Sepsis 101 in 10 Minutes What Is Sepsis? Recognizedtreated and Early Promptly

Sepsis 101 in 10 Minutes What is Sepsis? recognizedtreated and early promptly. organs. It maytoorganmultiple shock, lead failure not if death,especially and Sepsis

Stage 1 arises body’sthe when response toinfection an injures itstissues ownand circulatorysystem. infectionthe enterand the produceleave site original the of the toxinsgerms and they defense mechanisms. Pathogenic – A localinfection generalinflammation localFrom infectiona toa overcomesbody’s the local Source: Source: world – e.g. the lung in e.g. - sepsis - day.org What is Sepsis?

Organ Dysfunction

2 This leads to a general inflammatory response: SIRS (systemic inflammatory response syndrome). The function of individual organ starts to deteriorate and may completely fail. Sepsis

starts with the onset of at least one new organ dysfunction. Stage Stage

Septic Shock Several organs stop functioning 3 sequentially or simultaneously and cardio-circulatory failure leads to a sudden drop in blood

Stage Stage pressure. This is called septic shock. Source: world-sepsis-day.org Source: CDC Vital Signs, August 2016 Sepsis at a Glance Sepsis is a medical emergency . . . minutes matter

Every hour a patient in septic shock doesn't receive antibiotics, the risk of death increases by 4 percent.

Source: NEJM, The Timing of Early Antibiotics and Hospital Mortality in Sepsis, 2017 Speed is Important

Time is Tissue! Would you wait an hour to treat a stroke? Heart attack?

Mortality rates increase as the number of failing organs increase. Know the Signs & Symptoms Know the Signs & Symptoms 3-Hour Bundle

To be completed within 3 hours of time of presentation*: 1. Measure lactate level 2. Obtain 2 sets of blood cultures prior to administration of antibiotics from 2 different sites. 3. Administer broad spectrum antibiotics 4. Administer 30ml/kg crystalloid IVF for hypotension or lactate ≥ 4 mmol/L

* “Time of presentation” is defined as the time of earliest chart annotation consistent with all the elements of severe sepsis or septic shock ascertained through chart review.

http://www.survivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdf 6-Hour Bundle

To be completed within 6 hours of time of presentation 5. Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) and titrate pressors to a mean arterial pressure (MAP) ≥ 65 mm Hg. 6. In the event of persistent hypotension after initial fluid bolus (MAP < 65 mm Hg) or if initial lactate was ≥ 4 mmol/L, re-assess volume status and tissue perfusion and document findings. 7. If initial lactate is elevated > 2, re-measure lactate within 6 hours.

http://www.survivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdf Hour-1 Bundle

• The most important change in the revision of the SSC bundles is that the 3-hour and 6-hour bundles have been combined into a single “Hour-1 Bundle” with the explicit intention of beginning resuscitation and management immediately. • There are no new or deleted elements • This does not impact CMS core elements (no change). • “There is no reason to delay treatment for patients with sepsis and septic shock,” comments lead author Mitchell Levy, MD, MCCM. “Recognizing the urgent need to treatment, clinicians must (and many already do) begin treatment immediately, rather than waiting for 3 or 6 hours in these critically ill patients.”

Critical Care Medicine, 2018 Society of Critical Care Medicine and the European Society of Intensive Medicine Keys to Survival

Early Identification • Subtle signs and symptoms • Don’t wait until your patient is hypotensive! Appropriate antibiotics in a timely manner • For every hour antibiotics are delayed during septic shock, the patient’s risk of death increases by 4% • The single most important intervention in treating sepsis Source Control • Antibiotics • Surgery IV Fluids and vasopressors if necessary (hemodynamic stability) Emergency supportive care for acute organ dysfunction • Ventilator • Continuous Renal Replacement Therapy (CRRT) • Prone positioning Patient’s Journey Does Not End at Discharge

Possible post-sepsis symptoms are: Other symptoms can include: • Neuromuscular weakness • Sleep disturbance, including • Chronic pain insomnia • Post-traumatic stress disorder • Extreme tiredness and fatigue • Cognitive impairment • Inability to concentrate • Depression • Loss of confidence and self-belief

Incidence of post-traumatic stress disorder1

Sepsis accounts for 50-60% of ICU cases1

1_ Kessler RC, Sonnega A, Bromet E, et al.: Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry, 52: 1048– 60, 1995. // Davydow DS, Gifford JM, Desai SV, et al.: Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry, 30: 421-434, 2008. Healthcare Providers Can . . .

Prevent infections. • Hand washing is #1 way to prevent infection • Sterile technique and maintenance o Foley insertion (and maintenance) o Line insertion and draws (and maintenance) o Invasive procedures • Vaccines o Flu and pneumonia shots

Reassess patient management. Check patient progress frequently. Reassess antibiotic therapy 24-48 hours or sooner to change therapy as needed (narrow the spectrum). Be sure the antibiotic type, dose and duration are correct. Educate patients and their families. Stress the need to prevent infections, manage chronic conditions and seek care if signs of severe infection or sepsis are present.