Society of Critical Care Medicine Along With Other Medical Societies Partner to Address Need to Better Define, Monitor Sepsis

1/29/2002

From: Society of Critical Care Medicine, 847-827-6869; Web site: www.sccm.org

SAN DIEGO, Jan. 29 -- With the advent of new therapeutic agents coming on the market to treat sepsis, physicians need to better understand and monitor the progress of sepsis, the number one cause of death in the non-coronary ICU, critical care experts say. As a result, a landmark gathering of leaders from more than 10 medical societies in December tackled issues behind one of the leading killers in the United States.

"Sepsis has for years been one of the most complex and challenging conditions to treat. Finally, with new treatment options available, we need to continue to better understand the progression of the condition to know how to use these treatments most effectively." says Mitchell Levy, M.D,, FCCP, FCCM, associate professor of medicine at Brown University School of Medicine in Providence, R.I.

Dr. Levy today presented the results of the Sepsis Definitions Conference in Washington, D.C. that included 30 physicians representing the Society of Critical Care Medicine, European Society of Intensive Care Medicine, American College of Chest Physicians and American Thoracic Society. The presentation was held as part of the 31st Critical Care Congress in San Diego.

"Survival rates are improving because of better severe sepsis treatments. Consequently, defining and revisiting these definitions to accurately and precisely diagnose sepsis is becoming of paramount importance in the intensive care unit," says co-presenter Graham Ramsay, M.D., professor of intensive care at the Universiteit Maastricht and chairman of intensive care and the accident department at Academisch Ziekenhuis Maastricht, The Netherlands.

"The old definitions of sepsis, severe sepsis and septic shock that were developed in 1992 are still going to be used," states Dr. Levy. "Although the general consensus has been that we need a more precise way to stage the progression of sepsis, the unanimous feeling of the group is that we do not yet have the technological sophistication to stage the septic response more precisely. If a new therapy is developed for heart attacks, for instance, then it is important to differentiate chest pain for a heart attack. That's the problem and the challenge confronting physicians when challenged with sepsis. We are committed to doing more research to identify sepsis more clearly and earlier."

The conference was in part the outgrowth of a survey of physicians conducted by SCCM and ESICM, which indicated most physicians believe sepsis is misdiagnosed or diagnosed too late because of lack of clear definition. The survey also found that sepsis is among the most challenging conditions a doctor can treat.

Results The results of the sepsis definitions conference included:

-- Creation of the PIRO Model used to more effectively diagnose and track the progression of sepsis. In this model, 'P' represents the predisposition of patients for responding to infection in different ways, based on several factors including genetics and co-existing disease. 'I' represents infection. Different types of infection may give rise to a wide range of responses in different patients. 'R' represents response. Different marker of inflammation, produced by various types of cells, may allow for early identification of the deleterious response to infection. 'O' represents organ dysfunction. When the response to infection becomes severe, different organ systems begin to fail, indicating patient deterioration and placing patients at higher risk of death.

-- A comprehensive list of signs and symptoms of sepsis including: -- Chills -- Tachypnea -- Unexplained alterations in mental status -- Tachycardia -- Altered wbc -- Decreased platelets -- Elevated immature neutrophils -- Decrease skin perfusion -- Deceased urine output -- Skin mottling -- Poor capillary refill -- Hypoglycemia -- Petichae

-- Development of an educational initiative to promote the understanding of sepsis among clinicians. Each of the major critical care societies will begin to disseminate the information from this conference to a broad range of clinicians through several mechanisms. These include the websites of individual societies, national and regional educational programs and publication of a manuscript that describes the conclusions of the consensus conference.

Sepsis

Sepsis is a bacterial infection of the blood that is often a complication of burns, surgery or illness. Patients developing sepsis progress from ill to seriously ill, onto organ dysfunction and failure (called severe sepsis) and then to septic shock.

Approximately 750,000 Americans are sickened with severe sepsis annually, of whom slightly less than one-third will die. Though many patients who develop sepsis are already hospitalized for an unrelated illness, healthy people can also develop infections that rapidly progress to severe sepsis. Previous treatment for sepsis included respirators for lung failure, kidney dialysis, fluids and antibiotics.

"We need a hand-held device, much like a blood-sugar monitor, that can analyze a drop of blood and immediately identify chemicals in the blood that are hallmarks of the response to sepsis. Currently, laboratories can only roughly measure these biological markers.

The Society of Critical Care Medicine is the leading professional organization dedicated to ensuring excellence and consistency in the practice of critical care medicine. With more than 9,500 members worldwide, the Society is the only professional organization devoted exclusively to the advancement of multidisciplinary, multiprofessional intensive care through excellence in patient care, professional education, public education, research and advocacy. Members of the Society include intensivists, critical care nurses, critical care pharmacists, clinical pharmacologists, respiratory therapists and other professionals, which may include technicians, social workers, dieticians and members of the clergy.