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I mra na Ma lik, MD Asso c ia te Pro fe sso r De pa rtme nt o f - PowerPoint PPT Presentation

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Se psis: Ne w De finitio ns, Ne w Dire c tio n I mra na Ma lik, MD Asso c ia te Pro fe sso r De pa rtme nt o f Critic a l Ca re UT MD Ande rso n Ca nc e r Ce nte r Ho usto n, T e xa s, USA Disc lo sure No c o nflic ts o f inte re st

  1. Se psis: Ne w De finitio ns, Ne w Dire c tio n I mra na Ma lik, MD Asso c ia te Pro fe sso r De pa rtme nt o f Critic a l Ca re UT MD Ande rso n Ca nc e r Ce nte r Ho usto n, T e xa s, USA

  2. Disc lo sure  No c o nflic ts o f inte re st to re po rt re la te d to this ta lk

  3. L e ar ning Obje c tive s  1. Disc uss the justific a tio n a nd c rite ria e sta b lishing the ne w de finitio ns o f se psis a nd ho w the ir de ve lo pme nt impa c ts c ha ng e s a mo ng the a dult a nd pe dia tric po pula tio n  2. Co mpa re a nd c o ntra st the pre dic tive va lue fo r in ho spita l mo rta lity b y using the SOF A sc o re , SI RS c rite ria , L ODS sc o re a nd the de ve lo pme nt o f the q SOF A sc o re in ide ntifying suspe c te d infe c tio n in pa tie nts o utside o f a c ritic a l c a re se tting

  4. Outline  T he Ne w De finitio n o f Se psis  Additio n o f q SOF A  Stre ng ths & We a kne sse s o f T he Ne w De finitio ns  Othe r c o nside ra tio ns

  5. T he Ne w De finitio n o f Se psis  T he Ne w De finitio n o f Se psis  Justific a tio n a nd Crite ria  Re mo va l o f Se ve re Se psis Dia g no sis  Use in Adult vs. Pe dia tric Po pula tio n

  6.  Pub lishe d in F e b rua ry 2016  I nte nde d to impro ve the c la rity o f the de finitio ns fo r  c linic a l c a re , e pide mio lo g y, q ua lity impro ve me nt a nd re se a rc h  T he ne w de finitio ns ha ve b e e n va lida te d re tro spe c tive ly in a dult pa tie nts, using la rg e da ta b a se s in the U.S. a nd E uro pe . Sing e r M, e t. a l. JAMA 2016; 315 (8): 801-810

  7. T he Ne w De finitio n o f Se psis  Justific a tio n  T he de finitio ns o f se psis, se ptic sho c k, a nd o rg a n dysfunc tio n ha ve re ma ine d la rg e ly unc ha ng e d fo r o ve r 2 de c a de s  T he re is impro ve d unde rsta nding o f se psis pa tho b io lo g y  Diffe re ntia ting se psis fro m unc o mplic a te d infe c tio n  Upda ting de finitio ns o f se psis a nd se ptic sho c k  Cre a ting a va lida te d c rite rio n sta nda rd dia g no stic te st  Pro viding a mo re c o nsiste nt a nd re pro duc ib le pic ture o f se psis inc ide nc e a nd o utc o me s Sing e r M, e t. a l. JAMA 2016; 315 (8): 801-810

  8. T he Ne w De finitio n o f Se psis  Crite ria  Se psis is “ life thre ate ning o rg an dysfunc tio n c ause d b y dysre g ulate d ho st re spo nse to infe c tio n”  Org a n Dysfunc tio n  T he c linic a l dia g no sis o f se psis is b a se d o n the Se q ue ntia l Org a n F unc tio n Asse ssme nt sc o re (SOF A)  An a c ute c ha ng e in sc o re o f 2 o r g re a te r is dia g no stic  I de ntifie s pa tie nts with in-ho spita l mo rta lity o f >10%  And a 2-25 fo ld inc re a se d risk o f mo rta lity c o mpa re d to pa tie nts with a SOF A sc o re o f <2. Sing e r M, e t. a l. JAMA 2016; 315 (8): 801-810

  9. SOF A Sc o re Sing e r M, e t. a l. JAMA 2016; 315 (8): 801-810

  10. T he Ne w De finitio n o f Se psis  Crite ria  Se psis is “ life thre ate ning o rg an dysfunc tio n c ause d b y dysre g ulate d ho st re spo nse to infe c tio n”  Org a n Dysfunc tio n  T he c linic a l dia g no sis o f se psis is b a se d o n the Se q ue ntia l Org a n F unc tio n Asse ssme nt sc o re (SOF A)  An a c ute c ha ng e in sc o re o f 2 o r g re a te r is dia g no stic  Ide ntifie s pa tie nts with in-ho spita l mo rta lity o f >10%  And a 2-25 fo ld inc re a se d risk o f mo rta lity c o mpa re d to pa tie nts with a SOF A sc o re o f <2.  Se ptic Sho c k  Pe rsiste nt hypo te nsio n re q uiring va so pre sso rs (MAP>65mm HG)  Se rum la c ta te >2 mmo l/ L de spite a de q ua te re susc ita tio n  T he se c rite ria ide ntify pa tie nts with in-ho spita l mo rta lity >40% Sing e r M, e t. a l. JAMA 2016; 315 (8): 801-810

  11. T he Ne w De finitio n o f Se psis  Re mo va l o f Se ve re Se psis  T he ne w te rm ‘ se psis’ invo lve s o rg a n dysfunc tio n  Se pa ra ting it fro m simple infe c tio n a nd se ptic sho c k  ‘ Se ve re se psis’ b e c o me s supe rfluo us  Gre a te r c o nc e rn fo r a nd tre a tme nt o f the pa tie nt sho uld o c c ur with ‘ se psis’ witho ut ne e ding the a dditio na l a dje c tive

  12. T he Ne w De finitio n o f Se psis  Adult vs. Pe dia tric Po pula tio n  Upda te d de finitio ns a re fo r a dult po pula tio ns o nly  Pe dia tric pa tie nts c o mprise a c o mplic a te d sub se t o f se psis pa tie nts  Due to a g e -de pe nde nt va ria tio ns in physio lo g ic ra ng e s a nd re spo nse s  T a sk F o rc e re c o g nize s the ne e d to de ve lo p simila r de finitio ns in pe dia tric pa tie nts

  13. Additio n o f q SOF A  Additio n o f q SOF A  As a Sc re e ning T o o l  As a Pre dic to r o f Mo rta lity

  14. Additio n o f q SOF A – Sc re e ning T o o l  AMS is de fine d a s Gla sg o w Co ma Sc a le <15  Sc o re is c o nside re d to b e po sitive if a t le a st 2 o f the c rite ria a re me t  Do e s no t inc lude a me a sure me nt o f la c ta te o r a ny o the r la b te sts Sing e r M, e t. a l. JAMA 2016; 315 (8): 801-810

  15. Additio n o f q SOF A – Sc re e ning T o o l  T he T a skfo rc e re c o mme nds use o f q SOF A to pro mpt c linic ia ns to :  F urthe r inve stig a te fo r o rg a n dysfunc tio n  I nitia te o r e sc a la te the ra py a s a ppro pria te  Co nside r re fe rra l to c ritic a l c a re o r inc re a se the fre q ue nc y o f mo nito ring , if no t a lre a dy do ne Sing e r M, e t. a l. JAMA 2016; 315 (8): 801-810

  16. Additio n o f q SOF A –Pre dic tive Va lue  As a pre dic to r o f mo rta lity  Within the I CU, SOF A is b e tte r tha n q SOF A  Outside the I CU, q SOF A is simila r to SOF A  q SOF A ide ntifie s a dult pa tie nts with infe c tio n who a re mo re like ly to ha ve po o r o utc o me s Sing e r M, e t. a l. JAMA 2016; 315 (8): 801-810

  17. Additio n o f q SOF A –Pre dic tive Va lue In ICU Out of ICU SOF A 74% 79% Cha ng e in SOF A 72% 79% SI RS 64% 76% q SOF A 66% 81% L ODS* 75% ----- *L ODS= L o g istic Org an Dysfunc tio n Syste m Sing e r M, e t. a l. JAMA 2016; 315 (8): 801-810

  18. Sing e r M, e t. a l. JAMA 2016; 315 (8): 801-810

  19. Stre ng ths & We a kne sse s  Co nsiste nc y vs. Co mple xity  Pre dic tio n vs. E a rly Re c o g nitio n  Pra c tic a litie s o f Co ding fo r Se psis

  20. Stre ng ths & We a kne sse s  Co nsiste nc y  Co nsiste nc y o f de finitio ns impro ve d  se ve re se psis a nd se psis we re c o mmo nly use d inte rc ha ng e a b ly  I t ma y b e a b e tte r pre dic to r o f po o r o utc o me s  T he c ha ng e ma y a id in the a sse ssme nt o f ne w the ra pie s.

  21. Stre ng ths & We a kne sse s  Co mple xity  SOF A sc o re c a n b e c o mple x  SOF A sc o re is no t wide ly use d o utside c ritic a l c a re units.  I t ma ke s se psis a c ritic a l c a re de finitio n  E ve n tho ug h mo st pa tie nts with se psis a re no t in c ritic a l c a re  E a rly re c o g nitio n a nd tre a tme nt is a pro ve n stra te g y in re duc ing se psis-re la te d de a ths  T he ne w de finitio n c o uld le a d to de la ys in dia g no sis a nd in initia tio n o f tre a tme nt  T he re is no pro spe c tive da ta to suppo rt its use … ye t

  22. Stre ng ths & We a kne sse s  Pre dic tio n vs. E a rly Re c o g nitio n  Altho ug h SOF A sc o re s c a rry pre dic tive va lue , it is no t a s va lua b le in e a rly re c o g nitio n, whic h o fte n o c c urs o utside the I CU  E a rly re c o g nitio n re q uire s Sc re e ning fo r se psis  Using SI RS c rite ria  Ra ise d E a rly Wa rning sc o re s  Or using q SOF A  No t pro spe c tive ly va lida te d… ye t

  23. Stre ng ths & We a kne sse s  Pra c tic a litie s o f Co ding fo r Se psis  T he T a sk F o rc e ma de re c o mme nda tio ns fo r c o ding se psis b a se d o n the ne w de finitio ns a nd I CD-10 c o de s  T his ha s no t ye t b e e n tra nsla te d into pra c tic a l instruc tio ns fo r c linic a l c o de rs  Co de rs a re no t a b le to use SOF A sc o re s a nd infe c tio n to c o de fo r se psis  Co ding fo r se psis will still de pe nd o n c linic ia ns writing the dia g no sis in the no te s

  24. Othe r c o nside ra tio ns  Na tio na l inc e ntive s to impro ve se psis ma y b e a ffe c te d  So me c o untrie s ma y ha ve e xisting pro g ra ms a nd inc e ntive s to impro ve se psis ma na g e me nt  Ac hie ve me nt o f a g re e d ta rg e ts ma y ha ve sig nific a nt fina nc ia l implic a tio ns fo r ho spita ls  Ho spita ls sho uld e nsure tha t imple me nta tio n o f Se psis-3 do e s no t je o pa rdize a c hie ve me nt o f the ir ta rg e ts  T his ma y ha ve a de trime nta l e ffe c t o n re so urc e s fo r se psis ma na g e me nt.

  25. Othe r c o nside ra tio ns  Cha ng e in se psis po pula tio n a nd impa c t o n o utc o me s  Se psis impro ve me nt pro je c ts sho uld c o nside r ho w imple me nta tio n o f the ne w se psis de finitio ns ma y a ffe c t the ir o utc o me s  Cha ng e s in o utc o me s ma y b e re la te d to a c ha ng e in se psis po pula tio n ra the r tha n impro ve me nts in c a re .

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