JOURNAL OF CRITICAL CARE
Most cases of sepsis or septic shock are present on admission (POA). However, there is a second sepsis population of patients who develop sepsis or septic shock while hospitalized. Using electronic health record data, the study authors built predictive models to identify patients with sepsis POA vs sepsis onset postadmission (OPA). In this study, 77% to 93% of sepsis diagnoses were POA, with an average mortality rate of 12%. The sepsis OPA group represented 7% to 23% of diagnoses with an average 35% mortality rate. This study validates the presence of two distinct sepsis populations who likely have significant differences in mortality risk.
JOURNAL OF CRITICAL CARE
Protocols for early sepsis care or “sepsis bundles” exist at most hospitals and have been shown to improve patient outcomes. This multicenter, retrospective, cohort study showed that patients with hospital-onset sepsis (HOS) were less likely to receive SEP-1 adherent care than patients with community-onset sepsis. In addition, patients with HOS in the ICU were more likely to receive SEP-1 adherent care than patients in a ward. Given the increase in mortality observed in patients with HOS, much work still needs to be done to determine why performance of SEP-1 bundle elements is lower in this population and how adherence to the bundle affects outcomes.
JOURNAL CHEST®
Hospitalized patients who develop septic shock are often first recognized by rapid response teams (RRTs). In this multicenter study of inpatients assessed by an RRT for clinical deterioration with suspected infection, 24.5% of patients met Sepsis-3 septic shock criteria. Compared with patients who met systemic inflammatory response syndrome-based criteria for sepsis, patients meeting Sepsis-3 septic shock criteria had increased in-hospital morality (40.9%) and likelihood of discharge to long-term care (66.3%). This study supports the use of Sepsis-3 septic shock criteria for prognostication in hospitalized patients who become critically ill.
NEW ENGLAND JOURNAL OF MEDICINE
Restricting fluids in favor of early vasopressor does not pay. This multicenter study showed that prioritizing vasopressor over fluid resuscitation in adult patients with hypotensive sepsis in the ED did not decrease rates of 90-day mortality, mechanical ventilation, or renal replacement therapy, although one group did show an increase in ICU admissions. The study was halted at the second interim analysis for futility
NEW ENGLAND JOURNAL OF MEDICINE
In multicenter study of adult patients in the ICU receiving vasopressor therapy, restricting fluids showed no differences in 90-day mortality, serious adverse events, days alive without life support, and days alive out of the hospital compared with continuing fluids. These results support the findings of a recent systematic review and meta-analysis published in the journal CHEST examining fluid volumes in the management of sepsis (10.1016/j.chest.2019.11.050).
JAMA INTERNAL MEDICINE
Does early use of broad-spectrum antibiotics increase antibiotic use and abuse in sepsis? This observational study showed that decreasing the time to administration was not associated with increases in overall antibiotic use, days of use, or the broadness of antimicrobial coverage. However, mortality and hospital length of stay did decrease with the earlier antibiotic timing.
JAMA SURGERY
Don’t forget source control in sepsis. In this observational cohort study of patients undergoing early (<6 hours) or late (6-36 hours) source control from sepsis onset, early source control was associated with a decreased odds for mortality. Compared with 6 hours, 90-day mortality with source control at 3 hours was reduced by 0.5%, but increased by 1% at 12 hours, 3% at 24 hours, and 5% at 36 hours.
CRITICAL CARE MEDICINE
Read the full recommendations from the Surviving Sepsis Campaign, including updates to the 2016 recommendations and guidance on everything from antibiotic stewardship to ventilation and palliative care.
CRITICAL CARE MEDICINE
Review highlights and key details from the Surviving Sepsis Campaign recommendations for the care of patients with sepsis and septic shock.
INTENSIVE CARE MEDICINE
This study utilizes machine learning to identify and prioritize guidelines from the Surviving Sepsis Campaign into an optimal bundle of recommendations that minimize 28-day mortality among patients with sepsis and septic shock.
CRITICAL CARE MEDICINE
Identifying patients with infection who would benefit from early treatment is integral to providing tailored interventions. This study investigates clinical predictors of time-to-antibiotics and explores the effects of delays in treatment.