From the Guidelines
Patients with severe sepsis or septic shock require the most urgent transport to the hospital, as they are at a higher risk of morbidity and mortality if not treated promptly. According to the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 1, sepsis and septic shock are medical emergencies that necessitate urgent assessment and treatment. The guidelines recommend that treatment and resuscitation begin immediately, with at least 30 mL/kg of IV crystalloid fluid given within the first 3 h for patients with sepsis-induced hypoperfusion.
Key stages of sepsis that require rapid transport to the hospital include:
- Severe sepsis, characterized by organ dysfunction such as altered mental status, decreased urine output, or respiratory distress
- Septic shock, characterized by persistent hypotension despite fluid resuscitation, with a target mean arterial pressure (MAP) of 65 mm Hg for patients requiring vasopressors 1 During transport, it is essential to maintain airway patency, provide supplemental oxygen to maintain saturation above 94%, establish IV access for fluid resuscitation with crystalloids, and continuously monitor vital signs. Early recognition and rapid transport are critical, as each hour delay in appropriate antibiotic therapy increases mortality by approximately 8% 1.
The "golden hour" concept applies to sepsis, with early intervention significantly improving outcomes. Therefore, rapid transport to the hospital is crucial for patients with severe sepsis or septic shock, as it enables prompt treatment and resuscitation, which can significantly improve morbidity, mortality, and quality of life.
From the Research
Stages of Sepsis Requiring Rapid Transport to Hospital
The following stages of sepsis require rapid transport to a hospital:
- Severe sepsis: characterized by sepsis associated with acute organ dysfunction 2, 3
- Septic shock: implies severe sepsis that has led to circulatory shock refractory to fluid resuscitation alone 2, 4
- Sepsis with significant morbidity: patients with shock due to sepsis have circulatory and cellular and metabolic abnormalities that lead to a higher mortality 5
Key Considerations for Rapid Transport
Key considerations for rapid transport to a hospital include:
- Early recognition of sepsis and its stages 4, 6
- Immediate approach to severe sepsis following the ABCs of resuscitation: Airway, Breathing, and Circulation 2
- Efforts to uncover the source and empirically yet accurately treat the infective underpinnings of severe sepsis 2
- Addressing each of the patient's other organ systems at risk, including Renal/metabolic, gastrointestinal, hematological, and endocrine 2, 5
Organ Dysfunction in Sepsis
Organ dysfunction in sepsis can manifest in various ways, including:
- Cardiovascular dysfunction: vasodilation, reduced cardiac output, and hypotension/shock requiring fluids, vasopressors, and advanced hemodynamic monitoring 5
- Respiratory dysfunction: may require mechanical ventilation and attention to volume status 5
- Renal dysfunction: a frequent manifestation of sepsis 5
- Hematologic dysfunction: low platelets and either elevation or reduction of leukocytes 5
- Hepatic dysfunction: elevated bilirubin, often a late finding in sepsis, and may cause reductions in production of essential proteins 5
- Neurologic dysfunction: may result from local endothelial injury and systemic inflammation through activity of the vagus nerve 5