Sepsis

What is sepsis?

Septic shock occurs when abnormalities in the circulation, cells or metabolism are so severe that they increase the risk of mortality. This can be identified by persistent hypertension that requires vasopressors to maintain arterial pressure and serum lactate levels. With these criteria, and even with the necessary volume replenishment,  hospital mortality rates are over 40%.

Symptoms

Sepsis arises from an infection which changes the body and unleashes signs that may be associated with organic dysfunction or systemic hypoperfusion. These symptoms are:

• Change in consciousness
• Increased/decreased heart rate
• Arterial hypertension
• Reduced oxygen saturation
• Hyperthermia
• Hypothermia

Who does sepsis affect?

Every year there are on average 212.7 sepsis patients for every 100,000 citizens in the Catalan healthcare system. To be precise, between 2008 and 2012, 82,300 people were diagnosed with severe sepsis and in 2012 there were 20,228 recorded cases.

At Vall d’Hebron, 232 patients were admitted to Intensive Care with this condition in 2010, amounting to 25.2% of all admissions to this department.

Diagnosis

The following diagnostic tests are used for sepsis:

• Blood test with haemogram, haemostasis, biochemistry profile, biomarkers, arterial balance and biological samples in cultures according to the suspected diagnosis.
• Radiological tests
• Bedside screening
• Definitive diagnosis

Typical treatment

Early treatment can improve prognosis. Sepsis Coding is used for this reason:

• Fitting two short large-calibre IV lines.
• In the event of hypertension or high lactate, resuscitation is started with crystalloid fluids.
• Antibiotics administered within an hour of detecting sepsis.
• Oxygen supply.
• Source control in the first six hours after diagnosis.
• Monitoring and reassessing response to treatment.
• ICU support for the different organic dysfunctions.

Prevention

To prevent this condition, early detection of patients with a history suggestive of infection and organic dysfunction is vital. In some cases, vaccination is necessary.