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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Section of Critical Care Medicine Section of Infectious Diseases
Sepsis and Septic Shock Old Concepts, New Precepts. Anand Kumar, MD. Section of Critical Care Medicine Section of Infectious Diseases University of Manitoba, Winnipeg, Canada UMDNJ-Robert Wood Johnson Medical School Cooper Hospital, NJ. Incidence of Severe Sepsis/Septic Shock. - PowerPoint PPT Presentation
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Section of Critical Care MedicineSection of Infectious Diseases
University of Manitoba, Winnipeg, CanadaUMDNJ-Robert Wood Johnson Medical School
Cooper Hospital, NJ
Anand Kumar, MDAnand Kumar, MD
Sepsis and Septic Sepsis and Septic ShockShock
Old Concepts, New PreceptsOld Concepts, New Precepts
Incidence of Severe Sepsis/Septic ShockIncidence of Severe Sepsis/Septic Shock
Approximate Cases/Year800,000
600,000
400,000
200,000
0
Severe sepsis800,000
Septic shock400,000
Deaths from septic shock200,000
Sepsis and sequelae are a leading cause of death in ICUMortality in septic shock remains at 35 - 50%
-unchanged since advent of antibiotics (from 55 - 75%)
Bacterial SepsisBacterial Sepsis
Death Rate in the United States5.0
Chart adapted from CDC/National Center for Health Statistics, 1992.
4.0
3.0
2.0
1.00.00.80.7
0.5
0.4
0.6
0.2
0.1
0.3
1960 1965 1970 1975 1980 1985 1990
Rat
e p
er 1
00,0
00 P
op
ula
tio
n
4.1
Severe Sepsis: Severe Sepsis: Comparative Incidence and MortalityComparative Incidence and Mortality
Angus DC, et al. Crit Care Med. 2001; ACS.
0
50
100
150
200
250
300
AIDS BreastCancer
1st MI SevereSepsis
Incidence
Cas
es/1
00,0
00
0
50000
100000
150000
200000
250000
AIDS BreastCancer
AMI SevereSepsis
Mortality
Dea
ths/
Yea
r
Mortality of Severe Sepsis by Age in the Mortality of Severe Sepsis by Age in the United StatesUnited States
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
Sepsis-induced hypotension despite adequate fluid resuscitation along with the presence of perfusion abnormalities that may include, but are not limited to, lactic acidosis, oliguria, or an acute alteration of mental status; patients receiving inotropic or vasopressor agents may not be hypotensive at the time that perfusion abnormalities are measured.
CVP does not accurately estimate ventricular filling pressures in the critically ill.
When PWP is appropriately elevated to 12 - 15 mm Hg with fluid resuscitation, 90% of patients with septic shock exhibit a hyperdynamic circulatory state.
Hyperdynamic state persists to death
1
0
2
5
6
Car
dia
c In
dex
(L
/min
/m2)
3
4
1 2 4 7 10 1 2 4 7 10
Time (days)
7
SurvivorsNonsurvivorsAll Patients
Parker et al. Ann Intern Med. 1984.
Cardiac Index in Septic Shock (post - 1980)Cardiac Index in Septic Shock (post - 1980)
Hypovolemia in Septic Shock: CausesHypovolemia in Septic Shock: Causes