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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, TX2 University of Texas Health Science Center, Houston
Complex Systems
• Non-linear• Coupling• Sensitivity to initial conditions• Self-similarity• Emergence• Adaptability• Self-Organization• Connectivity• Robustness
Complicated
Light bulb changer
Linear
Complex Non-Linear
Coupling
1 + 1 = 3
Sensitivity to initial conditions
Self-organization
Fractals
Self-similarity
Emergence
NoveltyIrreducibility to component partsUnpredictable
Adaptability
Connectivity
Robustness
Intra-patient variability
Bone et al. /
Sepsis as a Complex System
• Non-linear• Coupling• Sensitivity to initial conditions• Self-similarity• Emergence• Adaptability• Self-Organization• Connectivity• Robustness
Sepsis
IV Immunoglobin
Corticosteroids
Xigris ™
Organ Support
EarlyAppropriate
ABX
Surviving SepsisCampaign
Surgical Intensive Care UnitUSNS Comfort Hospital Ship, Persian Gulf, 2003
Pattern Recognition
• Data display• “Sniffers”• Smart alarms• Computer decision support systems
Traditional Data Display
Novel Data Display
“Sniffer”
Smart AlarmDate : 13-Mar-11 11:10:09Bed : 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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CDSS
WVSM
Burn Resuscitation CDSS
Is sepsis a complex system?
38
Thank You!
