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Sepsis 101 PowerPoint Presentation

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This medical PowerPoint presentation talks about sepsis, a potentially life-threatening condition that occurs when the bodys immune system overreacts to an infection. It can lead to organ dysfunction, low blood pressure, and even death if left untreated. Sepsis can develop in response to any type of infection, including bacterial, viral, or fungal infections.

Tags : sepsis, organ dysfunction, low blood pressure, critical care medicine, critical care medicine PowerPoint presentation

Published on : Mar 28, 2023 | Views : 2840 | Downloads : 16

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Slide 1-

Sepsis 101 Colorado Hospital Association ©2019 CHA
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Objectives The learner will: Verbalize understanding of the criteria for severe sepsis and septic shock Explain the most common sources of infection for sepsis Explain and demonstrate treatment of severe sepsis and septic shock using the three- and six-hour bundles
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What is Sepsis? In a NORMAL response to an infection, the inflammatory and coagulation response is localized to the infection site as the immune system attacks the pathogen, eliminating it from the body. ©2019 CHA
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A Worldwide Problem Sepsis is a major, world-wide health care problem Affecting an estimated 30 million adults and children each year resulting in potentially six million deaths annually Accounts for ~20 percent of U.S. hospital admissions but is a factor in over 50 percent of U.S. hospital deaths Is the leading cause of U.S. hospital readmissions (20 percent) Although mortality has decreased in the last decade, it remains over 25 percent → 1 in 4 ©2019 CHA
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In Sepsis . . . The inflammatory and coagulation response is rapid and widespread, causing a dysregulated response The body’s reaction to the pathogen may overwhelm all of the body’s systems Immune systems that are too strong or too weak are unable to respond effectively to pathogen invasion ©2019 CHA
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Causes of Sepsis Bacterial infections are the most common Fungal, parasitic or viral infections can also cause sepsis The infection can originate from anywhere in the body and can cause organ damage to any system of the body Unknown (1/3 of all sepsis cases) ©2019 CHA
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Most Common Infection Sources https://www.cdc.gov/vitalsigns/sepsis/index.html ©2019 CHA
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Who is at Risk to Develop Sepsis? Host Factors Age, gender, genetics, comorbidities Elderly account for 60-85 percent of all cases of severe sepsis Immunosuppression Disease related, medications related Exposure risk Community acquired: pneumonia, urinary, wounds, trauma Health care acquired: invasive devices, secondary infections and skin breakdown ©2019 CHA
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Progression of Sepsis Early identification and treatment It is crucial to identify septic patients and initiate treatment as early along the continuum as possible and treat them to avoid developing organ damage or shock. SIRS + Infection Sepsis + End Organ Damage Severe Sepsis + Refractory (unresponsive) hypotension Temp. > 38 C or < 36 C, HR > 90, RR > 20 or PaCO2 < 32, WBCs > 12,000 or < 4,000 or > 10% bands Goal: early identification here Death can result ©2019 CHA
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SIRS Systemic Inflammatory Response Syndrome SIRS is a nonspecific inflammatory response to an insult that results in activation of the immune system. This inflammatory response is the body’s way of attempting to maintain homeostasis. SIRS is defined as two or more of the following variables: Body temperature < 36oC or > 38oC Heart rate > 90 beats per minute WBC > 12,000/mm3 or < 4,000/mm3 or > 10% bands Respiratory rate > 20 breaths per minute or PaCO2 < 32mmHg SIRS + infection = sepsis ©2019 CHA
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Severe Sepsis Sepsis + new organ dysfunction = severe sepsis Organ dysfunction is defined as a condition in which an organ does not function as expected. ©2019 CHA Acute Organ Dysfunction Related to Sepsis
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Septic Shock Severe sepsis + refractory hypotension OR lactate ≥ 4 mmol/L = septic shock Septic shock is a distributive shock Cytokine release leads to a large-scale inflammatory response Massive vasodilation Increased capillary permeability Decreased systemic vascular resistance Blood clots form in the microvasculature Hypotension reduces tissue perfusion causing tissue hypoxia ©2019 CHA
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Multiple Organ Dysfunction Syndrome (MODS) MODS is altered organ function in an acutely ill patient requiring medical intervention to achieve homeostasis. Can be the end result of septic shock. Sepsis-related organ dysfunction → No organ system is immune Respiratory failure Liver failure Kidney failure Heart failure Gut permeability DIC (disseminated intravascular coagulation) Altered mental status Brain death ©2019 CHA
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Treatment Bundle Lactate Blood cultures x2 before antibiotics Give antibiotics Give fluids at 30 mL/kg if: initial hypotension, lactate ≥ 4, or septic shock Reperfusion assessment ©2019 CHA
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Blood Cultures Source control: identify and stop the infection Why two sets of blood cultures? Corroboration of matching sets confirms treatment of a true pathogen versus a contaminate The goal is to prevent culture negative severe sepsis (CNSS) and septic shock Of 6.8 million severe sepsis admissions, 47 percent were culture negative CNSS was seen as a statistically significant independent predictor of death ©2019 CHA
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Antibiotics Antibiotics are the life-saving treatment for an infection Every hour antibiotic initiation is delayed increases the risk for mortality by four to eight percent. Antibiotics should be given as soon as possible after blood cultures are drawn. Preferably after the second set of cultures; however, if the second set is going to be delayed more than 30 minutes, antibiotics should be started after the first set. If more than one antibiotic is ordered, give the broadest-spectrum antibiotic first. Infuse multiple antibiotics concurrently, if appropriate. ©2019 CHA
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Antibiotics The MOST important thing you can do for your septic patient ©2019 CHA For every hour delay in antibiotic administration, mortality increases 4-8%
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Crystalloid Fluids The Society of Critical Care Medicine suggests isotonic saline (normal saline) or balanced salt solutions (lactated Ringers) for initial fluid resuscitation. Sepsis and severe sepsis without hypotension: For most patients, the provider will likely order a fluid bolus based on their assessment, but there is no specific requirement Severe sepsis with hypotension or lactate ≥ 4 mmol/L: 30 mL/kg of actual body weight for patients with a BMI < 30 30 mL/kg of ideal body weight for patients with a BMI > 30 Provider must document that they are using ideal body weight if BMI over 30 and document what the BMI is or state “obese” ©2019 CHA
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Lactate With sepsis, lactate is viewed as a marker of global tissue perfusion. Lactate has some predictive use: Sustained > 6 hours, an elevated lactate foreshadows increased mortality Mortality increases as lactate levels increase (Nguyen, et al., 2004; Shapiro, et al., 2005) ©2019 CHA
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Centers for Medicare and Medicaid Services SEP-1 Bundle Time zero (or time of presentation) is defined as: The earliest chart documentation consistent with all elements of severe sepsis or septic shock identified through chart review Elements for time zero (last qualifying element within 6-hour window): Provider documentation of infection or suspected infection Two SIRS criteria (last of the two) Organ dysfunction S ©2019 CHA
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Sepsis + new organ dysfunction = Severe Sepsis To be completed within three hours: Draw lactate Draw two blood cultures prior to antibiotic administration Administer broad-spectrum antibiotic(s) Fluid resuscitation of 30mL/kg crystalloid solution (NS or LR) SBP <90mmHg or MAP <65 mmHg Initial lactate > 4 mmol/L If initial lactate > 2 mmol/L, repeat lactate within six hours Severe Sepsis Within timeframe of six hours before or six hours after time zero ©2019 CHA
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Septic Shock Severe sepsis + refractory hypotension OR lactate ≥ 4 mmol/L = septic shock To be completed within three hours: Same as for severe sepsis To be completed within six hours: Repeat lactate if initial lactate was > 2.0 Start vasopressor if persistent hypotension after fluid bolus norepinephrine is preferred Perfusion assessment ©2019 CHA
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SEP-1 Bundle Documentation of Tissue Perfusion Reassessment Provider documentation of 5 of 8 of the following: Arterial oxygenation Vital signs Cardiopulmonary exam Capillary refill exam Peripheral pulse evaluation Skin exam Shock index Urine output OR Provider documentation of one of the following: Central venous pressure measurement Central venous oxygen measurement Bedside cardiovascular ultrasound Result of passive leg raise or fluid challenge Provider documentation of completion of perfusion reassessment: I have completed a full physical assessment Sepsis reassessment completed Sepsis tissue perfusion reassessment completed OR ©2019 CHA
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Do We Really Have Three Hours? Society of Critical Care Medicine published a retrospective cohort study: 5,072 patients with severe sepsis or septic shock The majority of the patients had the four three-hour bundle recommendations initiated within three hours In-hospital mortality was 27.8 percent Time after which a delay increased the risk of death: Lactate: 20 minutes Blood cultures: 50 minutes Antibiotics: 125 minutes Crystalloids: 100 minutes “The guideline recommendations showed that shorter delays indicate better outcomes. There was no evidence that three hours is safe; even very short delays adversely impact outcomes.” (Pruinelli, et al., 2018) ©2019 CHA
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Remember Sepsis signs and symptoms are highly variable due to an abnormal, dysregulated response most common response to infection is fever, although not everyone has a fever Sepsis is a medical emergency . . . minutes matter ©2019 CHA
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References Centers for Medicare and Medicaid. (2018). Specifications Manual for National Hospital Inpatient Quality Measures. Gupta, S., Sakhuja, A., Kumar, G., McGrath, E., Nanchal, R. S., & Kashani, K. B. (2016). Culture negative severe sepsis: nationwide trends and outcomes. Chest, 150(6), 1251-1259. Kumar, A., Roberts, D., Wood, K. E., Light, B,. Parrillo, J.E., Sharma, S., …& Gurka, D. (2006). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine, 34(6), 1589-1596. Levy, M. M., Evans, L. E., & Rhodes, A. (2018, June). The Surviving Sepsis Campaign bundle: 2018 update. Critical Care Medicine, 46(6), 997-1000. Mayr, F. B., Talisa, V. B., Balakumar, V., Chang, C. C., Fine, M., & Yende, S. (2017). Proportion and cost of unplanned 30-day readmissions after sepsis compared to other medical conditions. Journal of the American Medical Association, 317(5), 530-531. ©2019 CHA
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References Nguyen, H. B., Rivers, E. P., Knoblich, B. P., Jacobsen, G., Muzzin, A., Ressler, J. A., & Tomlanovich, M. C. (2004). Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Critical Care Medicine, 32(8), 1637-1642. Pruinelli, L., Westra, B. L., Yadav, P., Hoff, A., Steinback, M., Kumar, V., . . . Simon, G. (2018). Delay within the 3-hour Surviving Sepsis Campaign guideline on mortality for patients with severe sepsis and septic shock. Critical Care Medicine, 46(4), 500-505. Shapiro, N. I., Howell, M. D., Talmor, D., Nathanson, L. A., Lisbon, A., Wolfe, R. E., & Weiss, J. W. (2005). Serum lactate as a predictor of mortality in emergency department patients with infections. Journal of Emergency Medicine, 45(5), 524-528. World Health Organization. (2019, January 11). World Health Organization. Retrieved from Factsheets Detail Sepsis: https://www.who.int/news-room/fact-sheets/detail/sepsis ©2019 CHA