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Introduction To Sepsis
Dr. Hatem A. Soliman, MSc, MRCP (UK)
Specialist Intensivist
Mafraq Hospital, Abu Dhabi
EACVI Club 3...
“SAY: MY LORD, INCREASE ME
IN KNOWLEDGE”
QUR’AN 20:14
“ ‫لما‬ِ‫ع‬ ِ‫دني‬ِ‫ز‬ ِ‫ب‬َ‫ر‬ ‫ل‬ُ‫ق‬َ‫”و‬
‫العظيم‬‫هللا‬ ‫صدق‬
Disclosure
Nothing to disclose
Acknowledgement
Ancient Egypt: “Edwin Smith” Papyrus
NY Academy of Medicine
3000–2500 BC
Luxor, Egypt in 1980.
• The oldest known surgical textbook on trauma
• The oldest rational and scientific approach to
medicine
• The text is att...
• The word “Infection” mentioned for the first
time in history.
• Described Prevention and Curing “Infection”
with “Honey”...
• The word “brain” appears for the 1st time in
history.
• The procedures of this papyrus demonstrate an
Egyptian level of ...
History of Sepsis
HIPPOCRATES (460-370 BC)
Greek word: sipsis = make rotten
pepsis = good digestion
IBN SINA (Avicenna)
(979-1037 BC)
Noticed the coincidence
of blood putrefaction
(septicemia) and fever
History of Sepsis
A Dutch botanist in
Leyden. He thought that
toxic substances in the air
were the cause for sepsis.
History of Sepsis
HERRM...
IGNAZ SEMMELWEIS
(1818-1865)
Hungary
0
2
4
6
8
10
12
14
16
Maternalmortality,1842
First Clinic Second
Clinic
“It is not by...
The Intervention:
Hand scrub with chlorinated lime solution: removed the putrefying
smell from the hands of students and d...
Fired by the hospital board for enforcing
Hand Washing
requirement for doctors !!!!
He was committed to an asylum,
where h...
124 years later
2008 Austrian Commemorative Coin
LOUIS PASTEUR (1822-1895)
• Bacteria / microbes caused
putrefaction
• Killed by heating – sterilization
JOSEPH LISTER (182...
• Modern definition of sepsis (1914):
"Sepsis is present if a focus has developed
from which pathogenic bacteria,
constant...
Helped develop the multi-disciplinary
subspecialty of modern Critical Care
Medicine
Promoted evidence-based approach to
se...
Alzahra CME Hatem Soliman EGDT
What is Sepsis ??!!
"Sepsis is defined as an
invasion of microorganisms
and/or their toxins into the
bloodstream, along with the
organism's re...
Incidence
Incidence
• Sepsis is the leading cause of death by
infection in the world – despite modern
vaccines, antibiotics and inte...
Incidence
Even for those who survive sepsis, the after-effects
can be severe.
Incidence
Alzahra CME Hatem Soliman EGDT
Alzahra CME Hatem Soliman EGDT
Alzahra CME Hatem Soliman EGDT
Alzahra CME Hatem Soliman EGDT
Alzahra CME Hatem Soliman EGDT
Alzahra CME Hatem Soliman EGDT
Financial Burden
Alzahra CME Hatem Soliman EGDT
Epidemiology
• Sepsis > 200,000 deaths/year in the US
• Incidence is > 700,000/ year.
• Mortality for septic shock – 30% d...
Rising incidence of Severe Sepsis :
• Aging of the population
• Longevity of patients with chronic diseases
• Increase in ...
Any regional data ??
Surviving Sepsis Campaign (SSC)
In 2002, spearheaded by:
• ESICM (European Society of Intensive Care Medicine),
• ISF (Int...
Phase 1 : Barcelona declaration
Phase 2 : Evidence based
guidelines
Phase 3 : Implementation and
education
Phase 4 : Analy...
Definitions
Definitions
Is it time to update the definitions ??
April 23rd (NEJM)
Kaukonen et al
• We all encountered septic shock patients who
don’t typically meet the SIRS criteria (elderly,
immunosuppr...
Results
• The current definition excluded 1 in 8 patients (12%)
• Very poor sensetivity.
• The most precise criteria were ...
Sepsis Six (6)
Smartphone Apps ??
Of Course!! 
ESCAVO: iPhone, Android
Sepsis 6: iPhone, iPad
SSC official app: iPhone, Android
Stop Sepsis, Save lives
Stop Sepsis, Save
yourself and your loved
ones
Take-Home Message
“AND WHOEVER SAVES A LIFE, IT
IS CONSIDERED AS IF
HE SAVED AN ENTIRE WORLD”
QUR’AN 5:32
“ َ‫ي‬ْ‫ح‬َ‫أ‬‫ا‬َ‫م‬َّ‫ن‬َ‫أ‬َ‫ك‬...
Thank YouThank
You
hatem.soliman@gmail.com
0508669484
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
Introduction to Sepsis
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Introduction to Sepsis

Introduction to Sepsis

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Introduction to Sepsis

  1. 1. Introduction To Sepsis Dr. Hatem A. Soliman, MSc, MRCP (UK) Specialist Intensivist Mafraq Hospital, Abu Dhabi EACVI Club 35 Ambassador to the UAE
  2. 2. “SAY: MY LORD, INCREASE ME IN KNOWLEDGE” QUR’AN 20:14 “ ‫لما‬ِ‫ع‬ ِ‫دني‬ِ‫ز‬ ِ‫ب‬َ‫ر‬ ‫ل‬ُ‫ق‬َ‫”و‬ ‫العظيم‬‫هللا‬ ‫صدق‬
  3. 3. Disclosure Nothing to disclose
  4. 4. Acknowledgement
  5. 5. Ancient Egypt: “Edwin Smith” Papyrus NY Academy of Medicine 3000–2500 BC Luxor, Egypt in 1980.
  6. 6. • The oldest known surgical textbook on trauma • The oldest rational and scientific approach to medicine • The text is attributed by some to ”Imhotep”: an architect, high priest, and physician of the Old Kingdom (King Zoser) Ancient Egypt: Edwin Smith Papyrus
  7. 7. • The word “Infection” mentioned for the first time in history. • Described Prevention and Curing “Infection” with “Honey” • Systematic anatomical classification of body parts injuries from head to toes. • Prognostic classification of disease outcomes. Ancient Egypt: Edwin Smith Papyrus
  8. 8. • The word “brain” appears for the 1st time in history. • The procedures of this papyrus demonstrate an Egyptian level of knowledge of medicines that surpassed that of Hippocrates, who lived 1000 years later (Ghalioungui, et al) Ancient Egypt: Edwin Smith Papyrus Source: Edwin Smith Papyrus, Wikipedia
  9. 9. History of Sepsis HIPPOCRATES (460-370 BC) Greek word: sipsis = make rotten pepsis = good digestion
  10. 10. IBN SINA (Avicenna) (979-1037 BC) Noticed the coincidence of blood putrefaction (septicemia) and fever History of Sepsis
  11. 11. A Dutch botanist in Leyden. He thought that toxic substances in the air were the cause for sepsis. History of Sepsis HERRMAN BOERHAVE (1668-1738), NL
  12. 12. IGNAZ SEMMELWEIS (1818-1865) Hungary 0 2 4 6 8 10 12 14 16 Maternalmortality,1842 First Clinic Second Clinic “It is not by chance that a single obstetrician has 16 fatal cases in a single month - I can only dispel the sadness which falls upon me by gazing into that happy future when the infection will be banished” History of Sepsis
  13. 13. The Intervention: Hand scrub with chlorinated lime solution: removed the putrefying smell from the hands of students and doctors Hand hygiene basin Vienna, 1847
  14. 14. Fired by the hospital board for enforcing Hand Washing requirement for doctors !!!! He was committed to an asylum, where he died at age 47 of pyaemia, after being beaten by the guards, only 14 days after he was committed What was Dr Semmelweiss’s reward in 1848 for this major contribution ???
  15. 15. 124 years later 2008 Austrian Commemorative Coin
  16. 16. LOUIS PASTEUR (1822-1895) • Bacteria / microbes caused putrefaction • Killed by heating – sterilization JOSEPH LISTER (1827-1912) • Post amputation mortality – 50% • Skin & instrument disinfection with carbolic acid – antiseptic method
  17. 17. • Modern definition of sepsis (1914): "Sepsis is present if a focus has developed from which pathogenic bacteria, constantly or periodically, invade the blood stream in such a way that this causes subjective and objective symptoms.” • “Therapy should not be directed against bacteria in the blood but against the released bacterial toxins” History of Sepsis HUGO SCHOTTMULLER (1867-1936) Germany
  18. 18. Helped develop the multi-disciplinary subspecialty of modern Critical Care Medicine Promoted evidence-based approach to sepsis History of Sepsis ROGER C. BONE (1941-1997) US
  19. 19. Alzahra CME Hatem Soliman EGDT What is Sepsis ??!!
  20. 20. "Sepsis is defined as an invasion of microorganisms and/or their toxins into the bloodstream, along with the organism's reaction against this invasion.“ (1989) History of Sepsis ROGER C. BONE (1941-1997)
  21. 21. Incidence
  22. 22. Incidence • Sepsis is the leading cause of death by infection in the world – despite modern vaccines, antibiotics and intensive care. • Over 6.000.000 of neonatal and early childhood deaths. • Over 100.000 maternal deaths
  23. 23. Incidence
  24. 24. Even for those who survive sepsis, the after-effects can be severe. Incidence
  25. 25. Alzahra CME Hatem Soliman EGDT
  26. 26. Alzahra CME Hatem Soliman EGDT
  27. 27. Alzahra CME Hatem Soliman EGDT
  28. 28. Alzahra CME Hatem Soliman EGDT
  29. 29. Alzahra CME Hatem Soliman EGDT
  30. 30. Alzahra CME Hatem Soliman EGDT
  31. 31. Financial Burden
  32. 32. Alzahra CME Hatem Soliman EGDT
  33. 33. Epidemiology • Sepsis > 200,000 deaths/year in the US • Incidence is > 700,000/ year. • Mortality for septic shock – 30% die within first month & 50% dying within 6 months of diagnosis
  34. 34. Rising incidence of Severe Sepsis : • Aging of the population • Longevity of patients with chronic diseases • Increase in people with AIDS • Widespread use of antimicrobials, immunosuppressives, indwelling catheters, mechanical ventilation Epidemiology
  35. 35. Any regional data ??
  36. 36. Surviving Sepsis Campaign (SSC) In 2002, spearheaded by: • ESICM (European Society of Intensive Care Medicine), • ISF (International Sepsis Forum) and • SCCM (Society of Critical Care Medicine) Aim: improving the diagnosis, survival, and management of patients with sepsis by addressing the challenges associated with it.
  37. 37. Phase 1 : Barcelona declaration Phase 2 : Evidence based guidelines Phase 3 : Implementation and education Phase 4 : Analysis of aggregate database, revision of guidelines Surviving Sepsis Campaign (SSC)
  38. 38. Definitions
  39. 39. Definitions
  40. 40. Is it time to update the definitions ??
  41. 41. April 23rd (NEJM)
  42. 42. Kaukonen et al • We all encountered septic shock patients who don’t typically meet the SIRS criteria (elderly, immunosuppressed, on B-blockers) • 1,171,797 patients studied in 172 ICUs in Australia and New Zealand from 2000-2013. 100.000 of them had an acute infection and organ failure. • The patient’s then grouped into SIRS-positive (two or more criteria) and SIRS-negative groups.
  43. 43. Results • The current definition excluded 1 in 8 patients (12%) • Very poor sensetivity. • The most precise criteria were HR and RR • The poorest is the WCC. • SIRS-negative group had overall better outcome than SIRS-positive. • Expected change in the definitions.
  44. 44. Sepsis Six (6)
  45. 45. Smartphone Apps ?? Of Course!! 
  46. 46. ESCAVO: iPhone, Android
  47. 47. Sepsis 6: iPhone, iPad
  48. 48. SSC official app: iPhone, Android
  49. 49. Stop Sepsis, Save lives Stop Sepsis, Save yourself and your loved ones Take-Home Message
  50. 50. “AND WHOEVER SAVES A LIFE, IT IS CONSIDERED AS IF HE SAVED AN ENTIRE WORLD” QUR’AN 5:32 “ َ‫ي‬ْ‫ح‬َ‫أ‬‫ا‬َ‫م‬َّ‫ن‬َ‫أ‬َ‫ك‬َ‫ف‬ ‫ا‬َ‫اه‬َ‫ي‬ْ‫ح‬َ‫أ‬ ْ‫ن‬َ‫م‬َ‫و‬‫ا‬‫يع‬ِ‫م‬ََ ََ‫ا‬ََّّ‫ال‬‫ا‬ ” ‫العظيم‬‫هللا‬ ‫صدق‬
  51. 51. Thank YouThank You hatem.soliman@gmail.com 0508669484

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