Sepsis and Treatment Handouts PDF

27-03-2024 A couple of celebs... CARIM Cardiovascular Research Institute Maastricht Meet the expert(s) Christopher Reeve *1952 - †2004 Sepsis and its treatment Bernie Mac *1957 - †2008 Larry King *1933 - †2021 Jeff Conaway *1950 - †2011 DAMPS-PAMPS & NETosis Heather O’Rourke *1975 - †1988 Jim Henson...

27-03-2024 A couple of celebs... CARIM Cardiovascular Research Institute Maastricht Meet the expert(s) Christopher Reeve *1952 - †2004 Sepsis and its treatment Bernie Mac *1957 - †2008 Larry King *1933 - †2021 Jeff Conaway *1950 - †2011 DAMPS-PAMPS & NETosis Heather O’Rourke *1975 - †1988 Jim Henson *1936 - †1990 Socrates *1954 - †2011 March 26th 2024 Mariana Bridi Costa *1988 - †2009 Robert Palmer *1949 - †2003 Dr. Marcel van de Poll Muhammad Ali *1942 - †2016 Dr. Gerry Nicolaes Anna Nicole Smith *1967 - †2007 Charlbi Dean *1990 - †2022 George Michael *1963 - †2016 Department of Biochemistry, Maastricht University 1 Leslie Nielsen *1926 - †2010 Pope John Paul II *1920 - †2005 GN 2 GN 4 GN 6 2 A couple of celebs... 7 themes Focus: current and future Therapies & Treatment 1. immune modulation Christopher Reeve *1952 - †2004 Bernie Mac *1957 - †2008 7. Microbiome Larry King *1933 - †2021 Jeff Conaway *1950 - †2011 They all might still be alive if it weren’t for sepsis/septic disease Heather O’Rourke *1975 - †1988 Socrates *1954 - †2011 Jim Henson *1936 - †1990 6. allergy, hypersensitivity & auto-immune disease Mariana Bridi Costa *1988 - †2009 2. innate immunity Robert Palmer *1949 - †2003 Muhammad Ali *1942 - †2016 Anna Nicole Smith *1967 - †2007 George Michael *1963 - †2016 Department of Biochemistry, Maastricht University 5. Immune therapy in oncology mental/neurological modifiers Charlbi Dean *1990 - †2022 Leslie Nielsen *1926 - †2010 Pope John Paul II *1920 - †2005 GN 3 3 4. Sterile inflammation & CVD 3. Viral disease Department of Biochemistry, Maastricht University 4 What is sepsis? What is septic shock? Sepsis may lead to a life-threatening organ dysfunction caused by a dysregulated host response to infection Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality Or in lay terms: sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs septic shock patients can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP>65 mm Hg and having a serum lactate level > 2mM despite adequate volume resuscitation. Within these criteria, hospital mortality is > 40%. JAMA 2016 “Sepsis-3”, The Third International Consensus Definitions for Sepsis and Septic Shock JAMA 2016 “Sepsis-3”, The Third International Consensus Definitions for Sepsis and Septic Shock Sepsis is a complication caused by the body’s overwhelming and life-threatening response to an infection, which can lead to tissue damage, organ failure, and death www.cdc.gov Department of Biochemistry, Maastricht University 5 GN 5 Department of Biochemistry, Maastricht University 6 1 27-03-2024 Significance Epidemiology That Sepsis is one of the most common diseases Sepsis is a problem which strikes an estimated 49 million people worldwide every year 11 million sepsis related deaths were recorded worldwide = ~20% of all global deaths Sepsis is a global healthcare problem. It is more common than heart attack, and claims more lives than any cancer, yet even in the most developed countries fewer than half of the adult population have heard of it. In the least developed countries, sepsis remains a leading cause of death source: World federation of Pediatric Intensive & Critical care Department of Biochemistry, Maastricht University GN Fact sheet sepsis – Global sepsis alliance Rudd et al, The Lancet, 2020 7 7 Department of Biochemistry, Maastricht University GN 8 8 Epidemiology What causes sepsis? Any infection: Sepsis is a problem which strikes an estimated 49 million people worldwide every year /yr, ases 80% c n io mill en 20 e 49 betwe r day d i ldw pe tes Wor ality ra deaths t r 0 11 million sepsis related deaths were recorded worldwide = ~20% of all global deaths mo 30,00 > bacteria (25% Gram(+), 25% Gram (-) ) fungi (5-10%) viruses (..) mixed (15%) Certain infections and germs lead to sepsis most often. Most common are Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Klebsiella species, Pseudomonas aeruginosa. Sepsis is a global healthcare problem. It is more common than heart attack, and claims more lives than any cancer, yet even in the most developed countries fewer than half of the adult population have heard of it. In the least developed countries, sepsis remains a leading cause of death Sepsis is often associated with infections of the: lungs (e.g., pneumonia) urinary tract (e.g., kidney) Skin Gut Fact sheet sepsis – Global sepsis alliance Rudd et al, The Lancet, 2020 Department of Biochemistry, Maastricht University GN 9 9 Department of Biochemistry, Maastricht University GN 10 10 Sepsis signs Department of Biochemistry, Maastricht University 11 GN 11 Department of Biochemistry, Maastricht University GN 12 12 2 27-03-2024 May 11th 2017 Dhr L. 1950 Medical History Mild COPD (smoking 40 packyears) TURP Umbilical hernia >50 years ago No prescription drugs advertising/creative artist, computer programmer Married, 3 children Living in Bertogne (B) 13 14 History Started feeling unwell 3-4 days before Presented to ED 2 days before 15 16 Initial treatment Admission Sputum cultures Antibiotics Steroids Sedatives Endotracheal Intubation Mechanical ventilation 17 18 3 27-03-2024 Clinical course Other organ systems failing… Decreasing oxygen saturation (SaO2 70%) Decreasing blood pressure (MAP 60) Despite Despite: FiO2 100% Positive End Expiratory Pressure Resuscitation with intravenous fluids Norepinepehrine Epinephrine Anuria Temperature 19 39ºC 20 Lab tests pH Base Excess Lactate 7,22 -14,4 7,1 (> 7,35) (> -2,5) (