1. SEPSIS
3rd
November 2011
Dr. Vimal Desai

2. ∗ What is sepsis?
∗ Why should we be worried?
∗ How to assess
∗ How to manage
AIMS

3. What is sepsis?

4. ∗ Body’s response to infection
What is sepsis?

5. Why is it important?

6. ∗ Sepsis is common
∗ SEPSIS KILLS!!! (36,800 deaths in UK in 2005)
∗ Early intervention saves lives (in a study of over
15,000 patients across 30 countries over 2 years,
mortality fell by 20%)
Why is it important?

7. SIRS

8. ∗ 2 or more of...
∗ Temp >38o
C or < 36o
C
∗ HR > 90
∗ WCC >12 or <4
∗ RR > 20 or PaCO2 < 4.2
SIRS

9. Sites of infection

10. Sites of infection
∗ Chest
∗ Urine / reproductive♀
∗ GI
∗ Biliary
∗ Cannula site
∗ Bone / joint / disc
∗ CNS
∗ Endocarditis
∗ ENT
∗ Prosthesis
∗ Skin / soft tissue / wound
∗ Other

11. SIRS + Infection = SEPSIS

12. Other causes of SIRS

13. ∗ Trauma
∗ Major surgery
∗ Blood transfusion
∗ Pancreatitis
∗ PE
∗ ACS
Other causes of SIRS

14. Surviving Sepsis Campaign

15. First hour care in sepsis or ‘sepsis six’

16. ∗ High flow oxygen
∗ Peripheral blood cultures
∗ IV antibiotics (as per local policy)
∗ Fluid resuscitate
∗ Serum lactate
∗ Measure hour fluid balance (?catheterise)
First hour care in sepsis or ‘sepsis six’

17. Next step...

18. Evidence of organ dysfunction

19. ∗ SBP < 90 / MAP < 65 / fall of 40mmHg
∗ Urine output < 0.5 ml / kg / h for adults
∗ INR > 1.5
∗ Bilirubin > 34
∗ Lactate > 2
∗ O2 needed to keep SaO2 > 90% (new)
∗ Platelets < 100
∗ Creatinine > 177
∗
Evidence of organ dysfunction

20. Sepsis + Organ Dysfunction = SEVERE SEPSIS
Mortality = 35%

21. ∗ PaO2 < 8 or SaO2 < 85% on 100% O2 or PaCO2 > 7 (>9
if chronic) or exhaustion
∗ Stridor, tracheal tug or see-saw chest
∗ SBP < 90mmHg despite resuscitation
∗ pH < 7.15 or lactate > 6 (>4 after resus.)
∗ Seizures
∗ GCS < 9
∗ Arrest
∗ EES > 8
Consider ITU referral if...

22. If severe sepsis results in SBP < 90 / MAP < 65 / a fall of
40mmHg or lactate > 4
↓
SEPTIC SHOCK
Mortality = 50%

23. Six hour resuscitation bundle

24. ∗ Further fluid resuscitation if indicated
∗ Ensure Hb > 7 g / dl
∗ If still shocked (low BP / urine output / high↓
lactate) insert central line and ensure CVP = 8-
12mmHg; consider noradrenaline or dopamine
∗ Check ScvO2; consider dobutamine if <70%
Six hour resuscitation bundle

25. ∗ APACHE II score
∗ ?Low tidal volume ventilation
∗ Ventilation care bundle
∗ Hydrocortisone
∗ ?vasopressin
∗ ?Activated protein C
ITU

26. ∗ Assessment of sepsis
∗ Management of sepsis
Summary