Early Goal-Directed Therapy in Pediatric Sepsis Derek S. Wheeler, MD, FAAP, FCCP, FCCM Associate Professor of Clinical Pediatrics University of Cincinnati.

Slides:

Advertisements

Similar presentations

Pediatric Septic Shock

Advertisements

R. Phillip Dellinger, MD, MCCM, FCCP

The golden hour(s) for severe sepsis and septic shock treatment

SEPSIS KILLS program Paediatric Inpatients

The Duration of Hypotension Prior to Initiation of Effective Antimicrobial Therapy is the Critical Determinant of Survival in Human Septic Shock Anand.

The New Surviving Sepsis Bundles: From Time Zero to Tomorrow

Surviving Sepsis Campaign Database: Revision based on the 2012 Guidelines Christa A. Schorr RN, MSN, FCCM.

A Randomized Trial of Protocol-Based Care for Early Septic Shock Andrea Caballero, MD January 15, 2015 LSU Journal Club The ProCESS Investigators. N Engl.

Sepsis...a major Medical Emergency Dr Ron Daniels Fellow: NHS Improvement Faculty Chair: United Kingdom SSC, Sepsis Trust & Pre-hospital Working Group.

Copyright Wigfull 2013 The Sepsis Timebomb James Wigfull Critical Care and Anaesthesia Sheffield Teaching Hospitals.

Compliance with Severe Sepsis Protocol: Impact on Patient Outcomes Lisa Hurst RN BSN CCRN and Kim Raines RN CCRN References The purpose of this study is.

Shock and Sepsis 2 of 2 William Whitehead, M.D., Ph.D. Department of Anesthesiology.

Severe Sepsis Initial recognition and resuscitation

GAPP Coaching Call Sepsis Working Session August 14, 2014 Jan Ratterree Lynne Hall Jean Allred.

Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock CR 杜宜霖.

Adult Sepsis Nursing Competency

In 2001, the European Society of Intensive Care Medicine (ESICM), Society of Critical Care Medicine (SCCM), and the International Sepsis Forum (ISF) developed.

Early Goal Therapy in Severe Sepsis & Septic Shock

MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?

Goal-Directed Resuscitation for Patients with Early Septic Shock NEJM October 2014 ARISE.

Surviving Sepsis Michael Stewart CT2 EM

SEPSIS Early recognition and management. Aims of the talk Understand the definition of sepsis and severe sepsis Understand the clinical significance of.

Innovation in Pediatric Sepsis: Is there anything new on the horizon? Derek S. Wheeler, MD, FAAP, FCCP, FCCM Associate Professor of Clinical Pediatrics.

Surviving Sepsis 2008 Guidelines Early Goal Directed Therapy MAZEN KHERALLAH, MD, FCCP INFECTIOUS DISEASE AND CRITICAL CARE MEDICINE.

Applying the Surviving Sepsis Campaign Guidelines to Clinical Practice

SEPSIS Where are the goal posts now?. What is the new evidence? RCTs: Trilogy of EGDT trials ( ) RCT: SEPSIS-PAM (2014) RCT: ALBIOS (2014) Observational.

Sepsis and Early Goal Directed Therapy

Sepsis course – VI: Surviving Sepsis Campaign Zsolt Molnár University of Szeged 2009.

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 A Guide To The Guidelines … Nabil Abouchala,

Pediatric Septic Shock

SEPSIS & SEPTIC SHOCK Jaime Palomino, MD Pulmonary & Critical Care Medicine Tulane University Health Sciences Center New Orleans, Louisiana.

The Surviving Sepsis Campaign: The Sepsis Epidemic: How to Win.

Stuart L. Goldstein, MD Professor of Pediatrics

Prof. Jean-Louis TEBOUL Medical ICU Bicetre hospital University Paris-South France Optimal blood pressure target in septic shock.

COMBINED USE OF TRANSPULMONARY THERMODILUTION (TPTD) TECHNIQUE IN FLUID MANAGEMENT FOR SEPSIS PATIENTS 1 St. Marianna University School of Medicine, Kanagawa,

Early goal directed therapy in the treatment of sepsis Nouf Y.Akeel General surgery demonstrator Saudi board trainee R3.

Sepsis Management in the Emergency Department Bryon K. Frost, MD, FACEP September 13, 2010 Medical Staff Meeting.

Virtual Journal Club ACMQ

1 Search and Rescue: The keys to Surviving Sepsis July 22, 2008 Emmel B. Golden, Jr., MD, ICU Medical Director Melanie Polzin, RN, CCRN, ICU Head Nurse.

The (Surviving) Sepsis Campaign at Cork University Hospital

United States Statistics on Sepsis

Acute Care Perspective How Power Hour is Saving Lives at Virginia Mason Christin Gordanier, RN MN Inpatient Nursing Director April 1, 2016 Christin Gordanier,

Tiffany M. Osborn, MD University of Virginia ACEP Chair Critical Care Section ACEP Representative Surviving Sepsis Campaign.

Dr Alex Hieatt, EM Consultant MEHT Dr Ron Daniels, Chair of the UK Sepsis Trust and Global Sepsis Alliance (Slides with permission.)

Dr Michelle Webb Renal Consultant, Associate Medical Director Patient Safety, East Kent Hospitals University NHS Foundation Trust and Co-lead for Sepsis.

Departments of Surgery & Critical Care Medicine Characterization of the Murine Septic Response Using Wireless Telemetry Technology: Modeling the Murine.

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y j 내과 R2 이지영.

Surviving Sepsis 2008 Guidelines Therapy Across the Sepsis Continuum MAZEN KHERALLAH, MD, FCCP INFECTIOUS DISEASE AND CRITICAL CARE MEDICINE.

Anything else? Glucose – tight control must be better NICE-SUGAR study investigators. Intensive versus conventional glucose control in critically ill.

Bela Patel MD Associate Professor of Medicine UT Health Science Center Houston Memorial Hermann Hospital – Texas Medical Center.

Update in Critical Care Medicine Ann Intern Med 2007;147:

Preventing Sepsis in Wales

UNC Hospitals Sepsis Mortality Reduction Initiative General CMS Compliant Sepsis Training Updated Code Sepsis.

Code Sepsis: Current Evidence Based Guidelines and the CMS Sepsis Core Measure Adult Patients - Abbreviated Updated May 26, 2017.

Acute Care Perspective How Power Hour is Saving Lives at Virginia Mason Christin Gordanier, RN MN Inpatient Nursing Director April 1, 2016.

Code Sepsis: Current Evidence Based Guidelines and the CMS Sepsis Core Measure Adult Patients - Abbreviated Updated August 30, 2017.

Todd W. Rice, MD, Gordon R. Bernard, MD

Sepsis Surgeon Champions Talking Points

The Duration of Hypotension Prior to Initiation of Effective Antimicrobial Therapy is the Critical Determinant of Survival in Human Septic Shock Anand.

‘TAP THE TAZ’ Liz Casey A/Resuscitation & EWS Training Officer

Code Sepsis: Current Evidence Based Guidelines and the CMS Sepsis Core Measure Adult Patients - Abbreviated Updated August 30, 2017.

Early Goal Directed Therapy Fondazione Ospedale Maggiore

Improving Outcomes for Severe Sepsis and Septic Shock: Tools for Early Identification of At-Risk Patients and Treatment Protocol Implementation Emanuel.

Recognising sepsis and taking action

Infections in Surgical Patients: Intensive Care Unit

Pediatric Code Sepsis Grace Sund RN, MSN, CPNP, CPHON, CNS| Janae Sieder RN, BSN 6 North Wing – Pediatrics | Santa Monica UCLA Medical Center Clinical.

Sepsis Core Measure August 25, 2015.

Sepsis George Bailey Emergency Department, St Mary’s Hospital.

Assistant Clinical Professor

Presentation transcript:

Early Goal-Directed Therapy in Pediatric Sepsis Derek S. Wheeler, MD, FAAP, FCCP, FCCM Associate Professor of Clinical Pediatrics University of Cincinnati College of Medicine Clinical Director, Division of Critical Care Medicine Cincinnati Children’s Hospital Medical Center The James M. Anderson Center for Health Systems Excellence Co-Director, The Center for Acute Care Nephrology

Early Goal-directed Therapy

Protocolized Care for Early Septic Shock (ProCESS) NCT (expected study completion August 2013)

Crit Care Med 2010; 38:367 Surviving Sepsis Campaign N=15,022 Sepsis Resuscitation (6 H) Bundle Measure Serum Lactate Administer broad-spectrum antibiotics (<3 h) Early resuscitation to EGDT Targets Sepsis Management Bundle Low-dose corticosteroids Drotrecogin alfa Tight glucose control Plateau Pressure < 30 cm H2O

Crit Care Med 2006; 34:1589 N=2,731 adults with septic shock Only 50% of pts received antimicrobial therapy within 6 h of documented hypotension! Early Antibiotics “Door to antibiotics” decreased from 143 to 38 minutes TCH Sepsis Protocol Cruz et al. Pediatrics 2011; 127:e758

Crit Care Med 2006; 34:1589 N=2,731 adults with septic shock Only 50% of pts received antimicrobial therapy within 6 h of documented hypotension! Early Antibiotics “Door to Antibiotics” < 3 hours Primary Children’s Sepsis Protocol Larsen et al. Pediatrics 2011; 127:e1585

Arch Dis Child 2001; 85:386 Reduction in mortality from 23% to 2.5%! Early Resuscitation

Pediatrics 2003; 112:793 Early Resuscitation

Intensive Care Med 2008; 34:1065 Minimize variation Early Resuscitation

Minimize variation Early Resuscitation Intensive Care Med 2008; 34:1065

Minimize variation Early Resuscitation 28-day Mortality 39.2% versus 11.8% Intensive Care Med 2008; 34:1065

Minimize variation Early Resuscitation No differences in HR, MAP, CVP, ScvO2, or Lactate at Baseline, 6 H, or 72 H Intensive Care Med 2008; 34:1065

Minimize variation Early Resuscitation No differences in TOTAL fluid volume administered at 72 H Significant differences in amount of fluid volume administered at 6 H Early administration of inotropes Intensive Care Med 2008; 34:1065

Final Thoughts 1.Protocolized care to minimize practice variations. 2.Early recognition = Early Treatment 3.Better therapeutic endpoints are on the horizon

R18 HS The James M. Anderson Center for Health Systems Excellence Stephen Muething, MD Patrick Brady, MD Uma Kotagal, MBBS, MSc Janet Jacob, RN, MBA Children’s Hospital of Akron Mary D. Patterson, MD, MEd Cincinnati Children’s Center for Simulation and Research Gary Geis, MD John Whitt, MD Tom LeMaster, RN, MSN, MEd, REMT-P, EMSI University of Cincinnati College of Medicine Amy Bunger, PhD University of Michigan Ross School of Business Kathleen M. Sutcliffe, MSN, PhD Applied Decision Science, LLC Laura Militello, MA MacroCognition, LLC Gary Klein, PhD Division of Critical Care Medicine Hector R. Wong, MD Carley Riley, MD Erika Stalets, MD Thank You!