Sepsis_and_Septic_Shock_-_FINAL_COPY-1

Sepsis_and_Septic_Shock_-_FINAL_COPY-1 - Sepsis and Septic...

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Section of Critical Care Medicine Section of Infectious Diseases University of Manitoba, Winnipeg, Canada UMDNJ-Robert Wood Johnson Medical School Cooper Hospital, NJ Anand Kumar, MD Anand Kumar, MD Sepsis and Septic Sepsis and Septic Shock Shock Old Concepts, New Precepts Old Concepts, New Precepts
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Incidence of Severe Sepsis/Septic Shock Incidence of Severe Sepsis/Septic Shock Approximate Cases/Year 800,000 600,000 400,000 200,000 0 Severe sepsis 800,000 Septic shock 400,000 Deaths from septic shock 200,000 Sepsis and sequelae are a leading cause of death in ICU Mortality in septic shock remains at 35 - 50% -unchanged since advent of antibiotics (from 55 - 75%)
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Bacterial Sepsis Bacterial Sepsis Death Rate in the United States 5.0 Chart adapted from CDC/National Center for Health Statistics, 1992. 4.0 3.0 2.0 1.0 0.0 0.8 0.7 0.5 0.4 0.6 0.2 0.1 0.3 1960 1965 1970 1975 1980 1985 1990 Rate per 100,000 Population 4.1
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Severe Sepsis: Severe Sepsis: Comparative Incidence and Mortality Comparative Incidence and Mortality Angus DC, et al. Crit Care Med. 2001; ACS. 0 50 100 150 200 250 300 AIDS Breast Cancer 1st MI Severe Sepsis Incidence Cases/100,000 0 50000 100000 150000 200000 250000 AIDS Breast Cancer AMI Severe Sepsis Mortality Deaths/Year
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Mortality of Severe Sepsis by Age in the Mortality of Severe Sepsis by Age in the United States United States Angus DC, et al. Crit Care Med. 2001. •0% •5% •10% •15% •20% •25% •30% •35% •40% •45% •0 •1 •5 •10 •15 •20 •25 •30 •35 •40 •45 •50 •55 •60 •65 •70 •75 •80 •85 Age Mortality •Without Co-morbidity •With Co-morbidity •Overall
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Projected Incidence of Severe Sepsis in the Projected Incidence of Severe Sepsis in the US: 2001 - 2050 US: 2001 - 2050 200,000 400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 1,600,000 1,800,000 2001 2025 2050 Year 100,000 200,000 300,000 400,000 500,000 600,000 Severe Sepsis Cases US Population Sepsis Cases Total U.S. Population/1,000 Angus DC, et al. Crit Care Med. 2001.
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Systemic Inflammatory Response Syndrome Systemic Inflammatory Response Syndrome (SIRS) (SIRS) Systemic inflammatory response to a variety of severe clinical insults. Manifested by two or more of the following: Temperature > 38 o C or < 36 o C Heart rate > 90 beats/min Respiratory rate > 20 breaths/min or PaCO 2 < 32 mm Hg WBC > 12,000/mm 3 , < 4000/mm 3 , or > 10% immature (band) forms ACCP/SCCM Consensus Statement Chest. 1992;1644-1655.
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Sepsis: ACCP/SCCM Definitions Sepsis: ACCP/SCCM Definitions Infection Inflammatory response to microorganisms or invasion of normally sterile tissues Sepsis The systemic response to infection – i.e., confirmed or suspected infection plus 2 SIRS criteria Severe Sepsis Sepsis associated with organ dysfunction, hypoperfusion, or hypotension Hypoperfusion abnormalities may include but are not limited to lactic acidosis, oliguria, acute alteration in mental status ACCP/SCCM Consensus Statement. Chest. 1992;101:1644-55.
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Sepsis - ACCP/SCCM Definitions: Sepsis - ACCP/SCCM Definitions: The Update The Update Altered mental status Edema or increased fluid balance Hyperglycemia (absent diabetes) Increased CRP or procalcitonin Hypotension Increased SvO 2 CI > 3.5 L/min/m 2 Arterial hypoxemia (PaO 2 /FiO 2 < 300) Acute oliguria (> 2 hours) Increased serum Cr (> 0.5 mg/dL) Coagulopathy (INR > 1.5) Ileus (absent bowel sounds) Thrombocytopenia (< 100,000/uL)
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