MedReg+1 Loveridge Acute Medicine

Developing people for health and healthcare

Sepsis

Acute Medicine

24th July

The story behind sepsis management

Developing people forhealth and healthcare

OUTLINE

• To summarize the background behind sepsis management guidance

• To understand why simplified guidelines are being promoted

• • To consider briefly some of the possible

future trends in sepsis care

Developing people forhealth and healthcare

Developing people forhealth and healthcare

Developing people forhealth and healthcare

Developing people forhealth and healthcare

Developing people forhealth and healthcare

Developing people forhealth and healthcare

Developing people forhealth and healthcare

Developing people forhealth and healthcare

WHY WAS SIMPLIFICATION NEEDED?

• Poor compliance with bundles• Guidance involves some complex

measures• Mortality still stands at 30-35%• 36,800 lives lost annually in UK• Sepsis costs the NHS £2.5 billion

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THE SEPSIS SIX

• Lactate• Blood cultures• Early antibiotic administration• Fluid resuscitation• Urine output monitoring• High flow oxygen

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WHY THE SEPSIS SIX?

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PREDICTED BENEFITS OF SEPSIS SIX

• Achieving 80% compliance with Sepsis Six expected to save 15,000 lives per year in UK

• …..and £170,000,000• (Extrapolated from unpublished data

relating to reduced length of stay)

Developing people forhealth and healthcare

Developing people forhealth and healthcare

THE PROCESS TRIAL

• Did not show statistically significant survival of patients treated with EGDT over and above less aggressive protocols or ‘usual care’

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WHAT NEXT?

• PROMISE & ARISE trials• NICE Guideline due 2016• Targeted in the National Outcomes

Framework for the NHS Commissioning Board

• Research into biomarkers, pathogen recognition, pathogenesis, targeted therapy

Developing people forhealth and healthcare

REFERENCES AND FURTHER READING

• Surviving sepsis campaign:International Guideline for Management of Severe Sepsis and Septic Shock 2012 http://www.sccm.org/Documents/SSC-Guidelines.pdf

• Surviving the first hours in sepsis: getting the basics right (an intensivist’s perspective) J Antimicrob Chemother 2011: 66 Suppl 2 ii11-1123

• A randomized trial of protocol-based care for early septic shock; The Process Investigators NEJM 2014; 370:1683-1693

• Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program; Critical care medicine; August 2014 (42) Issue 8: 1794-1755

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References continued

• The Ombudsman report 2013

• http://www.ombudsman.org.uk/__data/assets/pdf_file/0004/22666/FINAL_Sepsis_Report_web.pdf

• The UK Sepsis Trust report 2013

• http://www.england.nhs.uk/wp-content/uploads/2013/12/spesis-brief.pdf