Podcast
Questions and Answers
What is the primary aim of the recommendations provided in the 'Surviving Sepsis Campaign' guidelines?
What is the primary aim of the recommendations provided in the 'Surviving Sepsis Campaign' guidelines?
- To replace clinicians' judgment with standardized protocols.
- To limit the use of performance improvement programs in hospitals.
- To offer guidance for clinicians managing adult patients with sepsis or septic shock in a hospital. (correct)
- To dictate clinicians' decisions in managing sepsis and septic shock.
According to the 'Surviving Sepsis Campaign' guidelines, what constitutes a key component of sepsis performance improvement programs?
According to the 'Surviving Sepsis Campaign' guidelines, what constitutes a key component of sepsis performance improvement programs?
- Limiting the program to only sepsis screening activities
- Integrating education, measurement of bundle performance, and outcome tracking. (correct)
- Excluding actions for identified opportunities
- Focusing solely on patient outcomes without process measures
What is the recommendation regarding the use of qSOFA as a single screening tool for sepsis or septic shock?
What is the recommendation regarding the use of qSOFA as a single screening tool for sepsis or septic shock?
- qSOFA is not recommended as a single screening tool. (correct)
- qSOFA should be used in conjunction with SIRS criteria for effective screening.
- qSOFA should be used to rule out sepsis and septic shock.
- qSOFA is strongly recommended as the primary screening tool.
According to the 'Surviving Sepsis Campaign' guidelines, how soon should antimicrobials be administered to adults with possible septic shock or a high likelihood of sepsis?
According to the 'Surviving Sepsis Campaign' guidelines, how soon should antimicrobials be administered to adults with possible septic shock or a high likelihood of sepsis?
In adults with sepsis or septic shock and a high risk for multidrug-resistant (MDR) organisms, which empiric treatment approach is suggested in the guidelines?
In adults with sepsis or septic shock and a high risk for multidrug-resistant (MDR) organisms, which empiric treatment approach is suggested in the guidelines?
For adults with sepsis or septic shock at low risk of fungal infection, what do the guidelines suggest regarding empiric antifungal therapy?
For adults with sepsis or septic shock at low risk of fungal infection, what do the guidelines suggest regarding empiric antifungal therapy?
In the management of sepsis or septic shock, what is the recommendation, accordingly to the guidelines, regarding optimizing dosing strategies of antimicrobials?
In the management of sepsis or septic shock, what is the recommendation, accordingly to the guidelines, regarding optimizing dosing strategies of antimicrobials?
What do the 'Surviving Sepsis Campaign' guidelines advise regarding initial fluid resuscitation for adults with sepsis-induced hypoperfusion or septic shock?
What do the 'Surviving Sepsis Campaign' guidelines advise regarding initial fluid resuscitation for adults with sepsis-induced hypoperfusion or septic shock?
According to the Surviving Sepsis Campaign guidelines, what is the first-line vasopressor recommended for adults with septic shock?
According to the Surviving Sepsis Campaign guidelines, what is the first-line vasopressor recommended for adults with septic shock?
What is the recommendation, as outlined in the 'Surviving Sepsis Campaign' guidelines, for adults with septic shock on vasopressors regarding target mean arterial pressure (MAP)?
What is the recommendation, as outlined in the 'Surviving Sepsis Campaign' guidelines, for adults with septic shock on vasopressors regarding target mean arterial pressure (MAP)?
What is the Surviving Sepsis Campain recommendation for using starches for resuscitation in adults?
What is the Surviving Sepsis Campain recommendation for using starches for resuscitation in adults?
Why does the Surviving Sepsis Campaign recommend using Low Molecular Weight Heparin rather than Unfractionated Heparing for VTE prophylaxis?
Why does the Surviving Sepsis Campaign recommend using Low Molecular Weight Heparin rather than Unfractionated Heparing for VTE prophylaxis?
What does the Surviving Sepsis Campaign recommend against when a patient is receiving volume support and shows additional signs of hypoperfusion indicating fluid strategies??
What does the Surviving Sepsis Campaign recommend against when a patient is receiving volume support and shows additional signs of hypoperfusion indicating fluid strategies??
Following the initial fluid bolus, which factor should primarily guide the need for additional IV fluids in patients with sepsis and septic shock?
Following the initial fluid bolus, which factor should primarily guide the need for additional IV fluids in patients with sepsis and septic shock?
What have the studies showed regarding the management of fluid strategies for patients with severe sepsis?
What have the studies showed regarding the management of fluid strategies for patients with severe sepsis?
According to the Surviving Sepsis Campaign guidelines, what has studies showed about short-term mortality when using prolonged infusion of beta-lactams?
According to the Surviving Sepsis Campaign guidelines, what has studies showed about short-term mortality when using prolonged infusion of beta-lactams?
In addition to antimicrobials, what do the Surviving Sepsis campaign recommend on treating Candida?
In addition to antimicrobials, what do the Surviving Sepsis campaign recommend on treating Candida?
What is the one common goal that all patients with ARDS should be treated by?
What is the one common goal that all patients with ARDS should be treated by?
What is one factor involved in selecting the optimal form of medication method (pressure)?
What is one factor involved in selecting the optimal form of medication method (pressure)?
If the optimal duration of therapy is unclear what does the Surviving Sepsis Campain suggest?
If the optimal duration of therapy is unclear what does the Surviving Sepsis Campain suggest?
If the arterial systolic drops below, it is considered...?
If the arterial systolic drops below, it is considered...?
In previous Surviving Sepsis Campagin guidelines, what did they highlight?
In previous Surviving Sepsis Campagin guidelines, what did they highlight?
What is not a recommendation discussed for initial resuscitation?
What is not a recommendation discussed for initial resuscitation?
According to Table 1, what are the changes form 2016 recommendations?
According to Table 1, what are the changes form 2016 recommendations?
According to Evans et al, how should recommendations in timing be administered?
According to Evans et al, how should recommendations in timing be administered?
Flashcards
What is Sepsis?
What is Sepsis?
Life-threatening organ dysfunction caused by a dysregulated host response to infection.
Sepsis performance improvement programs
Sepsis performance improvement programs
Programs including screening, education, bundle performance, patient outcomes, and actions for improvement.
Sepsis screening tools
Sepsis screening tools
Tools to promote early sepsis identification, using clinical data either manually or automatically via EHR.
Mortality benefit of active screening
Mortality benefit of active screening
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Standard operating procedures
Standard operating procedures
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Sepsis bundles compliance effect
Sepsis bundles compliance effect
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Recommendation against qSOFA
Recommendation against qSOFA
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Treatment and resuscitation recommendation.
Treatment and resuscitation recommendation.
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IV crystalloid suggest
IV crystalloid suggest
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Dynamic measures fluid.
Dynamic measures fluid.
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Vasopressors on target
Vasopressors on target
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Patients in ICU
Patients in ICU
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Alternative diagnoses.
Alternative diagnoses.
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Administer antimicrobials immediately.
Administer antimicrobials immediately.
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non-infectious causes
non-infectious causes
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persist after 3 hrs investigation
persist after 3 hrs investigation
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deferring antimicrobial
deferring antimicrobial
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Empiric antimicrobials recommendation.
Empiric antimicrobials recommendation.
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Contraindicate coverage.
Contraindicate coverage.
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two antimicrobials.
two antimicrobials.
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Study Notes
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021
- Sepsis and septic shock impact millions globally and kill between 1 in 3 and 1 in 6 affected individuals.
- Early identification and management of sepsis improves patient outcomes.
- These guidelines are for clinicians treating adult sepsis or septic shock patients in hospitals.
- Recommendations do not substitute clinical judgment based on individual patient variables.
- The guidelines are meant to reflect ideal practices
Screening and Early Treatment Recommendation
- Hospitals should use performance improvement programs for sepsis, encompassing screening of acutely ill, high-risk individuals and standard treatment procedures.
- The recommendation has a strong level with moderate-quality evidence for screening and strong level with very low-quality evidence for standard procedures.
Screening Rationale
- Sepsis performance improvement initiatives feature screening, education, bundle performance measurement, outcomes, and opportunity identification.
- A meta-analysis of 50 observational studies showed that these programs improved sepsis bundle adherence and reduced mortality (OR, 0.66; 95% CI, 0.61–0.72) in sepsis and septic shock patients.
- Components of performance improvement are not as vital as a program incorporating sepsis screening and metrics.
- Screening instruments aim to facilitate early sepsis detection using EHRs either manually or automatically.
- Diagnostic accuracy varies widely among sepsis tools, with most having inadequate predictive capabilities, though some correlate with better care processes.
- Variables and tools include SIRS criteria, vital signs, infection indicators, qSOFA, SOFA criteria, NEWS, and MEWS.
- Machine learning could enhance screening tool performance; a meta-analysis of 42,623 patients across seven studies showed higher SAUROC (0.89; 95% CI, 0.86–0.92), sensitivity (81%; 95% CI, 80−81), and specificity (72%; 95% CI, 72−72).
- Screening may focus on in-patient units, emergency rooms, or ICUs.
- A three-RCT pooled analysis found no mortality benefit from active screening (RR, 0.90; 95% CI, 0.51−1.58).
- Early sepsis identification with screenings tools is a crucial component for timely intervention.
- Standard operating procedures involves early identification, lactate tests, cultures, antibiotics, and fluids.
- Retrospective study in 509 US hospitals demonstrated lower mortality in hospitals adhering to sepsis bundles following New York State sepsis regulations
- Meta-analysis of two RCTs in Sub-Saharan Africa showed higher mortality (RR, 1.26; 95% CI, 1.00-1.58) with standard procedures, while standard procedures decreased mortality (adjusted hazard ratio [HR]; 95% CI, 0.55–0.98) in one observational study.
qSOFA Recommendation
- qSOFA is not advised as a singular screening, it has strong recommendation, with moderate evidence.
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