Tag Archives: Sepsis

Outcomes of Mandated Sepsis Bundles

It is a requirement in some hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. Therefore, Seymour et al set out to determine the association between the time until completion of the 3-hour bundle and risk-adjusted mortality.

They found that more rapid completion of the 3-hour bundle of sepsis care and rapid antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk-adjusted in-hospital 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.

Antibiotics for Treating Sepsis

Liaisons from the Society of Critical Care Medicine, Infectious Diseases Society of America, American College of Emergency Physicians, and the Society of Hospital Medicine recently released recommendations for the use of antibiotics for the treatment of sepsis.

Titled “Sepsis National Hospital Inpatient Quality Measure (SEP-1): Multi-stakeholder Work Group Recommendations for Appropriate Antibiotics for the Treatment of Sepsis,” the material was published in Clinical Infectious Diseases.

In this article, the work group promotes the appropriate use of antimicrobials to combat antimicrobial resistance and provides recommendations for appropriate antibiotics for the treatment of sepsis.

For more sepsis resources, visit www.survivingsepsis.org.

Sepsis Awareness Month

As part of Sepsis Awareness Month, the Global Sepsis Alliance and the World Health Organization are teaming up to host the World Sepsis Congress (WSC) Spotlight: Maternal and Neonatal Sepsis on September 12, 2017.

The WSC Spotlight is a free online congress in which 25 renowned experts from all around the world will give presentations on all aspects of maternal and neonatal sepsis, as well as give updates on sepsis in general.

For more information on the program, speakers, time zones, and to register for free, visit www.wscspotlight.org.

The U.S. Centers for Disease Control and Prevention (CDC) is also marking Sepsis Awareness Month, recently launching an initiative entitled Get Ahead of Sepsis that urges healthcare professionals, patients and caregivers to be alert to the symptoms, act fast if sepsis is suspected, and to prevent infections that can lead to sepsis. As part of this initiative, the CDC will be hosting the Get Ahead of Sepsis Twitter chat on September 12 at 12 p.m. ET. Join the conversation with #SepsisChat.

Also, if you have not already done so, you are also encouraged to review the new adult sepsis guidelines 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).

World Sepsis Congress

As part of Sepsis Awareness Month, the Global Sepsis Alliance and the World Health Organization are teaming up to host the World Sepsis Congress (WSC) Spotlight: Maternal and Neonatal Sepsis on September 12, 2017.

The WSC Spotlight is a free online congress in which 25 renowned experts from all around the world will give presentations on all aspects of maternal and neonatal sepsis, as well as give updates on sepsis in general.

For more information on the program, speakers, time zones, and to register for free, visit www.wscspotlight.org.

Also, if you have not already done so, you are also encouraged to review the new adult sepsis guidelines 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).

Resolution on Sepsis

On May 26, 2017, the World Health Organization (WHO) held its 70th World Health Assembly in Geneva, Switzerland. During this assembly, delegates agreed on a resolution to improve the prevention, diagnosis and treatment of sepsis, outlining these important actions for WHO:

  • Urge governments to strengthen policies and processes related to sepsis and emphasize the importance of reinforcing health worker training to more effectively diagnose and treat sepsis
  • Develop a report on sepsis and guidance for its prevention and management
  • Help countries develop the necessary infrastructure, laboratory capacity, strategies and tools to reduce the burden of sepsis
  • Assist developing countries in gaining access to quality, safe, efficacious and affordable sepsis treatments and tools for infection prevention and control

Learn more about this resolution on sepsis by visiting the WHO assembly website.

Sepsis and Therapeutic Interventions

The global burden of sepsis is substantial. Therefore, in a retrospective before-after clinical study, Marik et al compared the outcome and clinical course of consecutive septic patients treated with intravenous vitamin C, hydrocortisone and thiamine during a seven-month period (treatment group) at an intensive care unit (ICU) at Sentara Norfolk General Hospital compared to a control group treated (without intravenous vitamin C or thiamine) during the preceding seven months at the same ICU. The primary outcome was hospital survival.

The study’s results suggest that the early use of intravenous vitamin C, together with corticosteroids and thiamine, may prove to be effective in preventing progressive organ dysfunction and in reducing the mortality of patients with severe sepsis and septic shock.

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.

Hemodynamic Support Guidelines

The American College of Critical Care Medicine (ACCM) recently released guidelines addressing hemodynamic support of pediatric and neonatal septic shock.

Titled “American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock,” the material was published in the June 2017 issue of Critical Care Medicine.

This update of the 2007 ACCM guidelines is available for free download and includes major new recommendations such as the need to address hemodynamic support of septic shock at the institutional level.

Molecular Detection of Pathogens

Microbiological diagnosis of infections remains insufficient. The resulting empirical antimicrobial therapy leads to multidrug resistance and inappropriate treatments. Cambau et al therefore evaluated the cost-effectiveness of direct molecular detection of pathogens in blood for patients with severe sepsis, febrile neutropenia, and suspected infective endocarditis.

They found that the addition of molecular detection to standard care improves microbiological diagnosis and thus efficiency of healthcare resource usage in patients with 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.

Maternal Sepsis Webinar

Register today for a free webinar offering continuing education credits hosted by the Centers for Disease Control and Prevention (CDC) in partnership with the Society of Critical Care Medicine, the American Nurses Association, and the Association of Women’s Health, Obstetric & Neonatal Nurses. Leading sepsis experts will discuss the CDC’s recent sepsis Vital Signs and protocols for early recognition of maternal sepsis.

Featured speakers include:

  • Elizabeth Rochin, PhD, RN, NE-BC; Vice President of Nursing, Education and Practice; Association of Women’s Health, Obstetric and Neonatal Nurses
  • Seun Ross, DNP, MSN, CRNP-F, NP-C, NEA-BC; Director of Nursing Practice and Work Environment, American Nurses Association
  • Sean Townsend, MD; Vice President of Quality & Safety, California Pacific Medical Center
  • Lauren Epstein, MD, MSc; Medical Officer, CDC’s Division of Healthcare Quality Promotion
  • Katarina Lanner-Cusin, MD; Medical Director Women’s Services, Sutter Health, Alta Bates Summit Medical Center
  • Lori Olvera, DNP, RNC-OB, EFM-C; Bedside Nurse, Anderson Lucchetti Women’s and Children Hospital; Kaiser Permanente

Sepsis Standard Work: Improving Compliance with Early Recognition and Management of Perinatal Sepsis will take place on Wednesday, May 17, 2017, at 11:00 a.m. Eastern Time. Registration is complimentary for all participants. If you have any questions, please contact SCCM Customer Service at +1 847 827-6888.

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.