NAVIGATING THE CHALLENGES OF SEPSIS...
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Greater Awareness Increasing Antibiotic Resistance Aging Population NAVIGATING THE CHALLENGES OF SEPSIS MANAGEMENT SEPSIS FACTS WHO’S AT RISK 2,3 1 MILLION+ CASES of Severe Sepsis and Septic Shock Each Year in U.S. 4 INCREASING Due to: 2 SEVERE SEPSIS DISEASE PROGRESSION sepsis associated with organ dysfunction (oliguria / lactic acidosis), hypoperfusion, or hypotension. 1 SEPTIC SHOCK sepsis induced hypotension despite adequate fluid resuscitation with perfusion abnormaliltes (i.e. oliguria, lactic acidosis). 1 SEPSIS a potentially life threatening complication of an infection accompanied by two or more of the following: abnormal body temperature, heart rate, respiratory rate or blood gas, and white blood cell count. 1 Elderly Immunocompromised Chronically ill at Highest Risk: Diabetes Liver or Kidney Disease Cancer AIDS Most Expensive U.S. Inpatient Cost $20 Billion Each Year 8 $25,000 – $50,000 Average Cost Per Episode 6 Leading Cause of Death in U.S. 5 Severe Sepsis and Septic Shock Kill 1 in 4 Affected Patients 2 Early and Effective Treatment with Fluids and Antibiotics Shown to Increase Survival 9 50% of Patients with Severe Sepsis Admitted to ICU 6 with an average stay of 7 – 14 Days 7 CMS ACTION High Frequency and Sepsis Mortality Drive Need to Improve Outcomes The Centers for Medicare and Medicaid Services (CMS) introduced a new measure to assess the quality of sepsis care in hospitals. This measure is consistent with the guidelines of the Surviving Sepsis Campaign and the National Quality Forum. 10 The Severe Sepsis and Septic Shock Management Bundle was recently updated to include “dynamic assessment of fluid responsiveness with either a fluid bolus or passive leg raise fluid challenge.” 11,12 Beginning October 1, 2015, 4000+ US hospitals must begin data collection on the sepsis bundle. 13 Performance against the bundle is scheduled to impact future CMS reimbursement to hospitals. 13 10 th
Transcript of NAVIGATING THE CHALLENGES OF SEPSIS...
GreaterAwareness
IncreasingAntibioticResistance
AgingPopulation
NAVIGATING THE CHALLENGES OFSEPSIS MANAGEMENT
SEPSIS FACTS
WHO’S AT RISK 2,3
1 MILLION+ CASESof Severe Sepsis and Septic Shock Each Year in U.S.4
INCREASING Due to:2
SEVERE SEPSIS
DISEASE PROGRESSION
sepsis associated with organ dysfunction (oliguria / lactic acidosis), hypoperfusion, or hypotension.1
SEPTICSHOCKsepsis induced hypotension despite adequate fluid resuscitation with perfusion abnormaliltes (i.e. oliguria, lactic acidosis).1
SEPSIS a potentially life threatening complication of an infection accompanied by two or more of the following: abnormal body temperature, heart rate, respiratory rate or blood gas, and white blood cell count.1
ElderlyImmunocompromisedChronically ill at Highest Risk:
Diabetes Liver or Kidney DiseaseCancer AIDS
Most Expensive U.S. Inpatient Cost
$20 Billion Each Year8
$25,000 – $50,000Average Cost Per Episode6
Leading Cause of Death in U.S.5
Severe Sepsis and Septic Shock Kill 1 in 4 Affected Patients2
Early and E�ective Treatment with Fluids and Antibiotics Shown to
Increase Survival9
50% of Patients with Severe Sepsis Admitted to ICU6 with an average stay of
7 – 14 Days7
CMS ACTIONHigh Frequency and Sepsis Mortality Drive Need to Improve OutcomesThe Centers for Medicare and Medicaid Services (CMS) introduced a new measure to assess the quality of sepsis care in hospitals. This measure is consistent with the guidelines of the Surviving Sepsis Campaign and the National Quality Forum.10
The Severe Sepsis and Septic Shock Management Bundle was recently updated to include “dynamic assessment of fluid responsiveness with either a fluid bolus or passive leg raise fluid challenge.”11,12
Beginning October 1, 2015, 4000+ US hospitals must begin data collection on the sepsis bundle.13
Performance against the bundle is scheduled to impact future CMS reimbursement to hospitals.13
10th
BP
HR
SpO2
ECG
RESUSCITATION
RESPONSE
50%
100%
THE CLINICALCHALLENGE
Knowing the right amount of fluid to administer to maintain adequate organ perfusion
CAREGIVERS CHALLENGE
WHO WILL RESPOND?
Patients' Fluid Requirements Di�er Based on Underlying Health Condition and Other Factors15
Both Under- and Over-Resuscitation Can Lead to:16,17
Sub-Optimal OutcomesComplicationsMortality
Why Dynamic Measurements?Real-time quantification of fluid responsiveness resulting from a fluid challenge or passive leg raise
More complete view of perfusion status
An effective tool without the limitations of pressure measurements (CVP, PWP)20,21
Included in the guidelines of the Surviving Sepsis Campaign and the National Quality Forum
CHEETAH NICOM™ & STARLING™ SVMonitoring Solutions for
Volume Management in Sepsis
1. Bone et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101 (6): 1644–1655. 2. http://www.nigms.nih.gov/Education/Pages/factsheet_sepsis.aspx 3. http://www.cdc.gov/sepsis/basic/qa.html 4. Hall MJ et al. Inpatient Care for Septicemia or Sepsis: A Challenge for Patients and Hospitals. NCHS Data Brief 2011. 5. LaRosa, SP (2010). Sepsis. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/infectious-disease. 6. Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti Infect Ther 2012; 10(6) 701-706. 7. https://www.atrainceu.com/course-module/1884974-107_sepsis-module-03 8. Tori C and Andrews R. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp 9. Kumar A et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Med 2006; 34(6) 1589-1596. 10. http://www.hasc.org/sites/main/files/sepsis_fact_sheet_10_01_15.pdf 11. http://www.survivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdf 12. http://www.qualityforum.org/revision_for_sepsis_measure.aspx 13. http://www.calhospital.org/cha-news-article/cms-announces-data-collection-sepsis-bundle-measure 14. Michard F. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002; 121(6):2000-2008. 15. Lira A and Pinsky M. Choices in fluid type and volume during resuscitation: impact on patient outcomes. Annals of Intensive Care 2014; 4 (38): 1-13. 16. Rivers, E. Early goal directed therapy in the treatment of severe sepsis and septic shock. New Engl J Med 2001; 1345: 1368-1377. 17. Kelm DJ, et al. Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock 2015; 43(1):68-73. 18. Lucet JC et al. Infectious risk associated with arterial catheters compared with central venous catheters. Crit Care Med 2010; 38(4):1030-1035. 19. Duus N et al. The reliability and validity of passive leg raise and fluid bolus to assess fluid responsiveness in spontaneously breathing emergency department patients. Journal of Critical Care 2015; 30(217):e1-e5 20. Cecconi M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014; 40(12):1795-815. 21. The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury. N Engl J Med 2006; 354:2564-2575.
100% non-invasive, hemodynamic monitoring solutions for dynamic assessment of fluid responsiveness
Cheetah Monitoring Solutions can help to support compliance with the Severe Sepsis and Septic Shock Management Bundle
For more information visit
www.cheetahmedical.com/sepsis
Document number: R-MRK 030 rev 1
50% of Patients May Not Respond to Fluid Administration14
Supports individualized fluid therapy without requiring an invasive arterial or central line, potentially reducing the risk of hospital-acquired infections18
Measures stroke volume, a ventricular function
Works in mechanically ventilated and spontaneously breathing patients19
Moves seamlessly across the continuum of care ED OR ICU Floor
