Recently, we’ve been making a number of important updates to the content of our Sepsis app that we would like to briefly review here. These updates have been made to the English version of the Sepsis app and will soon be made to the Spanish version in the coming days.
First, we have updated the definitions of sepsis and septic shock to reflect the new Sepsis-3 definitions recently issued by SCCM and ESICM at the 45th Annual Critical Care Congress in Feb. 2016. Important changes include the removal of the SIRS criteria from the definition of sepsis and its replacement with the SOFA score, and a new rapid assessment score called quick-SOFA (qSOFA). The “severe sepsis” designation has also been removed since its criteria are now essentially integrated into the basic sepsis definition. The new definitions can be found in the app’s Diagnosis chapter under “Definitions and Diagnostic Criteria.” The previous definitions and criteria have been left in the app for reference. A quick-SOFA tool has been added to the Calculators section of the app.
Secondly, we have updated a number of management steps to reflect the results of the important ARISE, ProCESS and ProMISe trials. These trials compared mortality and other clinical and cost outcomes in septic patients treated with EGDT vs. usual therapy in Australia/New Zealand, the US and the UK, respectively. All 3 studies found that although EGDT leads to more intensive treatment and use of resources, it is not superior to usual care in reducing mortality at 90 days. ProMISe also found that EGDT is not cost-effective at 1 year. Another take-home point, emphasized by ProCESS investigators, is that central hemodynamic and oxygenation monitoring using a central line does not improve outcomes, and therefore, other noninvasive methods of assessing volume and oxygenation status should be considered. These findings are partially reflected in the new Sepsis-3 definitions and criteria. Changes to the app’s content have been made in the Management section and elsewhere to reflect these updates. Summaries of these studies and their key findings can be found in the Resources chapter of the app under “Sepsis Clinical Trials.”
Lastly, a new section titled ‘The Human Cost of Delaying Effective Antibiotic Treatment” has been added to the Management section of the Sepsis app. We would like to thank Dr. Anand Kumar, MD, a leading sepsis expert from the University of Manitoba, for providing the content for this section and helping us integrate it into the app. This section summarizes the findings of several studies conducted by Dr. Kumar that demonstrated the critical importance of timely effective antibiotic treatment. With each passing hour of delay in administering correct antibiotics after hypotension onset in septic shock, survival decreases nearly 10%, to 50% by 6 hours and to 10-20% by 24 hours (a 2006 study estimated that 24-hour delays in administering antibiotics in septic shock caused approx. 35,000 preventable deaths in the U.S.). Other significant findings included a 5-fold decrease in survival if the wrong antibiotic is initially administered, a 4-fold increase in mortality if sources are not controlled, and a very low survival of 20% from sepsis due to fungal and yeast infections as these pathogens tend to be poorly recognized and treated. Although some of these outcomes have improved in developed countries since publication of these studies as sepsis awareness has grown and hospitals have instituted stricter sepsis guidelines, these issues remain serious problems in many parts of the world and continue to cause a great deal of preventable morbidity and mortality.
Thank you for your continued use of the Sepsis app and we hope it is helping you in your everyday clinical practice. If you have any questions, comments or suggestions please reach out to us at firstname.lastname@example.org. And if you haven’t done so already, please take a moment to rate and review our app in the Google Play and iTunes app stores, your reviews and ratings are very important to us.
Daniel Nichita, MD
The ESCAVO Team