sepsis is common in ICU Septic shock is common in sepsis admissions
- 10. MedicalSurgical Cardiothoracic Neurological Sepsis Sepsis is common in ICU Septic shock is common in sepsis admissions
- 11. Eritoran Tifacogin Drotrecogin alpha Xigris Sentoxin High Volume Haemofiltration ProCESS Early Goal Directed Therapy Vitamin C Extra-corporeal detoxification B blockers SteroidsStatins Heparin Pentoxifylline immunomodulation Naloxone Intravenous immunoglobulin Interferon-gamma Cytokine and endotoxin inactivation Fluid Bolus Therapeutic Hypothermia Ibuprofen Plasmapheresis GM-CSF Norasept N-acteyl cysteine deltibant Talactoferrin Alfa ProCESS
- 13. Adult Patient Database 1.4 million adult ICU episodes 2000-2012 1,117,908 ICU admissions 59,200 Readmissions 21, 593 Missing data 1,037,115 ICU admissions 100,064 Severe sepsis
- 14. 0% 2% 4% 6% 8% 10% 12% 14% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Sepsis admissions to ICU are increasing Septic shock admissions to ICU are increasing
- 15. Sepsis admissions to ICU are increasing Septic shock admissions to ICU are increasing 0% 2% 4% 6% 8% 10% 12% 14% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
- 16. 0% 5% 10% 15% 20% 25% 30% 35% 40% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Mortality(%) Mortality (95%CI) Mortality is improving
- 17. 1 AdjustedOddsRatio Year of ICU admission No Sepsis Sepsis 4.0 3.5 3.0 2.5 2.0 1.5 Mortality is improving but discharges to chronic care are also climbing. Discharge to Rehab or Chronic Care Facility
- 18. Future Trends
- 19. Future Trends 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Septic shock Severe sepsis “The well young septic”
- 20. Future Trends 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Septic shock Severe sepsis “The well young septic”
- 21. Future Trends 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Septic shock Severe sepsis “The well young septic”
- 22. Future Trends 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Septic shock Severe sepsis “The well young septic”
- 23. Future Trends 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Septic shock Severe sepsis “The well young septic”
- 24. Future Trends 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Septic shock Severe sepsis “The well young septic”
- 25. Summary Sepsis admissions are increasing. Mortality outcomes are improving. Knowledge of illness severity is important. Outcomes beyond hospital mortality should be considered.