Did this hospital really just drop sepsis infections by 75%?

CEC_Sepsis_Logo_HiRes_CMYKSepsis accounts for one-third to one-half of all deaths that occur in US hospitals, or between 225,000 and 350,000 deaths a year. That puts it right behind heart disease and cancer as a leading cause of death among Americans.

But we don’t hear much about it. Hospitals, ever wary of litigation, play it down. But at the recent convention: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) a paper was presented that will revolutionize the way we treat sepsis. The Dartmouth-Hitchcock Medical Center and the Centers for Medicare and Medicaid Services and a network of other medical centers got together to tackle the problem. 

Now, for self-reliant people this is interesting because we now know what to ask for when a loved one is admitted to hospital. We can’t perform the tests in a field environment, but as a general rule we can see that a broad-spectrum antibiotic (you should always have some in your SHTF first aid kit. Talk to an understanding doctor, and remember antibiotics do diminish with age) and lots of fluids can work where other remedies might not.

Here’s what they found:

  • taking a blood sample to measure lactate, a byproduct of turning blood sugar into energy. A high serum lactate level is a sign of severe metabolic distress
  • culturing the blood to identify infection
  • starting the patient on a broad-spectrum antibiotic
  • keeping him or her well hydrated
  • As our use of the three-hour bundle went from 0 percent to 90 percent over a three-month period, deaths from sepsis plummeted — in the first two months of the initiative, we had no deaths from sepsis.

Here’s the medical rationale:

Process  A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement (by 31 societies listed in the Acknowledgment).

Key Findings From Evidence Synthesis  Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant.

Recommendations  Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%. In out-of-hospital, emergency department, or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical of sepsis if they have at least 2 of the following clinical criteria that together constitute a new bedside clinical score termed quickSOFA (qSOFA): respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100 mm Hg or less.

Conclusions and Relevance  These updated definitions and clinical criteria should replace previous definitions, offer greater consistency for epidemiologic studies and clinical trials, and facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing sepsis.