Orris

Create ppt - Sepsis management with recent guidelines

Reading File
Reading File
Reading File
Finding Sources
Searching PubMed

"sepsis" AND "management guidelines"

Searching the Web

Surviving Sepsis Campaign guidelines 2024 2025 updates

Reading File
Reading Web Page

https://www.sccm.org/clinical-resources/guidelines/guideline…

Finding Sources
Reading File
Reading Web Page

https://www.ebmedicine.net/media_library/files/Sepsis-Emerge…

Running Command

mkdir -p /home/daytona/workspace/sepsis-ppt && ls /home/daytona/workspace/sepsis-ppt

Writing File

~/sepsis-ppt/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Sepsis Management – 2026 Guidelines";

// ─── Color palette ───────────────────────────────────────────────────────────
const C = {
  navy:    "0D1B2A",  // dominant dark background
  teal:    "1B6CA8",  // section accent
  tealLt:  "2A9D8F",  // supporting accent
  gold:    "E9C46A",  // highlight / accent
  red:     "E63946",  // warning / critical
  white:   "FFFFFF",
  offWhite:"F0F4F8",
  slate:   "4A6274",
  textDark:"1A1A2E",
};

// ─── Helpers ─────────────────────────────────────────────────────────────────
function darkSlide(slide) {
  slide.background = { color: C.navy };
}
function lightSlide(slide) {
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}
function accentBar(slide, color) {
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    x: 0, y: 0, w: 0.07, h: 5.625, fill: { color: color || C.teal },
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}
function sectionHeader(slide, num, title, sub) {
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    fontSize: 180, bold: true, color: C.teal, align: "center",
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      x: 0.5, y: 3.35, w: 9, h: 0.7,
      fontSize: 18, color: C.gold, fontFace: "Calibri",
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}
function slideTitle(slide, title, color) {
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    x: 0.22, y: 0.15, w: 9.5, h: 0.62,
    fontSize: 22, bold: true, color: color || C.navy,
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    x: 0.22, y: 0.78, w: 9.56, h: 0,
    line: { color: C.teal, width: 2.5 },
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}
function addBullets(slide, items, opts) {
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  slide.addText(arr, base);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – Title slide
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  // Top color band
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.2, fill: { color: C.teal } });
  // Bottom accent
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.0, w: 10, h: 0.625, fill: { color: C.tealLt } });
  // Icon-like circle
  s.addShape(pres.ShapeType.ellipse, { x: 8.1, y: 1.5, w: 1.6, h: 1.6, fill: { color: C.teal }, line: { color: C.gold, width: 3 } });
  s.addText("🩺", { x: 8.1, y: 1.55, w: 1.6, h: 1.5, fontSize: 36, align: "center" });
  // Title
  s.addText("SEPSIS MANAGEMENT", {
    x: 0.4, y: 1.35, w: 7.4, h: 1.1,
    fontSize: 40, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 3,
  });
  s.addText("Evidence-Based Approach & 2026 Guidelines", {
    x: 0.4, y: 2.5, w: 7.8, h: 0.7,
    fontSize: 20, color: C.gold, fontFace: "Calibri", italic: true,
  });
  s.addText("Based on Surviving Sepsis Campaign 2026  |  Harrison's Principles of Internal Medicine 22E", {
    x: 0.4, y: 3.3, w: 9, h: 0.5,
    fontSize: 13, color: C.offWhite, fontFace: "Calibri",
  });
  s.addText("Prescott H, Antonelli M et al. Crit Care Med. 2026  |  doi.org/10.1097/CCM.0000000000007075", {
    x: 0.4, y: 3.8, w: 9, h: 0.4,
    fontSize: 11, color: C.slate, fontFace: "Calibri", italic: true,
  });
  s.addText("June 2026", { x: 0.4, y: 5.0, w: 4, h: 0.55, fontSize: 13, color: C.white, fontFace: "Calibri" });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – Overview / Agenda
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.teal);
  slideTitle(s, "Presentation Overview");
  const topics = [
    { num: "01", text: "Definitions & Sepsis-3 Criteria", color: C.teal },
    { num: "02", text: "Pathophysiology & Organ Dysfunction", color: C.tealLt },
    { num: "03", text: "Early Recognition & Screening Tools", color: C.teal },
    { num: "04", text: "Initial Management: The First Hour Bundle", color: C.tealLt },
    { num: "05", text: "Fluid Resuscitation & Hemodynamic Targets", color: C.teal },
    { num: "06", text: "Antimicrobial Therapy & Stewardship", color: C.tealLt },
    { num: "07", text: "Vasopressors & Corticosteroids", color: C.teal },
    { num: "08", text: "Mechanical Ventilation & Supportive Care", color: C.tealLt },
    { num: "09", text: "Source Control & De-escalation", color: C.teal },
    { num: "10", text: "2026 SSC Guidelines – Key Updates", color: C.tealLt },
  ];
  topics.forEach((t, i) => {
    const row = Math.floor(i / 2);
    const col = i % 2;
    s.addShape(pres.ShapeType.roundRect, {
      x: 0.22 + col * 4.88, y: 0.95 + row * 0.88,
      w: 4.62, h: 0.75,
      fill: { color: t.color }, rectRadius: 0.07,
    });
    s.addText(`${t.num}  ${t.text}`, {
      x: 0.22 + col * 4.88, y: 0.95 + row * 0.88,
      w: 4.62, h: 0.75,
      fontSize: 13, color: C.white, fontFace: "Calibri", bold: true,
      align: "left", margin: [0, 0, 0, 0.18],
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION 01 divider
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionHeader(s, 1, "Definitions & Sepsis-3 Criteria", "Sepsis-3 Consensus Definitions (Singer et al., JAMA 2016)");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – Definitions
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.teal);
  slideTitle(s, "Sepsis-3 Definitions (2016 – Current)");

  // Three definition cards
  const cards = [
    { title: "INFECTION", body: "Suspected or confirmed microbial process causing host response", color: C.teal },
    { title: "SEPSIS", body: "Life-threatening organ dysfunction caused by dysregulated host response to infection\n\n▸ SOFA score increase ≥ 2 from baseline", color: C.tealLt },
    { title: "SEPTIC SHOCK", body: "Sepsis + vasopressor requirement to maintain MAP ≥ 65 mmHg\n+ Serum lactate > 2 mmol/L despite adequate fluid resuscitation", color: C.red },
  ];
  cards.forEach((c, i) => {
    s.addShape(pres.ShapeType.roundRect, {
      x: 0.22 + i * 3.22, y: 0.92, w: 3.0, h: 4.4,
      fill: { color: c.color }, rectRadius: 0.12,
    });
    s.addText(c.title, {
      x: 0.22 + i * 3.22, y: 0.95, w: 3.0, h: 0.65,
      fontSize: 18, bold: true, color: C.white, align: "center", fontFace: "Calibri",
    });
    s.addShape(pres.ShapeType.line, {
      x: 0.35 + i * 3.22, y: 1.6, w: 2.7, h: 0,
      line: { color: C.white, width: 1.5 },
    });
    s.addText(c.body, {
      x: 0.3 + i * 3.22, y: 1.7, w: 2.8, h: 3.5,
      fontSize: 14, color: C.white, fontFace: "Calibri", valign: "top",
      align: "left",
    });
  });
  // SOFA note
  s.addText("SOFA: Sequential [Sepsis-related] Organ Failure Assessment  |  Replaced SIRS criteria for sepsis definition", {
    x: 0.22, y: 5.2, w: 9.5, h: 0.35,
    fontSize: 10.5, color: C.slate, italic: true, fontFace: "Calibri",
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – SOFA Score
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.tealLt);
  slideTitle(s, "SOFA Score – Organ Dysfunction Assessment");

  const headers = ["System", "Parameter", "Score 1", "Score 2", "Score 3", "Score 4"];
  const rows = [
    ["Respiratory",    "PaO₂/FiO₂ (mmHg)",  "<400",           "<300",          "<200 + vent",   "<100 + vent"],
    ["Coagulation",    "Platelets (×10³/μL)", "<150",           "<100",          "<50",           "<20"],
    ["Liver",          "Bilirubin (mg/dL)",   "1.2–1.9",        "2.0–5.9",       "6.0–11.9",      "≥12.0"],
    ["Cardiovascular", "MAP or vasopressors", "MAP <70 mmHg",   "Dopa ≤5 or Dobu", "Dopa 5–15 or Epi/NE ≤0.1", "Dopa >15 or Epi/NE >0.1"],
    ["CNS",            "GCS",                 "13–14",          "10–12",         "6–9",           "<6"],
    ["Renal",          "Creatinine / Urine",  "1.2–1.9 mg/dL",  "2.0–3.4",       "3.5–4.9 or <500 mL/d", "≥5.0 or <200 mL/d"],
  ];

  const tW = [1.6, 2.0, 1.45, 1.45, 1.85, 1.85]; // column widths
  const tX = [0.22]; tW.forEach((w, i) => i < tW.length - 1 && tX.push(tX[i] + tW[i]));

  // Header row
  headers.forEach((h, c) => {
    s.addShape(pres.ShapeType.rect, { x: tX[c], y: 0.92, w: tW[c] - 0.04, h: 0.42, fill: { color: C.teal } });
    s.addText(h, { x: tX[c], y: 0.92, w: tW[c] - 0.04, h: 0.42, fontSize: 11.5, bold: true, color: C.white, align: "center", fontFace: "Calibri" });
  });

  rows.forEach((row, r) => {
    const bg = r % 2 === 0 ? "E8F4F8" : C.white;
    row.forEach((cell, c) => {
      s.addShape(pres.ShapeType.rect, { x: tX[c], y: 1.36 + r * 0.62, w: tW[c] - 0.04, h: 0.6, fill: { color: c <= 1 ? "D0EAF5" : bg } });
      s.addText(cell, {
        x: tX[c], y: 1.36 + r * 0.62, w: tW[c] - 0.04, h: 0.6,
        fontSize: 10.5, color: C.textDark, align: "center", fontFace: "Calibri", valign: "middle",
      });
    });
  });

  s.addText("Score ≥ 2 from baseline = Organ dysfunction suggesting sepsis  |  Max score: 24", {
    x: 0.22, y: 5.2, w: 9.5, h: 0.35,
    fontSize: 10.5, color: C.slate, italic: true, fontFace: "Calibri",
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION 02 divider
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionHeader(s, 2, "Pathophysiology", "Dysregulated Host Response to Infection");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – Pathophysiology
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.teal);
  slideTitle(s, "Pathophysiology of Sepsis");

  const nodes = [
    { x: 3.8, y: 0.92, w: 2.4, h: 0.65, text: "INFECTION\n(Bacteria / Fungi / Virus)", color: C.teal },
    { x: 3.8, y: 1.85, w: 2.4, h: 0.65, text: "PAMPs / DAMPs Activation\n(PRRs / TLRs / NF-κB)", color: C.tealLt },
    { x: 3.8, y: 2.78, w: 2.4, h: 0.65, text: "Pro-inflammatory Cytokine Storm\n(TNF-α, IL-1β, IL-6)", color: C.gold },
  ];
  nodes.forEach(n => {
    s.addShape(pres.ShapeType.roundRect, { x: n.x, y: n.y, w: n.w, h: n.h, fill: { color: n.color }, rectRadius: 0.08 });
    s.addText(n.text, { x: n.x, y: n.y, w: n.w, h: n.h, fontSize: 11, color: C.white, align: "center", fontFace: "Calibri" });
  });
  // Arrows
  [1.57, 2.5].forEach(y => {
    s.addShape(pres.ShapeType.line, { x: 5.0, y, w: 0, h: 0.3, line: { color: C.teal, width: 2 } });
  });

  // Consequences panel (bottom)
  const cons = [
    { label: "Endothelial\nDysfunction", icon: "🫀" },
    { label: "Microvascular\nThrombosis", icon: "🩸" },
    { label: "Mitochondrial\nDysfunction", icon: "⚡" },
    { label: "Organ\nHypoperfusion", icon: "🫁" },
  ];
  s.addShape(pres.ShapeType.rect, { x: 0.22, y: 3.6, w: 9.56, h: 0.22, fill: { color: C.red } });
  s.addText("DOWNSTREAM CONSEQUENCES", { x: 0.22, y: 3.6, w: 9.56, h: 0.22, fontSize: 11, bold: true, color: C.white, align: "center", fontFace: "Calibri" });
  cons.forEach((c, i) => {
    s.addShape(pres.ShapeType.roundRect, { x: 0.22 + i * 2.44, y: 3.84, w: 2.28, h: 1.5, fill: { color: "FFF3E0" }, rectRadius: 0.1 });
    s.addText(c.icon, { x: 0.22 + i * 2.44, y: 3.9, w: 2.28, h: 0.6, fontSize: 24, align: "center" });
    s.addText(c.label, { x: 0.22 + i * 2.44, y: 4.5, w: 2.28, h: 0.8, fontSize: 12.5, color: C.textDark, align: "center", fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION 03 divider
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionHeader(s, 3, "Early Recognition & Screening", "qSOFA · NEWS · AI-based Tools");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – Recognition
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.tealLt);
  slideTitle(s, "Early Recognition & Screening Tools");

  // qSOFA box
  s.addShape(pres.ShapeType.roundRect, { x: 0.22, y: 0.92, w: 4.4, h: 3.4, fill: { color: C.teal }, rectRadius: 0.12 });
  s.addText("qSOFA Score", { x: 0.22, y: 0.95, w: 4.4, h: 0.55, fontSize: 18, bold: true, color: C.gold, align: "center", fontFace: "Calibri" });
  s.addText("(Quick SOFA – Bedside Screening)", { x: 0.22, y: 1.45, w: 4.4, h: 0.4, fontSize: 12, color: C.white, align: "center", fontFace: "Calibri", italic: true });

  const qItems = [
    "Respiratory Rate ≥ 22 breaths/min",
    "Glasgow Coma Scale < 15",
    "Systolic BP ≤ 100 mmHg",
  ];
  qItems.forEach((item, i) => {
    s.addShape(pres.ShapeType.ellipse, { x: 0.38, y: 1.95 + i * 0.7, w: 0.36, h: 0.36, fill: { color: C.gold } });
    s.addText(`${i + 1}`, { x: 0.38, y: 1.95 + i * 0.7, w: 0.36, h: 0.36, fontSize: 12, bold: true, color: C.navy, align: "center" });
    s.addText(item, { x: 0.82, y: 1.97 + i * 0.7, w: 3.7, h: 0.36, fontSize: 13.5, color: C.white, fontFace: "Calibri" });
  });
  s.addShape(pres.ShapeType.line, { x: 0.35, y: 4.05, w: 4.1, h: 0, line: { color: C.gold, width: 1.5 } });
  s.addText("Score ≥ 2 → HIGH RISK for poor outcome\n→ Proceed to full SOFA assessment", {
    x: 0.28, y: 4.1, w: 4.3, h: 0.65,
    fontSize: 12, color: C.gold, fontFace: "Calibri", align: "center",
  });

  // Right panel
  s.addText("Other Screening Tools", { x: 4.85, y: 0.95, w: 4.9, h: 0.45, fontSize: 16, bold: true, color: C.teal, fontFace: "Calibri" });
  const tools = [
    { name: "NEWS2", desc: "National Early Warning Score – Tracks 7 physiologic parameters; widely used in UK/EU" },
    { name: "MEWS", desc: "Modified Early Warning Score – Simpler bedside tool for general wards" },
    { name: "AI TREWS", desc: "Targeted Real-Time Early Warning – ML model predicting sepsis up to 4–28h before onset" },
    { name: "SIRS (legacy)", desc: "No longer preferred; low specificity. Replaced by Sepsis-3 SOFA-based criteria" },
  ];
  tools.forEach((t, i) => {
    s.addShape(pres.ShapeType.roundRect, {
      x: 4.85, y: 1.5 + i * 0.95, w: 4.9, h: 0.82,
      fill: { color: i % 2 === 0 ? "E8F4F8" : C.white },
      line: { color: C.tealLt, width: 1 }, rectRadius: 0.07,
    });
    s.addText(t.name, { x: 5.0, y: 1.55 + i * 0.95, w: 1.4, h: 0.38, fontSize: 13, bold: true, color: C.teal, fontFace: "Calibri" });
    s.addText(t.desc, { x: 5.0, y: 1.91 + i * 0.95, w: 4.6, h: 0.36, fontSize: 11.5, color: C.textDark, fontFace: "Calibri" });
  });

  s.addText("2026 SSC: No single tool is preferentially endorsed — use institutional protocols", {
    x: 0.22, y: 5.2, w: 9.5, h: 0.35,
    fontSize: 10.5, color: C.red, italic: true, fontFace: "Calibri",
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION 04 divider
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionHeader(s, 4, "Initial Management", "The 1-Hour Bundle & First Response");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 – 1-Hour Bundle
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.red);
  slideTitle(s, "The 1-Hour Bundle – SCCM / SSC 2026");

  const steps = [
    { icon: "🔬", step: "Measure Lactate", detail: "Re-measure if initial lactate > 2 mmol/L. Lactate > 4 mmol/L = high risk, initiate aggressive resuscitation." },
    { icon: "🧫", step: "Blood Cultures", detail: "Draw ≥2 sets (aerobic + anaerobic) BEFORE antibiotics — do not delay antibiotics >45 min for cultures." },
    { icon: "💊", step: "Broad-Spectrum Antibiotics", detail: "Within 1 hour of septic shock recognition. Within 3 hours if sepsis without shock." },
    { icon: "💧", step: "Crystalloid Fluid Bolus", detail: "30 mL/kg IV crystalloid for hypotension or lactate ≥ 4 mmol/L. Reassess after each bolus." },
    { icon: "💉", step: "Vasopressors if Needed", detail: "Start norepinephrine if MAP < 65 mmHg despite fluids. Can initiate via peripheral IV to avoid delay." },
  ];

  steps.forEach((st, i) => {
    s.addShape(pres.ShapeType.roundRect, {
      x: 0.22, y: 0.9 + i * 0.92, w: 9.56, h: 0.82,
      fill: { color: i % 2 === 0 ? "FFF9F0" : C.white },
      line: { color: C.gold, width: 1 }, rectRadius: 0.06,
    });
    s.addShape(pres.ShapeType.roundRect, {
      x: 0.22, y: 0.9 + i * 0.92, w: 0.58, h: 0.82,
      fill: { color: C.red }, rectRadius: 0.06,
    });
    s.addText(st.icon, { x: 0.22, y: 0.9 + i * 0.92, w: 0.58, h: 0.82, fontSize: 20, align: "center" });
    s.addText(st.step, { x: 0.88, y: 0.95 + i * 0.92, w: 2.4, h: 0.38, fontSize: 13.5, bold: true, color: C.teal, fontFace: "Calibri" });
    s.addText(st.detail, { x: 0.88, y: 1.3 + i * 0.92, w: 8.8, h: 0.36, fontSize: 12, color: C.textDark, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION 05 divider
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionHeader(s, 5, "Fluid Resuscitation", "Targets · Monitoring · Restrictive Strategy");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 – Fluids
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.teal);
  slideTitle(s, "Fluid Resuscitation – 2026 SSC Guidance");

  // Left column – Fluid Strategy
  s.addShape(pres.ShapeType.roundRect, { x: 0.22, y: 0.9, w: 4.6, h: 4.45, fill: { color: "EBF5FB" }, line: { color: C.teal, width: 1.5 }, rectRadius: 0.1 });
  s.addText("Fluid Strategy", { x: 0.28, y: 0.92, w: 4.45, h: 0.45, fontSize: 15, bold: true, color: C.teal, fontFace: "Calibri" });
  addBullets(s, [
    { text: "Initial bolus: 30 mL/kg crystalloid (balanced preferred)" },
    { text: "Reassess after EACH bolus: HR, MAP, UO, CRT, lactate clearance" },
    { text: "Target: MAP ≥ 65 mmHg (range 60–70 mmHg practical)" },
    { text: "Balanced crystalloids (e.g., Ringer's lactate) preferred over 0.9% saline (reduces AKI/mortality)" },
    { text: "Avoid over-resuscitation — liberal fluids associated with worse outcomes" },
    { text: "2026 SSC: Active fluid REMOVAL (de-resuscitation) in later phases of shock is conditionally recommended" },
    { text: "Albumin: use in patients who have received large volumes of crystalloid (conditional recommendation)" },
  ], { x: 0.3, y: 1.38, w: 4.4, h: 3.85, fontSize: 13, color: C.textDark });

  // Right column – Hemodynamic Targets
  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 0.9, w: 4.68, h: 4.45, fill: { color: "E8F8F5" }, line: { color: C.tealLt, width: 1.5 }, rectRadius: 0.1 });
  s.addText("Hemodynamic Targets", { x: 5.18, y: 0.92, w: 4.5, h: 0.45, fontSize: 15, bold: true, color: C.tealLt, fontFace: "Calibri" });

  const targets = [
    ["MAP", "≥ 65 mmHg\n(60–70 range)", C.teal],
    ["Lactate", "Clearance ≥ 10% / 2h\nTarget < 2 mmol/L", C.tealLt],
    ["Urine Output", "> 0.5 mL/kg/hr", C.teal],
    ["ScvO₂", "≥ 70% (central)", C.tealLt],
    ["Hgb Transfusion", "Trigger < 7 g/dL\n(restrictive strategy – STRONG rec)", C.red],
  ];
  targets.forEach((t, i) => {
    s.addShape(pres.ShapeType.roundRect, { x: 5.18, y: 1.42 + i * 0.75, w: 4.5, h: 0.66, fill: { color: C.white }, rectRadius: 0.06 });
    s.addShape(pres.ShapeType.rect, { x: 5.18, y: 1.42 + i * 0.75, w: 0.06, h: 0.66, fill: { color: t[2] } });
    s.addText(t[0], { x: 5.28, y: 1.45 + i * 0.75, w: 1.3, h: 0.6, fontSize: 12.5, bold: true, color: t[2], fontFace: "Calibri" });
    s.addText(t[1], { x: 6.6, y: 1.45 + i * 0.75, w: 3.05, h: 0.6, fontSize: 12, color: C.textDark, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION 06 divider
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionHeader(s, 6, "Antimicrobial Therapy", "Right Drug · Right Time · Stewardship");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 – Antibiotics
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.tealLt);
  slideTitle(s, "Antimicrobial Therapy – Principles & Timing");

  const headers = ["Situation", "Timing", "Regimen Approach"];
  const rows = [
    ["Septic Shock", "< 1 hour", "Broad-spectrum IV antibiotics immediately"],
    ["Sepsis (no shock, high probability)", "< 1–3 hours", "IV broad-spectrum; cultures first if no delay"],
    ["Suspected sepsis (uncertain)", "< 3 hours", "Clinical evaluation; if no alternative dx, give antibiotics"],
    ["Pulmonary (CAP)", "ASAP", "β-lactam (ceftriaxone) + macrolide OR respiratory FQ"],
    ["HAP / VAP", "ASAP", "Vancomycin/linezolid + antipseudomonal β-lactam or carbapenem"],
    ["Neutropenic fever", "< 1 hour", "Antipseudomonal β-lactam (cefepime or pip-tazo)"],
    ["Necrotizing fasciitis", "ASAP", "Vancomycin or linezolid + pip-tazo or carbapenem"],
    ["Unknown source (MRSA risk)", "ASAP", "Add vancomycin; double gram-neg if Pseudomonas risk"],
  ];

  const colW = [2.9, 1.8, 5.06];
  const colX = [0.22, 3.12, 4.92];
  // Header
  headers.forEach((h, c) => {
    s.addShape(pres.ShapeType.rect, { x: colX[c], y: 0.9, w: colW[c] - 0.05, h: 0.42, fill: { color: C.teal } });
    s.addText(h, { x: colX[c], y: 0.9, w: colW[c] - 0.05, h: 0.42, fontSize: 12.5, bold: true, color: C.white, align: "center", fontFace: "Calibri" });
  });
  rows.forEach((row, r) => {
    const bg = r % 2 === 0 ? "EBF5FB" : C.white;
    row.forEach((cell, c) => {
      s.addShape(pres.ShapeType.rect, { x: colX[c], y: 1.34 + r * 0.5, w: colW[c] - 0.05, h: 0.48, fill: { color: bg } });
      s.addText(cell, {
        x: colX[c] + 0.05, y: 1.34 + r * 0.5, w: colW[c] - 0.1, h: 0.48,
        fontSize: 11.5, color: C.textDark, fontFace: "Calibri", valign: "middle",
      });
    });
  });
  s.addText("De-escalate within 48–72h based on culture results | Duration: 7–10 days (shorter preferred) | 2026 SSC: Discourage empiric antifungal unless high suspicion", {
    x: 0.22, y: 5.2, w: 9.5, h: 0.35,
    fontSize: 10.5, color: C.red, italic: true, fontFace: "Calibri",
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION 07 divider
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionHeader(s, 7, "Vasopressors & Corticosteroids", "Hemodynamic Support in Septic Shock");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 17 – Vasopressors
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.red);
  slideTitle(s, "Vasopressors & Adjunctive Therapies");

  // Vasopressor ladder
  s.addShape(pres.ShapeType.roundRect, { x: 0.22, y: 0.9, w: 5.5, h: 4.45, fill: { color: "FFF5F5" }, line: { color: C.red, width: 1.5 }, rectRadius: 0.1 });
  s.addText("Vasopressor Ladder", { x: 0.3, y: 0.93, w: 5.3, h: 0.42, fontSize: 15, bold: true, color: C.red, fontFace: "Calibri" });

  const vpItems = [
    { rank: "1st line", drug: "Norepinephrine", dose: "0.01–3 mcg/kg/min IV\nTitrate to MAP ≥ 65 mmHg", color: C.red },
    { rank: "2nd line", drug: "Vasopressin", dose: "Fixed 0.03 U/min (add to NE)\nReduces NE dose / catecholamine toxicity", color: C.teal },
    { rank: "3rd line", drug: "Epinephrine", dose: "0.01–0.5 mcg/kg/min\nFor refractory shock", color: C.slate },
    { rank: "Inotrope", drug: "Dobutamine", dose: "2.5–20 mcg/kg/min\nFor low cardiac output + adequate MAP", color: C.tealLt },
  ];
  vpItems.forEach((v, i) => {
    s.addShape(pres.ShapeType.roundRect, {
      x: 0.3, y: 1.42 + i * 0.92, w: 5.3, h: 0.82,
      fill: { color: C.white }, line: { color: v.color, width: 1.5 }, rectRadius: 0.06,
    });
    s.addText(v.rank, { x: 0.38, y: 1.44 + i * 0.92, w: 1.05, h: 0.38, fontSize: 10.5, bold: true, color: C.white, align: "center", fontFace: "Calibri",
      fill: { color: v.color }, // via shape
    });
    s.addShape(pres.ShapeType.roundRect, { x: 0.38, y: 1.44 + i * 0.92, w: 1.05, h: 0.36, fill: { color: v.color }, rectRadius: 0.04 });
    s.addText(v.rank, { x: 0.38, y: 1.44 + i * 0.92, w: 1.05, h: 0.36, fontSize: 10.5, bold: true, color: C.white, align: "center", fontFace: "Calibri" });
    s.addText(v.drug, { x: 1.5, y: 1.45 + i * 0.92, w: 1.85, h: 0.38, fontSize: 13.5, bold: true, color: v.color, fontFace: "Calibri" });
    s.addText(v.dose, { x: 1.5, y: 1.78 + i * 0.92, w: 4.0, h: 0.42, fontSize: 11, color: C.textDark, fontFace: "Calibri" });
  });
  s.addText("2026: May initiate vasopressors via peripheral IV to avoid CVC delay", {
    x: 0.3, y: 5.14, w: 5.3, h: 0.35, fontSize: 10.5, color: C.red, italic: true, fontFace: "Calibri",
  });

  // Right panel – Corticosteroids
  s.addShape(pres.ShapeType.roundRect, { x: 6.0, y: 0.9, w: 3.78, h: 4.45, fill: { color: "F0F8E8" }, line: { color: C.tealLt, width: 1.5 }, rectRadius: 0.1 });
  s.addText("Corticosteroids", { x: 6.08, y: 0.93, w: 3.6, h: 0.42, fontSize: 15, bold: true, color: C.tealLt, fontFace: "Calibri" });
  const cItems = [
    "Indication: Refractory septic shock\n(persists despite adequate fluids + vasopressors)",
    "Drug: Hydrocortisone",
    "Dose: 200 mg/day IV\n(50 mg IV bolus q6h OR continuous infusion)",
    "Duration: Until vasopressors no longer needed; then taper",
    "2024 SCCM Guidelines: Recommended in septic shock if shock not resolved in 2–4h on vasopressors",
    "Fludrocortisone 50 mcg oral daily may be added (evidence limited)",
  ];
  cItems.forEach((item, i) => {
    s.addShape(pres.ShapeType.roundRect, {
      x: 6.08, y: 1.44 + i * 0.58, w: 3.6, h: 0.52,
      fill: { color: i % 2 === 0 ? C.white : "E8F8F0" }, rectRadius: 0.05,
    });
    s.addText(item, { x: 6.14, y: 1.46 + i * 0.58, w: 3.5, h: 0.5, fontSize: 11, color: C.textDark, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION 08 divider
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionHeader(s, 8, "Mechanical Ventilation & Supportive Care", "Lung-Protective Ventilation · Nutrition · VTE Prophylaxis");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 19 – Ventilation & Supportive Care
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.teal);
  slideTitle(s, "Mechanical Ventilation & Supportive Care");

  // Two column layout
  const cols = [
    {
      title: "Lung-Protective Ventilation (ARDS)",
      x: 0.22, w: 4.6,
      color: C.teal,
      items: [
        "Tidal volume: 6 mL/kg IBW (max 8 mL/kg)",
        "Plateau pressure: ≤ 30 cmH₂O",
        "PEEP: Individualize; higher PEEP for severe ARDS",
        "FiO₂: Titrate to SpO₂ 92–96%",
        "Prone positioning: ≥16h/day if P/F ratio < 150",
        "NMBA (Neuromuscular blockade): Consider for first 48h in severe ARDS (P/F < 150)",
        "HFNC: Use before intubation in hypoxemic respiratory failure",
        "ECMO: Last resort for refractory ARDS",
      ],
    },
    {
      title: "Supportive Care Bundles",
      x: 5.1, w: 4.68,
      color: C.tealLt,
      items: [
        "Glucose control: Insulin therapy at ≥180 mg/dL; target 140–180 mg/dL (STRONG rec)",
        "Nutrition: Early enteral nutrition within 72h (conditional rec)",
        "VTE prophylaxis: Heparin (LMWH preferred) — all critically ill patients",
        "Stress ulcer prophylaxis: PPI or H₂ blocker in high-risk patients",
        "SDD (Selective Digestive Decontamination): 2026 SSC recommends for mechanically ventilated patients (NEW)",
        "DVT: Sequential compression devices",
        "Sedation: Minimize benzodiazepines; ABCDE bundle",
        "Renal replacement therapy: For AKI with life-threatening metabolic derangements",
      ],
    },
  ];

  cols.forEach(col => {
    s.addShape(pres.ShapeType.roundRect, { x: col.x, y: 0.9, w: col.w, h: 4.48, fill: { color: "F7FBFF" }, line: { color: col.color, width: 1.5 }, rectRadius: 0.1 });
    s.addText(col.title, { x: col.x + 0.08, y: 0.93, w: col.w - 0.12, h: 0.45, fontSize: 14, bold: true, color: col.color, fontFace: "Calibri" });
    const arr = col.items.map((item, i) => ({
      text: item, options: { bullet: { type: "bullet", characterCode: "25B8" }, breakLine: i < col.items.length - 1, fontSize: 12, color: C.textDark },
    }));
    s.addText(arr, { x: col.x + 0.1, y: 1.42, w: col.w - 0.18, h: 3.85, fontFace: "Calibri", valign: "top", fontSize: 12 });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION 09 divider
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionHeader(s, 9, "Source Control & De-escalation", "Identifying & Eliminating the Infection Source");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 21 – Source Control
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.tealLt);
  slideTitle(s, "Source Control & Antimicrobial De-escalation");

  s.addShape(pres.ShapeType.roundRect, { x: 0.22, y: 0.9, w: 4.6, h: 4.45, fill: { color: "EAF7F5" }, line: { color: C.tealLt, width: 1.5 }, rectRadius: 0.1 });
  s.addText("Source Control", { x: 0.3, y: 0.93, w: 4.4, h: 0.42, fontSize: 15, bold: true, color: C.tealLt, fontFace: "Calibri" });
  addBullets(s, [
    { text: "Identify anatomic source within 6 hours of presentation" },
    { text: "Priorities: Abscess drainage, infected device removal, debridement of necrotic tissue" },
    { text: "Source control target: Within 6–12h for most infections (earlier for life-threatening)" },
    { text: "Surgical emergencies: Necrotizing fasciitis, perforated viscus, emphysematous cholecystitis → immediate OR" },
    { text: "Remove intravascular devices when source of sepsis" },
    { text: "Percutaneous drainage preferred over surgery when equally effective" },
    { text: "All intra-abdominal collections require drainage" },
  ], { x: 0.3, y: 1.42, w: 4.42, h: 3.85, fontSize: 12.5, color: C.textDark });

  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 0.9, w: 4.68, h: 4.45, fill: { color: "FFF8EC" }, line: { color: C.gold, width: 1.5 }, rectRadius: 0.1 });
  s.addText("Antimicrobial De-escalation", { x: 5.18, y: 0.93, w: 4.5, h: 0.42, fontSize: 15, bold: true, color: C.tealLt, fontFace: "Calibri" });
  addBullets(s, [
    { text: "Daily reassessment of antibiotic appropriateness" },
    { text: "Narrow spectrum based on culture & sensitivity results (48–72h)" },
    { text: "Procalcitonin-guided de-escalation: SSC 2026 recommends its use to guide antibiotic duration" },
    { text: "Recommend AGAINST empiric anaerobic coverage unless intra-abdominal source suspected" },
    { text: "Recommend AGAINST empiric antifungal therapy unless high clinical suspicion / risk" },
    { text: "Duration: 7–10 days for most; shorter courses acceptable if clinically well" },
    { text: "Bacteremia: 14 days for S. aureus; 5–7 days for gram-negative rod bacteremia" },
  ], { x: 5.18, y: 1.42, w: 4.5, h: 3.85, fontSize: 12.5, color: C.textDark });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION 10 divider
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionHeader(s, 10, "2026 SSC Guidelines", "Key Updates & New Recommendations");
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 23 – 2026 Key Updates
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.gold);
  slideTitle(s, "Surviving Sepsis Campaign 2026 – Key Updates");

  const updates = [
    { tag: "NEW", text: "MAP target: 60–70 mmHg range acceptable (not fixed 65 mmHg)", color: C.red },
    { tag: "NEW", text: "Selective Digestive Decontamination (SDD) recommended for mechanically ventilated patients to prevent VAP", color: C.red },
    { tag: "NEW", text: "Active fluid removal (de-resuscitation) conditionally recommended in later phases of shock", color: C.red },
    { tag: "UPDATED", text: "Discourage empiric antifungal & anaerobic coverage when clinical suspicion is low", color: C.teal },
    { tag: "UPDATED", text: "Encourage rapid antibiotic de-escalation guided by PCT and culture results", color: C.teal },
    { tag: "UPDATED", text: "Peripheral vasopressor initiation supported to avoid CVC delays", color: C.teal },
    { tag: "UPDATED", text: "Restrictive transfusion strategy strongly recommended (trigger Hgb < 7 g/dL)", color: C.teal },
    { tag: "UPDATED", text: "Early enteral nutrition (within 72h) conditionally recommended", color: C.teal },
    { tag: "UNCHANGED", text: "Norepinephrine as first-line vasopressor; vasopressin as second-line", color: C.tealLt },
    { tag: "UNCHANGED", text: "30 mL/kg crystalloid bolus for initial resuscitation; reassess after each bolus", color: C.tealLt },
  ];

  updates.forEach((u, i) => {
    const row = Math.floor(i / 2);
    const col = i % 2;
    s.addShape(pres.ShapeType.roundRect, {
      x: 0.22 + col * 4.88, y: 0.92 + row * 0.9,
      w: 4.62, h: 0.82,
      fill: { color: col === 0 ? "FFF5F5" : "F0F8FF" },
      line: { color: u.color, width: 1 }, rectRadius: 0.06,
    });
    s.addShape(pres.ShapeType.roundRect, {
      x: 0.22 + col * 4.88, y: 0.92 + row * 0.9, w: 1.05, h: 0.32,
      fill: { color: u.color }, rectRadius: 0.04,
    });
    s.addText(u.tag, {
      x: 0.22 + col * 4.88, y: 0.92 + row * 0.9, w: 1.05, h: 0.32,
      fontSize: 10, bold: true, color: C.white, align: "center", fontFace: "Calibri",
    });
    s.addText(u.text, {
      x: 0.3 + col * 4.88, y: 1.22 + row * 0.9, w: 4.45, h: 0.48,
      fontSize: 12, color: C.textDark, fontFace: "Calibri",
    });
  });

  s.addText("Prescott H, Antonelli M et al. SSC International Guidelines 2026. Crit Care Med. 2026. doi:10.1097/CCM.0000000000007075", {
    x: 0.22, y: 5.2, w: 9.5, h: 0.35,
    fontSize: 10.5, color: C.slate, italic: true, fontFace: "Calibri",
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 24 – Sepsis Bundles Summary Visual
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.teal);
  slideTitle(s, "Sepsis Management Timeline Overview");

  // Timeline bar
  s.addShape(pres.ShapeType.rect, { x: 0.22, y: 2.55, w: 9.56, h: 0.18, fill: { color: C.teal } });

  const phases = [
    { label: "T = 0", title: "Recognition", x: 0.22, w: 2.3, color: C.red, items: ["Suspect sepsis", "Vital signs", "Lactate + blood cultures"] },
    { label: "T < 1h", title: "Resuscitation", x: 2.62, w: 2.3, color: C.teal, items: ["Broad-spectrum ABx", "30 mL/kg crystalloid", "Vasopressors if MAP < 65"] },
    { label: "T = 1–6h", title: "Stabilization", x: 5.02, w: 2.3, color: C.tealLt, items: ["ICU admission", "Source control", "Reassess fluid balance"] },
    { label: "T > 6h", title: "Optimization", x: 7.42, w: 2.14, color: C.gold, items: ["De-escalate ABx", "Fluid removal", "Ventilation weaning"] },
  ];
  phases.forEach(p => {
    // Top box
    s.addShape(pres.ShapeType.roundRect, { x: p.x, y: 0.9, w: p.w, h: 1.55, fill: { color: p.color }, rectRadius: 0.1 });
    s.addText(p.label, { x: p.x, y: 0.9, w: p.w, h: 0.38, fontSize: 12.5, bold: true, color: C.white, align: "center", fontFace: "Calibri" });
    s.addText(p.title, { x: p.x, y: 1.25, w: p.w, h: 0.38, fontSize: 14.5, bold: true, color: C.white, align: "center", fontFace: "Calibri" });
    // Circle on timeline
    s.addShape(pres.ShapeType.ellipse, { x: p.x + p.w / 2 - 0.14, y: 2.48, w: 0.28, h: 0.28, fill: { color: p.color } });
    // Bottom bullets
    s.addShape(pres.ShapeType.roundRect, { x: p.x, y: 2.85, w: p.w, h: 2.45, fill: { color: "F7FAFC" }, line: { color: p.color, width: 1 }, rectRadius: 0.1 });
    const arr = p.items.map((item, i) => ({
      text: item, options: { bullet: { type: "bullet", characterCode: "25B8" }, breakLine: i < p.items.length - 1, fontSize: 13, color: C.textDark },
    }));
    s.addText(arr, { x: p.x + 0.1, y: 2.92, w: p.w - 0.18, h: 2.3, fontFace: "Calibri", valign: "top" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 25 – Mortality & Prognosis
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  accentBar(s, C.red);
  slideTitle(s, "Outcomes, Prognosis & Post-Sepsis Syndrome");

  const stats = [
    { val: "11M", sub: "Annual deaths worldwide from sepsis", color: C.red },
    { val: "~20%", sub: "30-day mortality – Sepsis", color: C.teal },
    { val: "~40%", sub: "30-day mortality – Septic Shock", color: C.red },
    { val: "7–8%", sub: "Mortality increase per 1h delay in antibiotics", color: C.gold },
  ];
  stats.forEach((st, i) => {
    s.addShape(pres.ShapeType.roundRect, {
      x: 0.22 + i * 2.44, y: 0.9, w: 2.28, h: 2.2,
      fill: { color: st.color }, rectRadius: 0.1,
    });
    s.addText(st.val, { x: 0.22 + i * 2.44, y: 0.95, w: 2.28, h: 1.1, fontSize: 36, bold: true, color: C.white, align: "center", fontFace: "Calibri" });
    s.addText(st.sub, { x: 0.22 + i * 2.44, y: 2.0, w: 2.28, h: 1.0, fontSize: 12.5, color: C.white, align: "center", fontFace: "Calibri" });
  });

  // Post-Sepsis Syndrome
  s.addShape(pres.ShapeType.roundRect, { x: 0.22, y: 3.2, w: 9.56, h: 2.1, fill: { color: "F0F4F8" }, line: { color: C.teal, width: 1.5 }, rectRadius: 0.1 });
  s.addText("Post-Sepsis Syndrome (PICS – Post-Intensive Care Syndrome)", { x: 0.32, y: 3.22, w: 9.3, h: 0.42, fontSize: 15, bold: true, color: C.teal, fontFace: "Calibri" });
  const pics = [
    "Physical: Muscle weakness, fatigue, functional disability",
    "Cognitive: Memory impairment, attention deficits, delirium sequelae",
    "Psychological: PTSD, anxiety, depression (30–50% survivors)",
    "2025 S3 Guidelines: Structured follow-up care after hospital discharge now formally recommended",
    "2026 SSC: Stronger focus on patient-centered care beyond acute treatment",
  ];
  const pArr = pics.map((item, i) => ({
    text: item, options: { bullet: { type: "bullet", characterCode: "25B8" }, breakLine: i < pics.length - 1, fontSize: 12.5, color: C.textDark },
  }));
  s.addText(pArr, { x: 0.32, y: 3.68, w: 9.3, h: 1.55, fontFace: "Calibri", valign: "top" });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 26 – References & Conclusion
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.9, fill: { color: C.teal } });
  s.addText("Key References & Guidelines", {
    x: 0.3, y: 0.12, w: 9.4, h: 0.65,
    fontSize: 22, bold: true, color: C.white, fontFace: "Calibri",
  });

  const refs = [
    "1. Prescott H, Antonelli M et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med. 2026. doi:10.1097/CCM.0000000000007075",
    "2. Weiss SL, Peters MJ et al. Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock in Children 2026. Pediatr Crit Care Med. 2026;27:e456. [PMID: 41869844]",
    "3. Singer M, Deutschman CS et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–810.",
    "4. Evans L, Rhodes A et al. SSC International Guidelines 2021. Intensive Care Med. 2021;47:1181–1247.",
    "5. Rhee C et al. 2024 Focused Update: Corticosteroids in Sepsis, ARDS, CAP. Crit Care Med. 2024;52(5):e219–e233.",
    "6. Harrison's Principles of Internal Medicine, 22nd Edition (2025). Chapter 315: Sepsis and Septic Shock.",
    "7. Yang GX et al. Quality of guidelines for infection management in sepsis: AGREE II appraisal. BMC Med Res Methodol. 2025. [PMID: 39984828]",
    "8. Weiss SL et al. SSC Pediatric Guidelines 2026. Intensive Care Med. 2026 May. [PMID: 41870559]",
  ];
  const refArr = refs.map((r, i) => ({
    text: r, options: { breakLine: i < refs.length - 1, fontSize: 12, color: C.offWhite },
  }));
  s.addText(refArr, { x: 0.3, y: 0.98, w: 9.4, h: 4.2, fontFace: "Calibri", valign: "top" });

  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.05, w: 10, h: 0.575, fill: { color: C.tealLt } });
  s.addText("Sepsis Management – Evidence-Based 2026 Guidelines  |  Orris AI  |  June 2026", {
    x: 0.3, y: 5.07, w: 9.4, h: 0.52,
    fontSize: 12, color: C.white, fontFace: "Calibri",
  });
}

// ─── Write file ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/sepsis-ppt/Sepsis_Management_2026.pptx" })
  .then(() => console.log("✅ DONE: Sepsis_Management_2026.pptx written"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });
Running Command

cd /home/daytona/workspace/sepsis-ppt && node build.js 2>&1

Running Command

ls -lh /home/daytona/workspace/sepsis-ppt/Sepsis_Management_2026.pptx

Your presentation is ready!

Sepsis Management 2026

Presentation · PPTX

What's inside (26 slides)

#SlideContent
1Title SlideBranded cover with SSC 2026 citation
2Overview10-topic agenda with color-coded tiles
3–5Definitions & SOFASepsis-3 definitions, SOFA score full table
6–7PathophysiologyPAMPs/DAMPs → cytokine storm → organ failure cascade
8–9Early RecognitionqSOFA criteria, NEWS2, MEWS, AI-TREWS compared
10–111-Hour Bundle5 action steps with timing (SSC 2026)
12–13Fluid Resuscitation30 mL/kg crystalloid, MAP targets 60–70, de-resuscitation
14–15Antimicrobial TherapyTiming table by infection site, CAP/HAP/VAP regimens
16–17Vasopressors & SteroidsNE → vasopressin → epi ladder; hydrocortisone 200 mg/day
18–19Ventilation & Supportive CareLung-protective ventilation, SDD, glucose control, nutrition
20–21Source Control & De-escalation6-12h target, PCT-guided antibiotic narrowing
22–232026 SSC Key Updates10 NEW/UPDATED/UNCHANGED tagged recommendations
24Management TimelineT=0, <1h, 1–6h, >6h visual flow
25Outcomes & PICSMortality stats, post-sepsis syndrome
26References8 key citations including SSC 2026, Harrison's 22E

Notable 2026 SSC updates highlighted

  • MAP target range of 60–70 mmHg (not fixed 65)
  • SDD now recommended for mechanically ventilated patients
  • Active fluid removal (de-resuscitation) in later shock phases
  • Discourage empiric antifungal and anaerobic cover when suspicion is low
  • Peripheral IV vasopressor initiation supported
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