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

Abstract

The early recognition and treatment of sepsis is paramount to reducing the mortality of this disease. However, unlike trauma, stroke or acute myocardial infarction, the initial signs of sepsis are subtle and easily missed by clinicians. Thus, hospital-based systems are needed to identify and triage patients who might be septic. This review focuses on the early diagnosis of sepsis and the implementation of a systems-based approach to help coordinate the identification and treatment of patients with this disease. Alterations in traditional hemodynamic parameters, such as blood pressure and heart rate, are poor predictors of the presence of septic shock. Other more subtle findings (such as the 10 signs of vitality) are stronger determinants of poor tissue perfusion in a patient who may be septic. Early detection of a patient who is 'in trouble' on the ward by bedside nurses or physicians and activation of a medical emergency team has been shown to improve outcome. By coupling the medical emergency team with early goal-directed therapy, patients with sepsis can be discovered earlier and have therapy instituted within the so-called 'golden hour', first appreciated with trauma care. 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.