Your doctor or the intensivist (a doctor with special expertise and training in the care of critically ill patients) in the ICU may have told you that your loved one has sepsis. This condition may be the reason he or she was admitted to the ICU, or it may have developed during hospitalization. Whatever the cause, your loved one is seriously ill, and you undoubtedly have questions. This brochure is designed to help you understand sepsis and its treatment.
What is sepsis?
Sepsis is the body’s response to infection. Normally, the body’s own defense system fights infection, but in various stages of sepsis, the body’s response goes into overdrive, setting off a series of events that can lead to inflammation throughout the body. The forms of sepsis include severe sepsis, which occurs when an organ cannot function normally or fails completely such as the kidneys or liver, and septic shock, when the cardiovascular system begins to fail so that blood pressure drops, depriving vital organs of an adequate blood supply.
How does someone get sepsis?
Each year, sepsis strikes an estimated 1,600,000 people in the United States alone (Agency for Healthcare Research and Quality Center for Delivery, Organization, and Markets. Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1993-2009). Any kind of infection—bacterial, viral,
parasitic, or fungal—anywhere in the body can trigger sepsis. It can strike anyone at any age, although the very old, very young, hospitalized patients, and people with other medical conditions may be at increased risk. Factors that may make an individual susceptible to sepsis include:
• An underactive or depressed immune system (such as during chemotherapy or when medications are used to prevent the rejection of an organ transplant)
• Recent surgery
• Mechanical ventilation (machine-assisted breathing)
• Genetic tendency
• Invasive procedures or intravenous (IV) lines to provide fluids or medicine
Signs and symptoms of sepsis
Sepsis is the body’s response to an infection. The symptoms can include:
• Fever and shaking chills
• Reduced mental alertness, sometimes with confusion
• Nausea and vomiting
• Increased heart rate, greater than 90 beats per minute
• Increased breathing rate
• High or low white blood cell count (blood test)
• Low blood pressure
• Altered kidney or liver function
Sepsis can develop quickly. The sooner it is diagnosed and treated, the better. The most frequent sites of infection leading to sepsis are the lung, urinary tract, abdomen, and pelvis. In up to 30% of patients, however, a definite source of infection cannot be identified. The course of the disease may be unpredictable. Some patients may deteriorate quickly, while others suffer from varying degrees of organ dysfunction or failure, but most will recover with treatment. Sometimes there are long term physical or brain function consequences. This varies with the severity of the illness.
The course of sepsis
Harmful germs may sneak past the body’s defense systems and cause infection. The defense system tries to fight these invaders with chemical signals. However, in sepsis, the defense system overreacts and produces too many signals. High amounts of these signals make the blood vessels inflamed. Some factors may make the defense system’s response worse, such as older age, other ongoing illnesses, or the type of germ involved.
This inflammation of the blood vessels also can cause problems like blood clots and low blood pressure, which can lead to low blood flow to the lungs, brain, kidney, liver, and heart.
Treatment of sepsis
Sometimes it is hard to tell if someone has sepsis because this condition looks similar to other medical problems. A person with sepsis may have a fever, fast heartbeat, breathing problems, and decreased urination, but these are also signs of other illnesses. The first line of treatment is to find the infection early. Anti-infection medicine or surgery can help get rid of the infection. Some patients need other treatments, such as:
• Fluids and drugs to raise the low blood pressure
• A breathing machine
• A feeding tube
• Pain killers or sedative drugs to increase comfort
• Drugs to lower the level of stomach acid and prevent ulcers and bleeding
• Dialysis for kidney problems
The best way to stop sepsis is to treat it quickly. Patients should get fluids and anti-infection medicine within one hour of the doctor’s diagnosis of sepsis. There is no one treatment for sepsis. Scientists are doing research every day to find new treatments for this serious disease. If you think your
loved one may have sepsis, ask the doctor or nurse to evaluate your loved one. It’s better to ask than to presume that this condition is not present.
ICU-USA, Inc. ICU medical conditions: sepsis. www.icu-usa.com
Mayo Clinic. Diseases and conditions: sepsis. www.mayoclinic.com
Sepsis Alliance. Someone I know was diagnosed with sepsis. www.sepsisalliance.org
Society of Critical Care Medicine. Patients and families: what is critical care? www.myicucare.org or www.sccm.org
Surviving Sepsis Campaign. www.survivingsepsis.org