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SEPSIS – 3.0 SEPSIS – 3.0

SEPSIS – 3.0 - PowerPoint Presentation

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SEPSIS – 3.0 - PPT Presentation

CALS Instructor Update July 14 2016 Definitions Definition vs Clinical Criteria Definition What it is Clinical Criteria How we operationalize the definition at the bedside Definitions ACCPSCCM ID: 601730

infection sepsis definitions hypotension sepsis infection hypotension definitions criteria clinical lactate qsofa septic sirs organ shock definition hypoperfusion response dysfunction resuscitation induced

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Slide1

SEPSIS – 3.0

CALS Instructor Update

July 14, 2016Slide2

DefinitionsSlide3

Definition

vs

Clinical Criteria

Definition

: What it is

Clinical Criteria: How we operationalize the definition at the bedsideSlide4

Definitions (ACCP/SCCM)

Systemic Inflammatory Response Syndrome

(SIRS)

: 2 or more of the following

Fever or hypothermia (T >100.4 or < 96.8)

Tachycardia ( HR > 90)

Tachypnea ( RR > 20 or PaCO2 < 32)

Leukocytosis, leukopenia or left shift (WBC > 12,000, < 4,000 or > 10% bands)SepsisSIRS as a result of infection

Crit

Care Med 1992;20:864-874Slide5

Definitions

Severe Sepsis

Sepsis associated with organ dysfunction,

hypoperfusion

, or hypotension.

Hypoperfusion

and perfusion abnormalities may include: lactic acidosis, oliguria or acute alteration in mental status.

Septic shockA subset of severe sepsis with hypotension (BP < 90 or drop of > 40 from baseline), despite adequate fluid resuscitation

Crit

Care Med 1992;20:864-874Slide6
Slide7

Definitions – 2012 Surviving Sepsis Guideline

Sepsis:

The presence (probable or documented) of infection together with systemic manifestations of infection

(More than just SIRS plus infection)Slide8
Slide9

Table 1 Continued. Criteria for sepsisSlide10

Definitions - 2012

Severe Sepsis:

Sepsis plus sepsis-induced organ dysfunction or tissue

hypoperfusion

Sepsis-induced hypotension: Systolic Blood pressure <90 mm Hg or MAP <70 mm Hg or SBP decrease > 40mm Hg

Septic Shock:

Sepsis induced hypotension persisting despite adequate fluid resuscitationSlide11
Slide12

What is wrong with these definitions

Too sensitive

A bad cold could be classified as sepsis

Routine post op patients

Too much variability in the definition which can affect reported outcome such as mortalitySlide13
Slide14

JAMA Feb 23, 2016Slide15

New Definition of Sepsis

“Sepsis is defined

as

life-threatening organ dysfunction caused by a

dysregulated

host response to infection

”Slide16

Organ Dysfunction

Can be identified as an acute change in total SOFA score of ≥ 2Slide17

Sequential Organ Failure Assessment (SOFA) Score

Not good for screening in EdSlide18

MedCalcSlide19

In lay terms

Sepsis is a life-threatening condition that arises when the body’s response to an infection injures it’s own tissues and organs”Slide20

Clinical criteria of Sepsis

Attempted to differentiate Sepsis from uncomplicated infections

Interrogated large clinical data sets of hospitalized patients with presumed infection correlating 21 different clinical and laboratory criteria with clinical outcomes

Mortality and ICU length of stay > 3 days

qSOFA

– simple bedside criteria to screen those with infection who are likely to have poor outcomes.Slide21

qSOFA – for screening for Sepsis

Need 2 out of 3Slide22
Slide23

Remember qSOFA

= HAT

Hypotension (BPs < 100)

Altered Mental Status (GCS ≤ 13)

Tachypnea (RR > 22)Slide24

New Sepsis DefinitionsSlide25

Septic Shock Definitions

1991

Sepsis induced hypotension, persisting despite adequate fluid resuscitation, along with the presence of

hypoperfusion

abnormalities or organ dysfunction

2001

State of acute circulatory failure characterized by persistent arterial hypotension unexplained by other causes

2016Subset of sepsis in which underlying circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than sepsis aloneSlide26

Septic Shock Clinical Criteria

Despite adequate fluid resuscitation, vasopressors needed to maintain MAP ≥ 65

And

Lactate > 2

Slide27

SIRS

SIRS has it’s place.

… though not for diagnosing sepsis

WBC, Temp are still useful in helping to form a provisional diagnosis of infection

SIRS is an appropriate – but not necessarily dysregulated host response toe infection.Slide28

Lactate

What does and elevated lactate mean?

Marker of cellular/metabolic stress

… not necessarily tissue hypoperfusion

C

an also occur with liver disease, catecholamine Rx, other drugs (metformin)

Independent predictor of mortalitySlide29

Why Lactate in Septic Shock Definition

Septic shock is more that hypotension alone

Wanted to reflect a sicker subset at higher risk for dying

Needed a readily available marker of cellular/metabolic abnormality

Lactate is the best current measure that fits this roleSlide30

Lactate + qSOFA

Lactate added only small improvement to the predictive value compared with

qSOFA

alone

May have some utility in intermediate risk patients (

qSOFA

= 1)

Not discouraging its use as a management tool or as a guide to therapeutic response nor and indicator of severitySlide31

Sepsis – 3:

What’s

Out

SIRS

Severe Sepsis

Routine sepsisSlide32

Sepsis – 3: What’s

in

Sepsis

Septic Shock

SOFA

qSOFASlide33