In this compelling episode of the FlightBridgeED Podcast, Dr. Michael Lauria delves into one of the most critical yet underappreciated aspects of emergency and critical care medicine: maternal sepsis and septic shock. As maternal mortality rates rise across the U.S., critical care transport providers are increasingly faced with the challenge of managing septic mothers and post-partum patients. Dr. Lauria, alongside special guest Dr. Elizabeth Garchar, MD, FACOG, an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a particular interest in obstetric critical care, breaks down the latest evidence and best practices for diagnosing and treating septic shock in obstetrical patients.

Explore the pathophysiology of sepsis, the role of cytokine release in organ dysfunction, and the management strategies for ensuring maternal and fetal well-being. Whether you're in pre-hospital care, the ICU, or critical care transport, this episode is packed with insights for all levels of healthcare providers.

Key Takeaways:

Early Sepsis Detection & Organ Impact: Sepsis isn't just about blood pressure. Inflammatory cytokines can cause brain dysfunction (septic encephalopathy), kidney damage, and even septic cardiomyopathy. Be vigilant with these patients.
Unique Obstetric Considerations: Pregnancy causes physiological changes that can mask early sepsis signs. Differentiating between normal pregnancy symptoms and systemic inflammatory response can be challenging but is crucial for survival.
Aggressive Management is Key: Whether it's antibiotics, fluid resuscitation, or early norepinephrine administration, aggressively managing septic obstetric patients can significantly improve outcomes.
Antibiotics First, Always: Ensure that septic patients receive broad-spectrum antibiotics within the first hour. It’s a key factor in preventing further deterioration.
Fluid Responsiveness: Use dynamic assessments to determine fluid responsiveness instead of blindly administering large amounts of fluid.
Pressors are Safe: Norepinephrine is a safe and recommended first-line vasopressor for septic pregnant patients. Don't hesitate to use it.

Listen anywhere you get your podcasts or directly from our website at flightbridgeed.com. While you’re there, be sure to explore our award-winning courses designed to elevate your critical care expertise.

---
References

1. Albright CM, Ali TN, Lopes V, Rouse DJ, Anderson BL. The Sepsis in Obstetrics Score: a model to identify risk of morbidity from sepsis in pregnancy. Am J Obstet Gynecol. Jul 2014;211(1):39 e1-8. doi:10.1016/j.ajog.2014.03.010

2. Barton JR, Sibai BM. Severe sepsis and septic shock in pregnancy. Obstet Gynecol. Sep 2012;120(3):689-706. doi:10.1097/AOG.0b013e318263a52d

3. Bauer ME, Bateman BT, Bauer ST, Shanks AM, Mhyre JM. Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis. Anesth Analg. Oct 2013;117(4):944-950. doi:10.1213/ANE.0b013e3182a009c3

4. Chau A, Tsen LC. Fetal optimization during maternal sepsis: relevance and response of the obstetric anesthesiologist. Curr Opin Anaesthesiol. Jun 2014;27(3):259-66. doi:10.1097/ACO.0000000000000077

5. Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-Related Mortality in the United States, 2011-2013. Obstet Gynecol. Aug 2017;130(2):366-373. doi:10.1097/AOG.0000000000002114

6. Dellinger RP, Rhodes A, Evans L, et al. Surviving Sepsis Campaign. Crit Care Med. Apr 1 2023;51(4):431-444. doi:10.1097/CCM.0000000000005804

7. Evans L, Rhodes A, Alhazzani W, et al. Executive Summary: Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock 2021. Crit Care Med. Nov 1 2021;49(11):1974-1982. doi:10.1097/CCM.0000000000005357

8. Fan S-R, Liu P, Yan S-M, Huang L, Liu X-P. New Concept and Management for Sepsis in Pregnancy and the Puerperium. Maternal-Fetal Medicine. 2020;2(4):231-239. doi:10.1097/fm9.0000000000000058

9. Guarino M, Perna B, Cesaro AE, et al. 2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department. J Clin Med. Apr 28 2023;12(9)doi:10.3390/jcm12093188

10. Guinn DA, Abel DE, Tomlinson MW. Early goal directed therapy for sepsis during pregnancy. Obstet Gynecol Clin North Am. Sep 2007;34(3):459-79, xi. doi:10.1016/j.ogc.2007.06.009

11. Joseph J, Sinha A, Paech M, Walters BN. Sepsis in pregnancy and early goal-directed therapy. Obstet Med. Sep 2009;2(3):93-9. doi:10.1258/om.2009.090024

12. Knowles SJ, O'Sullivan NP, Meenan AM, Hanniffy R, Robson M. Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study. BJOG. Apr 2015;122(5):663-71. doi:10.1111/1471-0528.12892

13. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. Jun 2006;34(6):1589-96. doi:10.1097/01.CCM.0000217961.75225.E9

14. Oud L, Watkins P. Evolving trends in the epidemiology, resource utilization, and outcomes of pregnancy-associated severe sepsis: a population-based cohort study. J Clin Med Res. Jun 2015;7(6):400-16. doi:10.14740/jocmr2118w

15. Plante LA. Management of Sepsis and Septic Shock for the Obstetrician-Gynecologist. Obstet Gynecol Clin North Am. Dec 2016;43(4):659-678. doi:10.1016/j.ogc.2016.07.010

16. Plante LA, Pacheco LD, Louis JM. SMFM Consult Series #47: Sepsis during pregnancy and the puerperium. Am J Obstet Gynecol. Apr 2019;220(4):B2-b10. doi:10.1016/j.ajog.2019.01.216

17. Sawyer RG, Claridge JA, Nathens AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. May 21 2015;372(21):1996-2005. doi:10.1056/NEJMoa1411162

18. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. Jun 2014;2(6):e323-33. doi:10.1016/S2214-109X(14)70227-X

19. Shields A, de Assis V, Halscott T. Top 10 Pearls for the Recognition, Evaluation, and Management of Maternal Sepsis. Obstet Gynecol. Aug 1 2021;138(2):289-304. doi:10.1097/aog.0000000000004471

20. Snyder CC, Barton JR, Habli M, Sibai BM. Severe sepsis and septic shock in pregnancy: indications for delivery and maternal and perinatal outcomes. J Matern Fetal Neonatal Med. Mar 2013;26(5):503-6. doi:10.3109/14767058.2012.739221

21. Timezguid N, Das V, Hamdi A, et al. Maternal sepsis during pregnancy or the postpartum period requiring intensive care admission. Int J Obstet Anesth. Jan 2012;21(1):51-5. doi:10.1016/j.ijoa.2011.10.009

22. van Dillen J, Zwart J, Schutte J, van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis. Jun 2010;23(3):249-54. doi:10.1097/QCO.0b013e328339257c

23. Wang T, Liao L, Tang X, Li B, Huang S. Effects of different vasopressors on the contraction of the superior mesenteric artery and uterine artery in rats during late pregnancy. BMC Anesthesiol. Jun 30 2021;21(1):185. doi:10.1186/s12871-021-01395-6

24. Xu S, Shen X, Liu S, Yang J, Wang X. Efficacy and safety of norepinephrine versus phenylephrine for the management of maternal hypotension during cesarean delivery with spinal anesthesia: A systematic review and m...

(Lower Intermediate) 你听过‘奥利给’吗？Chinese Internet Slangs 2020