This document discusses the background and development of sepsis management guidelines. It notes that previous guidelines were complex and compliance was poor, while mortality from sepsis remains high. Simplified guidelines called the "Sepsis Six" were introduced, focusing on six key treatment steps to be completed within one hour like lactate measurement and antibiotics. The guidelines aim to save lives and costs by improving compliance. While a clinical trial did not show clear survival benefits of early goal-directed therapy, further research continues into biomarkers and targeted therapies for sepsis.

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• (Extrapolated from unpublished data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