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QUALI RISULTATI VORRESTI E QUALI HAI

QUALI RISULTATI VORRESTI E QUALI HAI. Journal Club ‘Sopravvivere alla Sepsi: i primi 5 anni’ 2 dicembre 2010. SURGICAL - “SEPTIC” ICU (01/2005-12/2008). ICU (2005-2009) severe sepsis/septic shock. 307 patients severe sepsis/septic shock. 112 excluded: - cirrhosis waiting list OLT

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QUALI RISULTATI VORRESTI E QUALI HAI

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  1. QUALI RISULTATI VORRESTI E QUALI HAI Journal Club ‘Sopravvivere alla Sepsi: i primi 5 anni’ 2 dicembre 2010

  2. SURGICAL - “SEPTIC” ICU (01/2005-12/2008) ICU (2005-2009) severe sepsis/septic shock 307 patients severe sepsis/septic shock 112 excluded: - cirrhosis waiting list OLT - OLT - Pediatrics 195 patients 129 Septic shock 66 Severe sepsis

  3. GUIDELINES • I. Management of Severe Sepsis • Initial Resuscitation • Diagnosis • Antibiotic therapy • Source Control • Fluids • Vasopressor • Inotropic Therapy • Steroids • rhAPC • Blood Product adiministartion • II. Supportive Therapy of Sepsis • Mechanical Ventilation • Sedation • Glucose control • Renal replacement • Bicarbonate Therapy • Deep Vein Thrombosis Prophylaxis • Stress Ulcer Prophylaxis • SDD • Limitation of Support • III. Pediatric Consideration in severe sepsis 50 Strong Recommendations (1 A-C) 19 Weak Recommendations (2 B-D)

  4. SEPSIS BUNDLES

  5. ICU (2005-2007) severe sepsis/septic shockBUNDLES COMPLIANCE 6-Hours 24-Hours % patients All bundles Jan 05 Jun 05 July 05 Dec 05 Jan 06 Jun 06 July 06 Dec 06 Jan 07 Jun 07 PROCESS CHANGES EDUCATION

  6. ICU (2005-2008) severe sepsis/septic shockBUNDLES COMPLIANCE n =195 6H bundle Percentageofpatients 24 H bundle Percentageofpatients

  7. ICU (2005-2008) severe sepsis/septic shockMORTALITY TI (2005-2008) severe sepsis/septic shockBUNDLES COMPLIANCE SAPS II hospital 30 days Septic shock n = 129 SEPSIS TEAM EDUCATION GIViTI Septic Shock

  8. ICU (2005-2008) severe sepsis/septic shockMORTALITY (f) BUNDLES TI (2005-2008) severe sepsis/septic shockBUNDLES COMPLIANCE

  9. ICU (2005-2008) severe sepsis/septic shockmortality (f) sepsis interventions Multivariate Logistic Regression 30-d Mortality Confounders: age, sex, SAPS II, SOFA, Shock, Semester Independent: 9 sepsis interventions* + IgGAM n =129 • * sepsis Interventions • Blood Cultures • Antibiotic < 3h • Source control • Fluids • SvO2> 70% • Glycamia • Steroids • rhAPC • PIP<30cmH20 Hosmer-Lemeshow = 0,565

  10. WHICH INTERVENTION ? • 77 Spanish ICUs • 2804 patients severe sepsis/septic shock • Before and after 2 months educational program

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