3. INTERNATIONAL CONSENSUS ON SEPSIS AND SEPTIC
SHOCK,,,,,1991 TO 2001 AND 2004
2004 THROUGH 2008 SURVIVING SEPSIS
CAMPAIGN,SSC
THIRD INTERNATIONAL CONSENSUS ON SEPSIS
,,,2016
HOUR-1 UPDATE 2018
HISTORICAL PERSPECTIVE
4. AFFECTS MILLIONS AROUND THE GLOBE
LOADS OF STUDIES ON EPIDEMIOLOGY,,,SIMPLE
EQUATION IS THAT THE DISEASE HAS RISEN FROM
THOUSANDS PER YEAR IN MAJOR CLINICAL SETTINGS TO
OVER A MILLION AND A HALF PER YEAR IN THE LAST 40-
50 YEARS.
ECONOMIC BURDEN,,,20 BILLION USD IN US AND KSA ???
MAJOR CAUSE OF MORTALITY,,,30-50 % FOR SEP SHOCK
AND 20-30 % FOR SEPSIS
MAJOR HEALTH CARE ISSUE
5. ITS AS IMPORTANT AS A CASE OF POLYTRAUMA IN
ER
OR A CASE OF ACUTE MI
OR A PATIENT WITH STROKE
ACUTE MD EMERGENCY,,,,,,PARAMOUNT IMP
MAGNITUDE OF PROBLEM
6. PRIMARY CAUSE OF DEATH FROM INFECTION ESP IF
NOT RECOGNISED EARLY
A SYNDROME SHAPED BY PATHOGEN FACTOR AND
HOST FACTOR
SEPSIS INDUCED ORGAN DYSFUNCTION MAY BE
OCCULT,,,
UNEXPLAINED ORGAN DYSFUNCTION----UNDERLYING
SEPSIS
KEY CONCEPTS OF SEPSIS
7. SITE OF INFECTION,,,,,,,,RTI 44-60 %
,,,ABDOMEN 26%
,,,BLOODSTREAM 20%
,,,URIN SYSTEM 12-20 %
,,,,SKIN/SOFT TISSUE 14%
NO DEFINITE SOURCE IN 20-30 %
KEY CONCEPTS
8. GRAM POITIVE REMAIN THE MOST FREQUENT
GRAM NEGATIVE SUBSTANTIAL
FUNGAL SEPSIS IS ON THE RISE BUT REMAINS
LOWER THAN THE BACTERIAL
IN ALMOST HALF THE CASES NO PATHOGEN IS
IDENTIFIED (CULTURE NEGATIVE SEPSIS)
THE PATHOGENS
9. PATHOGEN VARY,,,REGION,HOSPITAL
SIZE,SEASON,TYPE OF UNIT ETC
90 % OF IDENTIFIED PTHOGENS ARE GRAM POSITIVE
AND NEGATIVE
SINCE MID 80’S,,,G POS SURPASED THE G NEG SEPSIS
G POS CN STAPH AUREUS,ENTERO,STREP
G NEG E COLI,KLEB PNEUM,PSEUDOM
E COLI REMIANS THE MOST PREVLANT SINGLE
PATHOGEN
PATHOGENS,,,CONT-D
10. INCIDENCE,,,,,EVER RISING NO OF PATIENTS
HOSPITALIZATION,,,BED OCCUPANCY BY SEPSIS
RELATED PTIENTS HAS RISEN SHARPLY
COST/ECONOMIC BURDEN,,,HEFY AMOUNT OF
MONEY AND HUMAN RESOURCES BEING SPENT ON
THEM
MORTALITY,,,,ONE OF EVERY FOUR PATIENTS WILL
DIE
ENOUPH???
11. SEPSIS HAS BEEN REDEFINED AS LIFE-THREATENING
ORGAN DYSFUNCTION CAUSED BY A DYSREGULATED
HOST RESPONSE TO A NEW INFECTION.
SEPTIC SHOCK HAS ALSO BEEN REDEFINED AS A
SUBSET OF SEPSIS IN WHICH PARTICULARLY
PROFOUND CIRCULATORY, CELLULAR, AND METABOLIC
ABNORMALITIES ARE ASSOCIATED WITH A GREATER
RISK OF MORTALITY THAN WITH SEPSIS ALONE
NEW DEFINITIONS
14. • "THE SOFA SCORE FOUND PATIENTS MORE LIKELY TO
BE SEPTIC BOTH IN AND OUT OF THE ICU. BUT IT
INVOLVES THE USE OF MANY LAB TESTS AND IS A BIT
COMPLEX.
• FOR PATIENTS NOT IN THE ICU, THE PERFORMANCE OF
QUICK SOFA SCORE WAS SIMILAR TO THAT OF THE
SEQUENTIAL ORGAN FAILURE ASSESSMENT SCORE.
CHOOSING THE SCORING SYATEM
15. IN THE OLD CRITERIA FOR SEPSIS, SIRS SCORE WAS A
MEASURE OF RESPIRATORY RATE, WHITE BLOOD
CELL COUNT, HEART RATE, AND FEVER.
• THE SEQUENTIAL ORGAN FAILURE ASSESSMENT
SCORE( SOFA ) AND THE LOGISTIC ORGAN
DYSFUNCTION SYSTEM SCORE ( LODS ) ARE MORE
RECENT ,PREDICT ORGAN DYSFUNCTION AND
MORTALITY BETTER
16. MODIFIED VERSION OF SOFA,
BEDSIDE WITH QSOFA,
▫ RESPIRATORY RATE ≥22/MIN
▫ ALTERED MENTATION
▫ SYSTOLIC BLOOD PRESSURE ≤ 100MMHG
THE PRESENCE OF AT LEAST TWO OF THESE CRITERIA
STRONGLY PREDICTS THE LIKELIHOOD OF POOR
OUTCOME IN OUT-OF-ICU PATIENTS WITH CLINICAL
SUSPICION OF SEPSIS.
IDENTIFICATION OF EARLY SEPSIS
QSOFA
17. HITORIC,,,,,,SIRS
Q SOFA
TRACT AND TRIGGER WARNING SCORE,,,MEWS
SCORING SYSTEM
THE SCREENING PROMPTS
18.
19.
20. SIRS IS STILL RELEVANT?
IT HELP IDENTIFY THE SOURCE OF INFECTION
PRESENCE OF 2 SIRS CRITERIA WILL DIG OUT THE
UNCOMPLICATED SEPSIS