Beruflich Dokumente
Kultur Dokumente
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
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 threatening1
57 California Emergency Departments (1990-1999)2
50% (387,616) Severe Sepsis Cases Initially Present ED
Cross-sectional analysis of
25,886 patients enrolled in GUSTO-1
659 hospitals, 22 SAVE sites
SAVE: Survival and
Ventricular Enlargement, ACE
(angiotensin-converting enzyme)
benefits post-MI patients with LV
dysfunction
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!!