Sepsis Alert

Early recognition of sepsis allows more effective treatment


      Before her tragic death, nothing about Mariana Bridi da Costa's remarkable life had been surprising.

   Her rise to fame in the world modeling and pageant communities was really no surprise--she was strikingly beautiful. In 2006, she had been voted one of the four most beautiful faces in the world. And nobody was surprised when she placed fourth at the 2008 Miss World pageant in Brazil.

   The surprise didn't begin until January 2009, when Mariana was admitted to the hospital for complications from a recent bladder infection. The surprises continued later that month when it was announced that doctors would remove her hands and feet in a desperate attempt to save her life. Surprise turned to shock on January 24, when it was announced that Mariana da Costa, the rising Brazilian star, was dead at the age of 20 from multiple organ failure.1 The underlying culprit was septic shock.2 Thousands attended the funeral, each asking some form of the same question: "How could such a thing happen?"

AT WAR WITH SEPSIS

   In truth, Mariana's case is neither rare nor isolated. The Mayo Clinic reports treating about 100 severe sepsis cases each year in otherwise young, healthy individuals. On average, one in four will die.3 Those numbers increase rapidly when we start adding at-risk patient populations to the equation. The very young, very old, those with recent surgeries, invasive procedures or illnesses and those with depressed immune systems have far greater infection and mortality rates.

   Nationwide, American hospitals are expected to treat approximately one million cases of severe sepsis in 2010. Of those patients, 30% will die within one month of diagnosis. An additional 20% will succumb over the next five months.4–6 By the time you finish reading this article, five more patients will have lost their lives to sepsis.

   That mortality rate is comparable to those of lung and breast cancer combined. It's also on par with the 28-day mortality rates of patients suffering acute myocardial infarctions in 1960.7 While the world medical establishment has attacked the AMI patient population with research, education and technology, sepsis remains a silent killer.

   It's also getting worse. Sepsis rates are predicted to rise at a rate of 1.5% a year. That will mean an additional million cases in the U.S. alone by 2020.8 But the silent killer at the bedside also presents a unique and exciting challenge to caregivers.

   The story of sepsis isn't all bad news. It's also a story of doctors looking for unique assessment tools to identify septic patients early. It's a story of aggressive treatment regimens that are showing promising results. And now it's a story that has come to the prehospital arena.

   When emergency room physician Wayne Guerra, MD, was tasked with standardizing in-hospital treatment of sepsis patients across the Adventist Division of the Centura Health hospital group in Colorado, he teamed up with John Riccio, MD, the local EMS medical director, to create a unique addition to area prehospital protocols: a one-of-a-kind prehospital sepsis alert program.

   The goal of the program is simple enough. "First we need to decide if we can identify these patients in the field," Riccio explains. "If we can't identify them, it's going to be hard to say we're making a difference. Second, does [identifying the sepsis patient] make a difference in their length of stay, complications, mortality, etc.?" It's a compelling question. But before we can address it, we need to answer an even more fundamental inquiry.

WHAT IS SEPSIS?

   Part of the challenge of addressing sepsis research and education is the lack of a clear answer to the question "What is sepsis?" Thankfully, the medical establishment is getting closer to a consensus. This lack of clear identification and treatment guidelines is part of the ongoing fight to reduce sepsis mortality.

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