Sepsis-3.0 has been released!
Please read the paper!
Then read some of the amazing discussions from the FOAM community:
- Jeremy Faust and Lauren Westafer reveal the new sepsis definitions.
- Great links to pro/con discussion too by Natalie May and Richard Carden at St Elmyn’s.
- Justin Mandeville also summarises Sepsis 3.0 and uses the “rule of 2s” in his post from ICMWK.
Then read Josh's PulmCrit Post
And only then, listen to this discussion with Mervyn Singer, lead author of the new definitions.
Here from Cliff Deutschman as well
- On this EMCrit Sepsis Wee
Flowchart from the Paper
Links and Stuff
- SOFA Calculator
- NY STOP SEPSIS Collaborative Triage Screening
- SCCM Sepsis Redefined Resource Page
- More on Timing of Antibiotics from Salim
- Meta-Analysis that Salim Mentions (Crit Care Med 2015;43:1907)
Please let me know what you think in the comments section below.
Update
Additional New Information
More on EMCrit
- Podcast 241 – Sepsis Update 2019
- EMCrit 345 – I Guess We Need to Talk about CLOVERS and Fluids in Sepsis (Hopefully for the Last Time Ever)
- We are Complicit – A glimpse into the current state of Severe Sepsis/Septic Shock Quality Measures
Additional Resources
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Dr. Weingart, Because I am a (critical care) paramedic, the most interesting thing I got from the podcast with Dr. Singer was your comment, made two or three times, that you would like to see a “triage” tool, which could be used by nurses to alert the ED docs that a patient was at a high risk of sepsis. Of course, I carry that just a tad further and would hope that paramedics in the field could do the same. Frankly, it probably doesn’t much matter if we are talking about early simple sepsis. The patient would go to our… Read more »
Grant, Great to hear from you. In anticipation of the new Regs in NYC we looked into peds sepsis. When you discount the baseline chronically ill children from the mix, peds septic shock is exceedingly rare. If you had a case, advanced notification may be a great idea at a non-Peds ED run institution. At childrens’ hospitals, I hope/trust the peds ED docs should be able to handle this as routine care. Great mnemonic!
HI Scott & Mervyn
Thanks for clearing up that AND / OR question with lactates. This was a real talking point at our team meeting – confused us but now it it all clear as day.
Cheers
C
Primary Care needs involvement .We see patients regularly particularly in the nursing homes .
There is Pneumonia Cellulitis Urine Infection .Regular review and note of baseline Blood pressure respiratory rate pulse oximetry level and alertness in all its shades is a Primary Care and Nursing care knowledge base .
The Ultra early detection Scott is interested in can be derived to an extent from the primary care experience .
Also the rate the acceleration into sepsis though it can be thunderclap sudden is interesting .
Dear Dr Weingart, I’m a foundation doctor (house officer/resident) in the UK. I’ve read this post and your other recent posts regarding sepsis with interest. I have also read many of the linked Dr Marik publications. Whilst I can broadly follow the guidelines, I’m struggling to understand the underlying pathophysiology of sepsis and therefore don’t fully understand the basis of guidance. I was hoping you might be able to clear things up for me. Having read basic pathology texts regarding sepsis, it seems like the dogma is that organ dysfunction in sepsis occurs secondary to impaired tissue perfusion. However, in… Read more »
There’s a distinctive and persistent lack of infection biomarkers like presepsin and procalcitonin in these definitions and scores. It feels like the ball is moving more and more into the court of Intensive Care and away from Infectious Diseases and I don’t think that’s the best for the majority of septic patients.
In order to calculate a SOFA score, does one now need to obtain an ABG? Would a VBG be sufficient?
In your podcast you made several references to your own Triage criteria for early identification of sepsis. Can you expand upon this and discuss what you are using as your triage screen? Great podcast and discussion; please keep it up!
it is in the shownotes above Andi
Hi Scott, Quality work as usual. 1) The Sepsis 3.0 population looks like a sicker population that the previous SIRS based population. Does that mean we need to re-examine or even redo some of the equivocal sepsis trials? What about sepsis trials where the drug is no longer available or has been withdrawn from the market? 2) Defining Septic shock now requires both vasopressor dependant hypotension AND a persistently elevated lactate despite achieving euvolaemia. The mortality risk for each of vasopressor dependant hypotension and persistently elevated lactate is 18% and 20% respectively, which is greater than that of the qSOFA… Read more »
1. Not aware of any trial using SIRS–they all used SIRs merely to screen for severe/shock, no? So I don’t qSOFA will change them.
2. Reason for the change is that many patients with alactemic hypotension just need a pressor and do great. These pts probably don’t deserve the imprimatur of septic shock. They are sepsis. Sepsis is now a sick patient.