MedReg+1 Loveridge Acute Medicine

Developing people for health and healthcare

Sepsis

Acute Medicine

24th July

The story behind sepsis management

Developing people forhealth and healthcare

OUTLINE

• To summarize the background behind sepsis management guidance

• To understand why simplified guidelines are being promoted

• • To consider briefly some of the possible

future trends in sepsis care


WHY WAS SIMPLIFICATION NEEDED?

• Poor compliance with bundles• Guidance involves some complex

measures• Mortality still stands at 30-35%• 36,800 lives lost annually in UK• Sepsis costs the NHS £2.5 billion


THE SEPSIS SIX

• Lactate• Blood cultures• Early antibiotic administration• Fluid resuscitation• Urine output monitoring• High flow oxygen


WHY THE SEPSIS SIX?


PREDICTED BENEFITS OF SEPSIS SIX

• Achieving 80% compliance with Sepsis Six expected to save 15,000 lives per year in UK

• …..and £170,000,000• (Extrapolated from unpublished data

relating to reduced length of stay)


THE PROCESS TRIAL

• Did not show statistically significant survival of patients treated with EGDT over and above less aggressive protocols or ‘usual care’


WHAT NEXT?

• PROMISE & ARISE trials• NICE Guideline due 2016• Targeted in the National Outcomes

Framework for the NHS Commissioning Board

• Research into biomarkers, pathogen recognition, pathogenesis, targeted therapy


REFERENCES AND FURTHER READING

• Surviving sepsis campaign:International Guideline for Management of Severe Sepsis and Septic Shock 2012 http://www.sccm.org/Documents/SSC-Guidelines.pdf

• Surviving the first hours in sepsis: getting the basics right (an intensivist’s perspective) J Antimicrob Chemother 2011: 66 Suppl 2 ii11-1123

• A randomized trial of protocol-based care for early septic shock; The Process Investigators NEJM 2014; 370:1683-1693

• Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program; Critical care medicine; August 2014 (42) Issue 8: 1794-1755


References continued

• The Ombudsman report 2013

• http://www.ombudsman.org.uk/__data/assets/pdf_file/0004/22666/FINAL_Sepsis_Report_web.pdf

• The UK Sepsis Trust report 2013

• http://www.england.nhs.uk/wp-content/uploads/2013/12/spesis-brief.pdf

MedReg+1 Loveridge Acute Medicine

Health & Medicine

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