![Page 1: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/1.jpg)
Ricard Ferrer Intensive Care Department
Mutua Terrassa University Hospital Barcelona. SPAIN
![Page 2: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/2.jpg)
La sepsis es una de las enfermedades más frecuentes pero menos reconocidas del
mundo
1. INTRODUCCIÓN MEDICINA INTENSIVA
![Page 3: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/3.jpg)
Su incidencia está aumentando de
forma exponencial.
Los hospitalizados por sepsis se han duplicado en los últimos 10 años.
1. INTRODUCCIÓN MEDICINA INTENSIVA
![Page 4: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/4.jpg)
En un año, por cada 100.000 personas, 377 sufrirán sepsis, 135 su forma grave o shock
séptico.
1. INTRODUCCIÓN MEDICINA INTENSIVA
![Page 5: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/5.jpg)
![Page 6: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/6.jpg)
Entre 20-30 millones de
personas en todo el mundo son
afectadas cada año. De las cuales
8 millones mueren.
1. INTRODUCCIÓN MEDICINA INTENSIVA
![Page 7: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/7.jpg)
Cada 4 segundos
alguien muere por sepsis en el
mundo
1. INTRODUCCIÓN MEDICINA INTENSIVA
![Page 8: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/8.jpg)
![Page 9: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/9.jpg)
Crit Care Med 2009; 37: 1268–1274
Mortality (%)
ICU 15.5
Hospital 28.3
1 Year 40.9
2 Year 44.9
Quality of life (EuroQol-5D)=
![Page 10: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/10.jpg)
Crit Care Med 2009; 37: 1268–1274
![Page 11: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/11.jpg)
Crit Care Med 2009; 37: 1268–1274
![Page 12: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/12.jpg)
Pillars of Sepsis Treatment
ABX Source Control EGDT
Lactate Radiology
YOUR speed is LIFE!
![Page 13: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/13.jpg)
Phase 1 Barcelona declaration
Phase 2 Evidence based guidelines
Phase 3 Implementation and education
Surviving Sepsis
Surviving Sepsis
![Page 14: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/14.jpg)
Campaign Targets
•Mortality goal
•25% reduction in 5 years
•35% to 26%:
•72,000 lives saved in US
•500,000 worldwide
![Page 15: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/15.jpg)
Phase 1 Barcelona declaration
Phase 2 Evidence based guidelines
Phase 3 Implementation and Education
Surviving Sepsis
![Page 16: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/16.jpg)
![Page 17: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/17.jpg)
Phase 1 Barcelona declaration
Phase 2 Evidence-based guidelines
Phase 3 Implementation and education
Surviving Sepsis
![Page 18: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/18.jpg)
SSC Phase III: Methodology
• Partner with Institute for Healthcare
Improvement (IHI)
–Develop sepsis “change bundles”
• Facilitate adoption of guidelines – VAP, CLABSI
• 15 member panel – Gap analysis
![Page 19: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/19.jpg)
Surviving Sepsis Campaign: Timeline
Barcelona
Declaration
SSC
Guidelines
2010
Phase IV
Guidelines
And
bundles
Revision
2005
NEJM editorial
2004
2002
Guidelines
Revision
Phase III starts:
IHI partnership
2008 2012
Results
published
15,000 pts
20% RRR
2006 2012--
![Page 20: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/20.jpg)
EDUSEPSIS es una organización independiente de profesionales que
atienden al paciente crítico, tanto adulto como pediátrico, cuyo objetivo es reducir la
mortalidad de la sepsis grave y el shock séptico mediante la evaluación de la
eficacia y eficiencia de los tratamientos y la transferencia del conocimiento científico.
![Page 21: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/21.jpg)
Acciones
• Intervenciones de Transferencia del Conocimiento en Sepsis. – Adultos
– Pediatría
• Evaluaciones de la efectividad de los tratamientos de la sepsis. – Nacional
– Internacional: SSC
• Evaluaciones de costes y Coste-Efectividad.
![Page 22: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/22.jpg)
Transferencia del Conocimiento
![Page 24: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/24.jpg)
Knowledge Transfer in Critical Care
Fowler et al. CCM 2007;35:1696-1702
![Page 25: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/25.jpg)
Variability in Clinical Practice
• Variability based on:
– Knowledge deficits
– Faulty application of knowledge
– Simple forgetting
– UANACCEPTABLE
• Variability based on
– Different weighting of relevant knowledge
– EXPECTED
• Performance measures, check-lists, bundles:
– Making the clinical decision-making process explicit
– Aids in identifying source of variability
![Page 26: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/26.jpg)
Crit Care Med 2008; 36:2719–2725
Perception
![Page 27: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/27.jpg)
PRE-INTERVENTION PROCESS-OF-CARE MEASURES
POST-INTERVENTION PROCESS-OF-CARE MEASURES
IMPROVE KWONLEDGE
CHANGE BEHAVIOUR
IMPROVE OUTCOME
EDUCATIONAL
STRATEGIES STRUCTURE AND
ORGANIZATIONAL
STRATEGIES
Performance Improvement Interventions
![Page 28: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/28.jpg)
Intensive Care Med 2008;34:17-60
SEPSIS RESUSCITATION BUNDLE
6H
SEPSIS MANAGEMENT BUNDLE
24H
![Page 29: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/29.jpg)
Multifaceted Interventions
Intervention Effect
Interventions incorporating educational outreach Modest
Educational material + Educational meetings Small-Modest
Educational material + Audit and Feedback Modest
Educational material + Audit and Feedback +
Educational meetings
Small-Modest
Educational material + Educational meetings +
organizational interventions
Small-Modest
Reminders + Patient-directed interventions Moderate-Large
Remainders have a summative effect with other interventions
![Page 30: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/30.jpg)
EDUCATIONAL
PROGRAMME
POST-EDUCATION
DATA COLLECTION
OCT-DEC JAN-FEB MAR-JUN
2005 2006
BASELINE
DATA COLLECTION
a before-and-after intervention study
2007
LONG-TERM
FOLLOW-UP
MAR-JUN
JAMA 2008;299(19):2294-2303
Study Timeline
PE
RC
EP
TIO
N
![Page 31: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/31.jpg)
Multifaceted Intervention
PI
Hospital
Manager
Interview
Physicians
Nurses
ICU
ED
Medical Ward
Surgical Ward
Graphic material:
distribution and display
Clinical training
![Page 32: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/32.jpg)
0
10
20
30
40
50
60
70
80
90%
Lactate Blood
Cultures
Antibiotics Fluids +
vasopresors
CVP>8 ScvO2>70 All
RESUSCITATION BUNDLE COMPLIANCE
Objective Subjective
Sepsis bundles: Audit vs Subjective Perception
![Page 33: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/33.jpg)
0
10
20
30
40
50
60
70
80
90%
Steroids aPC Glucose IPP All
MANAGEMENT BUNDLE COMPLIANCE
Objective Subjective
Sepsis bundles: Audit vs Subjective Perception
![Page 34: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/34.jpg)
Resuscitation Bundle (6H)
0
10
20
30
40
50
60
70
80
90
% C
om
plia
nc
e
Lactate Blood Cultures Antibiotics Fluids +
Vasopresors
CVP>8 SvcO2>70 All
Preintervention Intervention
* p<0.05
*
*
*
*
* *
![Page 35: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/35.jpg)
Management Bundle (24h)
0
10
20
30
40
50
60
70
80
90
% C
om
plia
nc
e
Steroids APC Glucose IPP All
Preintervention Intervention
* p<0.05
* * *
*
![Page 36: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/36.jpg)
Educational Program and Mortality
4439,7
36,4
31,1
0
10
20
30
40
50
%
Hospital Mortality ICU Mortality
Preintervention Intervention
p= .036 p= .01
Absolute reduction: 4.3%
Relative reduction 10%
28d Mortality: Kaplan-Meier curve
Absolute reduction: 4.3%
Relative reduction 10%
SSC objective was 25%!
![Page 37: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/37.jpg)
Impact of Baseline Compliance
0
5
10
15
20
25
30
Pre-Intervention Post-Intervention
%
Cat 1 Cat 2 Cat 3
0
5
10
15
20
25
30
Pre-Intervention Post-Intervention
%
Cat 1 Cat 2 Cat 3
20
25
30
35
40
45
50
Pre-Intervention Post-Intervention
%
Cat 1 Cat 2 Cat 3
Resuscitation Bundle Management Bundle
Mortality
* p<0.05
*
* *
*
*
Cat 1: < 4 tasks (n= 20)
Cat 2: 4-5 tasks (n= 19)
Cat 3: > 5 tasks (n= 20)
![Page 38: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/38.jpg)
Resuscitation Bundle (6H)
0
10
20
30
40
50
60
70
80
90
% C
om
plia
nc
e
Lactate Blood Cultures Antibiotics Fluids +
Vasopresors
CVP>8 SvcO2>70 All
Preintervention Intervention Long-term
Long-term follow up (23 centers) * p<0.05
* *
*
*
*
![Page 39: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/39.jpg)
Time to Treatment
0
50
100
150
200
250
Min
ute
s
Lactate Blood culture Antibiotics PVC >8 ScvO2>70
Preintervention Intervention Long-term
* p<0.05
*
Long-term follow up (23 centers)
![Page 40: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/40.jpg)
Educational Program and Mortality
42,538,7
0
10
20
30
40
50
%
Hospital Mortality
Preintervention Intervention Long-term
38,0
Long-term follow up (23 centers)
![Page 41: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/41.jpg)
PRE-INTERVENTION GUIDELINE IMPLEMENTATION
POST-INTERVENTION GUIDELINE IMPLEMENTATION
IMPROVE KWONLEDGE
IMPROVE OUTCOME
EDUCATIONAL STRATEGIES
Continuous Performance Improvement
![Page 42: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/42.jpg)
Crit Care Med 2010; 38(2):367-374
n= 15.022
![Page 43: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/43.jpg)
Crit Care Med 2010; 38(2):367-374
![Page 44: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/44.jpg)
ABISS Edusepsis Study Antibiotic Intervention in Severe Sepsis
![Page 45: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/45.jpg)
Objectives
• Efficacy:
– Reduce time to empiric antibiotic in severe sepsis.
– Increase appropriateness of antibiotic treatment
– Reduce hospital mortality.
• Safety:
– Increase antibiotic deescalation.
By a multifaceted quality-improvement intervention in patients with severe sepsis/septic shock admitted to the Spanish ICUs.
![Page 46: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/46.jpg)
Multifaceted Intervention
• Audit and Feed-back.
• Educational meetings: PP presentation.
• Interactive Sepsis simulation on-line.
• Posters and pocket material about initial TTM.
• Support for antibiotic prescription.
• Remainders by mail and SMS to all staff assisting to educational meetings.
![Page 47: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/47.jpg)
Remainders: SMSs
![Page 48: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/48.jpg)
Audit and Feed-Back
![Page 49: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/49.jpg)
120 hospitals were invited to participate and received the educational material: -Poster “La Sepsis Mata”: 360 -Poster “Pilares del tratamiento de la Sepsis”: 360 -Poster “Juego interactivo”: 360 -Triptics “Pilares del tratamiento de la Sepsis”: 6000 Educational intervention: -80 hospitals complete the educational intervention -4567 doctors and nurses attend to the meetings and provide a email address and/or mobile phone for remainders.
Educational Meetings
![Page 50: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/50.jpg)
Educational Material
![Page 51: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/51.jpg)
Prescription Support
• Local Guidelines of empiric antibiotic treatment • Spanish Society of Intensive Care Guidelines of empiric antibiotic treatment
![Page 52: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/52.jpg)
Gamification
![Page 53: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/53.jpg)
Remainder. SMSs
• En sepsis la administración del antibiótico adecuado es una emergencia.Consulta tu guia local de tto antibiotico empirico.TU VELOCIDAD ES VIDA.
• Los pilares del tratamiento de la sepsis son:antibióticoterapia, control del foco y resucitación hemodinámica.¡COMPLETALOS RAPIDAMENTE!
• Tardamos 3 horas en administrar antibiótico empírico en sepsis con mortalidad 33%. Administrado en 1h la mortalidad sería inferior!.
• Antes del tto antibiótico, recuerda tomar hemocultivos + cultivos adicionales según foco de sepsis, después podrás ajustar tu tto empírico!.
![Page 54: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/54.jpg)
Results
• 72 hospitals in Spain.
• 2576 patients: PRE 1,325, POST: 1,251
• Age 64.1 ± 15.1 years, 54.1% male.
• CHARLSON 2.7 ± 2.2
• Septic Shock 67.6%, 32.4% severe sepsis.
• Bacteriemia: 33%
• APACHE-II 22 ± 8.
• SOFA 9 ± 3
• PCT 25 ± 35
![Page 55: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/55.jpg)
Results: Blood Cultures Microorganism n
Escherichia coli 299 Staphylococcus aureus MS and MR 78
Streptococcus neumoniae 75 Staphylococcus CN 60
Klebsiella spp 53 Pseudomonas aeuroginosa 42
Enterococcus spp 35 Streptococcus pyogenes 28
Enterobacter spp 25 Streptococcus other 22
Candida spp 21 Multiple microorganisms 19 Proteus mirabilis 16
Bacterioides fragillis 14
Acinetobacter baumanii 11
Clostridium 6 Neisseria meningitidis 5
Salmonella 5 Listeria monocytogenes 4
Serratia marcescens 4
![Page 56: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/56.jpg)
Results: Source Control
Técnica n
Colectomía parcial/total 201
Colecistectomía 96
Resección intestino delgado 70
Desbridamiento piel-partes blandas
77
Drenaje abdominal percutáneo 48
Nefrostomía 41
Cateterismo ureteral 37
Drenaje vía biliar 33
Drenaje torácico 24
Desbridamiento de absceso 19
Cirugía gástrica 19
Técnica n
Apendicectomía 17
Pancreatectomía parcial 13
Sutura úlcera 17
Cirugía hepática 9
Nefrectomía 7
Esofaguectomía 4
Desbridamiento cuello/mediastino 6
Histerectomía 3
Cirugía craneal 2
Cirugía de pulmón y bronquio 1
Cirugía valvular cardiaca 1
28,3% de los pacientes precisan una técnica de control del foco
![Page 57: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/57.jpg)
Results
PRE POST P value
Age 64.3±15.3 63.9±15.0 0.480
Charlson 2.7±2.3 2.7±2.3 0.308
Leukocytes 14.4±11.5 15.9±11.0 0.290
CRP 27.1±24.8 25.0±24.5 0.055
PCT 25.1±35.2 25.6±34.5 0.804
Lactate (mmol/L) 3.5±3.1 3.6±2.8 0.247
APACHE II 22.6±8.1 21.4±8.0 <0.001
Number OF 3.0±1.4 3.0±1.4 0.897
SOFA 8.7±3.5 8.5±3.4 0.073
![Page 58: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/58.jpg)
Results: Source Infection
p< 0.05
![Page 59: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/59.jpg)
Results: Acquisition
p< 0.05
![Page 60: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/60.jpg)
Results: Quality indicators
p< 0.05 p< 0.05 p< 0.05 p= 0.58
![Page 61: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/61.jpg)
Results: Source control
p= 0.611
![Page 62: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/62.jpg)
Results: Antibiotics
p< 0.001 p= 0.020
![Page 63: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/63.jpg)
Results
p= 0.002 p= 0.001
![Page 64: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/64.jpg)
Results
p= 0.422 p= 0.182
![Page 65: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/65.jpg)
ABISS Edusepsis
Pediatric
![Page 66: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/66.jpg)
ABISS pediatric net
PICUs ABISS: 33
![Page 67: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/67.jpg)
ABISS pediatric
ABISS PICUs characteristics:
• Total: 380 PICU beds
• Total admissions/month: 1460
• 100% of PICU with residents
• 94% public
• 83.3% medical and surgical, 25% pediatrics-
neonatal
• Protocols for sepsis management 100%
• Use of biomarkers: PCR 100%, PCT 64%
• Hemofiltration: 50%; ECMO: 20%
![Page 68: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/68.jpg)
Preintervention results
• 198 cases
• 118 ♂ (59.6%)
• Median age (years) 2.9 ±4.6 ( 7 days-17.8 ys)
• Underlying diseases: 88 (44,4%)
• SOFA 6,74±3.71
• PRISM3 10.71± 7.21
• Biomarkers:
– PCT 36.97±52.25 ng/ml
– CRP 19.60±21.66 mg/dl
![Page 69: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/69.jpg)
Preintervention results
• Global Mortality 15.6%
– Mortality Septic shock 26.2%
• Days of mechanical ventilation: 13.6±42.6
• Days of inotropic support: 5.77± 8.43
• PICU length of stay (days): 12.02±35.03
• Hospital length of stay (days): 26±45.09
![Page 70: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/70.jpg)
Preintervention results
• Antibiotics previous to the onset of sepsis: 46
(23,2%)
• Evaluation of treatment: Change of ATB at 72
hs:
![Page 71: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/71.jpg)
![Page 72: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/72.jpg)
Evaluación Efectividad de los Tratamientos
Eficacia Efectividad
![Page 73: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/73.jpg)
Assessment of the Effects of Treatments
for Severe Sepsis on Mortality
Randomized
Control Trials
Observational
Studies
![Page 74: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/74.jpg)
Randomized Control Trials in CCM
Pros:
• RCT is the standard for generating evidence.
• Bias are minimized.
• Confounders are limited.
• Data about efficacy and safety.
Cons:
• Lack of biomarkers:
Heterogeneous
groups of patients.
• Stringent eligibility
criteria.
• Difficult to
homogenize
treatments.
• Complex outcomes.
• Ethical constraints.
![Page 75: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/75.jpg)
• Consistency: – Biological plausibility.
– Confirmatory studies of single RCT.
– Multicentric confirmation of unicentric studies.
• Effectiveness studies in “real world scenario”. – Patients excluded from RCT.
– Effect of combining several treatment.
– Feasibility of complex therapeutic interventions/algorithms.
• Efficiency: Cost-effectiveness studies.
• Pharmacovigilance/Post-commercialization studies: Safety
Knowledge Generation
![Page 76: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/76.jpg)
Objective: To analyze the impact on hospital
mortality of severe sepsis treatments
included in the SSC guidelines in a
prospective multicenter observational
study (n= 2,796 adult patients with
severe sepsis in 77 Spanish ICUs).
Method: The effectiveness of each sepsis
treatment was estimated by using PS.
AJRCCM 2009;180:861–866.
![Page 77: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/77.jpg)
TREATMENTS and MORTALITY
• Adjust for possible confounders:
–Clinical risks factors for mortality
–Other treatments and therapeutic
goals
–Propensity Score
![Page 78: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/78.jpg)
Propensity Score. Antibiotics.
![Page 79: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/79.jpg)
0,4 0,6 0,8 1 1,2 1,4 1,6 1,8
Odds ratio
OR and 95% CI
Broad spectrum AB:
Fluid challenge#
0-1 Hour 1-3 Hour 3-6 Hour Previous AB No AB first 6H
Steroids in septic shock
APC in MOF
Fluid challenge, only severe sepsis
Ferrer R et al. AJRCCM 2009;180:861–866
Effectiveness of APC in MOF
Final Model: All risk factors + Other TTMs + PS
![Page 80: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/80.jpg)
time from hypotension onset (hrs)
fraction o
f to
tal patients
0.0
0.2
0.4
0.6
0.8
1.0 survival fraction
cumulative antibiotic initiation
Early antibiotic treatment
Kumar A et al. Crit Care Med 2006;34:1589-96
• Retrospective
• Only septic shock
• Only adequate treatment
![Page 81: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/81.jpg)
Time to Treatment. Antibiotics
Ferrer et al. ESICM 2011, Abstract 139; Annals Internal Medicine Submitted
25.089 patients with severe sepsis or septic shock
Predicted Mortality with 95% CI0
.1
.2
.3
.4
Ho
spita
l M
ort
alit
y
0 1 2 3 4 5 6
Time to ABX, hours
Patient: North America, one baseline organ failure, and community acquired infection
Hospital Mortality by Time to ABX
Time to ABX, hrs
OR 95% CI p-value
0 (ref) 1.00 --- --- --- 1 1.05 1.02 1.07 < 0.001 2 1.09 1.04 1.15 < 0.001 3 1.14 1.06 1.23 < 0.001 4 1.19 1.08 1.32 < 0.001 5 1.25 1.11 1.41 < 0.001 6 1.31 1.13 1.51 < 0.001
![Page 82: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/82.jpg)
Time to Treatment. Antibiotics
25.089 patients with severe sepsis or septic shock
Predicted Mortality with 95% CI0
.1
.2
.3
.4
Ho
spita
l M
ort
alit
y
0 1 2 3 4 5 6
Time to ABX, hours
Severe sepsis Septic shock
Patient: North America, one baseline organ failure, and community acquired infection
Hospital Mortality by Time to ABX
Ferrer et al. ESICM 2011, Abstract 139; Annals Internal Medicine Submitted
![Page 83: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/83.jpg)
![Page 84: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/84.jpg)
![Page 85: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/85.jpg)
Cox proportional hazard regression of PP < 30 cm H2O in patients without ALI
Cox proportional hazard regression of PP < 30 cm H2O in patients with ALI
![Page 86: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/86.jpg)
Factores de Riesgo de Muerte
en Pacientes > 80 años
Hospital Mortality 48% Multivariate Analysis
![Page 87: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/87.jpg)
![Page 88: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/88.jpg)
Coste y Coste-Efectividad
Can it work? Efficacy
Does it work? Effectiveness
Efficiency Is it worth it?
Life year gained (LYG)
Quality adjusted life year (QALY)
![Page 89: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/89.jpg)
60.000 euros/LYG
30.000 euros/LYG
rechazo
?
adopción ADOPTION
+ EFFECTIVENESS
+ C
OS
T
Cost-Effectiveness
![Page 90: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/90.jpg)
Cost-Effectiveness Analysis
• Ratio of the cost of the intervention to a
relevant measure of its effect.
THERAPEUTIC
INTERVENTION
Expenditures Outcome
Improvement in Health Costs
Incremental Cost-Effectiveness Ratio (ICER)
Incremental Cost-Utility Ratio (ICUR)
![Page 91: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/91.jpg)
16935
18671
15000
16000
17000
18000
19000
20000
Eu
ros
Hospital Costs
Preintervention Intervention
5.445.98
3.75 4.12
0
1
2
3
4
5
6
7
Years
LYG QALY
Preintervention Intervention
Adjusted ICER 4,435 euros per LYG
Adjusted ICUR 6,428 euros per QALY
![Page 92: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/92.jpg)
Distribution of mean costs per patient
1296314018
3100
3773820
826
54
52
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Control group Treatment group
Co
st
per
pati
en
t (E
uro
s 2
006)
ICU Ward SSC protocol interventions Emergy Department
![Page 93: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/93.jpg)
60.000 euros/LYG
30.000 euros/LYG
rechazo
?
adopción ADOPTION
+ EFFECTIVENESS
+ C
OS
T
SSC
Cost-Effectiveness
![Page 94: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/94.jpg)
Premios 1. Premi a la millor comunicació presentada a la SOCMIC 2008, Badalona.
2. Mejores Ideas Diario Médico 2008 Política profesional por el Estudio Edusepsis.
3. Accèsit a la millor comunicació mèdica presentada SOCMIC 2009.
4. Premi mutual médica Dr. Josep Font millor article científic 2008.
5. Award for the best abstract on sepsis (International Sepsis Forum): Poster Award Winner 2009. 23rd Annual Congress ESICM.
6. Millor Comunicació Publicada SOCMIC 2010. AJRCCM.
7. Millor comunicació mèdica presentada SOCMIC 2010.
8. Premis Científics Capio – Hospital General de Catalunya, Edició 20. Categoria Assistencial.
9. Mejor Comunicación XLVII CONGRESO NACIONAL DE LA SEMICYUC
10. Millor comunicació mèdica presentada SOCMIC 2013.
![Page 95: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/95.jpg)
Conclusions
1. La sepsia greu continua teneint una elevada incidència i mortalitat. El reconeixement social encara és escàs.
2. La sepsia greu és una emergencia mèdica. Cal que rebi una atenció multidisciplinar, coordinada i precoç.
3. Pla Nacional de Sepsis. Indicadors de Qualitat.
4. Codi de Sepsis
![Page 96: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/96.jpg)
![Page 97: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/97.jpg)
7 de Noviembre del 2013
![Page 98: Transferencia del Conocimiento: Surviving Sepsis Campaign y Edusepsis](https://reader033.vdocuments.pub/reader033/viewer/2022050708/556b47b6d8b42adc248b5640/html5/thumbnails/98.jpg)
Ricard Ferrer Intensive Care Department
Mutua Terrassa University Hospital Barcelona. SPAIN