Sepsis Coordinator Network Webinar Sepsis: Common, Lethal, … · OBJECTIVES §Describe emerging...

Presenter: Angel Coz, MD, FCCPAssociate Professor of MedicineUniversity of Kentucky

Sepsis Coordinator Network WebinarSepsis: Common, Lethal, and Unrecognized

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Sepsis Alliance Mission

To save lives and reduce suffering by raising awareness of sepsis as a medical emergency

https://www.sepsis.org

https://www.sepsis.org/


Presenter Biography

Angel Coz, MD, FCCPAssociate Professor of MedicineUniversity of Kentucky

• Pulmonary and Critical Care specialist• Medical Director of the Intensive Care Unit at the Lexington Veterans Affairs Medical Center • Holds multiple leadership positions at the American College of Chest Physicians (CHEST), and has

been awarded the Distinguished CHEST Educator (DCE) designation two years in a row• Member of the Advisory Board of the Sepsis Alliance• Strong interest in critical care, mechanical ventilation, sepsis resuscitation, and medical education• Has given multiple talks on critical care, sepsis, and pulmonary topics at the national and international

level.

SEPSIS: COMMON, LETHAL AND UNRECOGNIZED

Angel Coz MD, FCCP, DCELexington Veterans Affairs Medical Center

Associate Professor of MedicineUniversity of Kentucky

August 27, 2019

DISCLOSURES

• I have no financial disclosures

OBJECTIVES

§ Describe emerging severe sepsis prediction algorithms and the impact on patient survival and hospital length of stay

§ Recognize and identify early detection of sepsis through community engagement strategies (i.e. TIME)

§ Summarize severe sepsis treatment and improvement in delivery of care for disease specific populations

Compared to Acute MI, the in-hospital mortality from severe sepsis/septic shock is:

A. About the same

B. 25 % higher

C. 50 % higher

D. 300 % higher

SEPSIS

§ Common, Lethal and Underrecognized

§ Every 2 minutes, a person in the US dies of sepsis

WHAT CAN WE DO?

§ Early Recognition

§ Early and Appropriate therapy

A SYSTEMS APPROACH TO SEPSIS CARE

Early

RecognitionAntibiotics IV Fluids

Risk

Stratification

Hemodynamic

Optimization

Global Tissue

Hypoxemia

Crit Care Med 2018; 46:513–516

Sepsis

• Infection +

• SIRS ≥ 2

Severe Sepsis

• Infection +

• End organ damage

Septic Shock

• Infection +

• Refractory Hypotension

Sepsis

• Infection +

• ↑ SOFA ≥ 2

Septic Shock

• Infection +

• Refractory Hypotension +

• Lactate ≥ 2

SEPSIS-1SEPSIS-2

SEPSIS-3

OUTCOME

SIRS ≥ 2

-5-10-15

qSOFA ≥ 2 ONLY ≈ 50% PATIENTSqSOFA ≥ 2

Am J Respir Crit Care Med 2017;195(7):906–911

Ann Intern Med. 2018;168:266-275

SEPSIS DIAGNOSIS

CHEST 2018; 153(3):646-655

DEATH


SIRS ≥ 2 qSOFA

Early


Risk

Stratification

Hemodynamic

Optimization

Global Tissue

Hypoxemia

CAN BOTH SIRS AND Q SOFA BE USED?

§ If SIRS is present à Look for organ dysfunction

§ If qSOFA is present à Patient has a high mortality risk

Crit Care Med 2016; 44:368–374

BMJ Open 2018;8:e017833

ROC = 0.92 ROC = 0.87 ROC = 0.96

SEPSIS SEVERE SEPSIS SEPTIC SHOCK

BMJ Open 2018;8:e017833

ROC = 0.85

BIOMARKERS

• Combination of 3 studies across 7 sites

• Prospective and observational – 450 patients

• Objective – Distinguish SIRS from sepsis

• Four genes – RT-qPCR assay: CEACAM4, LAMP1, PLAC8, PLA2G7

• Sepsis diagnosis by adjudication


SHOCK 2018; 49(4):364–370

Journal of Applied Laboratory Medicine 2019; 3(4): 724-29

WHAT ABOUT ON THE PATIENT SIDE?

SEPSIS AWARENESS

0%

20%

40%

60%

80%

100%

2007 2017

PUBLIC AWARENESS OF SEPSIS


Early


Risk

Stratification

Hemodynamic

Optimization

Global Tissue

Hypoxemia

Crit Care Med 2006; 34:1589–1596

Each hour delay = ↓ survival 7.6%

OR=1.67

OR=92.5

N Engl J Med 2017;376:2235-44

AJRCCM 2017:196(7):856–863

Crit Care Med 2017; 45:623–629

Each hour delay = ↑ 8% progression to septic shock

CHEST 2019; 155(5):938-946

OR = 1.10

Annals ATS 2019;16(4):426-429


Early


Risk

Stratification

Hemodynamic

Optimization

Global Tissue

Hypoxemia

FLUID THERAPY

How Much?

When to give?

What Type?

When to stop?

0

1000

2000

3000

4000

5000

6000

EGDT PBC UC EGDT UC EGDT UC

PROCESS ARISE PROMISE

Randomization 6 hours

30.5 29.2 28.0 34.6 34.7

IV FLUIDS

Intensive Care Med (2017) 43:625–632

Crit Care Med 2017; 45:1596–1606

WHAT ABOUT THEM?

• Hemodynamic stable patients with lactate 2-4 mMol/L

Am J Respir Crit Care 2016;193(11):1264–1270

N Engl J Med 2017;376:2235-44

Crit Care Med 2017; 45:1596–1606

FLUID THERAPY

How Much?

When to give?

What Type?

When to stop?

N Engl J Med 2018;378:829-39.

0%

10%

20%

30%

40%

MAKE 30 Overall MAKE 30 Sepsis Mortality

15.4%

38.9%

11.1%14.3%

33.8%

10.3%

SALINE BALANCED

P = 0.04

P = 0.01

P = 0.06

N Engl J Med 2018;378:829-39

NNT = 20


Early


Risk

Stratification

Hemodynamic

Optimization

Global Tissue

Hypoxemia

Lactate ≤ 4

Lactate > 4

20%

25%

30%

35%

40%

45%

No Hypotension

Hypotension

23.3%29.3%

29.0%

44.5%

Crit Care Med 2015 Mar;43(3):567-73

Crit Care Med. 2009 May;37(5):1670-7

CHEST 2018; 154(2):302-308

BLOOD CULTURE LACTATE ANTIBIOTICS FLUIDS

Crit Care Med 2018; 46:500–505

SEP -1 MORTALITY

70%

88%

21%28%

75%

0%

37%

97% 98%

77%

64%

84%89%

20%

0%

20%

40%

60%

80%

100%

Lactate within 1 h Blood culturesbefore antibiotics

Antibiotics within1h

IV Fluids (30ml/Kg)

Repeat Lactatewithin 6h

Vasopressorswithin 6h

Mortality

PAST VS CURRENT STATE

Before After

[email protected]@sepsis.org

Sepsis.org

Questions?


Sepsis Awareness Month

• Launched in 2011 by Sepsis Alliance• State designations• Community events• Sepsis Superhero™ Challenge• Toolkits for healthcare providers

ØPrintable Posters and InfographicsØDigital and Social Media toolsØIdeas to get involvedØTemplate messaging


Sepsis Heroes

• Annual celebration of sepsis leadership across the country• September 12, 2019 • Marquee New York City


GE Sponsored Webinar

Series: Can We Help ‘Solve’ Sepsis Together? “Biomarkers: We Just Need To Be Better Listeners”September 18 at 2-2:45 pm ET

Register at SepsisWebinar.org

Speaker:Dr. Eric GluckSwedish Covenant Hospital

Sepsis Alliance gratefully acknowledges the support provided by GE Healthcare.


Sepsis: Across the Continuum of Care Webinar

The Blind Spot of Antibiotic Stewardship: Antibiotic Overuse at DischargeSeptember 24 at 2-3 pm ET

Register at SepsisWebinar.org

Speaker:Valerie Vaughn, MD, MScAssistant Professor University of Michigan Medical School

Sepsis Alliance gratefully acknowledges the support provided for this webinar by Thermo Fisher Scientific.


Disclaimer

The information in this webinar is intended for educational purposes only. The presentations and content are the opinions, experiences, views of the specific authors/presenters and are not statements of advice or opinion of Sepsis Alliance. The presentation has not been prepared, screened, approved, or endorsed by Sepsis Alliance.

Sepsis Coordinator Network Webinar Sepsis: Common, Lethal, … · OBJECTIVES §Describe emerging...

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