Episode 29 - Sepsis 2020: What Surgeons Need to Know
Oct 10, 2020
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Dr. Matt Martin, a retired army colonel and trauma care expert, joins Dr. Vanessa Ho, an accomplished associate professor and sepsis researcher. They dive into evolving definitions of sepsis and the importance of early detection. Discussion highlights include challenges in antibiotic selection, fluid management strategies, and the role of steroids in septic shock. They also explore innovative treatments and emphasize the necessity for tailored approaches in managing severe infections and the impact of recent studies on surgical sepsis.
Understanding the new Sepsis-3 definitions is essential for effective diagnosis and timely treatment, emphasizing organ dysfunction and infection evidence.
Early and appropriate antibiotic administration, alongside awareness of local resistance patterns, is critical in reducing mortality rates associated with sepsis.
A tailored approach to enteral feeding in septic patients, considering their catabolic state, can enhance nutritional outcomes and prevent complications.
Deep dives
The Importance of Sepsis Awareness
Sepsis is a significant concern in healthcare, with over 750,000 annual admissions in the United States. The conversation highlights shifts in the definition and understanding of sepsis, particularly through the transition from the SIRS criteria to the Sepsis-3 definitions, which emphasize the role of end-organ injury rather than merely relying on broad criteria. Current definitions require evidence of infection alongside organ dysfunction, complicating the clinical recognition for healthcare providers. Understanding these criteria is crucial for effective diagnosis and timely treatment, as early intervention is emphasized as a key to better patient outcomes.
Antibiotic Administration in Sepsis
In the management of sepsis, the importance of early and appropriate antibiotic administration is underscored, with a focus on broad-spectrum coverage. Time is of the essence, as delays in antibiotic initiation can significantly increase mortality rates. The discussion points out the evolving approach to antibiotic regimens, suggesting an empirical strategy that should include respective coverage for common pathogens while being aware of local resistance patterns. Moreover, it emphasizes the need for careful de-escalation once cultures return to better align treatment with the identified organisms.
Fluid Resuscitation and Vasopressor Use
Effective fluid resuscitation is paramount in treating septic shock, with crystalloid solutions being the first-line choice. The conversation also stresses the importance of monitoring patients dynamically to evaluate fluid responsiveness and make appropriate adjustments. Starting vasopressors, particularly norepinephrine, is essential when hypotension persists despite adequate fluid resuscitation, as it helps maintain organ perfusion. This proactive approach to hemodynamic support helps mitigate potential organ failures and solidifies the critical care team's role in rapid interventions.
Role of Nutrition in Critical Care
The initiation of enteral feeding in critically ill patients has garnered attention, especially regarding timing and caloric goals. While early enteral nutrition is important, patients in septic states require careful consideration due to their catabolic state, suggesting that lower calorie feeds may be beneficial initially. The discussion advocates for a tailored approach to nutrition, factoring in the patient's risk level and adjusting the nutritional support dynamically. Emphasizing the expertise of dietitians can enhance nutritional outcomes while preventing the complications associated with overfeeding.
Future Directions in Sepsis Management
The future of sepsis management looks towards enhanced diagnostics and more targeted therapies, potentially improving patient outcomes. The identification of different sepsis phenotypes may lead to more personalized treatment plans. Ongoing research into alternative therapies, such as hemoperfusion to remove inflammatory mediators, may provide additional tools for managing severe sepsis cases. The consensus among experts is that continuous adaptation to emerging evidence will be crucial in refining sepsis care and antibiotic stewardship.
In recognition of Sepsis Awareness Month, Dr. Matt Martin joins us once again on Rounds to discuss state-of-the-art sepsis management in 2020. Also joining us on Rounds is Dr. Vanessa Ho from MetroHealth Medical Center in Cleveland, Ohio, who authored a recently published review paper in Surgical Infections earlier this year, "Sepsis 2019: What Surgeons Need to Know".
