2. What is sepsis?
• Body's response to infection
• Normally, the body's own defense system fights
infection
• But in severe sepsis, the body's normal reaction
goes into overdrive, setting off a cascade of
events that can lead to widespread inflammation
and blood clotting in tiny vessels throughout the
body.
3. Human costs
• Sepsis remains an unacknowledged killer
• Severe sepsis cases is growing at a rate of 1.5%
per annum, adding an additional 1 million cases
per year in the USA alone by 2020!!!!
• >18 million cases of severe sepsis worldwide / yr
• Kills approx 1,400 people worldwide / day
• Severe sepsis is the leading cause of death in
the non-coronary ICU
• Each year sepsis costs €7.6 billion in Europe
and €17.4 billion in the US
4. Human costs
• Sepsis impacts the lives of many people:
– Patient
– Doctors, nursing and care staff
– Families
• When patients are sick
• When they eventually get discharged home
• When they die
5. Who is at risk?
• The very young
• The very old
• Those with "compromised" immune system
• Those with wounds or injuries
• Alcoholics or drug abusers
• Those receiving certain treatments or
examinations (e.g., IV catheters, wound
drainage, urinary catheters
• Those more prone to develop sepsis than others
because of genetic factors
6. Is it increasing??
• Yes
– Especially as a result of:
• Medical and technological advances associated
with treatments
• > use of IV access devices
• The increasing number of elderly or debilitated
people, and patients with underlying diseases
such as cancer, who require therapy
• The widespread use of antibiotics, which
encourages the growth of drug-resistant micro-
organisms
7. Definitions
Systemic Inflammatory Response Syndrome (SIRS) :
• Systemic inflammatory response to various
stresses.
• Meets 2 or more of the following criteria :
– Temperature of >38C/<36degree C
– Heart rate of more than 90 beats/min
– RR >20 breaths/min
– WBC >12,000/mm3 or <4000/mm3
8. SEPSIS
• Evidence of SIRS accompanied by known
or suspected infection.
– SIRS PLUS a documented infection
• Positive CXR
• Positive Urinalysis
• Cellulitis /Abscess /Infected Lines
• Positive Blood Culture / Urine / CSF
9. Severe Sepsis
• Sepsis accompanied by hypo perfusion or organ
dysfunction.
• Cardiovascular :
– SBP<90mmhg/MAP<70 for at least 1 hr despite
adequate volume resuscitation or the use of
vasopressors to achieve the same goals.
• Renal :
– Urine output <0.5ml/kg/hr or Acute Renal Failure.
• Pulmonary :
– Low Oxygen saturation / PaO2/FiO2 <250if other
organ dysfunction is present
10. • Gastrointestinal :
– Hepatic dysfunction (High Bilirubin levels)
• CNS :
– Alteration in Mental status (delirium)
• Hematological :
– Low Platelet count or decreased by 50% over 3 days/DIC
• Metabolic :
– PH<7.30 or base deficit >5.0mmol/L
– Elevated Plasma lactate
Septic Shock :
• Severe Sepsis with persistent hypo perfusion or
hypotension despite adequate fluid resuscitation
Severe SEPSIS (contd) :
11. Types of sepsis
• Uncomplicated sepsis
– common and millions get each year - all stay at
home
• Severe sepsis
– arises when sepsis occurs in combination with
problems in one or more of the vital organs. Because
of problems with their vital organs, people with severe
sepsis are likely to be very ill and are more likely to
die (in 30-35 % of cases) than those with
uncomplicated sepsis.
• Septic shock
– as above but BP very low. Death rate c. 50%
12. Prevention & control of infection
• Hand hygiene
• Infection control
• Diagnosis of infection
• Management of indwelling devices
– Does the pt need this device?
– How long does the device need to stay in?
– If in doubt take it out / do not put in
• Removing foci of infection
• ‘Rational’ prescribing
13. Early recognition
• Vital
• The earlier it is recognised the earlier
treatments can be started
• The earlier it is recognised the earlier other help
can be sought
14. Sepsis screening tool
• If patients have a history of suspected infection
PLUS two or more of the following (and it is new ) they
may have a SEPSIS
– Temperature
• >38O
C or <36O
C
– HR
• >90 beats per minute
– Respiratory rate
• >20 breaths per minute
– WBC
• >12 or <4
– Mean arterial pressure
• <65 mmHg
15. Sepsis resuscitation Bundle
• Bundle of care designed to optimise the 1st
6
hours following the onset of severe sepsis
• Comprises of
– 6 steps
– Completion of EGDT (Surviving Sepsis)
16. Sepsis resuscitation Bundle (6 hour)
1. Give oxygen – lots of
2. Good IV access (How would you do this??)
3. Serum lactate measured
4. Blood cultures prior to antibiotics
5. Broad-spectrum antibiotics administered within
1 hours of documented diagnosis (VITAL)
6. If hypotension (MAP < 65) or lactate > 4
mmol/L, initial fluid resuscitation with 500mls
Hartmann’s
7. Consider vasopressors – noradrenaline
17. Treatment of Sepsis
• Identification
– Continuous monitoring
• Pulse, blood pressure, pulse ox, urine output
– Laboratory tests
• Blood and urine cultures.
• Lactate Acid (a marker of tissue hypoxia)
– Chest Radiography
• Pneumonia makes up a large portion of the cases.
• Remember – initial complaints can be nonspecific
19. Conclusion
• The incidence of Sepsis is increasing.
• Possible contributing factors :
– Use of antibiotics leading to microbial resistance
– More invasive procedures
– Increasing use of immuno suppressants
• Identify sooner rather than later
• Act upon your observations
• Look – listen – feel
• Use your instincts
• Better to be safe than sorry
• Ask for help early --
