The Net Guide: Sepsis

MDNG Hospital Medicine, August 2010, Volume 4, Issue 4

Medical WebsitesNeonatal Sepsis

This teaching aid, provided by the National Neonatology Forum of India, comprises a power point presentation with an accompanying PDF that supplements the content contained within each slide. The teaching aid covers topics including early vs. late sepsis, clinical features, diagnosis, supportive care, antibiotic therapy, superficial infections and infection prevention, handwashing, and control of outbreak.

Link Code: h4350

The Educated PatientUnderstanding Sepsis

Produced by the International Sepsis Forum, Understanding Sepsis was designed and “written for family members who are trying to understand this common and devastating disease.” Available in Dutch, English, Spanish, Italian, Portuguese, German, French, and Japanese, “the booklet explains sepsis, severe sepsis, and septic shock, and various treatments and management techniques that may be used by physicians and other health care professionals in treating this disease.” Hospital units can request up to 10 copies by filling out a simple feedback form.

Link Code: h4351

Surviving Sepsis Campaign

SSC was created through the partnership of the European Society of Intensive Care Medicine, the International Sepsis Forum, and the Society of Critical Care Medicine and strives to “reduce mortality from sepsis via a multi-point strategy” that includes building awareness, improving diagnosis, education, developing guidelines of care, facilitating data collection, and more. The campaign itself has ended, but the “web site will remain an active resource through 2011 to provide information and resources for patients, healthcare professionals, and the general public.” Visit or direct your patients here while there’s still time to take advantage of this excellent resource.

Link Code: h4352

eAbstracts

Introduction of a Comprehensive Management Protocol for Severe Sepsis is Associated with Sustained Improvements In Timeliness Of Care And SurvivalJournal: Quality and Safety in Health Care (July 29, 2010)

Authors: MacRedmond R, Hollohan K, Stenstrom R, et al

Purpose: “This study investigates the effectiveness of a comprehensive management protocol for recognition and initial treatment of severe sepsis that spans from the emergency department to the intensive care unit.” This protocol involved “development of a management algorithm including early goal-directed therapy, a computerized physician order entry set for suspected sepsis, introduction of invasive hemodynamic monitoring and antibiotics stocked in the ED, and an extensive education campaign involving ED nurses and physicians.”

Results: After introduction of the protocol, investigators witnessed “significant improvements…in mean time to initiation of goal-directed therapy...and achievement of resuscitation goals…There was a trend towards more rapid administration of antibiotics” which decreased “crude hospital mortality rate.” The improvements had been sustained at 16-month follow-up.

Link Code: h4353

Impact of the Surviving Sepsis Campaign on the Recognition and Management of Severe Sepsis in the Emergency Department: Are We Failing?Journal: Emergency Medicine Journal (July 26, 2010)

Authors: Cronshaw H, Daniels R, Bleetman A, et al

Purpose: Despite ‘a concerted international effort to tackle” the problem of sepsis-related mortality “through the Surviving Sepsis Campaign (SSC),” bundle delivery remains problematic.” To assess this, researchers audited “recognition and management of patients presenting with severe sepsis/septic shock (SS) across three emergency departments within the West Midlands.”

Results: Investigators found that of 255 patients identified, only “17% were documented as septic by ED staff.” Overall, only 23% of patients with SS/SS received the College of Emergency Medicine standard of care. And though “89% of patients received the ‘treatment’ aspects of care…71% of patients with SS/SS had no documented discussion or consideration of referral to the intensive care unit.”

Link Code: h4354

Fluid Therapy in Septic ShockJournal: Current Opinion in Critical Care (August 2010)

Authors: Rivers E, Jaehne A, Eichhorn-Wharry L, et al

Purpose: “The role of fluid therapy in the pathogenesis of severe sepsis and septic shock,” was examined, as well as “the type, composition, titration, management strategies and complications of fluid administration [with] respect to outcomes.”

Results: “Early titrated fluid administration modulates inflammation, improves microvascular perfusion, and impacts organ function and outcome.” Researchers also found that though “fluid administration has limited impact on tissue perfusion during the later stages of sepsis and excess fluid is deleterious to outcome, the type of fluid solution does not seem to influence these observations.”

Link Code: h4355

Clinical TrialsEndothelium in Severe SepsisStudy Type: Observational

Age/Gender Requirements: 18 years (male/female)

Sponsor: Beth Israel Deaconess Medical Center

Purpose: Researchers posit that “severe sepsis is associated with endothelial dysfunction” which, “in turn, is predictive of subsequent organ failure and death.” Therefore, “adult patients with severe sepsis who are enrolled in the Protocolized Care for Early Severe Sepsis (ProCESS) trial” will receive “early, effective, protocol-directed resuscitation,” which researchers hope will “attenuate endothelial dysfunction leading to improved survival.”

Link Code: h4356

Immunomodulatory Properties of Ketamine in SepsisStudy Type: Interventional

Age/Gender Requirements: 21 years (male/female)

Sponsor: Beth Israel Deaconess Medical Center

Purpose: Researchers “hypothesize that ketamine will modulate the cytokine response to sepsis and reduce morbidity and mortality,” and accordingly will “assess the effect of a short-term infusion at analgesic dosage” compared with a normal saline placebo.

Link Code: h4357

Indicators of Inflammation and Coagulation in SepsisStudy Type: Observational

Age/Gender Requirements: 18 years (male/female)

Sponsor: University of Oklahoma

Purpose: Researchers will take blood samples “on the day of admission and on days 1, 3, and 7 thereafter” of patients “with the diagnosis of sepsis and other ICU patients;” the samples will be frozen and analyzed in order that researchers are able to “describe the course of different mediator levels and organ injury markers and follow their progression throughout the course of the study.”

Link Code: h4358

Online CMEThe Science and Medicine of Sepsis ManagementCredits: 1.50

Fee: None

Expires: March 20, 2012

Multimedia: Audio/Video/Slides

This CME’s creators designed the session to educate participants on “prognostic factors that determine clinical outcomes of patients with severe sepsis…epidemiology and causative factors of sepsis…pathophysiological and clinical impact of modulating TLR-derived signals…and emerging strategies for improving patient care and clinical outcomes.” Internet access is required for the duration of the program.

Link Code: h4359

Newswatch

New Mexico Prepared for New Rule for Reporting Healthcare-Associated Infections

New Mexico will begin reporting data on hospital-acquired infections later this year on a public website, according to the New Mexico Department of Health (DOH), with hospital-specific numbers expected in July of 2011. Though the effort is voluntary, New Mexico DOH spokeswoman Deborah Busemeyer says that of the more than 40 hospitals in the state, 17 “report the number of central-line bloodstream infections patients contracted in ICU wards,” while “25 facilities report on how many health care workers are vaccinated for influenza;” reporting on clostridium difficile and colon infection will being in November. In addition to increased attention to patient safety, participating hospitals may have a leg up on non-participants when hospitals are required to report medical errors and infections to the Department of Health and Human Services under healthcare reform legislation beginning in 2014.

Link Code: h43510

Pharma Focus

Vancocin (vancomycin)

eAbstracts

Understanding Pharmacokinetics/Pharmacodynamics in Managing Neonatal SepsisJournal: Current Opinion in Infectious Diseases (June 2010)

Authors: Lutsar I, Metsvaht T

Purpose: “This review describes recent pharmacokinetic and/or pharmacodynamic studies of antimicrobial agents used for treatment of neonatal sepsis.”

Results: Because “pharmacodynamic targets in adults and neonates with sepsis are likely similar” the authors posit that “extrapolations are possible.” Specifically regarding vancomycin, the authors indicate that “the pharmacokinetic/pharmacodynamic target area under the serum concentration curve (AUC)/MIC ratio of more than 400 is advocated for clinical effectiveness in adults, but with current dosing this will be achieved only if MIC is less than 2 mg/l. In other situations alternative agents are recommended.” The authors do realize, however, that though the proposed targets “are likely applicable to neonates…prior to recommending them for clinical application, more studies in septic neonates are required.”

Link Code: h43513