Surviving Sepsis Michael Stewart CT2 EM Definition agreed 1992, revised 2001. SSC launched 2002 – aim 25% RR by 2009 (10% absolute reduction) Michael Stewart CT2 EM

Mortality severe sepsis – 30-50%; in septic shock >50%.

SIRS + Sepsis Systemic Inflammatory Response Syndrome: Temp<36/>38.3 HR > 90 RR >20 WCC <4/>12; >10% immature Acutely altered mental state BM > 6.6 in absence of diabetes Sepsis: SIRS caused by infection SIRS – 2 or more criteria met

Severe Sepsis Severe sepsis – sepsis leading to organ hypoperfusion or hypotension Septic shock – hypoperfusion persists after adequate fluid resuscitation Markers – Lactate>2, MAP<65, Cr>177, Bili>34, Plt<100, INR>1.5, APTT>60, UO<0.5ml/kg/hr for 2 hours, increased oxygen requirement to keep SpO2>90% Septic shock – MAP<65/Lac>4/Lac>4 initially still >2

Early Goal Directed Therapy Fluids (CVP 8-12) Vasopressors (MAP > 65) Optimise ScvO2: Transfusion (Hct > 30%) Inotropes (ScvO2 > 70%) CVP 12-15 if ventilated ARR 15% in some studies (at 28 days)

Sepsis Six Oxygen Cultures IV Antibiotics IV fluid resuscitation Blood tests, including Lactate Fluid balance monitoring Catheter. Aim abx <1hr if direct admission, <3hrs if A+E 20ml/kg IVI if severe sepsis