Introduction to Sepsis

1. Introduction To Sepsis
Dr. Hatem A. Soliman, MSc, MRCP (UK)
Specialist Intensivist
Mafraq Hospital, Abu Dhabi
EACVI Club 35 Ambassador to the UAE

2. “SAY: MY LORD, INCREASE ME
IN KNOWLEDGE”
QUR’AN 20:14
“ ‫لما‬ِ‫ع‬ ِ‫دني‬ِ‫ز‬ ِ‫ب‬َ‫ر‬ ‫ل‬ُ‫ق‬َ‫”و‬
‫العظيم‬‫هللا‬ ‫صدق‬

3. Disclosure
Nothing to disclose

4. Acknowledgement

5. Ancient Egypt: “Edwin Smith” Papyrus
NY Academy of Medicine
3000–2500 BC
Luxor, Egypt in 1980.

6. • The oldest known surgical textbook on trauma
• The oldest rational and scientific approach to
medicine
• The text is attributed by some to ”Imhotep”:
an architect, high priest, and physician of the Old
Kingdom (King Zoser)
Ancient Egypt: Edwin Smith Papyrus

9. • The word “Infection” mentioned for the first
time in history.
• Described Prevention and Curing “Infection”
with “Honey”
• Systematic anatomical classification of body
parts injuries from head to toes.
• Prognostic classification of disease outcomes.
Ancient Egypt: Edwin Smith Papyrus

10. • The word “brain” appears for the 1st time in
history.
• The procedures of this papyrus demonstrate an
Egyptian level of knowledge of medicines that
surpassed that of Hippocrates, who lived 1000
years later (Ghalioungui, et al)
Ancient Egypt: Edwin Smith Papyrus
Source: Edwin Smith Papyrus, Wikipedia

11. History of Sepsis
HIPPOCRATES (460-370 BC)
Greek word: sipsis = make rotten
pepsis = good digestion

13. IBN SINA (Avicenna)
(979-1037 BC)
Noticed the coincidence
of blood putrefaction
(septicemia) and fever
History of Sepsis

15. A Dutch botanist in
Leyden. He thought that
toxic substances in the air
were the cause for sepsis.
History of Sepsis
HERRMAN BOERHAVE
(1668-1738), NL

16. IGNAZ SEMMELWEIS
(1818-1865)
Hungary
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4
6
8
10
12
14
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Maternalmortality,1842
First Clinic Second
Clinic
“It is not by chance that a single obstetrician has 16
fatal cases in a single month - I can only dispel the
sadness which falls upon me by gazing into that
happy future when the infection will be banished”
History of Sepsis

17. The Intervention:
Hand scrub with chlorinated lime solution: removed the putrefying
smell from the hands of students and doctors
Hand hygiene basin Vienna, 1847

18. Fired by the hospital board for enforcing
Hand Washing
requirement for doctors !!!!
He was committed to an asylum,
where he died at age 47 of pyaemia,
after being beaten by the guards,
only 14 days after he was committed
What was Dr Semmelweiss’s reward in
1848 for this major contribution ???

19. 124 years later
2008 Austrian Commemorative Coin

20. LOUIS PASTEUR (1822-1895)
• Bacteria / microbes caused
putrefaction
• Killed by heating – sterilization
JOSEPH LISTER (1827-1912)
• Post amputation mortality – 50%
• Skin & instrument disinfection with
carbolic acid – antiseptic method

21. • Modern definition of sepsis (1914):
"Sepsis is present if a focus has developed
from which pathogenic bacteria,
constantly or periodically, invade the
blood stream in such a way that this
causes subjective and objective
symptoms.”
• “Therapy should not be directed against
bacteria in the blood but against the
released bacterial toxins”
History of Sepsis
HUGO SCHOTTMULLER
(1867-1936)
Germany

22. Helped develop the multi-disciplinary
subspecialty of modern Critical Care
Medicine
Promoted evidence-based approach to
sepsis
History of Sepsis
ROGER C. BONE (1941-1997)
US

23. Alzahra CME Hatem Soliman EGDT
What is Sepsis ??!!

24. "Sepsis is defined as an
invasion of microorganisms
and/or their toxins into the
bloodstream, along with the
organism's reaction against
this invasion.“ (1989)
History of Sepsis
ROGER C. BONE (1941-1997)

25. Incidence

26. Incidence
• Sepsis is the leading cause of death by
infection in the world – despite modern
vaccines, antibiotics and intensive care.
• Over 6.000.000 of neonatal and early
childhood deaths.
• Over 100.000 maternal deaths

28. Incidence

30. Even for those who survive sepsis, the after-effects
can be severe.
Incidence

31. Alzahra CME Hatem Soliman EGDT

32. Alzahra CME Hatem Soliman EGDT

33. Alzahra CME Hatem Soliman EGDT

34. Alzahra CME Hatem Soliman EGDT

35. Alzahra CME Hatem Soliman EGDT

36. Alzahra CME Hatem Soliman EGDT

37. Financial Burden

38. Alzahra CME Hatem Soliman EGDT

39. Epidemiology
• Sepsis > 200,000 deaths/year in the US
• Incidence is > 700,000/ year.
• Mortality for septic shock – 30% die within first
month & 50% dying within 6 months of
diagnosis

40. Rising incidence of Severe Sepsis :
• Aging of the population
• Longevity of patients with chronic diseases
• Increase in people with AIDS
• Widespread use of antimicrobials,
immunosuppressives, indwelling catheters,
mechanical ventilation
Epidemiology

41. Any regional data ??

43. Surviving Sepsis Campaign (SSC)
In 2002, spearheaded by:
• ESICM (European Society of Intensive Care Medicine),
• ISF (International Sepsis Forum) and
• SCCM (Society of Critical Care Medicine)
Aim: improving the diagnosis, survival, and
management of patients with sepsis by
addressing the challenges associated with it.

44. Phase 1 : Barcelona declaration
Phase 2 : Evidence based
guidelines
Phase 3 : Implementation and
education
Phase 4 : Analysis of aggregate
database, revision of guidelines
Surviving Sepsis Campaign (SSC)

45. Definitions

46. Definitions

47. Is it time to update the definitions ??

48. April 23rd (NEJM)

49. Kaukonen et al
• We all encountered septic shock patients who
don’t typically meet the SIRS criteria (elderly,
immunosuppressed, on B-blockers)
• 1,171,797 patients studied in 172 ICUs in
Australia and New Zealand from 2000-2013.
100.000 of them had an acute infection and
organ failure.
• The patient’s then grouped into SIRS-positive
(two or more criteria) and SIRS-negative groups.

50. Results
• The current definition excluded 1 in 8 patients (12%)
• Very poor sensetivity.
• The most precise criteria were HR and RR
• The poorest is the WCC.
• SIRS-negative group had overall better outcome than
SIRS-positive.
• Expected change in the definitions.

55. Sepsis Six (6)

61. Smartphone Apps ??
Of Course!! 

63. ESCAVO: iPhone, Android

65. Sepsis 6: iPhone, iPad

66. SSC official app: iPhone, Android

68. Stop Sepsis, Save lives
Stop Sepsis, Save
yourself and your loved
ones
Take-Home Message

69. “AND WHOEVER SAVES A LIFE, IT
IS CONSIDERED AS IF
HE SAVED AN ENTIRE WORLD”
QUR’AN 5:32
“ َ‫ي‬ْ‫ح‬َ‫أ‬‫ا‬َ‫م‬َّ‫ن‬َ‫أ‬َ‫ك‬َ‫ف‬ ‫ا‬َ‫اه‬َ‫ي‬ْ‫ح‬َ‫أ‬ ْ‫ن‬َ‫م‬َ‫و‬‫ا‬‫يع‬ِ‫م‬ََ ََ‫ا‬ََّّ‫ال‬‫ا‬ ”
‫العظيم‬‫هللا‬ ‫صدق‬

70. Thank YouThank
You
hatem.soliman@gmail.com
0508669484