Sepsis Challenges

In ICUs worldwide, hospital‐acquired sepsis is a frequent adverse outcome with high mortality (exceeding 40%) and increased length of stay.

There is urgent need to improve the implementation of global and local infection prevention and control strategies to reduce the burden of healthcare‐associated infections, as well as approaches for their early diagnosis and adequate treatment to prevent a progression to sepsis complications.¹

The Global Burden of Sepsis

According to a recent study of global deaths in 2017:

50M

Contracted
Sepsis²

10M

Died of
Sepsis

2.9M

Were Under
Age Five

Per CDC, in a typical year:

270K

Die of Sepsis
in the US

1 in 3

Hospital Deaths
Have Sepsis

87%

of Sepsis Cases Start Outside the Hospital

ScvO2 Monitoring Utility for Sepsis

It may be argued that changes in venous saturations may occur rapidly, particularly in haemodynamically instable patients, and that discontinuous spot measurements by drawing intermittent blood samples may miss these changes. Accordingly, continuous measurement of SvO2 in septic shock patients revealed a higher frequency of short-term changes in SvO2 in nonsurvivors.³
The use of venous oxygen saturations seems especially useful in the early phase of disease or injury.³
High ScvO2 values may thus represent an inability of the cells to extract oxygen or micro- circulatory shunting in sepsis.⁴
Global tissue hypoxia as a result of systemic inflammatory response or circulatory failure is an important indicator of shock preceding multiple organ dysfunction syndrome.³
The development of multiple organ dysfunction syndrome predicts the outcome of the septic patient.⁵

Sepsis & Septic Shock Management⁶

Patients with sepsis and septic shock require admission to the hospital. Initial treatment includes support of respiratory and circulatory function, supplemental oxygen, mechanical ventilation, and volume infusion.

Treatment of patients with septic shock has the following major goals:

Start adequate antibiotics (proper spectrum and dose) as early as possible
Resuscitate the patient from septic shock by using supportive measures to correct hypoxia, hypotension, and impaired tissue oxygenation (hypoperfusion)
Identify the source of infection and treat with antimicrobial therapy, surgery, or both (source control)
Maintain adequate organ system function, guided by cardiovascular monitoring, and interrupt the progression of MODS

Management principles for septic shock include the following:

Early recognition
Early and adequate antibiotic therapy
Source control
Early hemodynamic resuscitation and continued support
Proper ventilator management with low tidal volume in patients with acute respiratory distress syndrome (ARDS)

References:

Markwart R, et al, Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis Intensive Care Med (2020) 46:1536–1551.
Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, Colombara DV, Ikuta KS, Kissoon N, Finfer S et al (2020) Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet 395(10219):200–211.
van Beest et al. Critical Care 2011, 15:232. http://ccforum.com/content/15/5/232
Ince C, Sinaasappel M: Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med 1999, 27:1369-1377.
Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2008, 34:17-60.
https://emedicine.medscape.com/article/168402-treatment