Sepsis Management Update- Advanced Level 

Organised by: Malaysia Sepsis Alliance
Speaker: Dr Tan Toh Leong
Senior Lecturer and Emergency Department
AMS UKMMC Committee
SIGMARIS MALAYSIA

Malaysia Sepsis Alliance in conjunction with Emergency Department of Universiti Kebangsaan Malaysia Medical Centre had organized a Sepsis Management Update Course on 18th January 2019. It involved specialist around Malaysia which included expert from emergency department, microbiology department, biochemistry department and etc. In this course, the understanding of sepsis was enlightened by all of expert from various field. Sepsis Identification and Management was greatly emphasized in this course where quick identification of Sepsis or Septic Shock in suspected patients, determination state of sepsis either SIRS, CARS or MARS, obtained suggested biomarkers and management of sepsis by initiate 1 hour bundle while maintaining the volume and cardiac contractility.









Intermediate Sepsis Workshop and Advance Hemodynamic Monitoring in ED (sponsor by Edward Lifescience) 

Speaker: Dr Tan Toh Leong
Senior Lecturer and Emergency Department
AMS UKMMC Committee
SIGMARIS MALAYSIA

On 14th December 2018, The Emergency Department of Universiti Kebangsaan Malaysia Medical Centre held an Intermediate Sepsis Workshop for all emergency physicians and post graduate doctors. It's a great pleasure to have this workshop sponsored by Edward Lifescience. The definition of sepsis and its clinical stages characterisation have been changing for the past decades until most recently in 2018. It remains high mortality rate and healthcare provider find it challenging to understand and manage sepsis. Thus, this workshop was held to augment the understanding and management on sepsis with an ultimate aim to identify and treat sepsis as early as possible based on the latest Survival Sepsis Campaign Guideline. In conjunction to the workshop, Edward Lifescience took this opportunity to introduce non-invasive ClearSight system which extends the benefits of continuous hemodynamic monitoring includes measuring stroke volume, stroke volume variation, cardiac output, systemic vascular resistance and continuous blood pressure.







Surviving Sepsis Campaign Guideline- 1 hour bundle 2018

Surviving Sepsis Campaign Guideline- 1 hour bundle 2018

The management of sepsis is challenging. Guideline had been form to facilitate this. MySepsis are supporting the recent updated Surviving Sepsis Campaign Guideline recommended by Society of Critical Medicine . We hope this will enhance the sepsis management in our local setting. #MySepsis

Please find the protocol at the following link


http://www.survivingsepsis.org/Guidelines/Pages/default.aspx

Marik Cocktail - a "cure" of sepsis?

Vitamin C, Thiamin and Steriod improve organ failure rec


The components of Marik’s life-saving sepsis cocktail are simply steroids and vitamins, a therapy, which many have said is harmless, but may improve sepsis survival dramatically. Steroids for sepsis have been around decades, and although there have been several trials evaluating its benefits in the septic patient; it is safe to say that the use of steroids remains controversial. The recently completed HYPRESS trial did not demonstrate a benefit for steroids in patients with sepsis.  How about the use of vitamin C and thiamine? This is not a new concept and there are studies demonstrating benefit so perhaps, combining all these “harmless” therapies would work on the deranged physiologic pathways that are present in the septic patient.

So the conjecture here is that Marik’s new cocktail has little patient harm because the individual components are individually benign and have been studied before. In fact, Marik himself has made the claim that withholding this therapy while waiting for a multicenter trial to be completed would be unethical. In support of his statement he has even invoked the infamous “parachute analogy” where some therapies are so obvious that it would be illogical to test them in a clinical trial.

Abstract 
Adapted from (Marik et al 2016)
Background: The global burden of sepsis is estimated as 15 to 19 million cases annually
with a mortality rate approaching 60% in low income countries.

Methods: In this retrospective before-after clinical study, we compared the outcome and
clinical course of consecutive septic patients treated with intravenous vitamin C,
hydrocortisone and thiamine during a 7-month period (treatment group) compared to a
control group treated in our ICU during the preceding 7 months. The primary outcome was
hospital survival. A propensity score was generated to adjust the primary outcome.

Findings: There were 47 patients in both treatment and control groups with no significant
differences in baseline characteristics between the two groups. The hospital mortality was
8.5% (4 of 47) in the treatment group compared to 40.4% (19 of 47) in the control group (p
< 0.001). The propensity adjusted odds of mortality in the patients treated with the vitamin
C protocol was 0.13 (95% CI 0.04-0.48, p=002). The SOFA score decreased in all patients in
the treatment group with none developing progressive organ failure. Vasopressors were
weaned off all patients in the treatment group, a mean of 18.3 ± 9.8 hours after starting
treatment with vitamin C protocol. The mean duration of vasopressor use was 54.9 ± 28.4
hours in the control group (p<0.001).

Conclusion: Our results suggest that the early use of intravenous vitamin C, together with
corticosteroids and thiamine may prove to be effective in preventing progressive organ
dysfunction including acute kidney injury and reducing the mortality of patients with
severe sepsis and septic shock. Additional studies are required to confirm these
preliminary findings.

The clinical trial paper can be found at this link

https://digitalcommons.odu.edu/cgi/viewcontent.cgi?article=1127&context=bioelectrics_pubs

For those who want to get a quick glance on this topic, please kindly go to this link (credits to R.E.B.E.L EM group making the topic easy to understand):

http://rebelem.com/the-marik-protocol-have-we-found-a-cure-for-severe-sepsis-and-septic-shock/




Sepsis Interprofessional Workshop Nottingham University 2018

Once a year, we will conduct a sepsis workshop for the pharmacy students from Nottingham University UK, China and Malaysia. The workshop aim to share our clinical experiances in managing sepsis with the future pharmacist-to-be. The workshop aim to expose the Pharmacist-to-be to recognize the important of sepsis and how to approach Sepsis in the interprofessional manner. Our team comprise of  an Emergency Physician Dr Tan Toh Leong, a senior asistant Medical Officer, Mr Muhammad Kamarul and a senior Nurse Mdm Premalatha who are all very enthusiastic in sepsis care. The workshop was successful delivered and the students love it so much.

The syllabus and contents are originated from SEPSIS TRUST, United Kingdom, which Sepsis Six was introduced.

The link : https://sepsistrust.org/professional-resources/education-resources/

THE SEPSIS MANUAL Edited by Dr Ron Daniels and Dr Tim Nutbeam, provides detailed education free of charge for every healthcare professional in the UK. It includes UKST’s ‘Sepsis Six’ pathway (which halves the risk of patients dying). You may download the pdf file at the link provided.

 https://sepsistrust.org/wp-content/uploads/2018/06/Sepsis_Manual_2017_web_download.pdf

With the alignment with aim of Global Sepsis Allince and Asia Pacific Sepsis Alliance, we are at  our best to increase sepsis awareness in our country (Malaysia).