Journal Club

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Special Communication | CARING FOR THE CRITICALLY ILL PATIENT
The Third International Consensus Definitions
for Sepsis and Septic Shock (Sepsis-3)

Read PDF here.

Group, we are in the process of trialing a journal club initiative. In the months to come, we will be presenting several articles. For the first article, we will be discussing the updated  Sepsis guidelines. Feel free to contribute any opinions. For the discussion thread to be maximally productive we request two things: 

1.) Back any opinions with evidence. If no evidence exists, cite specific clinical experiences that you encountered which reinforce your judgment.

2.) No ad hominem attacks. We respect the diversity of opinions that exist and do not wish to disparage other professionals who may have alternate opinions.

 

Sincerely, 

Ryan O'Gowan

vjsccmne's picture

I think the new sepsis guidelines are a great way to kick off a journal club. We will also be experimenting with a Twitter based model. Colleagues, let us know what you think.

VJ

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Sincerely,

Ryan O'Gowan, MBA, PA-C, FCCM

NE Chapter President 

Great start to the Journal Club. I understand that this is an update to the sepsis definition that is "evidence based" as opposed to the original "consensus" definition. However I am not sure there is much difference and possibly a little more confusion.

In the old definition severe sepsis was associated with a high risk of death and it was characterized by "organ dysfunction" which includes objective criteria such as:
mental status changes (GCS<13)
platelet count less than 100
P/F ratio <300
SBP <90
Creatinine >2 or urine output <0.5 ml/kg/hr,
pH <7.30 or BD >5
INR >1.5 or PTT >60
bilirubin >2

the SOFA score:
GCS
platelets
P/F ratio
MAP
creatinine
INR
bilirubin

As you can see, the criteria for both definitions are essentially the same...except for the name change (talk about confusion). The SOFA score has a scale for the severity of organ dysfunction (0-4 points) in comparison to the "old" severe sepsis definition which is a yes/no system. If you look at more detail, it appears the criteria for the "old" severe sepsis definition correspond to the '2' s on the SOFA chart. SOFA was originally developed to be a mortality prediction score in which case a graded scale for severity of organ dysfunction is relevant. However, since the goal of SEPSIS-3 is to DEFINE sepsis and not score it, grade it, or predict severity, do we really need a grading system? Committing the SOFA scale to memory is also impractical, as such I'll probably be adding another Medcalculator for SOFA score to my smart phone. Wouldn't it be easier to create criteria that could be committed to memory? Wait, that would be the "old" definition. That said, I think the qSOFA is an excellent improvement and might be the only true difference which could, over time, improve recognition, treatment and potentially assist in triage decisions. Peter

Peter, great comment. The q Sofa score can found in the app MedCalX or online at http://www.mdcalc.com/qsofa-quick-sofa-score-for-sepsis-identification/

I agree wholeheartedly that such instruments are best used online and need not be memorized. 

Ryan

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