1. SEPSIS – What is Sepsis? <insert date>
Surviving Sepsis – ‘Recognise and Act’
<insert date>
Faculty: <insert faculty>

2. Sepsis
Aims:
To improve the recognition, assessment and management of septic patients
To drive improvements in patient outcomes from episodes of sepsis
Objectives:
To learn the terminology associated with sepsis
To increase knowledge of the sepsis 6
To be aware of special circumstances
© SaIL Centre 2015

3. What is sepsis? 26 year old female Complaining of abdominal pain
Fevers, chills, rigors
Temperature 39.4ºC
Heart rate 120
BP 130/70
RR 18
Sats 98% on air
Is this sepsis? Why?
© SaIL Centre 2015

4. SIRS Criteria What are the SIRS criteria? Temp <36 or >38
HR >90
RR >20/min or PaCO2 <32mmHg
WCC <4 or >12; >10% immature Forms
Acutely Altered Mental State
Hyperglycaemia; BM >7.7 in absence Of Diabetes Mellitus
© SaIL Centre 2015

5. SIRS Criteria
What support do we have to identify SIRS criteria and hence Septic patients?
© SaIL Centre 2015

6. © SaIL Centre 2015

7. The NEWS scoring actually reflects the latest evidence on identification of septic patients with poor outcomes.
High respiratory rate, low blood pressure and confusion are the strongest markers of poor outcome and are more sensitively detected in NEWS than in PAR scoring.
© SaIL Centre 2015

8. GSTT version

9. What is sepsis? 66 year old with known Systemic Lupus Erythematosis
On steroids
Presents with muscle aches and pains
Noted to have fevers
HR 95
Temperature 37.8ºC
RR 16
BP 150/90
WCC 16
Is this sepsis? Why?
© SaIL Centre 2015

10. What is sepsis? 45 year old male Known heavy alcohol intake
Presents with severe epigastric pain
HR 120
BP 155/80
Temp 37.4
RR 28
Sats 95% on air
Is this sepsis? Why?
© SaIL Centre 2015

11. SIRS + SEPSIS
Sepsis is the combination of an infection (purple circle) and SIRS – the systemic inflammatory response syndrome.
There are other causes of SIRS (see circles on right) and not all infections cause sepsis (where specific infection circles don’t overlap into the central pink sepsis area)

12. Sepsis
© SaIL Centre 2015

13. Organ Dysfunction in Severe Sepsis
Systolic blood pressure <90 mmHg or >40 mmHg fall from baseline, or mean arterial pressure <65 mmHg.
Bilateral pulmonary infiltrates with new need for oxygen to maintain saturations >90%, or with PaO2/FiO2 ratio<300 (mmHg) or 39.9 (kPa).
Lactate >2.0 mmol/l.
Serum creatinine >176.8 μmol/l or urine output <0.5 ml/kg/hr for 2 successive hours.
INR (international normalisation ratio) >1.5 or aPTT (activated partial thromboplastin time) >60 s.
Platelet count <100x109/l.
Bilirubin >34.2 μmol/l.
© SaIL Centre 2015

14. Sepsis ≥2 SIRS Criteria Temp <36 or >38 HR >90
RR >20/min or
PaCO2 <32mmHg
WCC <4 or >12
>10% immature
Forms
Acutely Altered
Mental State
Hyperglycaemia
BM >7.7 in absence
Of Diabetes Mellitus
≥2 SIRS Criteria
Hyperglycaemia
(>7.7) in the absence of DM
Septic shock is when sepsis (infection + SIRS) becomes unresponsive to fluid resuscitation
© SaIL Centre 2015

15. Sepsis
In the UK it is estimated that sepsis kills 37,000 patients per year.
© SaIL Centre 2015

16. Sepsis
Original Article Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock Emanuel Rivers M.D et al N Engl J Med 2001; 345: November 8, 2001
© SaIL Centre 2015

17. Sepsis
In order to target sepsis, an international campaign was launched.
This led to the development of the Sepsis Bundle concept.. Which was shown to significantly improve mortality
Sepsis consumes at least 50% of critical care resources
The Surviving Sepsis Campaign created evidence-led guidelines (2008, updated 2012) which led to the concept of the resuscitation bundle.
© SaIL Centre 2015

18. Sepsis
© SaIL Centre 2015

19. Sepsis
But……
In a survey in 2009, only 14% of patients were receiving the complete Sepsis bundle…
In recognition of this, the Sepsis 6 was developed.
6 key, early interventions
Previously identified as poorly performed
Use of the Sepsis 6 reduced mortality
20.0% vs 44.1% (p <0.001)
What are the Sepsis 6…?
© SaIL Centre 2015

20. The Sepsis 6 High flow Oxygen Cultures Antibiotics IV fluids
Lactate & Hb
Hourly Urine output
All within 1 hour…
© SaIL Centre 2015

21. SEPSIS NPSA Alert September 2014
NPSA alert in September 2014 – More to be done to identify and treat sepsis quickly.
© SaIL Centre 2015

22. Sepsis – horizon scanning
Coming in …
© SaIL Centre 2015

23. Sepsis – horizon scanning
Sepsis Guidelines coming July 2016
© SaIL Centre 2015

24. GSTT version The new GSTT Sepsis Screening Tool
Flow from identification (Pt unwell or via NEWS), to identifying SIRS, to asking ?infection.
This leads to identification of organ hypo-perfusion, advises the administration of the Sepsis 6 and early call for senior support.

25. Sepsis
The Sepsis 6 Video
© SaIL Centre 2015