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SIMI - X Congresso Lazio Molise
Alberto Tosoni, MDMedicina Interna, Policlinico Gemelli, UCSC
Definizione, dimensioni del problema e criticità
La definizione deve individuare un insieme
che abbia esattamente la stessa estensione
dell'insieme individuato dall'oggetto da definirsi.
Le Categorie, IV sec. a.C., Aristotele.
Sepsis-1 (1991)
Chest 1992; 101:1644
Sepsis-1 (1991)
172 ICUs in Australia & New Zealand
109.663 patientsinfection + organ failure
Sepsis-2 (2001)
First and foremost, sepsis is a broad term applied to an incompletely understood process.
There are no simple clinical criteria or laboratory features that uniquely identify a septic patient.
The new definitions rely on expert opinion;
further understanding of sepsis
will fuel their reevaluation and revision.
InfezioneRisposta
dell’ospite
Danno d’organo
SIRS +
segni specifici
di infezione
Pathways:
-Pro-infiammatori
-Anti-infiammatori
-Autonomici
-Ormonali
-Metabolici
-Genetici
-Epigenetici
Sepsis is defined as life-threatening organ dysfunction
caused by a dysregulated host response to infection.
Sepsis-3 (2016)
Sepsis-3
12 ICUsin Pennsylvania
148,907 patientswith suspected
infection
Quanto siete allarmati?
JACC 2015; 8:139
Septic shock is a subset of sepsis in which
underlying circulatory and cellular abnormalities
are profound enough to substantially increase mortality.
Sepsi
Lattati >2Ipotensione
Mortalità > 40%
Con parole semplici…
Sepsis is a life-threatening condition
that arises when the body’s response to infection
injures its own tissues and organs.
Epidemiologia della Sepsi
Hall et al. Impatient care for sepsis. NCHS Data Brief, 2011
Ospedalizzazione con e per setticemia/sepsi
Hall et al. Impatient care for sepsis. NCHS Data Brief, 2011
Tasso di ospedalizzazione per sesso ed età
Hall et al. Impatient care for sepsis. NCHS Data Brief, 2011
Lunghezza media di degenza
Epidemiologia in Medicina Interna
1/23 pazienti ricoverato con sepsi
68% sepsi severain Medicina Interna
Mortalità del 20-45%
31 Reparti Med InternaMar-Dic 2012
533 pazienti emocolture +
60% sepsi severa e 3.2% shock
7 pz trasferiti in ICU (1.3%)
Gestione della Sepsi
For the overall group,mortality risk increases
12% every hour
Significant increase in mortality risk
with increasing delays in administration of Ab therapy
Bassetti et al. PLoS ONE 2011; 6(9): e24198
Mortalità per candidemia e ritardo di inizio della terapia antifungina
Sepsis-3
Medicina Interna ICU - 24/7
Sepsis-3
Criticità nella terapia
NEJM 2014 NEJM 2014 NEJM 2015
April 2015
Surviving Sepsis Campaign
Within 3 hours…
Check Lactic acid
Send Blood Coltures
Give Antibiotics
30 mL/kg IV Fluids
(if low BP/high Lactate)
Surviving Sepsis Campaign
Within 6 hours…
Vasopressors if MAP<65mmHg
Re-assess Volume Status & Tissue Perfusion
Re-check Lactic Acid (unless initially normal)
CVP - ScvO2 - Cardiac US - Passive leg raise
In conclusione
Alta mortalità
Elevata incidenza in Medicina Interna
Necessario: Rapidità di diagnosi e terapia
Non necessario: approccio invasivo
Internal Medicine Sepsis Study Group
Carla Vallone Michele ImpagnatielloGiovanna Passaro
Antonio Mirijello Vincenzo Zaccone Alberto Tosoni
Grazie per l’attenzione
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