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Sepsis
Severe sepsis (acute organ dysfunction secondary to infection) and septic shock (severe sepsis plus hypotension not reversed with fluid resuscitation) are major healthcare problems, affecting millions of individuals around the world each year, with a mortality rate of 25%-35%, and increasing in incidence. An estimated 90% of patients with sepsis are treated in critical care units, and therefore, critical care physicians frequently direct care for this patient population.
Our understanding of the pathophysiological mechanisms—many of them involving the immune system, signaling cascades, pathogen recognition interfaces, and inflammation amplification effects—that culminate in the sepsis syndrome has suggested novel approaches to therapy. A growing consensus within the community of sepsis experts and investigators have proposed that severe sepsis results from the inability of the immune system to mitigate bacterial spread during an ongoing infection; in turn, massive bacterial load overrides the inhibitory mechanisms controlling inflammation. With these issues in focus, this panel of critical care specialists will explore new developments, scientific concepts, and management strategies at the frontiers of sepsis care.
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38th Critical Care Congress: Monotherapy Vs Combination Antimicrobial Therapy of Sepsis
During this session, the controversial debate on whether or not combination antimicrobial therapy is more efficacious than monotherapy for gram-negative bacteremia is presented. Although there are theoretical advantages to combination therapy, the data from studies of patients with gram-negative bacteraemias have been conflicting.
- Dennis G. Maki, MD, examines the evidence that modern monotherpy is sufficient
- Anand Kumar, MD, FCCM, examines the evidence that combination therapy yields improved outcomes
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37th Critical Care Congress: The Cutting Edge of Sepsis Therapies
- Daniel Meldrum, MD, examines when and why to use beta-blockers in septic shock
- Sara S. Cheng, MD, presents on the use of anticoagulants in sepsis
- Jeffery S. Vender, MD, FCCM, discusses hemodynamic monitoring in sepsis
- Claudio Ronco, MD, assesses the role of hemofiltration in sepsis
- Jean-Louis Vincent, MD, PhD, FCCM, presents an evidenced-based approach to sepsis
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37th Critical Care Congress: Selected Controversies in Sepsis Therapy in the PICU
- Jerry J. Zimmerman, MD, PhD FCCM, evaluates the role of steroid use in pediatric sepsis
- Vinay M. Nadkarni, MD, FCCM, discusses the approach to tight glycemic control in critically ill children
- Mark R. Rigby, MD, PhD, reviews the mechanisms and effects of tight glycemic control in children
- Joseph A. Carcillo, MD, describes the application of goal-directed therapy to pediatric septic shock
Elizabeth A. Farrington, PharmD, reviews current information on the use of vasopressin in pediatric septic shock
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37th Critical Care Congress: Hemodynamic Support of Sepsis
- Judith Jacobi, PharmD, FCCM, reviews the rationale for using various fluid products during the resuscitation of the septic patient, including the use of crystalloids versus colloids versus blood products
- Emanuel Rivers, MD, MPH, further explains early goal-directed therapy interventions for the patient with sepsis and how early treatment can reduce mortality
- Jean-Louis Vincent, MD, PhD, FCCM, discusses the results from clinical trials assessing the adequacy of resuscitation in the septic patient
- James Russell, MD, compares the rationales for vasopressin and norepinephrine in septic shock
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Guidelines
Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock 2008 [published correction appears in Crit Care Med 2008; 36(4):1394-1396]. Crit Care Med 2008: 36(1):296-327.
Surviving Sepsis Campaign Statement on Glucose Control in Severe Sepsis (June, 2009)
Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 2004 September 32(9):1928-1948
Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 2002 June 30 (6):1365-1378
Guidelines for the management of intravascular catheter-related infections
Clin Inf Dis 2001 32:1249-1272
Guidelines for the prevention of intravascular catheter-related infections
MMWR 2002 (RR-10):1-29
Supplements
Introduction to the Fifth Margaux Conference on Critical Illness: Protein C pathways: Bedside to bench (includes protein C in sepsis). CCM May 2004, Volume 32, Issue 5
Introduction to the Second Margaux Conference on Critical Illness Sepsis: Interface Between Inflammation, Coagulation, and the Endothelium. CCM July 2001, Volume 29, Issue 7 Supplement 1
1st International Sepsis Forum on Sepsis in Infants and Children. PCCM: May 2005, Volume 6, Issue 3
Early Goal-Directed Therapy in the Emergency Department. Early recognition and immediate action are key factors in resuscitating patients with severe sepsis or septic shock. Learn the vital role the emergency department plays in treatment for these patients. Critical Connections, August 2006
The Pharmacologic Horizon of Sepsis Therapy (available in print)
While there are several antisepsis drugs in the pipeline, the soonest the healthcare community can expect a new product is 2009. Discover which drugs are in development and what practitioners can concentrate on in the meantime. Critical Connections, August 2006
Publications
Septic Shock adult Critical Care Refresher Course – 2006.
Septic shock is defined as a failure of the circulatory system to maintain effective tissue perfusion, resulting in cellular dysfunction and acute organ failure. Unless effective tissue perfusion is promptly restored, the cellular dysfunction and organ failure may become irreversible. When shock develops because of a systemic inflammatory response to infection, it is termed septic shock.
Click here to view the entire chapter Septic Shock.
 For more information on caring for the critically ill or injured patients, the publication Septic Shock is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.
New Developments in the Management of Septic Shock and Multiple Organ Failure in Infants and Children. Pediatric Critical Care Refresher Course. 2006
The greatest breakthrough in improving outcomes in septic shock has been the realization of the simple concept that outcome is time-dependent on resuscitation. Newborn septic shock is frequently complicated by pulmonary hypertension. Children with fluid refractory shock can have any hemodynamic state. Children and infants have an age-specific resistance to dopamine and dobutamine. Hence, epinephrine (cold shock) and norepinephrine (warm shock) can be more commonly required.
Click here to view the entire chapter New Developments in the Management of Septic Shock and Multiple Organ Failure in Infants and Children.
For more information on caring for critically ill and injured patients, the publication Current Concepts in Pediatric Critical Care is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.
Sepsis/Systemic Inflammatory Response Syndrome. Pediatric Multiprofessional Critical Care Review. 2006
Management of a patient with Septic Shock embodies the discipline of pediatric critical care medicine. The typical patient with septic shock has simultaneous derangements of cardiovascular function, intravascular volume status, respiratory function, immune/inflammatory regulation, renal function, coagulation, hepatic function, and/or metabolic function. The degree to which any of these derangements are manifest in a given patient population is highly variable and influenced by multiple host and nonhost factors including developmental stages, the presence or absence of co-morbidities, the causative agent of septic shock, the host’s immune/inflammatory state, and the host’s genetic background. These factors combine, in turn, to profoundly influence the ultimate outcome of septic shock.
Click here to view the entire chapter Sepsis/Systemic Inflammatory Response Syndrome.
 For more information on caring for critically ill and injured patients, the publication Pediatric Multiprofessional Critical Care Review is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.
 PCCM: The 1st International Sepsis Forum on Sepsis in Infants and Children with Dr. Adrienne Randolph
Adrienne Randolph, MD, MSc, served as guest editor for the May 2005 supplement to Pediatric Critical Care Medicine. Dr. Randolph shares her thoughts on the importance of the 1st International Sepsis Forum on Sepsis in Infants and Children and the Pediatric Acute Lung Injury and Sepsis Investigator’s (PALISI) Network. She also highlights the most important aspects from the supplement, which she played such an instrumental role in producing. (Pediatr Crit Care Med 2005 Vol. 6, No. 3 (Suppl.)
SCCM Pod-22 Early Indicators of Sepsis Survival
Mitchell Levy, MD, FCCM, and Jean-Louis Vincent, MD, PhD, FCCM, discuss their article in the October issue of Critical Care Medicine. The article, "Early Changes in Organ Function Predict Eventual Survival in Severe Sepsis," can help clinicians identify variables associated with good outcomes in sepsis. The authors explain that if patients with sepsis are not getting better at the end of 24 hours, they may be getting worse. (Critical Care Medicine, Volume 33(issue 10) October 2005 pp 2194-2201).
SCCM Pod-24 Implementing the Surviving Sepsis Campaign
Michael Gropper, MD, PhD, is director of critical care medicine for the University of California San Francisco Medical Center and professor of medicine and anesthesiology at the medical school. He is one of the many healthcare professionals who have found success in implementing the Surviving Sepsis Campaign guidelines and discusses the strategies for implementation as well as the challenges his institution faced.
SCCM Pod-27 CCM: Dopamine's Influence on the Outcome of Shock
Jean-Louis Vincent, MD, PhD, FCCM, discusses an article from the March issue of Critical Care Medicine, "Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study." (Critical Care Medicine, Volume 34, Number 3, March 2006, pp 589-597.)
SCCM Pod-31 CC: Prophylactic Antimicrobial Use in the ICU
Phil Barie, MD, MBA, FCCM, discusses his article from the April edition of Critical Connections on antibiotic prophylaxis. He addresses when this therapy is most useful as well as the consequences of overuse. Dr. Barie is professor of surgery and public health at Weill Medical College of Cornell University in New York City, and he sits on the executive committee of the Society of Critical Care Medicine. (Crit Conn 2006 Vol.5 No.2)
SCCM Pod-39 CC: Revising the Surviving Sepsis Guidelines
Phillip Dellinger, MD, FCCM, professor of medicine at Robert Wood Johnson Medical School and director of the critical care section at Cooper University Hospital, and Roman Jaeschke, MD, a clinical professor at McMaster University discuss an article published in the August issue of Critical Connections. The article, "Revising the Surviving Sepsis Guidelines: A Closer Look," details the guideline revision process. (Crit Conn 2006 Vol.5 No. 4)
SCCM Pod-49 Responding to NEJM's Article on the SSC
Mitchell Levy, MD, FCCM, discusses a perspectives article published in the October 19, 2006, issue of the New England Journal of Medicine, titled "Surviving Sepsis—Practice Guidelines, Marketing Campaigns, and Eli Lilly," which criticizes the campaign and its major funding source, Eli Lilly.
SCCM Pod-51 SCCM Members Launch Major Sepsis Study
Derek Angus, MD, MPH, discusses a new, multicenter research consortium, called Protocolized Care for Early Septic Shock (ProCESS). The consortium is beginning a large-scale study to determine whether specific interventions can halt the progression to severe sepsis and septic shock. Dr. Angus along with SCCM members Mitchell Fink, MD, and Donald Yealy, MD, will lead a team of intensive care unit and emergency department personnel. The study is likely to offer valuable insight on the best ways to treat sepsis and the value of early goal-directed therapy. Dr. Angus is vice chairman of research for the University of Pittsburgh School of Medicine's critical care department.
SCCM Pod-77 CCM: Sepsis Bundles Associated With Decreased Mortality
H. Bryant Nguyen, MD, associate professor of emergency medicine at Loma Linda University in California, discusses an article published in the April 2007 edition of Critical Care Medicine, Implementation of a Bundle of Quality Indicators for the Early Management of Severe Sepsis and Septic Shock is Associated with Decreased Mortality.(Crit Care Med. 2007;35(4):1105).
For additional information on sepsis, please visit: www.survivingsepsis.org
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