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Sepsis
Acute Medicine
24th
July
The story behind sepsis
management

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health 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

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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• (Extrapolated from unpublished data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)

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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

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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