SEPSIS AND SEPTIC

SHOCK-
THE ONE HOUR
BUNDLE
PROF BILQUIS SHABBIR,
CHAIRPERSON DEPARTMENT OF
MEDICINE,
HEAD OF EAST MEDICAL WARD,
KING EDWARD MEDICAL UNIVERSITY.
 Why are we spending time on sepsis????!!!

MORTALITY:

Sepsis: 30-50%
Septic shock: 50-
60%
Why the burden of sepsis is
increasing?

Increasing
geriatricpopulation
number of immunocompromised host
drug resistance
metabolic disorders
Some terms:

 Bacteremia : transient invasion of

circulation by bacteria

 Septicemia: prolonged presence of

bacteria in the blood accompanied by
systemic reaction
 1 st
International Sepsis definition
Conference - SEPSIS-1
 1991, PUBLISHED 1992
 defined sepsis as systemic
inflammatory response
syndrome (SIRS) due to infection,
 Presence of more than 1 of 4 findings:
 Body temperature >38.0 °C or <36.0 °C
 Heart rate >90 beats/min
 Tachypnea >20 breaths/min or hyperventilation with PaCO2 <32 mm Hg
 White blood cell (WBC) count >12,000 ; or <4,000 cells/mm3;
2 nd
International Sepsis definition
Conference - SEPSIS-2
 Convened in 2001, and the results were
published in 2003

 This consensus retained the definitions of

sepsis as SIRS due to infection

 and of severe sepsis as sepsis associated

with acute organ dysfunction.
3 rd
International Sepsis definition
Conference - SEPSIS-3
Feb 2016

Life threatening
Organ dysfunction
Caused by dysregulated host response
To infection
SIRS will no longer
be the basis for
diagnosis!!
Sequential (Sepsis-Related) Organ Failure Assessment
(SOFA) score
Septic shock:

Refers to severe sepsis which is not

responsive to intravenous fluid infusion
for resuscitation and requires inotropic
or vasopressor agent to maintain
systolic blood pressure.
The culprit here is overaction of our defence mechanism…..not
the invader only
For non icu patients
GLUCOSE
CONTROL
BICARBONATE
NUTRITION

 Enteral in first 48
hrs
 Low dose
feeding initially
 Combined with
I/V glucose
RENAL REPLACEMENT THERAPY
PROPHYLAXIS AGAINST VTE

 PHARMACOPROPHYLAXIS
 MECHANICAL WHERE CONTRAINDICATED
STRESS ULCER PROPHYLAXIS

PROTON PUMP INHIBITORS

H2 BLOCKERS