THE SURVIVING SEPSIS CAMPAIGN          

Sepsis is a complex syndrome that is difficult to define, diagnose, and treat. It is a range of clinical conditions caused by the body's systemic response to an infection, which if it develops into severe sepsis, is accompanied by single or multiple organ dysfunction or failure, leading to death. It is a major cause of mortality, killing approximately 1,400 people worldwide every day (1).

In 2002, the European Society of Critical Care Medicine and the Society of Critical Care Medicine conducted an international survey to investigate physicians' views on sepsis, in particular, their satisfaction with current definitions, routes to diagnosis, and treatment options. Their inquiry revealed that most physicians find sepsis challenging and frustrating to diagnose and to treat. Of the 1050 physicians surveyed:

• 86% said that symptoms of sepsis can easily be misattributed to other conditions.
• 89% said that doctors are eager for a breakthrough in treating sepsis.
• 81% said that a common defiinition for sepsis among the medical community would be a significant step toward better treatment.

Mortality, Incidence and Costs

Mortality rates from severe sepsis are on a similar scale to lung, breast, and colon cancer, and it is one of the leading causes of death in the intesnive care unit (ICU) (1-3).

Due to its aggressive, multifactorial nature, sepsis is a rapid killer. Death is common among sepsis patients, with around 30% of patients dying within the first month of diagnosis and 50% dying within 6 months (4-6). The 28-day mortality rate in sepsis patients is comparable to the 1960s hospital mortality rate for patients of acute myocardial infarction (AMI) (7). Over recent years, there has been an improvement in the awareness and management of AMI, resulting in a decline in mortality, while sepsis remains an unacknowledged killer (7).

Moreover, the number of severe sepsis cases is set to grow at a rate of 1.5% per annum, adding an additional 1 million cases per year in the USA alone by 2020 (8). This will increase total mortality and increase the burden on healthcare resources. The increase is mainly due to the growing use of invasive procedures and increasing numbers of elderly and high-risk individuals, such as cancer and HIV patients. Older people are at an increased risk of sepsis as they are more vulnerable to infections due to aging, co-morbidities, use of invasive sugical techniques, and problems associated with institutionalization.

Sepsis places a significant burden on healthcare resources, accounting for 40% of total ICU expenditure and costing up to $7.6 billion annually in Europe and $16.7 billion in the United States in 2000. Average cost per individual case is approximately $22,000.

The SSC aims to raise awareness of these issues and to work with all parties to ensure the most appropriate management of these patients.

Challenges

Intensive care professionals consider sepsis to be one of the most challenging and difficult conditions to manage, as the course of sepsis varies widely from patient to patient and can develop as a result of a variety of circumstances.

Definition and Diagnosis

Sepsis is a range of clinical conditions caused by the body’s systemic response to an infection. Severe sepsis is a condition in which sepsis is accompanied by organ dysfunction or failure. Although this much is known, there is no clear clinical definition that can be easily communicated and adopted globally. Its absence makes the diagnosis and management of sepsis a clinical challenge. Some of the symptoms of sepsis, such as fever, rapid pulse, and respiratory difficulty, are very general and are present in many other disorders. In a recent survey conducted among physicians, 87% felt that the symptoms of sepsis can easily be attributed to other conditions, creating problems of late or misdiagnosis (9).

Universally accepted definitions would be a vital first step in helping the medical community manage sepsis effectively. A total of 81% of physicians surveyed recognise that a lack of a common definition could potentially lead to delays in treatment and additional complications and death of the patient (9).

Management

The rapid diagnosis and management of sepsis is critical to successful treatment. The sepsis patient is usually already critically ill and requires immediate attention to avoid rapid deterioration; therefore, it is necessary to treat the patient at the same time as confirming the diagnosis.

The management of sepsis patients involves a variety of therapeutic interventions. Treatment is more likely to be effective, and severe sepsis avoided, if appropriate therapy is used early. Once diagnosed, the goal of therapy is to eliminate the underlying infection with antibiotics. Due to the challenges of diagnosing and treating this complex condition, approximately 10% of sepsis patients do not receive prompt appropriate antibiotic therapy, which increases mortality by 10–15% (10). Depending on the patient’s condition, additional therapies are initiated, including drug therapy and supportive care, such as mechanical ventilation and kidney dialysis. Even with current treatments, patient responses are highly unpredictable and mortality is still high.

The management of sepsis involves a wide range of clinical specialties in its diagnosis and treatment. Many healthcare professionals may be involved in diagnosis and treatment of sepsis and healthcare professionals outside of the ICU may not have sufficient training to identify the symptoms to reach a timely diagnosis, due to the complex nature of the condition.

Clearer clinical definitions and the development and implementation of standards of care will assist in the timely diagnosis and effective management of patients and result in saved lives.

Surviving Sepsis Campaign Rationale

Spearheaded by the ESICM (European Society of Intensive Care Medicine), ISF (International Sepsis Forum) and SCCM (Society of Critical Care Medicine), the Surviving Sepsis Campaign is aimed at improving the diagnosis, survival, and management of patients with sepsis by addressing the challenges associated with it.

Key to success is the cross-functional cooperation of the healthcare professionals and support staff, the critical care organisations (ESICM and SCCM), payors, policy makers and insurers, patients, and their families.

The campaign acknowledges that:

• Mortality associated with sepsis is unacceptably high and is increasing
• Physicians are managing severe sepsis well, but improvements can be made
• Physicians may be unaware of all treatments/intervention options
• There is hope for new, exciting therapies through continuing innovation and research
• Awareness of these issues is low
• There is no consensus on an outcome target

Mission

The Surviving Sepsis program aims to:

• Increase awareness, understanding, and knowledge
• Change perceptions and behavior
• Increase the pace of change in patterns of care
• Influence public policy
• Define standards of care in severe sepsis
• Reduce the mortality associated with sepsis by 25% over the next 5 years
• Working with the relevant stakeholders, the Surviving Sepsis Campaign’s mission is to improve the management of sepsis through targeted initiatives
  
  

Guidelines

• Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 Crit Care Med 2008;36(1) 296-327
• Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock Crit Care Med 2002;30(6) 1365-1378

If you wish to implement the Surviving Sepsis Campaign in your institution, send a query to info@survivingsepsis.org or email lharmon@sccm.org.

References

1. Bone RC et al. Chest. 1992; 101: 1644–55.
2. OECD Health Report, 2000.
3. Kanji S et al. Pharmacotherapy. 2001; 21: 1389-402.
4. Rivers E et al. N Engl J Med. 2001; 345: 1368-77.
5. Natanson C et al. Crit Care Med. 1998; 26: 1927–31.
6. Bernard GR et al. N Engl J Med. 2001; 344: 699–709.
7. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur H J. 1996; 17: 43-63.
8. Angus DC et al. Crit Care Med. 2001; 29: 1303–10.
9. Sepsis: a study of doctors’ knowledge about sepsis in five European countries and the US; ESICM and SCCM: January 2001.
10. Lyseng-Williamson KA & Perry CM. Drugs. 2002; 62: 617-30.
11. Survey conducted by Yankelovich Partners, Inc., 2002