A systems approach to the early recognition and rapid administration of best practice therapy in sepsis and septic shock

Abstract

The institution of a rapid response system for the detection and treatment of septic shock requires a multidisciplinary approach. The infrastructure to create such a system must be facilitated by administrators and implemented by front-line healthcare providers. Continuous assessment of the outcome benefit of such a system by a quality assurance team is the final part of a truly integrated approach to sepsis treatment.

Can a Computerized Sepsis Screening and Alert System Accurately Diagnose Sepsis in Hospitalized Floor Patients and Potentially Provide Opportunities for Early Intervention? A Pilot Study

“…Sepsis management is time-sensitive. Most evidence-based recommendations require rapid implementation to influence most significantly patients' outcomes [3,9,12]. Management delays due to lack of recognition can be detrimental.…”

“…To facilitate their implementation, evidence-based practice guidelines from the Severe Sepsis Campaign recommend several interventions in the first 6 h, the sepsis resuscitation bundle, and other interventions within 24 h, the sepsis management bundle [3]. The sepsis resuscitation bundle includes serum lactate measurement to detect shock and risk-stratify patients [4][5][6][7], drawing blood cultures followed by administering appropriate antibiotics [5,[8][9][10] and administering early and adequate intravenous fluids for signs of end-organ hypoperfusion [3,4,6,[11][12][13]. These interventions are time-sensitive and must be instituted early to achieve better outcomes [3,9,11,12].…”

Management of sepsis: from evidence to clinical practice

“…Clinicians should focus their attention on other signs of vitality such as respiratory rate, SaO 2 , level of consciousness, capillary refill, urinary output and lactic acid level. 147 Almost all of these signs can be assessed in few minutes. Respiratory rate and capillary refill lack specificity, but they are both very sensitive in identifying patients at risk.…”

CVP vs. dynamic hemodynamic parameters as preload indicators in hemodynamically unstable patients after major surgery

“…However, the intervention is not possible without a proper assessment of the regional and peripheral tissue perfusion where adequate hemodynamic monitoring plays a crucial role. Hemodynamic optimization is a cornerstone in the management of critically ill patients and associated with improved outcome in the perioperative and intensive care setting (2,3). In hemodynamic optimization, fluid loading is considered the first step in the resuscitation and therefore the primary question is to assess the preload and whether the patient is volume responsive.…”