Do You Know How to Identify and Treat the Warning Signs of Sepsis?

A new push has begun for hospitals to be more aggressive in initiating treatment at the first sign of trouble in sepsis, the body’s life-threatening response to infection.

According to the Global Sepsis Alliance (GSA), sepsis affects approximately 750,000 Americans each year and costs the US healthcare nearly $1.7 billion. At an international sepsis conference sponsored by the Feinstein Institute for Medical Research, experts urged the medical community to “recognize sepsis as a medical emergency requiring the administration of fluids, antibiotics and other appropriate treatments of infection within one hour of suspicion of sepsis."

New research, they said in a statement, is needed to generate data demonstrating the efficacy of this approach and confirming sepsis as the common pathway to death and a leading cause of death worldwide.

"In the U.S., one in four hospital deaths is caused by sepsis, yet the majority of Americans have never even heard of the condition. Sepsis is a mystery to most Americans," said Kevin J. Tracey, MD, president of the Feinstein Institute. "The lack of awareness and understanding is one of the major challenges we face in health care today."

Although there is no EKG for sepsis, there are warning signs that physicians must be aware of, according to James O’Brien, MD, a critical care specialist at Ohio State University Medical Center. "Minutes matter," he said in an online article, adding that delays are too often "just an issue of not treating this like a medical emergency."

The earliest symptoms that indicate someone with an infection is sliding into sepsis are vague: patients often become often confused, experience shortness of breath, have an increased heart rate and lowered blood pressure, and feel weak.

So what can physicians do? Within an hour of suspicion of sepsis, start antibiotics and intravenous fluids, to counter the shock or low blood pressure. Every hour of delay lowers survival by nearly 8%, yet many hospitals do not get appropriate care started for four or even six hours, O'Brien said.

Physicians and nurses need to know that sepsis occurs more frequently in the young and the elderly, and in that many hospitals, it is the leading cause of death in non-coronary ICUs. In addition, anti-cancer drugs frequently render oncology patients susceptible to infection, and sepsis is a major cause of death in this population. While ICU physicians and nurses more often understand the risk of sepsis in seriously ill patients, healthcare professionals in other settings are often less aware and ill-prepared to recognize and deal with sepsis as a medical emergency.

Sepsis is under-recognized and poorly understood due a number of factors, including inadequate diagnostic tools, inconsistent application of standardized clinical guidelines to treat sepsis, and lack of documentation of sepsis as a cause of death on death certificates.

Experts, however, remain hopeful. “Available interventions can dramatically alter the course of sepsis and improve survival if administered within the first hour of suspicion of sepsis,” said Reinhart.

For more on this topic:

• International Organizations Declare Sepsis a Global Medical Emergency
• New clue to deadly sepsis as more aggressive care urged
• American Journal of Managed Care—Racial differences in severe sepsis outcomes may reflect hospital care

Do you think enough is being done to increase understanding and awareness of sepsis, both in the US and in other countries?