Introduction to Sepsis illness
Sepsis can be defined as life threatening illness which is mainly caused due to body's response to various infection (de Molina & Ferrer, 2011). Immune system is responsible for protecting a body from different infections but in many cases it can be overdrive response to infections. Sepsis is mainly the result of release of chemicals which is secreted in bloodstream to fight against infections. But due to imbalance it causes inflammation in the entire body which leads to sepsis. In severe cases it may also lead to septic shock which requires medical emergency. According to a survey report there are more than 3,00,00 cases of sepsis every year (Siddiqui & Razzak, 2010). The Surviving Sepsis Campaign is a worldwide initiative to combine all the organisations to reduce the rate of mortality which is caused due to sepsis. One of the major objective of SSC is to develop an international collaboration so that mortality rate due to sepsis can be reduced. The literature review in this assignment will broadly focus on critically analysing various research papers based on sepsis and septic shocks. Further this will also focus on identifying 3 important therapeutic strategies in order to treat sepsis and septic shocks in acute care settings.
Sepsis or septic shock in acute care settings results in inflammatory response which alters the body temperature invariantly. This is generally associated with circulatory abnormalitysuch as peripheral vasodilation, intra-vasculardepletion in the volume of oxygen and myocardial depression. Fluid therapy or resuscitation has been identified as one of the most effective methods to manage sepsis and septic shock. There is a greater need to identify the timing, quantity and need to give the therapy to the patients in severe cases. On other hand antibiotics are also used in managing septic shocks and infection in acute care settings. Administration of effective antimicrobials within the initial hour of sepsis is preferable. Rout e of administration and frequency of dose to be administered should be determined prior to the administration.
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The author Fang & et.al, (2008) discussed a brief introduction on colloid for fluid resuscitation. It contained an appropriate aim and it stated to study and investigate the effects of two commonly used resuscitation fluid strategies in patients who undergo sepsis shock (Fang & et.al, 2008). In this study the patients were randomised with signs of acute hypovolemia which further indicated two signs of tissue hypo-perfusion. Maintenance fluid consisting of isotonic crystalloids were given to both the cohort groups. Exclusion criteria was also adopted toand patients with previous fluid therapy, pregnancy, extended burns andliver ailment were not allowed to take part in the studies. Based on the studies it was revealed that mortality rate decreased after use of colloids in different forms. In the 28 days study there was a rate of 25.4 % mortality in patient who were administered with colloid and this percentage raised y 1.9% in patients who were given crystalloids groups. The renal replacement therapy which was given to both the groups was also similar (Fang & et.al, 2008). The use of colloidal form in management of sepsis is not preferable because it increases the risk of hospital mortality in acute care settings. Moreover, antibiotics are a better option which can be subjected to manage the sepsis shock. Some commonly used antibiotics are Beta lactum combined with azithromycin and antipseudomonal beta lactum combined with aminoglycoside.
The current article is based on hypoperfusion or septic shock in the ED of 32 ANZ tertiary-referral under which adult patients with sepsis are selected. The main aim of this this article is to determine the current resuscitation practices and outcome in patients. However, study mainly focuses upon emergency department withsepsis and hypo perfusion in New Zealand and Australia. In the regard, observational study conducted by taking into account prospective of three months along with multi centre approach.According to Peake & et.al, (2009) there are many factors which needs to be considered such as pharmaco-kinetic, weight, residual renal function, hepatic clearance,mode through which replacement therapy will take place, blood flow and rate of dialysis. Studies which determine the concentration of serum antibiotic level should also be considered because they are useful in establishing appropriate dosages for sepsis. No clear objectives have been defined in the paper but it has considered various factors while recommending antibiotic regimen in patients who are suffering fromsepsis and renal failure. This study can be considered in future because antibiotic dose regimen is also one of the common methods which can be helpful in managing sepsis but it is necessary to conduct further studies which can determine the serum antibiotic level so that frequency can be determined. It can also be concluded from the study that impact of ANZ and EGDT is uncertain and randomized controlled trial.
The author Siddiqui & Razzak, (2010) has been stated that use of hyper-tonic crystalloids solution was much studies. This includes the use of sodium chloride and bicarbonate for treating sepsis in severe cases. 94 patients were divided into three groups and all the groups received three different injections in the period of 15 minutes. One group with 32 patients with severe sepsis cases were given normal saline solution. Another group was incorporated with sodium chloride solution and the last group with 32 patients were given sodium bicarbonate solution. After giving three different injections to the three randomised group different aspects such as systolic blood pressure, arterial pressure, body temperature, heart rate, respiratory rate and flow of gases were analysed. There were no difference between the three groups which was conducted for 120 minutes or 8 hour follow-up. It can be concluded that all the three crystalloid solution can be used for initial volume loading in severe cases of sepsis (Siddiqui & Razzak, 2010). This article can be used in future studies because antibiotics can decrease the rate of sepsis mortality. Moreover,antibiotics are also administered so that they are able to balance the systolic and diastolic rate.
In yet another study, the objective of the review was to assess the difference in the results obtained in early and late administration of antibiotics in patient suffering from severe sepsis issues (Rusconi & et.al, 2015). This study was based on reviewing different articles which have conducted studies on this objective. Two authors made an assessment for selection of the articles based on inclusion and exclusion criteria.The main difference in the patients taking part in randomised controlled trials was the time difference between administrating antibiotics. According to the study it can be concluded that delayed administration of antibiotics in patients with sepsis can ultimately lead to worse clinical outcomes (Rusconi & et.al, 2015). This article can be considered for future studies as it is clear from the articles that late administration of antibiotics can lead to worsen the physical condition and lead to organ failure. It can be concluded that antibiotics at early stages helps in improving the symptoms of sepsis and can avoid the condition of sepsis.
Sepsis is defined as potentially harmful and life threatening medical issue that is caused due to bacterial infection (Paul & et.al, 2004). The aim of the research paper is to systematically review the evidence of treatment effects and potential harm due to the introduction of antibiotic regimen with therapeutic strategies in the management of the patient experiencing sepsis in acute care. Based on the systematic reviews there were many findings such as the there was a decrease in toxicity level of kidney when the patients were given beta lactum monotherapy with combination therapy. Although, the quality of evidence produced in this case was extremely low. Moreover, the estimation of adverse events was statistically non significant when itwas administered with combination of beta lactum therapy (Paul & et.al, 2004).
In another article presented by Casserly & et.al, (2012) the objective stated to determine the effect of administration of steroids to increase the survival rate of patients who are suffering fromadult septic shock. A detailed analysis was conducted to investigate the effect of low dose steroids in severe cases of sepsis shock. A total of 17,500 patients required a vasopressor therapy even after administrating fluid resuscitation and hence, met the criteria for receiving low dose steroids. The mortality rate in hospital was higher in the patients who received low dose steroidsas compared to those who did not received it. Steroids were administered in the treatment of adult septic shock but it was directly associated with increase mortality rate in the hospital (Casserly & et.al, 2012).
There are many benefits of use of low dose of corticosteroids in severe cases of sepsis and septic shock (Beale & et.al, 2010). Patients who are not able to respond to fluid resuscitation and vasopressor therapy are generally subjected to low dose of corticosteroids so that they are able to survive even after suffering from septic shocks. Patients who were involved in participating in the studies were subjected to less potency 50mg six hourly plus 50 micro gram alpha fludrocortisone of treatmentfor the case of severe sepsis in acute care setting. Logistic regression techniques were used to record the outcomeso that baseline imbalance can be managed. Although this therapy is widely used in many countries but based on the observation it was revealed that there has been increased rate of hospital mortality when patients were administered with low dose corticosteroids (Beale & et.al, 2010). The third strategy that can be adopted in order to manager sepsis and septic shock isthe use of steroids and corticosteroids. This study can be considered in future because it was noted that patients who are not able to respond to fluid resuscitation therapy and antibiotics are generally preferred corticosteroids therapy because it has reduced the mortality rate in recent times.
According to Minneci & et.al, (2009)the aim of the research paper was to investigate the effect of steroids during sepsis and also to determine the level of severity of illness (Minneci & et.al, 2009). Randomised controlled trials were conducted which compared glucocorticoid treatment with placeboin order to attain an inclusion criteriaAll the relevant journals were selected which focused on providing treatment control to patient with sepsis and sepsis shock. After the overall analysis it was confirmed that glucocorticoid given along with combination of different therapy was beneficial but increased the cases of mortality in patients who were admitted to acute care setting. Hence, it can be stated that this cannot be used in majority of the cases as this increases the rate of hospital mortality in severe cases of sepsis and septic shocks (Minneci & et.al, 2009). It can be concluded that combination of steroids can be administered to relive the conditions of sepsis so that it can prevent the organ failure. This studies can also be considered in future to determine the quantity of steroids to be administered so that health outcomes can be improved.
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Various studies were conducted to understand various aspects of strategies that are developed to treat the severity of sepsis and septic shock in hospital. Studies such as randomised controlled trials, systematic reviews, cohort studies were taken into account which revealed different results in all the cases.
- Beale, R. & et.al., (2010). Global utilization of low-dose corticosteroids in severe sepsis and septic shock: a report from the PROGRESS registry. Critical care, 14(3), 1.
- Casserly, B. & et.al., (2012). Low-dose steroids in adult septic shock: results of the Surviving Sepsis Campaign. Intensive care medicine, 38(12), 1946-1954.
- Chamberlain, D. J., Willis, E. M., & Bersten, A. B. (2011). The severe sepsis bundles as processes of care: a meta-analysis. Australian Critical Care, 24(4), 229-243.
- Cortes, D. O. & et.al., (2014). Colloids for fluid resuscitation: what is their role in patients with shock?. Minerva anestesiologica, 80(8), 963-969.
- de Molina, F. J. G., & Ferrer, R. (2011). Appropriate antibiotic dosing in severe sepsis and acute renal failure: factors to consider. Critical Care, 15(4), 1.
- Dellinger, R. P. & et.al., (2013). Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive care medicine, 39(2), 165-228.
- Fang, Z. X. & et.al., (2008). Effects of resuscitation with crystalloid fluids on cardiac function in patients with severe sepsis. BMC infectious diseases, 8(1), 1.
- Minneci, P. C. & et.al., (2009). The effects of steroids during sepsis depend on dose and severity of illness: an updated meta‐analysis. Clinical microbiology and infection, 15(4), 308-318.
- Paul, M. & et.al., (2004). β lactam monotherapy versus β lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomised trials. Bmj, 328(7441), 668.
- Peake, S. L. & et.al., (2009). Australasian resuscitation of sepsis evaluation (ARISE): a multi-centre, prospective, inception cohort study. Resuscitation, 80(7), 811-818.
- Rastegar, A. (2015). Rational fluid therapy for sepsis and septic shock; what do recent studies tell us?. Archives of Iranian medicine, 18(5), 308.
- Rochwerg, B. & et.al., (2014). Fluid resuscitation in sepsis: a systematic review and network meta-analysis. Annals of internal medicine, 161(5), 347-355.
- Rusconi, A. M. & et.al., (2015). Early goal-directed therapy vs usual care in the treatment of severe sepsis and septic shock: a systematic review and meta-analysis. Internal and emergency medicine, 10(6), 731-743.
- Siddiqui, S., & Razzak, J. (2010). Early versus late pre‐intensive care unit admission broad spectrum antibiotics for severe sepsis in adults. The Cochrane Library.
- Whittaker, S. A. & et.al., (2015). Epidemiology and outcomes in patients with severe sepsis admitted to the hospital wards. Journal of critical care, 30(1), 78-84.