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Related Experiment Videos

Crisis management during anaesthesia: sepsis.

J A Myburgh1, M J Chapman, S M Szekely

  • 1University of New South Wales, Director of Research, Department of Intensive Care Medicine, The St. George Hospital, Sydney, Australia.

Quality & Safety in Health Care
|June 4, 2005
PubMed
Summary

Managing anesthesia in septic patients is complex. A structured approach using algorithms like "COVER ABCD" and specific sepsis protocols aids in addressing multiple organ dysfunctions and interrelating problems effectively.

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Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Anesthesia in septic patients presents significant risks due to potential multi-organ dysfunction (respiratory, cardiovascular, renal, haematological).
  • Prompt management requires addressing numerous physiological systems simultaneously, necessitating a structured approach.

Purpose of the Study:

  • To evaluate the efficacy of the "COVER ABCD-A SWIFT CHECK" core algorithm, augmented with a sepsis-specific sub-algorithm, for managing anesthesia in septic patients.
  • To assess the structured approach's performance against actual clinical management in reported incidents.

Main Methods:

  • Analysis of the first 4000 incidents reported to the Australian Incident Monitoring Study (AIMS).
  • Comparison of the structured algorithm's diagnostic and therapeutic capabilities with the management provided by anesthesiologists.

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Main Results:

  • Sepsis was the primary issue in <1% of AIMS reports, predominantly in critically ill patients (70% ASA status III or worse).
  • The core algorithm aided diagnosis in 15% of cases; the sepsis sub-algorithm provided adequate strategies in 38%.
  • Additional sub-algorithms were required for desaturation (30%), cardiac arrest (15%), hypotension (8%), and aspiration (8%).

Conclusions:

  • Sepsis imposes severe physiological stress across multiple organ systems.
  • A structured approach, utilizing core and supplementary algorithms, offers effective checklists for managing complex, interrelated issues in septic patients during anesthesia.