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35Th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium, 17-20 March 2015

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35Th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium, 17-20 March 2015 Critical Care 2015, Volume 19 Suppl 1 http://ccforum.com/supplements/19/S1 MEETING ABSTRACTS 35th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium, 17-20 March 2015 Published: 16 March 2015 Publication charges for this supplement were funded by ISICEM. P1 but long-term observation and objective evaluation of gastrointestinal Cerebral autoregulation testing in a porcine model of intravenously motility are diffi cult. We developed a non-invasive monitoring system administrated E. coli induced fulminant sepsis capable of quantifying and visualizing gastrointestinal motility in real L Molnar1, M Berhes1, L Papp1, N Nemeth2, B Fulesdi1 time. In the study gastrointestinal motility was performed in patients 1Deoec Aneszteziologia, Debrecen, Hungary; 2University of Debrecen, Hungary with severe sepsis using this developed bowel sound analysis system, Critical Care 2015, 19(Suppl 1):P1 (doi: 10.1186/cc14081) and the correlation between bowel sounds and changes over time in blood concentrations of IL-6, which is associated with sepsis severity, Introduction To assess cerebral hemodynamics in an experimental was evaluated. sepsis model. Methods The study was a prospective, observational pilot study Methods Nineteen juvenile female Hungahib pigs were subjected into conducted in our hospital. Consecutive adult patients with severe control group (n = 9) or septic group (n = 10). Under general anesthesia sepsis, on a mechanical ventilator with an IL-6 blood concentration in animals of the sepsis group, Escherichia coli culture (2.5 × 105/ml; ≥100 pg/ml in the acute phase, defi ned as being up to the 28th day of strain: ATCC 25922) was intravenously administrated in a continuously illness in the ICU, were entered in this study between June 2011 and increasing manner as follows: 2 ml in the fi rst 30 minutes, then 4 ml December 2012. Subjects were divided into those who were treated in 30 minutes and afterwards 16 ml/hour for 2 hours (so a total of with steroids (steroid treatment group) and those who were not (no- 9.5 × 106 E. coli within 3 hours). In the control group the anesthesia steroids group) during the target period, because steroids strongly was maintained for 8 hours, infusion was administered as a similar aff ect IL-6 blood levels. volume of isotonic saline solution and no other intervention was Results The subjects were fi ve adult patients in the acute phase of made. Hemodynamic monitoring of all animals was performed by severe sepsis on a mechanical ventilator. Gastrointestinal motility PiCCo monitoring system. The middle cerebral artery of the pigs was was measured for a total of 62,399 minutes: 31,544 minutes in three insonated through the transorbital window and cerebral blood fl ow subjects in the no-steroids group and 30,855 minutes in two subjects velocity (MCAV) and pulsatility index was registered. in the steroid treatment group. In the no-steroids group, the bowel Results In the septic group, as expected, all animals developed sound counts were negatively correlated with IL-6 blood concentration fulminant sepsis and died within 3 to 7 hours two animals in 3 to 4 hours, (r = –0.76, P <0.01), suggesting that gastrointestinal motility was and three in 6 to 7 hours). In the septic animals the heart rate rose and suppressed as IL-6 blood concentration increased. However, in mean arterial pressure dropped, their ratio increased signifi cantly the steroid treatment group, gastrointestinal motility showed no compared with both the base values (at the 6th hour: P <0.001) and correlation with IL-6 blood concentration (r = –0.25, P = 0.27). The IL-6 the control group (P = 0.004). The control animals showed stable blood concentration appears to have decreased with steroid treatment condition over the 8-hour anesthesia. MCAV signifi cantly decreased irrespective of changes in the state of sepsis, whereas bowel sound during the development of sepsis (from 23.6 ± 6.6 cm/s to 16.0 ± 3.9 counts with the monitoring system refl ected the changes in the state cm/s, P <0.01) and pulsatility indices increased (from 0.68 ± 0.22 to of sepsis, resulting in no correlation. 1.37 ± 0.58, P <0.01), indicating vasoconstriction of the resistance Conclusion The new real-time bowel sound analysis system provides vessels. A signifi cant relationship was fund between percent change of a useful method of continuously, quantitatively, and non-invasively the MAP and the pulsatility index in septic animals (R2 = 0.32) referring evaluating gastrointestinal motility in severe patients. Furthermore, to maintained cerebral autoregulation. this analysis may predict disease severity in septic patients. Conclusion Cerebral autoregulation is preserved in the pig model of experimentally induced fulminant sepsis. P3 Usefulness of sepsis screening tools and education in recognising P2 the burden of sepsis on hospital wards New real-time bowel sound analysis may predict disease severity in EJ Galtrey, C Moss, H Cahill septic patients Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK J Goto1, K Matsuda1, N Harii1, T Moriguchi1, M Yanagisawa1, D Harada1, Critical Care 2015, 19(Suppl 1):P3 (doi: 10.1186/cc14083) H Sugawara1, O Sakata2 1University of Yamanashi School of Medicine, Chuo, Japan; 2University of Introduction Sepsis is defi ned as the presence of infection with systemic Yamanashi, Kofe, Japan signs of infection, and severe sepsis as sepsis plus sepsis-induced organ Critical Care 2015, 19(Suppl 1):P2 (doi: 10.1186/cc14082) dysfunction or tissue hypoperfusion [1]. Since the Surviving Sepsis Campaign (SSC) in 2002, the Health Service Ombudsman for England Introduction Healthy bowel function is an important factor when published recommendations for improving recognition and treatment judging the advisability of early enteral nutrition in critically ill patients, of sepsis [2], the Royal College of Physicians issued a toolkit for the management of sepsis in the acute medical unit [3], and NHS England released a patient safety alert to support prompt recognition and © 2015 BioMed Central Ltd treatment of sepsis [4]. In 2012 our Trust introduced a sepsis screening Critical Care 2015, Volume 19 Suppl 1 S2 http://ccforum.com/supplements/19/S1 tool and electronic order set (EPR alert) alongside an education P5 programme to improve delivery of the SSC bundle. Previous audits Audit of strategies to improve sepsis management in emergency showed only 43% full bundle compliance in those that were alerted, departments and this raised concerns regarding the burden of unalerted sepsis. We CE Thakker1, P Crook1, B Davies1, L Mawer1, T Tomouk1, E Williams1, C Gray2, sought to estimate the number of unalerted sepsis episodes to assess K Turner2 the effi cacy of our screening tool and improve early recognition. 1University of Cambridge, UK; 2Ipswich Hospital, Ipswich, UK Methods All referrals to our critical care response team with a diagnosis Critical Care 2015, 19(Suppl 1):P5 (doi: 10.1186/cc14085) of sepsis over a 3-month period (September to November 2014) were investigated to determine how many had an EPR sepsis alert Introduction Severe sepsis results in ~36,800 UK deaths each year comprising a prompt for blood cultures, serum lactate measurement, [1]. Prior studies demonstrate the benefi t of early recognition and fl uid challenge if hypotensive, and antibiotics within 1 hour. treatment of sepsis in reducing mortality [2]. The Sepsis Six [1] bundle Results Only 25/174 (14%) patients with a diagnosis of sepsis had an aims to optimise the fi rst hour of sepsis management. We assessed the EPR sepsis alert. There was no signifi cant diff erence between acute and proportion of emergency department (ED) patients with severe sepsis nonacute ward areas in their likelihood of using the screening tool or receiving the Sepsis Six bundle and whether this was improved by a alert, in contrast to previous audits of the alerted population which combination of staff education and use of Sepsis Six management showed that acute areas such as A&E and medical acute admission stickers in patient notes. wards had higher utilisation and bundle completion rates. Methods A closed loop audit was completed in the ED at Ipswich Conclusion Despite these interventions, most patients still do not Hospital, UK. Each cycle was 14 days with interventions made in a receive the full recommended treatment bundle. These fi ndings have 4-week period between the two cycles. The interventions consisted prompted a point prevalence audit at ward level, which will examine of: Sepsis Six management stickers and posters placed in the ED; all patients’ notes for the preceding 24 hours to ascertain if sepsis is two training sessions for all ED nurses on sepsis recognition and truly unrecognised or whether it is simply that our current tool is not management; a teaching session for all middle-grade doctors; and a a helpful adjunct to care. With national guidelines expected within the trolley in the ED with equipment required for the Sepsis Six. The notes year, we will redesign and re-launch our screening tools and education of all patients with lactate ≥2 mmol/l were retrospectively reviewed. programme to improve awareness and management of this common Those with ≥2 systemic infl ammatory response syndrome criteria and a medical emergency. documented suspicion of infection were deemed to have severe sepsis. References The times at which these patients had each of the Sepsis Six completed 1. Dellinger R, et al. Crit Care Med. 2013;41:580-637. were recorded, as were the fi nal diagnosis and 7/28 day mortality. 2. http://bit.ly/1nzV3Kp. Results In Cycle 1, 31/106 patients met the criteria for severe sepsis, 3. http://bit.ly/12Y3KHq. compared with 36/120 in Cycle 2. The delivery of the Sepsis Six 4. http://bit.ly/10PYi8G. interventions was highly variable.
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