SEPSIS+ 2019 Resolution’,2 which proposed a number of


actions that need to be taken. It included advice from the World Health Assembly (WHA) which stated that improving the coding of sepsis, and establishing a proper accounting in those statistics are essential steps.”


Schools against sepsis


Dr Daniels concluded his talk by sharing plans the charity has for the remainder of the year. In September 2019 the charity is launching a new campaign, ‘Schools against sepsis’. Dr Daniels explained: “We are collaborating with Iceland Foods Charitable Foundation, working with teachers, children and parents to raise awareness. “Inspired by the Coronation Street


storyline in which seven-year-old Jack Webster develops sepsis, we have created a lesson plan and related resources to educate Key Stage 2 school children (aged 9-11) about sepsis. “We are piloting the resources during the 2019 summer term prior to launching the campaign across the country in the 2019/20 academic year, and we are looking for schools to join us.”


The resources, developed in collaboration with PSHE Association include: l Sepsis lesson plan and activities l Teacher resources l Introduction video by TV’s paediatrician and UKST ambassador Dr Ranj Singh


l Animated video – Sam’s Monkey (voiced by actor Warwick Davis) that explains what sepsis is and why it’s important to know the signs


l Sepsis information cards for children to take home.


The campaign will be launched to coincide with World Sepsis Day on 13 September 2019.


Sepsis management workshop


The afternoon sessions began with a workshop presented by two representatives from headline sponsor Baxter Healthcare; Danny Roberts, medical scientific liaison, and Barry Wilkinson, acute therapy specialist. The oXiris blood purification set is the


a three-in-one set for continuous renal replacement therapy (CRRT)-sepsis management, in a bid to help simplify multiple treatment challenges for critically ill patients. Danny Roberts explained: “The needs of patients in the intensive care unit are often complicated. With the extended indication for removal of various inflammatory mediators, the oXiris set is designed to combine three functionalities in a single device: endotoxin removal, cytokine removal, and fluid/uremic toxin removal on Prismaflex and Prismax systems. “The oXiris blood purification set adsorbs


endotoxin, cytokines and uremic toxins. Excessive inflammatory toxins are frequently seen in patients with sepsis. The set combines the removal of inflammatory mediators and may help modulate the


Dr Tamas Szakmany is a consultant in intensive care and anaesthesia at Aneurin Bevan University Health Board.


body’s inflammatory response to infection.” Barry Wilkinson added: “The oXiris set has a unique, proprietary three-layer membrane structure. Firstly, the base AN69 membrane enables absorption of cytokines and toxins, while providing efficient renal support by diffusion and convection. Secondly, the PEI (polyethyleneimine) surface treatment allows for the adsorption of endotoxins, while the removal of fluid and toxins (CRRT) occurs throughout the entire membrane. Thirdly, the heparin graft on the membrane reduces membrane


thrombogenicity and is designed to minimize treatment interruptions while supporting adequate dialysis dose delivery.” Sepsis is a major and growing global healthcare challenge, with up to 40% of ICU patients affected by the condition. According to Danny and Barry, the use of oXiris to adsorb cytokines and endotoxins from the blood and perform CRRT therapy on the Prismaflex and Prismax systems represents a promising approach to treating patients requiring CRRT-sepsis management.


Sepsis recognition tools


Dr Tamas Szakmany is a consultant in intensive care and anaesthesia at Aneurin Bevan University Health Board. Tamas research interests encompass a broad spectrum of critical care practices - from monitoring and modulation of the inflammatory response in sepsis and after major surgery, to long-term outcomes following critical care discharge, and also participating actively in large randomised controlled trials. His talk described the sepsis screening tools currently available. He said: “The quick Sepsis Related Organ


Failure Assessment (qSOFA) score - also known as quickSOFA - is a bedside prompt that may identify patients with suspected infection who are at greater risk for a poor outcome outside the intensive care unit. It uses three criteria, assigning one point for low blood pressure (SBP≤100 mmHg), high respiratory rate (≥22 breaths per min), or altered mentation (Glasgow coma scale <15). “While the system is thorough – it is


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based on one million patients’ data, mostly from the US and Germany – it can easily be misinterpreted. It is not necessarily a screening tool, more a risk stratification tool. “The Systemic Inflammatory Response Syndrome (SIRS) Criteria is now rather old. In 1992, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) introduced definitions for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome (MODS). “The idea behind defining SIRS was to define a clinical response to a nonspecific insult of either infectious or non-infectious origin. SIRS is defined as a fever of >38˚C or <36˚C. Once again, many have challenged the data, such as the mortality rates of critically ill patients. “The Sepsis 6 Pathway is not supported by data and references, and two papers examined whether or not it is working by looking at acute medical admissions data. They concluded it was ‘not helpful’, as a number of patients were missed. Our own study demonstrated that it did not capture those who were at the highest risk.” Dr Szakmany then examined the Sequential Organ Failure Assessment (SOFA) Score which is used to track a person’s status during the stay in an intensive care unit, to determine the extent of a person’s organ function or rate of failure. “The score is based on six different scores, one each for the respiratory, cardiovascular, hepatic, coagulation, renal and neurological systems,” he said. “The quick SOFA score (qSOFA) assists health care providers in estimating the risk of morbidity and mortality due to sepsis. “The tool is complicated and it needs a lot of data to improve. Currently it is based on 3000 patients’ data, but is consistently the best tool to highlight patients at the highest risk of death. From the clinical tools we have looked at so far, this is the most robust at recognising sepsis.” Looking to the future, Dr Szakmany said there is a need for tools that look beyond sepsis as a cause of death. “Suspicion of sepsis doesn’t necessarily mean a patient has died of sepsis, for example heart disease may be the cause,” he asserted. “We need information and data that highlights this ambiguity.”


The day concluded with Q&As and visitors were encouraged to continue spreading the message of sepsis awareness across the UK’s Trusts.


References


1 Reproduced from: Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP, 2017.


2 Recognizing Sepsis as a Global Health Priority – A WHO Resolution https://www.nejm.org/doi/full/ 10.1056/NEJMp1707170


SEPTEMBER 2019 CSJ


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