a complex systems view of sepsis : implications for nursing
DESCRIPTION
A COMPLEX SYSTEMS VIEW OF SEPSIS : IMPLICATIONS FOR NURSING. LTC Elizabeth A. Mann-Salinas, PhD, RN, CCRN, CCNS 1,2 Joan Engebretson, DrPH , AHN-BC, RN 2 Andriy Batchinsky, MD 1 1 US Army Institute of Surgical Research, San Antonio, TX - PowerPoint PPT PresentationTRANSCRIPT
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A COMPLEX SYSTEMS VIEW OF SEPSIS:
IMPLICATIONS FOR NURSING
LTC Elizabeth A. Mann-Salinas, PhD, RN, CCRN, CCNS 1,2
Joan Engebretson, DrPH, AHN-BC, RN 2
Andriy Batchinsky, MD 1
1US Army Institute of Surgical Research, San Antonio, TX2 University of Texas Health Science Center, Houston
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Complex Systems
• Non-linear• Coupling• Sensitivity to initial conditions• Self-similarity• Emergence• Adaptability• Self-Organization• Connectivity• Robustness
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Complicated
Light bulb changer
Linear
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Complex Non-Linear
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Coupling
1 + 1 = 3
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Sensitivity to initial conditions
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Self-organization
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Fractals
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Self-similarity
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Emergence
NoveltyIrreducibility to component partsUnpredictable
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Adaptability
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Connectivity
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Robustness
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Intra-patient variability
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Bone et al. /
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Sepsis as a Complex System
• Non-linear• Coupling• Sensitivity to initial conditions• Self-similarity• Emergence• Adaptability• Self-Organization• Connectivity• Robustness
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Sepsis
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IV Immunoglobin
Corticosteroids
Xigris ™
Organ Support
EarlyAppropriate
ABX
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Surviving SepsisCampaign
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Surgical Intensive Care UnitUSNS Comfort Hospital Ship, Persian Gulf, 2003
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Pattern Recognition
• Data display• “Sniffers”• Smart alarms• Computer decision support systems
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Traditional Data Display
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Novel Data Display
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“Sniffer”
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Smart AlarmDate : 13-Mar-11 11:10:09Bed : 4N-4702
Reasons:
Less than 0.5 ml/kg per hour for more than 6 hours
UOP for hour 11:00 = 0.0 ml/kg UOP for hour 10:00 = 0.0 ml/kg UOP for hour 09:00 = 0.0 ml/kg UOP for hour 08:00 = 0.0 ml/kg UOP for hour 07:00 = 0.0 ml/kg UOP for hour 06:00 = 0.0 ml/kg
Vital Signs at 13-Mar-11 11:10:09:
Heart Rate = 129 bpm Blood Pressure: Systolic = 98 mmHg Diastolic = 63 mmHg MAP = 73 mmHg Last Serum Creatinine = N/A
Attending Physician Email: [email protected]
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CDSS
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WVSM
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Burn Resuscitation CDSS
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Is sepsis a complex system?
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38
Thank You!