Sepsis is a life-threatening condition caused by the body's response to infection. It has been defined in various ways over time, with the most recent Sepsis-3 definition describing it as a dysregulated immune response leading to organ dysfunction. Diagnosis involves assessing symptoms, signs of infection and organ dysfunction, along with diagnostic tests. Management involves rapid fluid resuscitation, antibiotics within 1 hour of recognition, vasopressors to maintain blood pressure and organ perfusion, and treatment of the underlying infection in an intensive care unit. Delays in recognition and treatment can increase mortality risk.
Talk given on 29 Sep 2015 at the Royal College of Emergency Medicine annual meeting.
Key areas:
What are the issues with sepsis in children?
How will it apply to the UK Sepsis CQUIN?
The Paediatric Sepsis 6 and screening for sepsis in children.
Additional notes following main talk.
Latest definition of sepsis, application of qSOFA, latest evidence on treatment of septic shock,role of fluids, role of steroids, isobalance salt solution
Septic shock, updated presentation, including latest guidelines from Intensive care societies and how to approach to the diagnosis with few notes about Early Goal Directed Therapy and role of steroids
Lactate has been viewed as a byproduct of anaerobic metabolism and an indicator of tissue hypoperfusion since the 1900s. This theory is still widely believed. Paul busts the myths surrounding lactic acidosis, anaerobic metabolism, tissue hypoxia and the role of lactate in sepsis.
Key take-away facts include:
- The production of lactate actually consumes hydrogen ions. Lactic acidosis is really lactic alkalosis.
- Lactate is produced physiologically and is a precursor for gluconeogenesis.
- During exercise, skeletal muscle exports lactate as the primary fuel for the heart and brain.
- At VO2max, intracellular oxygen stays the same. Anaerobic metabolism in cells only occur as a pre-terminal event. The exception is in complete arterial occlusion.
- Adrenaline promotes lactate production
- Lactate infusion has been shown to increase cardiac output in septic and cardiogenic shock
- Lactate is a survival advantage!
Talk given on 29 Sep 2015 at the Royal College of Emergency Medicine annual meeting.
Key areas:
What are the issues with sepsis in children?
How will it apply to the UK Sepsis CQUIN?
The Paediatric Sepsis 6 and screening for sepsis in children.
Additional notes following main talk.
Latest definition of sepsis, application of qSOFA, latest evidence on treatment of septic shock,role of fluids, role of steroids, isobalance salt solution
Septic shock, updated presentation, including latest guidelines from Intensive care societies and how to approach to the diagnosis with few notes about Early Goal Directed Therapy and role of steroids
Lactate has been viewed as a byproduct of anaerobic metabolism and an indicator of tissue hypoperfusion since the 1900s. This theory is still widely believed. Paul busts the myths surrounding lactic acidosis, anaerobic metabolism, tissue hypoxia and the role of lactate in sepsis.
Key take-away facts include:
- The production of lactate actually consumes hydrogen ions. Lactic acidosis is really lactic alkalosis.
- Lactate is produced physiologically and is a precursor for gluconeogenesis.
- During exercise, skeletal muscle exports lactate as the primary fuel for the heart and brain.
- At VO2max, intracellular oxygen stays the same. Anaerobic metabolism in cells only occur as a pre-terminal event. The exception is in complete arterial occlusion.
- Adrenaline promotes lactate production
- Lactate infusion has been shown to increase cardiac output in septic and cardiogenic shock
- Lactate is a survival advantage!
Nephritis is a inflammation of kidney .
It is classified into various types like lupus nephritis ,interstitial nephritis , glomerulonephritis ,pyelonephritis.
Lupus nephritis is an inflammation of kidney due to autoimmune disorder named as lupus .
It is inflammation of lower urinary tract .
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. HISTORY OF SEPSIS
• Recognition of sepsis changed markedly over time
• 4th century BC - Hippocrates was the first to use the term sipsi
(Greek for make rotten)
• Discoveries of microorganism
• Development of germ theory of disease
• 1989 - Dr Roger C. Bone published a paper described sepsis as a state of
invasion of microorganism into blood stream and its clinical complication
4. INFECTION SIRS SEPSIS
SEPSIS-1 DEFINITION (1991)
• American College of Chest Physician (ACCP) and Society of Critical Care Medicine (SCCM)
5.
6. SEPSIS -2 DEFINITION (2001)
• International Sepsis Definitions Conference
• American College of Chest Physician (ACCP), Society of Critical Care Medicine (SCCM), American
Thoracic Society (ATS), European Society of Intensive Care Medicine (ESICM) and Surgical
Infection Society (SIS)
INFECTION SIRS SEPSIS
Expanded
criteria:
General
Inflammatory
Hemodynamic
Tissues
perfusion
7.
8. INFECTION
≥2 SOFA/
q-SOFA
SEPSIS
SEPSIS -3 DEFINITION (2016)
• Life threatening organ dysfunction due to a dysregulated host response to
infection
• Clinical criteria – organ dysfunction is defined as an increase of 2 points or
more in the Sequential Organ Failure Assessment score (SOFA)
9. SEPSIS -3 DEFINITION (2016)
Septic Shock
• Subset of sepsis in which underlying circulatory and cellular / metabolic
abnormalities are profound enough to substantially increase mortality
• Clinical criteria – sepsis and (despite adequate volume resuscitation) both of :
persistent hypotension requiring vasopressors to maintain MAP greater than or
equal to 65 mmHg, and lactate greater than 2 mmol/L
10.
11. RISK FACTOR
• Age – infant and old age
• Gender - Males are 25% to 30% more likely to develop sepsis than females
• Ethnicity/ race
• Genetics - Interleukin 1β-511 homozygosity is increased risk of mortality from sepsis
• Factors that breach natural barriers to pathogen invasion or compromise immune function:
• Recent surgery or hospitalization
• Indwelling urinary catheters, intravascular access devices, endotracheal tubes
• Malnutrition
• Burns and/or trauma
• Chronic illness (eg, cancer, diabetes)
• Immunosuppression
• IVDU
• Pregnancy or recent childbirth, miscarriage, or termination of pregnancy
13. NORMAL RESPONSE TO INFECTION
• The host response to infection starts when innate immune cells like macrophages recognize
and binds to microbial components.
This can occur by:
• Pattern Recognition Receptors (PRR) on host cells which bind to Pathogen Associated
Molecular Patterns (PAMP) in microbes
• PRR include Toll Like Receptors (TLR) and nucleotide-binding oligomerization domain-like
receptors (NOD)-like receptors (NLRs)
• PRR can also recognize endogenous signals such as danger-associated molecular patterns
(DAMPs) that are released during the inflammatory insult.
• DAMPs are nuclear, cytoplasmic, or mitochondrial structures acquiring new functions when
released in the extracellular environment.
14.
15. NORMAL RESPONSE TO INFECTION
• Binding of host immune cell receptors to microbial components causes polymorphonuclear
leukocytes (PMNs) become activated and express adhesion molecules that cause aggregation
and margination to the vascular endothelium.
• The release of mediators by PMNs at the site of infection is responsible for the cardinal signs
of local inflammation: warmth and erythema due to local vasodilation and hyperaemia, and
protein-rich oedema due to increased microvascular permeability
• The balance of pro-inflammatory and anti-inflammatory mediators regulates the inflammatory
processes, including adherence, chemotaxis, phagocytosis of invading bacteria, bacterial killing,
and phagocytosis of debris from injured tissue.
• If the mediators balance each other and the initial infectious insult is overcome, homeostasis
will be restored. The end result will be tissue repair and healing.
16.
17. TRANSITION TO SEPSIS
• Sepsis occurs when the release of pro-inflammatory mediators in response to an infection
exceeds the boundaries of the local environment, leading to a more generalized response.
• This causes decreased oxygen utilization associated with mitochondrial dysfunction rather
than or in addition to poor oxygen delivery to tissues.
• The cellular injury, accompanied by the release of pro-inflammatory and anti-inflammatory
mediators, often progresses to organ dysfunction and leads to high mortality.
18.
19.
20. WHY WOULD AN IMMUNE RESPONSE
SPREAD BEYOND AN INFECTIOUS POINT?
EFFECTS OF MICROORGANISM
• Endotoxins (LPS) found in gram
negative organisms.
• Caused release of pro
inflammatory cytokines (TNF-a
and IL-1)
• Stimulate activation of
coagulation and fibrinolysis
leads to thrombosis.
COMPLEMENT ACTIVATION
• Protein cascade, which
promoting, and coordinating
inflammation response.
• Regulate btw innate and
adaptive immunity.
• When pathogen escaped from
being eliminate, complementary
system continue its effort by
exacerbate inflammation which
eventually leads to SIRS.
GENECTIC SUSCEPTIBILITY
• Polymorphisms in genes coding
for proteins involved in the
recognition and the response to
bacterial pathogens can
influence the amount or
function of the protein
produced in response to
bacterial stimuli.
21.
22. SYSTEMIC EFFECTS OF SEPSIS
When the immune response becomes generalized during an infection, widespread cellular injury
may occur
Mechanisms proposed to explain the cellular injury include:
• Tissue ischemia (insufficient oxygen relative to oxygen need)
• Cytopathic injury (direct cell injury by pro-inflammatory mediators and/or other products of
inflammation)
• Altered rate of cell death pathways
• Activation of the coagulation system and vascular endothelium
23. • Hypotension due to diffuse vasodilation
• ▼ventricular performance due to release of myocardial depressant substances
• Interfere with redistribution of blood flow from splanchnic organs to core organs
(heart and brain) when oxygen delivery is depressed
CIRCULATION
• Endothelial injury ▼pulmonary
blood flow, ▲ microvascular
permeability, leads to pulmonary
edema ▶V/P mismatch, hypoxia
LUNGS
• The circulatory abnormalities in
sepsis may depress the gut's
normal barrier function
• allows translocation of bacteria
and endotoxin
GI SYSTEM
• Systemic hypotension, direct renal
vasoconstriction, release of
cytokines contribute to renal
injury
RENAL
• Liver dysfunction can prevent the
elimination of enteric-derived
endotoxin and bacteria-derived
products, which prevents the
appropriate local cytokine
response.
LIVER
• The most common CNS
complications are an altered
sensorium (encephalopathy).
• The pathogenesis of the
encephalopathy is poorly defined.
• CNS dysfunction has been
attributed to changes in
metabolism and alterations in cell
signalling due to inflammatory
mediators.
CNS
EFFECTS OF
SEPSIS
26. HISTORY TAKING
•Thorough and timely history focuses on symptoms, comorbidities, recent surgery, recent
antibiotic use, presence of medical devices, and travel
• Common generalized symptoms of sepsis include: fever, chills, rigors, nausea, vomiting,
lethargy, malaise, myalgia, dyspnoea
• Localizing symptoms:
• CNS: headache, photophobia, neck stiffness, seizure etc
• Respiratory: cough (chesty/ dry), runny nose, shortness of breath, pleurisy
• Abdomen: pain, diarrhoea, dysuria, haematuria, cloudy urine
• Peripheral: wounds, joint pain, swelling
•Elderly persons may have limited or nonspecific symptoms (eg, poor oral intake, inanition)
27. CLINICAL EXAMINATION
Physical examination focuses on detecting generalized signs of sepsis and on determining the
source.
Generalized evidence of sepsis is highly variable but commonly includes:
₋ Fever (more than 38.5°C) or hypothermia (less than 36°C)
₋ Hypotension - Presenting sign in 40% of patients with sepsis
₋ Tachycardia
₋ Tachypnoea
₋ Altered mental status; older patients may present with irritability or agitation
₋ Increased capillary refill time (more than 3 seconds)
₋ Mottled/ clammy skin
Systemic examination should be carried out thoroughly as it may uncover an unexpected site.
28. LABORATORY INVESTIGATION
Full blood counts : TWC ↑, Platelets ↓, HB ↓ / ↔
Coagulation profile
Renal profile: Urea/ Creat ↑ (AKI)
Liver function test: transaminitis
Blood gas : acidosis
Lactic acid ↑
Biomarkers: CRP, PCT
Microbiology: Blood cultures, Urine cultures, Sputum cultures
Urine dipstick : look for UTI
29.
30.
31.
32. Biomarkers for sepsis
• May be used for early diagnosis of sepsis, to predict outcome and to guide the choice of
antibiotic therapy.
• Many potential biomarkers have been evaluated – CRP and PCT remain the most commonly
used and widely available.
• To date, no single ideal biomarker for sepsis hence a combination of biomarkers + clinical
assessment are used for early Dx and better risk assessment.
C- REACTIVE PROTEIN:
Produced in the liver in response to infection
and/or inflammation.
Increase within 4-8H of inflammatory stimulus
and peak after 36-72 H
Slowly normalise
Low specificity – drawback as biomarker of
sepsis in adults.
PROCALCITONIN:
Released in parenchymal cells in response to
bacterial toxins
Increase within 2-4H of inflammatory stimulus
and peak after 8-24 H
Normalise quick with patient in recovery
Levels are slightly elevated in severe parasite
and fungal infections
Levels are low in viral diseases
33. Imaging
₋ Radiography:
₋ Chest: pneumonia/ tuberculosis/ effusions / mass or lesions
₋ Abdomen: perforation / stones etc
₋ Ultrasonography
₋ Abdominal ultrasonography is used to identify abdominal infections (eg, appendicitis, cholecystitis,
pancreatitis)
₋ Renal ultrasonography is used to identify renal obstruction or pyelonephritis
₋CT:
₋ CT of abdomen and pelvis to identify abdominal or pelvic abscesses (eg, pancreatic abscess, renal
abscess) or ischemic bowel
₋ CT may also be used to determine depth and extent of some serious soft tissue infections (eg,
necrotizing fasciitis)
₋ MRI of brain and/or spine is used in evaluation of meningitis, encephalitis, and epidural abscess
38. INITIAL RESUSCITATION
•At least 30 mL/kg of intravenous (IV) crystalloid fluid should be given within the first 3 h of
resuscitation
•To avoid over- and under-resuscitation, fluid administration beyond the initial resuscitation
should be guided by careful assessment of intravascular volume status and organ perfusion.
•Dynamic parameters include response to a passive leg raise or a fluid bolus, using stroke
volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV), or
echocardiography, should be use to assess fluid responsiveness.
•Serum lactate is an important biomarker of tissue hypoxia and dysfunction. It was suggested to
decrease serum lactate in patients with elevated lactate level.
•Capillary refill time to guide resuscitation as an adjunct to other measures of perfusion.
39. HEMODYNAMIC MANAGEMENT
•Keep MAP > 65mmHg
• Crystalloid as first line fluid for resuscitation.
• To start vasopressor early.
•Delay in initiation of vasopressor therapy was
associated with an increased mortality risk.
• Avoid overload. Faster achieving target MAP,
preventing onset or progress of organ
dysfunction.
• Noradrenaline as first line agent. Epinephrine as
second line.
40. 5 fundamental questions to assessment
of hemodynamic:
1. Should I give more fluids?
- Stroke volume variation
- Pulse pressure analysis
2. Is giving more fluid harmful?
- ultrasonography of lungs
3. Is inotrope needed?
4. Is vasoactive agent needed?
- Continuous oesophageal Doppler
- Velocity time integral (VTI) of left ventricular
outflow tract (LVOT)
- Passive leg raising test
5. Is the organ/ tissue perfusion adequate?
- Capillary refill time
- Serum lactate
- Mottling score
41.
42.
43. ICU
Delayed admissions of critically ill patients
from ED are associated with decreased
sepsis bundle compliance and increased
mortality, ventilator duration, and ICU and
hospital length of stay
45. CONCLUSION
• Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection.
• Sepsis and septic shock are medical emergencies, treatment should be started immediately
upon recognition.
•Initial resuscitation and antibiotics should be given within 1 hour (infection present)
•Adequate fluid resuscitation and early starting of vasopressor to prevent overloading and
achieve target MAP faster.
• Keep MAP > 65 mmHg
•ICU admission within 6 hours is recommended.
Editor's Notes
When a similar process occurs in response to a non-infectious condition (eg, pancreatitis, trauma), the process is referred to as systemic inflammatory response syndrome (SIRS).
• Sepsis can be conceptualized as malignant intravascular inflammation.
• Malignant because it is uncontrolled, unregulated, and self-sustaining
• Intravascular because the blood spreads mediators that are usually confined to cell to-cell interactions within the interstitial space
• Inflammatory because all characteristics of the septic response are exaggerations of the normal inflammatory response
The complement system plays an invaluable role in promoting and coordinating the inflammatory process that is triggered in response to pathogens. The anaphylatoxins C3a and C5a are actively involved in the regulation of various critical events during an inflammatory response, such as changes in vascular flow and blood vessel calibre, increased vascular permeability, and leukocyte extravasation and chemotaxis [5]. These processes are essential for recruiting and activating the cells that are involved in the innate immune response, including neutrophils, monocytes and macrophages
Host genetic variability in the regulatory and coding regions of genes for components of the innate immune system may influence the susceptibility to and/or outcome from sepsis.
Low threshold of suspicion and early recognition of sepsis are essential for successful outcomes
ABCDE
PCT concentrations increase earlier and normalize more rapidly than CRP, PCT has the potential advantage of earlier disease diagnosis, as well as better monitoring of disease progression.[9] Moreover, a number of studies have shown that the systematic use of PCT for sepsis diagnosis and monitoring may also have a positive impact on the reduction of antibiotic (AB) treatment, therefore allowing a shorter stay in the ICU and lower costs per case. This will also be beneficial in combating the increase of antibiotic-resistant micro-organisms which is mainly related to the excess use of antibiotics.[10,11,12,13] Additionally, researchers found a ≥30% decrease in PCT levels between days 2 and 3 to be an independent predictor of survival in ICU patients
Quick SOFA • Out-of-hospital, ED, general medical ward • Patients with suspected infection who are likely to have a prolonged ICU stay or to die in hospital can be promptly identified at the bedside with qSOFA • Non-invasive, speed, repeatability to re-assess patient
NEW RECOMMENDATION BY SSC IN 2021 – HOUR 1 BUNDLE TO REPLACE HOUR 3 AND HOUR 6 BUNDLE