medreg+1 loveridge acute medicine
TRANSCRIPT
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Developing people for health and healthcare
Sepsis
Acute Medicine
24th July
The story behind sepsis management
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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
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Developing people forhealth and healthcare
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Developing people forhealth and healthcare
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Developing people forhealth and healthcare
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Developing people forhealth and healthcare
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Developing people forhealth and healthcare
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Developing people forhealth and healthcare
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Developing people forhealth and healthcare
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Developing people forhealth and healthcare
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
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Developing people forhealth and healthcare
THE SEPSIS SIX
• Lactate• Blood cultures• Early antibiotic administration• Fluid resuscitation• Urine output monitoring• High flow oxygen
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Developing people forhealth and healthcare
WHY THE SEPSIS SIX?
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Developing people forhealth and healthcare
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• …..and £170,000,000• (Extrapolated from unpublished data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)
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Developing people forhealth and healthcare
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Developing people forhealth and healthcare
THE PROCESS TRIAL
• Did not show statistically significant survival of patients treated with EGDT over and above less aggressive protocols or ‘usual care’
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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
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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
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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