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Sepsis 3
Dr. Ashraf Nadeem
MD , Critical Care Medicine
Head of ICU
Hafr Elbatin Central Hospital
Saudi Arabia
An infection , unnoticed ,
turn Unstoppable
Sepsis is the leading cause of death in noncoronary care intensive care units, with a
mortality rate between 30-50%
Hospitalization rates
SIRS Criteria
Two or more of:
Temperature >38C or <36C
Heart rate >90/min
Respiratory rate >20/min or PaCO2 <32 mm Hg
(4.3 kPa)
White blood cell count >12000/mm3 or
<4000/mm3 or >10% immature bands
Bone et al.Crit Care Med. 1992;20(6):864-874.
Introduction
This is one of the largest collaborative studies
ever conducted in the field of critical care
medicine. It is also one of the first studies of
electronic health records in field of Intensive
care.
Introduction
Focused primarily on patients in the intensive
care unit who were receiving antibiotics and
fluid cultures, as those were the patients who
were thought to be infected.
The team analyzed 148,907 patients with
suspected infection, and evaluated how well the
existing and the new criteria predicted sepsis
mortality in these patients.
The co-chairs
Drs Deutschman & Singer)
The process
Definitions and clinical criteria were generated
through meetings, Delphi processes, analysis of
electronic health record databases, and voting,
followed by circulation to international
professional societies, requesting peer review
and endorsement (by 31 societies listed in the
Acknowledgment).
New definitions
Sepsis is defined as life-threatening organ
dysfunction caused by a dysregulated host
response to infection.
NB:
The SIRS criteria have been removed
It may present in simple, non-complicated infection, or
in response to non infectious-triggers (i.e. trauma,
pancreatitis, post-cardiac arrest syndrome),
Or may even be absent in critically ill patients with
obvious evidence of a life-threatening infection.
New definitions
Organ dysfunction can be identified as an acute
change in total SOFA score> 2 points consequent to
the infection.
A SOFA score > 2 reflects an overall mortality risk of
approximately 10% in a general hospital population
with suspected infection
The baseline SOFA score can be assumed to be zero
or in patients not known to have preexisting organ
dysfunction.
New definitions
Septic shock is a subset of sepsis in which
underlying circulatory and cellular/metabolic
abnormalities are profound enough to
substantially increase mortality.
Clinical criteria identifying such condition include the
need for vasopressors to obtain a MAP 65mmHg and
an increase in lactate concentration > 2 mmol/L, despite
adequate fluid resuscitation.
Terms like Severe Sepsis/Septicemia has been removed
Organ Failure Check Best in the ICU, Quick Score Better Elsewhere
Recommendation
Infection plus two or more sequential organ
failure assessment points, and the use of quick
sepsis-related organ failure assessment score as
a prompt to identify patients likely to be septic
early on,.
Septic shock
Conclusions
Among ICU encounters with suspected infection, the
predictive validity for in-hospital mortality of SOFA
was not significantly different than the more complex
LODS but was statistically greater than SIRS and
qSOFA, supporting its use in clinical criteria for sepsis.
Among encounters with suspected infection outside of
the ICU, the predictive validity for in-hospital
mortality of qSOFA was statistically greater than SOFA
and SIRS, supporting its use as a prompt to consider
possible sepsis.
Finally
It took us more than 10 years to understand
sepsis , now we will have to change it all
Is it the final word in sepsis .. ? or the
starting point of discussion and additional
research into this deadly condition
Julie A. Jacob, MA JAMA. 2016;315(8):739-740. doi:10.1001/jama.2016.0736.
Thank you