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MedReg+1 Loveridge Acute Medicine

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  • 1. Developing people for health and healthcare Sepsis Acute Medicine 24th July The story behind sepsis management
  • 2. Developing people for health and healthcare OUTLINE • To summarize the background behind sepsis management guidance • To understand why simplified guidelines are being promoted • • To consider briefly some of the possible future trends in sepsis care
  • 3. Developing people for health and healthcare
  • 4. Developing people for health and healthcare
  • 5. Developing people for health and healthcare
  • 6. Developing people for health and healthcare
  • 7. Developing people for health and healthcare
  • 8. Developing people for health and healthcare
  • 9. Developing people for health and healthcare
  • 10. Developing people for health and healthcare WHY WAS SIMPLIFICATION NEEDED? • Poor compliance with bundles • Guidance involves some complex measures • Mortality still stands at 30-35% • 36,800 lives lost annually in UK • Sepsis costs the NHS £2.5 billion
  • 11. Developing people for health and healthcare THE SEPSIS SIX • Lactate • Blood cultures • Early antibiotic administration • Fluid resuscitation • Urine output monitoring • High flow oxygen
  • 12. Developing people for health and healthcare WHY THE SEPSIS SIX?
  • 13. Developing people for health and healthcare PREDICTED BENEFITS OF SEPSIS SIX • Achieving 80% compliance with Sepsis Six expected to save 15,000 lives per year in UK • …..and £170,000,000 • (Extrapolated from unpublished data relating to reduced length of stay)
  • 14. Developing people for health and healthcare
  • 15. Developing people for health and healthcare THE PROCESS TRIAL • Did not show statistically significant survival of patients treated with EGDT over and above less aggressive protocols or ‘usual care’
  • 16. Developing people for health and healthcare WHAT NEXT? • PROMISE & ARISE trials • NICE Guideline due 2016 • Targeted in the National Outcomes Framework for the NHS Commissioning Board • Research into biomarkers, pathogen recognition, pathogenesis, targeted therapy
  • 17. Developing people for health and healthcare REFERENCES AND FURTHER READING • Surviving sepsis campaign:International Guideline for Management of Severe Sepsis and Septic Shock 2012 http://www.sccm.org/Documents/SSC-Guidelines.pdf • Surviving the first hours in sepsis: getting the basics right (an intensivist’s perspective) J Antimicrob Chemother 2011: 66 Suppl 2 ii11-1123 • A randomized trial of protocol-based care for early septic shock; The Process Investigators NEJM 2014; 370:1683-1693 • Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline- based performance improvement program; Critical care medicine; August 2014 (42) Issue 8: 1794-1755
  • 18. Developing people for health and healthcare References continued • The Ombudsman report 2013 • http://www.ombudsman.org.uk/__data/assets/pdf_file/0004/22666/ FINAL_Sepsis_Report_web.pdf • The UK Sepsis Trust report 2013 • http://www.england.nhs.uk/wp-content/uploads/2013/12/spesis- brief.pdf