Finfer on Sepsis

• 1. SepsisProfessor Simon FinferRoyal North Shore HospitalThe George Institute for Global HealthandUniversity of Sydney

2. What isSepsis? 3. What isSepsis?1992 Systemic inflammatory response to infectionSevere Sepsis = sepsis plus organ dysfunctionSeptic Shock = sepsis plus fluid resistant hypotension 4. What isSepsis?vs.Late 19C Pasteur versus BchampIs it the soil or the germ? 5. Severe Sepsis: Organ dysfunction due to infectionProduct of the host response 6. Estimated 750,000 cases = 3 per 1000 7. 1999 200011.8% of patients in ICUEstimated 0.77 per 1000(about 15,000 per annum)Hospital mortality 37.5% 8. Confidently 25-30,000 per annum in ICU2500 to 4000 deaths 9. Contributes to 1 in 2 -3in-hospital deaths Most deaths werepatients with initiallyless severe sepsis Management of lesssevere sepsis has notbeen main focus 10. Treatments proven to improve outcome? 11. Treatments proven to improve sepsis outcomes 12. Treatments proven to improve sepsis outcomes?Time to treatment(Median [IQR])6 hrs [2.0 15.0] 13. What about the survivors? 14. What about the survivors? 15. What about the survivors?At 12 months (excluding pts at risk of pre-existing deficit)34% had cognitive deficits equating to moderate TBI24% had cognitive deficits equating to mild Alzheimer's