Tag Archives: Sepsis

Prognostic Accuracy of Sepsis-3

Does the quick Sequential Organ Failure Assessment (qSOFA) score more accurately predict in-hospital mortality than the systemic inflammatory response syndrome (SIRS) or severe sepsis criteria among emergency department patients with suspected infection? Freund et al set out to answer this question.

They found that among patients presenting to the emergency department setting with suspected infection, the use of qSOFA resulted in greater prognostic accuracy for in-hospital mortality than either SIRS or severe sepsis.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Relative Bradycardia and Septic Shock

Tachycardia is common in septic shock, but many patients with septic shock are relatively bradycardic. The prevalence, determinants, and implications of relative bradycardia in septic shock are unknown. Therefore, Beesley et al set out to determine mortality associated with patients who are relatively bradycardic while in septic shock.

They found that relative bradycardia in patients with septic shock is associated with lower mortality, even after adjustment for confounding.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Sepsis Guidelines Resources Available

The 46th Critical Care Congress announced the release of the updated Surviving Sepsis Campaign guidelines (available in both Critical Care Medicine and Intensive Care Medicine).

Since Congress, various new resources related to the guidelines and sepsis care have become available:

If you were unable to attend this Congress session, you can see what you missed by watching Critical Connections Live: New Guidelines for the Management of Sepsis and Septic Shock, which brings you the full session along with commentary after the broadcast. Also available are the Surviving Sepsis guidelines presentation slides.

In the newly available iCritical Care podcast SCCM Pod-336 Surviving Sepsis Campaign Guidelines: 2016 Update, Ludwig Lin, MD, speaks with Mitchell M. Levy, MD, MCCM, about the release of the updated Surviving Sepsis Campaign guidelines.

Members and nonmembers alike can access the SCCM guidelines for free by downloading the Guidelines App. The new sepsis guidelines can also be found on the Surviving Sepsis Campaign App

The Society of Critical Care Medicine has endorsed the Statement on Maternal Sepsis released by the World Health Organization.

For additional resources related to the guidelines and sepsis care, check out the list below and visit www.survivingsepsis.org:

Congress Session Addresses Antibiotic Stewardship in Sepsis

A session during the 46th Critical Care Congress addressed balancing early antibiotic administration and stewardship in sepsis.

At the start of the session, Mitchell Levy, MD, MCCM, notes the importance of the topic. “Through the Surviving Sepsis Campaign … we’ve produced sepsis performance metrics, which have now been adopted nationally by [the Centers for Medicare & Medicaid Services]. They mandate rapid institution of appropriate antibiotics for all patients suspected of sepsis within the first hour.”

That’s the good news. The bad news, according to Dr. Levy, is that “we live in a time of serious concerns about antibiotics resistance.” He noted many people say “the performance measures may have… unintended deleterious consequences by driving antibiotics into patients that turn out later to not have infections. That’s often been used as the reason to not to adhere to or accept the performance measures.”

The Society of Critical Care Medicine has been collaborating with the Centers for Disease Control and Prevention (CDC) and has been in conversation with the American College of Emergency Physicians (ACEP) and the Infectious Diseases Society of America (IDSA) to address this issue.

“We’ve come to see how to balance this by marrying the rapid institution of appropriate antibiotics with antibiotic stewardship,” Dr. Levy said. Panelists discussed the drive to make early antibiotics effective while minimizing how long patients receive antibiotics.

Panelists took questions from the audience and debated several questions, including whether the goals of integrating antibiotic stewardship with the rapid treatment of severe sepsis and septic shock were mutually exclusive. The group discussed practical and lesser-known benefits of a robust antibiotic stewardship program, and how to balance rapid antibiotic choices while still protecting against antimicrobial resistance.

Panelists included Lauren Epstein, MD, from the CDC, Tiffany Osborn, MD, MPH, FCCM, FACEP, representing the ACEP, and Stephen Weber, MD, representing the IDSA. The session aimed to review coordination and staging of timely antibiotic administration and to recognize the impact that antibiotic resistance has in clinical medicine and sepsis.

Dr. Epstein, along with Surviving Sepsis Campaign founder, R. Phillip Dellinger, MD, MCCM, served as guest panelists during the Critical Connections Live broadcast on the New Guidelines for the Management of Sepsis and Septic Shock.

The updated Surviving Sepsis Campaign guidelines (available in both Critical Care Medicine and Intensive Care Medicine) were released during the 46th Critical Care Congress, along with a viewpoint and synopsis published in JAMA. Materials are available at www.survivingsepsis.org.

Affiliated materials released in conjunction with the guidelines include:

Culture Negative Severe Sepsis: Nationwide Trends and Outcomes

Although 28% to 49% of severe sepsis hospitalizations have been described as being “culture negative,” there are very limited data on the epidemiology and outcomes of those with culture negative severe sepsis (CNSS). The objectives of a study by Gupta et al were to investigate the proportion and trends of CNSS and its association with mortality.

They found that CNSS among hospitalized patients is common, and its proportion is on the rise. They also found that CNSS is associated with greater acute organ dysfunction and mortality.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Long-Term Quality of Life Among Survivors of Severe Sepsis

Severe sepsis currently accounts for 10% of all intensive care unit admissions and is the leading cause of death in U.S. hospitals. Studies have shown that sepsis survivors suffer from many long-term after-effects. Among survivors, mobility and the ability to perform daily activities tend to be limited and are used as markers of quality of life (QoL). However, these prior studies have been small and have not taken into account high burdens of chronic disease prior to sepsis admission. A study conducted by Yende et al is a secondary analysis of two international, randomized clinical trials (A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis [ACCESS] and PROWESS-SHOCK), with the aim of describing QoL in sepsis survivors. The two cohorts analyzed included only adults with severe sepsis who were fully functional and living at home prior to sepsis hospitalization.

They found that approximately one-third of patients (as described above) who survived hospitalization for severe sepsis had died at six months. A further one-third had not returned to independent living by six months.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Join the CDC in Marking Sepsis Awareness Month

In honor of Sepsis Awareness Month this September, the U.S. Centers for Disease Control and Prevention (CDC) has sponsored and/or promoted numerous events stressing the importance of detecting this life-threatening condition early and taking preventative measures.

Help to continue raising awareness by participating in the CDC’s webinar, Empowering Nurses for Early Sepsis Recognition, on Thursday, September 22, at 1:00 p.m. (CT).

Keep the conversation going on social media by using the following hashtag: #ThinkSepsis.

If you have not already done so, you are also encouraged to review resources related to the new sepsis definitions released earlier this year and to familiarize yourself with the Society of Critical Care Medicine’s Surviving Sepsis Campaign and its THRIVE initiative, which centers on addressing post-intensive care syndrome (PICS).

Join the CDC in Marking Sepsis Awareness Month

September is Sepsis Awareness Month, and the U.S. Centers for Disease Control and Prevention (CDC) is sponsoring and/or promoting numerous events to stress the importance of detecting this life-threatening condition early and taking preventative measures.

All events to be held in September dovetail nicely with a Vital Signs report released by the CDC late last month that centered on sepsis. The release of the report coincided with a related press conference held by the CDC that featured CDC Director Thomas R. Frieden and Mitchell Levy, MD, MCCM, FCCP, a founding and Executive Committee member of the Surviving Sepsis Campaign, discussing the report and emphasizing the importance of early identification.

Events in September include:

The 1st World Sepsis Congress – Thursday, September 8 and Friday, September 9
In 13 distinctive sessions, more than 70 speakers from more than 20 countries will give 10-minute keynotes and presentations on the number one preventable cause of death worldwide: sepsis. After each talk, the speakers will answer live questions from the audience.

Twitter Chat Centered on Sepsis – Tuesday, September 13, at 12:00 p.m. (CT)
The chat will feature Dr. Richard Besser of ABC News discussing sepsis. Dr. Richard Besser is the Chief Health and Medical Editor for ABC News. To participate, use #abcDrBchat.

CDC Webinar – Advances in Sepsis: Protecting Patients Throughout the Lifespan – Tuesday, September 13, at 2:00 p.m. (CT)

CDC Webinar – Empowering Nurses for Early Sepsis Recognition – Thursday, September 22, at 1:00 p.m. (CT)

Before, during and after the above events, you are encouraged to keep the conversation going on social media by using the following hashtag: #ThinkSepsis.

If you have not already done so, you are also encouraged to review resources related to the new sepsis definitions released earlier this year and to familiarize yourself with the Society of Critical Care Medicine’s Surviving Sepsis Campaign and its THRIVE initiative, which centers on addressing post-intensive care syndrome (PICS).

Participate in Twitter Chat Centered on Sepsis

You are encouraged to participate in a twitter chat on Tuesday, September 13, 2016, at 12:00 p.m. (CT) that will feature Dr. Richard Besser of ABC News discussing sepsis. Dr. Richard Besser is the Chief Health and Medical Editor for ABC News.

To participate, use #abcDrBchat. This chat is part of World Sepsis Day, which is on September 13.

If you have not already done so, you are encouraged to review resources related to the new sepsis definitions released earlier this year in advance of the twitter chat.

Participate in Journal Club Twitter Chat on Sepsis Definitions

The Society of Critical Care Medicine’s (SCCM) Social Media Task Force will host a Journal Club Twitter chat regarding the new sepsis definitions on Wednesday, June 22, 2016, from 10:00 a.m. to 11:00 a.m. Central Time. Special guest, SCCM President Todd Dorman, MD, FCCM, will be on hand as SCCM Social Media Task Force member Mary E. Lough, CCRN, CNS, PhD, RN, moderates.

Clifford S. Deutschman, MS, MD, FCCM, a lead author of the article, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), and Manu Shankar-Hari, MD, MSc, also an author on Sepsis-3, will discuss and take questions via Twitter about the article. Released in February by the Journal of the American Medical Association, this popular article has been viewed more than 1 million times, making it one of the top 5% research outputs ever tracked by Altmetric.

Dr. Shankar-Hari also offers insight into the processes of the Sepsis Definitions Task Force in Developing a New Definition and Assessing New Clinical Criteria for Septic Shock, of which he is the lead author.

These thought leaders will offer highlights for understanding Sepsis-3 and related clinical assessment, take questions via Twitter related to the material and offer additional resources. We expect robust discussion about the impact of Sepsis-3, items of clarification and thoughtful questions from the audience.

Come prepared with relevant questions and make sure to use #SCCMJC and #SepsisRedefined in your tweets.

What is a Twitter chat?
A Twitter chat is a live event on Twitter, moderated and focused around a general topic. To filter all the chatter on Twitter into a single conversation, a hashtag is used. A set time is also established.

Find your chat leaders.

– Follow these sepsis thought leaders on Twitter: @CDMD62 (Dr. Deutschman) and @msh_manu (Dr. Shankar-Hari)

– Follow these key contributors on Twitter: @SCCMPresident (Dr. Dorman) and @maryloughPhD_RN (Dr. Lough)

– Follow these organizations that will offer key content: @SCCM (Society of Critical Care Medicine) and @ESICM (European Society of Intensive Care Medicine)

How do you participate?
To participate, all you need to do is tweet during the designated time using the conversation hashtags #SCCMJC and #SepsisRedefined. It’s easiest to follow and participate at www.twubs.com/SCCMJC.

Join Us for a Journal Club Twitter Chat on Sepsis Definitions

Join us on Wednesday, June 22, 2016, from 10:00 a.m. to 11:00 a.m. Central Time for the SCCM Social Media Task Force’s Journal Club Twitter chat on the new sepsis definitions. Special guest SCCM President Todd Dorman, MD, FCCM, will be on hand as SCCM Social Media Task Force member Mary E. Lough, CCRN, CNS, PhD, RN, moderates.

Clifford S. Deutschman, MS, MD, FCCM, a lead author on the article, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), and Manu Shankar-Hari, MD, MSc, also an author on Sepsis-3, will discuss and take questions via Twitter about the article.

Since its release in February by the Journal of the American Medical Association, the sepsis definitions article has been viewed more than 1 million times, making it one of the top 5% research outputs ever tracked by Altmetric.

Dr. Shankar-Hari is also the lead author of Developing a New Definition and Assessing New Clinical Criteria for Septic Shock, which offers insight into the processes of the Sepsis Definitions Task Force.
These thought leaders will offer highlights for understanding Sepsis-3 and related clinical assessment, take questions via Twitter related to the material and offer additional resources. We expect robust discussion about the impact of Sepsis-3, items of clarification and thoughtful questions from the audience.

Come prepared with relevant questions and make sure to use #SCCMJC and #SepsisRedefined in your tweets.

What is a Twitter chat?
A Twitter chat is a live event on Twitter, moderated and focused around a general topic. To filter all the chatter on Twitter into a single conversation, a hashtag is used. A set time is also established.

Find your chat leaders.

– Follow these sepsis thought leaders on Twitter: @CDMD62 (Dr. Deutschman) and @msh_manu (Dr. Shankar-Hari)

– Follow these key contributors on Twitter: @SCCMPresident (Dr. Dorman) and @maryloughPhD_RN (Dr. Lough)

– Follow these organizations that will offer key content: @SCCM (Society of Critical Care Medicine) and @ESICM (European Society of Intensive Care Medicine)

How do you participate?
To participate, all you need to do is tweet during the designated time using the conversation hashtags #SCCMJC and #SepsisRedefined. It’s easiest to follow and participate at www.twubs.com/SCCMJC.

Register for Second Sepsis Redefined Webcast

Due to overwhelming interest in the original webcast, the Society of Critical Care Medicine (SCCM) will hold a second “Sepsis Redefined” webcast featuring the same content. Register today to reserve your spot on Tuesday, April 26, 2016, at 2:00 p.m. Central Time. Space is limited for this complimentary 90-minute webcast.

Moderated by Craig M. Coopersmith, MD, FACS, FCCM, this webcast will feature leading sepsis experts who will discuss the recently published The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) and a related response that has been provided by the Surviving Sepsis Campaign (SSC). Preparation for this webcast may include review of the primary Sepsis-3 manuscript available from the Journal of the American Medical Association and the SSC statement responding to Sepsis-3.

Clifford S. Deutschman, MS, MD, FCCM, and Mitchell M. Levy, MD, MCCM, FCCP, will explore such topics as the rationale for the new definitions of sepsis and septic shock, the quick Sepsis-Related Organ Failure Assessment (qSOFA) and how this definition might apply to bedside sepsis screening.

Learning Objectives

  • Understand The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) and related clinical assessment tools
  • Recognize the rationale behind the new definitions for sepsis and septic shock
  • Understand the relationship of the new sepsis definitions to bedside screening and treatment of sepsis patients

Register online today using your Customer ID and password. If you have any questions, please contact SCCM Customer Service at +1 847 827-6888.

Keep the discussion going on Twitter by using #SepsisRedefined. Join the #SepsisRedefined conversation group for updates on upcoming Twitter Chats on this topic.

This webcast is supported by the Gordon and Betty Moore Foundation.

Registration Open for Additional Sepsis Redefined Webcast

Registration is now open for the upcoming webcast, “Sepsis Redefined,” from the Society of Critical Care Medicine (SCCM). Due to the overwhelming popularity of the original webcast, a second webcast featuring the same content will take place on Tuesday, April 26, 2016, at 2:00 p.m. Central Time for those who were unable to attend.

Moderated by Craig M. Coopersmith, MD, FACS, FCCM, this webcast will feature leading sepsis experts who will discuss the recently published The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) and a related response that has been provided by the Surviving Sepsis Campaign (SSC). Preparation for this webcast may include review of the primary Sepsis-3 manuscript available from the Journal of the American Medical Association and the SSC statement responding to Sepsis-3.

Clifford S. Deutschman, MS, MD, FCCM, and Mitchell M. Levy, MD, MCCM, FCCP, will explore such topics as the rationale for the new definitions of sepsis and septic shock, the quick Sepsis-Related Organ Failure Assessment (qSOFA) and how this definition might apply to bedside sepsis screening.

Learning Objectives

  • Understand The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) and related clinical assessment tools
  • Recognize the rationale behind the new definitions for sepsis and septic shock
  • Understand the relationship of the new sepsis definitions to bedside screening and treatment of sepsis patients

This 90-minute webcast will take place Tuesday, April 26, 2016, at 2:00 p.m. Central Time.

Register online today using your Customer ID and password. Registration is complimentary. If you have any questions, please contact SCCM Customer Service at +1 847 827-6888.

Keep the discussion going on Twitter by using #SepsisRedefined. Join the #SepsisRedefined conversation group for updates on upcoming Twitter Chats on this topic.

This webcast is supported by the Gordon and Betty Moore Foundation.

Risk Factors for Readmission for Sepsis Survivors

Hospital readmission is common after sepsis, yet the relationship between the index admission and readmission remains poorly understood. Sun et al sought to examine the relationship between infection during the index acute care hospitalization and readmission and to identify potentially modifiable factors during the index sepsis hospitalization associated with readmission.

They confirmed that the majority of unplanned hospital readmissions after sepsis are due to an infection. They also found that patients with sepsis at admission who developed a hospital-acquired infection, and those who received a longer duration of antibiotics, appear to be high-risk groups for unplanned, all-cause 30-day readmissions and infection-related 30-day readmissions.

Read the full Concise Critical Appraisal by logging in to the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.