What is the significance of sepsis in critical care?

From the Guidelines

Sepsis management is a critical care topic that demands rapid recognition and intervention, with the cornerstone of treatment being early identification and implementation of the "sepsis bundle" within one hour, as recommended by the Surviving Sepsis Campaign guidelines 1. The key components of the sepsis bundle include:

• Obtaining blood cultures
• Administering broad-spectrum antibiotics, such as piperacillin-tazobactam 4.5g IV q6h or meropenem 1g IV q8h
• Giving crystalloid fluid resuscitation with 30 mL/kg of balanced solutions like lactated Ringer's
• Monitoring lactate clearance For persistent hypotension despite fluids, starting norepinephrine at 0.05-0.5 mcg/kg/min as the first-line vasopressor, targeting a mean arterial pressure of 65 mmHg, is recommended 1. Source control is essential, with any infected devices being removed, and abscesses drained. Continuous monitoring of vital signs, urine output, and organ function guides ongoing management. This aggressive approach is necessary because sepsis represents a dysregulated host response to infection that triggers inflammatory cascades, endothelial dysfunction, and microcirculatory failure, leading to tissue hypoxia and organ damage. Each hour of delayed antibiotic administration increases mortality by approximately 8%, making time-sensitive intervention crucial for survival 1. The definition of sepsis has evolved, with the Sepsis-3 definition characterizing sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection, and septic shock being defined as a subset of sepsis with particularly profound circulatory, cellular, and metabolic abnormalities 1. Key aspects of sepsis management include:
• Early identification using criteria such as altered mental status, respiratory rate >22, systolic blood pressure <100 mmHg, and elevated lactate >2 mmol/L
• Implementation of the sepsis bundle within one hour
• Use of norepinephrine as the first-line vasopressor for persistent hypotension
• Source control and continuous monitoring of vital signs, urine output, and organ function.

From the Research

Sepsis Management in Critical Care

• Sepsis is a major cause of morbidity and mortality worldwide, and early identification and evidence-based treatment are associated with improved outcomes 2.
• The core treatment of sepsis relies on source control, early antibiotics, and organ support, with emerging strategies focusing on immunomodulation, artificial intelligence, and multi-omics approaches for personalized therapy 2.
• Nursing care plays a crucial role in the initial resuscitation of severe sepsis patients, with early recognition of sepsis reducing mortality, morbidity, and long-term consequences 3.

Antibiotic Therapy in Sepsis

• Meropenem and piperacillin-tazobactam are commonly used antibiotics in the treatment of sepsis and septic shock, with studies comparing their efficacy and safety 4, 5.
• A study found that meropenem had a lower mortality rate on ventilator-free days, vasopressor-free days, and hospital-free days compared to piperacillin-tazobactam 4.
• The Empirical Meropenem versus Piperacillin/Tazobactam for Adult Patients with Sepsis (EMPRESS) trial aims to compare the effects of empirical meropenem against piperacillin/tazobactam in adult, critically ill patients with sepsis 5.

Nursing Care for Sepsis Patients

• Nurses play a critical role in identifying patients at risk for developing sepsis and assessing patients with SIRS and sepsis for signs and symptoms of organ involvement and organ dysfunction 6.
• Evidence-based practice indicates initiation of fluid resuscitation, vasopressor therapy, positive inotropic support, and appropriate antibiotic therapy within the first hour of sepsis diagnosis 6.
• Enhanced monitoring, including the use of computerized early warning systems, can promote early recognition of sepsis and improve outcomes 3.