Sepsis care: the importance of rapid detection and management

How can we improve sepsis recognition and management? In a forum article published today in BMC Medicine, experts in sepsis care explore this issue, highlighting special considerations in different patient groups. This blog takes a look at the importance of detecting sepsis quickly, and possible strategies for improving early detection.

Sepsis, also known as blood poisoning, is a whole-body inflammatory response occurring as a result of infection. Despite medical advances such as antibiotics and vaccines, sepsis remains the primary cause of death from infection, and the number of hospitalizations for sepsis has increased approximately three-fold in the last decade.

if we continue to use [current] criteria, we may fail to identify septic patients and therefore potentially delay their treatment


Prof Rinaldo Bellomo

Rapid recognition and treatment of sepsis is essential to reduce preventable deaths. Following a recent study showing that one in eight patients with severe infection did not meet current criteria for admission to an intensive care unit, experts in Australia have called for a global review of guidelines for sepsis diagnosis. Professor Rinaldo Bellomo, who conceived the study, highlighted that:

if we continue to use [current] criteria, we may fail to identify septic patients and therefore potentially delay their treatment

Can early goal-directed therapy improve sepsis care?

Current guidelines recommend early goal-directed therapy (EGDT) to improve survival in patients with sepsis. However, while some studies have shown a positive effect of EGDT, others have found no benefit compared with usual care.

Ling Zhang and colleagues address this controversy in a meta-analysis published in BMC Medicine. The authors analyzed published randomized controlled trials, finding that EGDT is not associated with an overall survival benefit when compared with early lactate clearance as a target for therapy.

Zhang and colleagues’ meta-analysis highlights that the optimal way to improve sepsis management still needs to be determined, and the authors conclude that trials comparing EGDT with lactate clearance-guided treatment are now needed.

So how can we improve sepsis treatment outcomes?

In a forum article published in BMC Medicine, clinicians and researchers with expertise in sepsis care discuss the importance of rapid identification and treatment, and explore ways in which the situation can be improved.

Donald Yealy and David Huang describe advances in sepsis care that have occurred since the development of EGDT in 2001, but highlight that early sepsis care remains too slow in many cases.

“Early care matters –not so much a mandated catheter or prescriptive approach – and returning to the days of delayed action is not an option.”


Donald Yealy and David Huang

 Anthony Delaney discusses tools to identify patients with sepsis in a busy emergency department, and emerging biomarkers for the condition. While some novel biomarkers show promise as diagnostic indicators, Delaney emphasizes that current markers have limited sensitivity and specificity, and explains the importance of refining biomarker panels to reliably identify patients with sepsis.

Identifying sepsis in different patient groups

Detecting sepsis in patients with altered physiology – such as pregnant or postpartum women – can be extremely difficult. Globally, it is estimated that around 11% of maternal deaths are caused by sepsis. In our forum article, Marian Knight discusses the risk factors for maternal sepsis, which include anemia, febrile illness, and cesarean delivery. Knight recommends that:

along with early recognition and diagnosis, the key action for management is to institute a sepsis care bundle, including administration of timely antibiotics (within one hour of suspected sepsis), adequate fluid resuscitation and the measurement of serum lactate

There are also specific challenges associated with pediatric sepsis. Adrienne Randolph highlights that neonates and young infants are at particularly high risk because they have immature immune systems. Although rapid identification of sepsis is important in young children, Randolph cautions that they may be exposed to potentially unnecessary treatments given the broad definition of sepsis, and emphasizes that children should only be exposed to antimicrobial agents that are effective against their specific infection.

The importance of pre-hospital care for sepsis management

Patients with sepsis often arrive in the emergency department via an emergency medical service (EMS), and the pre-hospital setting is a key opportunity to recognize sepsis early and commence effective treatment.

“Improvement strategies are needed to increase early sepsis awareness in pre-hospital care at each step of the process.”


Ron Daniels and Tim Nutbeam

Ron Daniels and Tim Nutbeam explain that awareness of sepsis is low among EMS professionals, recommending a number of ways in which sepsis identification could be improved in the pre-hospital setting. Nutbeam and Daniels outline the importance of tools such as Sepsis Six and Red Flag sepsis to improve pre-hospital sepsis care.

Overall, the experts specializing in sepsis care in different patient groups emphasize the need for better strategies to recognize and treat sepsis early. As highlighted by Yealy and Huang,

Early care matters – not so much a mandated catheter or prescriptive approach – and returning to the days of delayed action is not an option.”

 

BMC-Medicine-man-147x150BMC Medicine: passionate about quality, transparency and clinical impact
2014 median turnover times: initial decision three days; decision after peer review 41 days

View the latest posts on the On Medicine homepage

Comments

By commenting, you’re agreeing to follow our community guidelines.

Your email address will not be published. Required fields are marked *