Professional Documents
Culture Documents
Osborn, MD
University of Virginia
ACEP Chair Critical Care
Section
ACEP Representative
Surviving Sepsis Campaign
Purpose for Existence?
Today Future
1,800,000 600,000
Severe Sepsis Cases
Total US Population/1,000
1,600,000 US Population
500,000
1,400,000
>750,000
Sepsis Cases
1,200,000 400,000
sepsis/year 800,000
300,000
Year
Deaths/Year
200
150,000
150
100,000
100
50,000
50
0
0
AIDS* Colon Breast CHF† Severe AIDS* Breast AMI† Severe
Cancer§ Sepsis‡ Cancer§ Sepsis‡
†
National Center for Health Statistics, 2001. §American Cancer Society, 2001. *American Heart Association.
2000. ‡Angus DC et al. Crit Care Med. 2001;29(7):1303-1310.
;29(7):1303-1310
Comparable Global
Epidemiology
• 95 cases per 100,000
– 2 week surveillance
– 206 French ICUs
• 95 cases per 100,000
– 3 month survey
– 23 Australian/New
Zealand ICUs
• 51 cases per 100,000
– England, Wales and
Northern Ireland.
Emergency Department Critical
Care Volume Increases
• 102 million National ED visits in 1999
•17% (17.5 million) “immediately life threatening”1
• 57 California Emergency Departments (1990-1999)2
• 50% (387,616) Severe Sepsis Cases Initially Present ED
70
Visits / ED (% Change)
Total visits/ED
Critical Care
50
Urgent
Nonurgent
30 P < 0.001 for all groups
LV dysfunction 15
10
0
Pre-SAVE Post-SAVE
Majumdar SR, et al. Am J Med 2002;113:140-5
Clinical Inertia: Low Levels of
Compliance at Research Centers
• Specifically selected
care elements
– From evidence based
guidelines
– Implemented together
provide improved
outcomes compared to
individual elements
alone
SSC Steering Committee:
Global Consensus
13 September 2004
Catania, Sicily
• Steering
Committee Met
• 6 hour bundle
formed
• 24 hour bundle
formed
Gaining Consensus:
Finding Nemo
6 Hour Resuscitation Bundle
• Early Identification
• Early Antibiotics and
Cultures
• Early Goal Directed
Therapy
6 - hour Severe Sepsis/
Septic Shock Bundle
• Vasopressors:
• Early Detection: – Hypotension not
– Obtain serum lactate level. responding to fluid
– Titrate to MAP > 65
• Early Blood Cx/Antibiotics: mmHg.
– within 3 hours of
presentation. • Septic shock or lactate > 4
mmol/L:
• – CVP and ScvO2 measured.
Early EGDT:
– CVP maintained >8 mmHg.
• Hypotension (SBP < 90, MAP – MAP maintain > 65 mmHg.
< 65) or lactate > 4 mmol/L:
– initial fluid bolus 20-40 ml of • ScvO2<70%with CVP > 8
crystalloid (or colloid equivalent) mmHg, MAP > 65 mmHg:
per kg of body weight.
– PRBCs if hematocrit < 30%.
– Inotropes.
Rhode Island Hospital EGDT Data
• Implementation Sepsis
Bundles
• Web-based and CD rom
• IHI Website (IHI.org)
• Tool Kit
– Educational material
– Process for developing
“Change teams”
– Data collection tools and
descriptions (database)
– Taylor: Culture Specific
The Future: ED and ICU
Interface
• Collaboration:
Emergency Medicine
and Critical Care
– Defining patient care
globally
– Setting standards for
ED/ICU collaborations
– Establishing new format
to change clinical
practice and improve
outcomes
• Providing tools
– JCAHO, Medicare
THANK YOU!!