History of sepsis. How to recognize sepsis according to Sepsis-3 definition. Principle of sepsis management

1. Sepsis & Septic Shock
New Definition

2. Nicholas
Machiavelli
(1532 AD)
Sepsis: hectic fever,
in its beginning,
is difficult to recognise but
easy to cure;
in the course of time,
it becomes easy to recognise
but difficult to cure

3. Sepsis: physiologic, pathologic, and
biochemical abnormalities induced by
infection
More than $20 billion of total US hospital
cost in 2011
estimates: sepsis is a leading cause of
mortality & critical illness worldwide

4. History

5. +

11. Sepsis is defined as
Life-threatening
organ dysfunction
caused by
a dysregulated
host response
to infection

14. quick SOFA
RR > 22
Altered mentation
Systolic BP < 100 mmHg

15. Why?
a dysregulated
host response
to infection

16. Pro-inflammatory
mediators
TNF - α
IL - 1
IL - 6
IL - 8
Anti-inflammatory
mediators
IL - 10
TGF - β
IL - 11
IL - 13
SIRS CARS

17. How about Procalcitonin?

18. PCT: Prohormon (Calcitonin), released into
circulation in response to bacterial infection
sensitivity 88%
specificity 81%

21. But, there is no Procalcitonin investigation to
establish sepsis definition
So, no need to wait for Procalcitonin result to
initiate resuscitation

27. 3-hour Bundles
Measure Lactate level
Obtain cultures prior to administration of antibiotics
Administer broad spectrum antibiotics
Administer 30 mL/kg crystalloid for hypotension or lactate > 4 mmol/L
“Time of presentation” is defined as the time of triage in ED, or, if presenting from
another venue, from the earliest chart notation consistent with all elements of severe
sepsis or septic shock ascertained through chart review

28. 6-hour Bundles
Apply vasopressors* to maintain MAP > 65 mmHg
Re-assess volume status & tissue perfusion**
Re-measure lactate if initial lactate elevated
*for hypotension that does not respond to initial fluid resuscitation
** In the event of persistent hypotension (MAP < 65 mmHg) or lactate > 4 mmol/L

29. Physician think
they do a lot for a
patient when they
give his disease a
name
Emmanuel Kant (1743-1804)