Transcript A Complex Systems View of Sepsis

A COMPLEX SYSTEMS
VIEW OF SEPSIS:
IMPLICATIONS FOR NURSING
LTC Elizabeth A. Mann-Salinas, PhD, RN, CCRN, CCNS 1,2
Joan Engebretson, DrPH, AHN-BC, RN 2
Andriy Batchinsky, MD 1
1US
Army Institute of Surgical Research, San Antonio, TX
of Texas Health Science Center, Houston
2 University
Complex Systems
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Non-linear
Coupling
Sensitivity to initial conditions
Self-similarity
Emergence
Adaptability
Self-Organization
Connectivity
Robustness
Light bulb changer
Linear
Complicated
Complex
Non-Linear
Coupling
1+1=3
Sensitivity to initial conditions
Self-organization
Fractals
Self-similarity
Emergence
Novelty
Irreducibility to component parts
Unpredictable
Adaptability
Connectivity
Robustness
Intra-patient variability
Bone et al. /
Sepsis as a Complex System
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Non-linear
Coupling
Sensitivity to initial conditions
Self-similarity
Emergence
Adaptability
Self-Organization
Connectivity
Robustness
Sepsis
IV Immunoglobin
Organ Support
Corticosteroids
Xigris ™
Early
Appropriate
ABX
Surviving
Sepsis
Campaign
Surgical Intensive Care Unit
USNS Comfort Hospital Ship, Persian Gulf, 2003
Pattern Recognition
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Data display
“Sniffers”
Smart alarms
Computer decision support systems
Traditional
Data Display
Novel Data Display
“Sniffer”
Smart Alarm
Date : 13-Mar-11 11:10:09
Bed : 4N-4702
Reasons:
Less than 0.5 ml/kg per hour for more than 6 hours
UOP for hour 11:00 = 0.0 ml/kg
UOP for hour 10:00 = 0.0 ml/kg
UOP for hour 09:00 = 0.0 ml/kg
UOP for hour 08:00 = 0.0 ml/kg
UOP for hour 07:00 = 0.0 ml/kg
UOP for hour 06:00 = 0.0 ml/kg
Vital Signs at 13-Mar-11 11:10:09:
Heart Rate = 129 bpm
Blood Pressure:
Systolic = 98 mmHg
Diastolic = 63 mmHg
MAP
= 73 mmHg
Last Serum Creatinine = N/A
Attending Physician Email:
[email protected]
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C
D
S
S
DATA
“Heart rate 120, blood pressure 96, lactate 4, base deficit -6…”
INFORMATION
“85% likelihood needs Life-Saving Intervention”
DECISION SUPPORT
“Stop bleeding & give 2 units of plasma”
AUTOMATED CARE
“Go to Closed Loop Resuscitation”
WVSM
Burn Resuscitation CDSS
Is sepsis a complex system?
Thank You!
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