Surviving sepsis are new technologies the answer or should we do it old-school - Heart & Lung 2013
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Surviving sepsis are new technologies the answer or should we do it old-school - Heart & Lung 2013

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Surviving sepsis are new technologies the answer or should we do it old-school - Heart & Lung 2013 ...

Surviving sepsis are new technologies the answer or should we do it old-school - Heart & Lung 2013

Laura Kierol Andrews, PhD, APRN, ACNP-BC
Assistant Professor, Yale School of Nursing, New Haven, CT, USA

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    Surviving sepsis are new technologies the answer or should we do it old-school - Heart & Lung 2013 Surviving sepsis are new technologies the answer or should we do it old-school - Heart & Lung 2013 Document Transcript

    • Heart & Lung 42 (2013) 161 Contents lists available at SciVerse ScienceDirect Heart & Lung journal homepage: www.heartandlung.org Editorial Surviving sepsis: Are new technologies the answer or should we do it old-school? Infectious diseases have been a major cause of death since recorded history, tracing back to writings from ancient Egypt.1 The term sepsis was derived from the Greek word meaning “to rot”, “putrefy” or “decompose”, and Hippocrates wrote of its evil nature and his search for substances to combat it.2,3 Today, severe sepsis and septic shock account for over 20% of intensive care unit (ICU) admissions, is the number one cause of ICU deaths, and is the 10th leading cause of death in the United States.1 The Society of Critical Care Medicine (SCCM) and the American College of Chest Physicians (ACCP) published the first consensus definitions of sepsis and its syndromes for use in clinical research and bedside care, and laid the groundwork for over 2 decades of sepsis research, the Surviving Sepsis Campaign (SSC), and subsequent guidelines.4e7 Despite the attention and advancements in management of sepsis, mortality is still over 25%1 and recent mainstream media attention has highlighted significant deficiencies in the recognition and timely treatment of septic patients. One such story, published in the New York Times, was that of Rory Staunton, a 12-year-old boy who died from an infected cut on his arm.8 Even though he had cardinal signs of Systemic Inflammatory Response Syndrome (SIRS), the precursor of septic shock, the signs and symptoms where either ignored or misinterpreted and he died in an ICU three days later. Rory’s story sparked an outcry from the public and prompted legislation to combat sepsis. So what are we as health practitioners to do? How do we identify sepsis in its early stage, knowing that for each hour of delayed treatment mortality rises? New technologies, such as electronic medical records (EMR), and clinical decision systems are being used to help identify patients with early signs of SIRS and sepsis. These systems analyze electronic vital sign data and send out an alert to healthcare providers. It’s a way of saying “pay attention” and there are data to support using both early warning and clinical monitoring systems.9,10 Nevertheless, it is still the bedside clinician who must act on these alerts and that is where good old-fashioned old-school ways take over. Investing in the old-school way of focused training programs that target areas where patients are at high risk for sepsis (ICUs, hospital wards) and areas with high patient to nurse ratios (emergency departments, skilled nursing facilities) is needed. We have to recertify our CPR skills every two years, why not our surviving sepsis skills, especially because early sepsis can be subtle and easily missed? We must remember to listen to our patients, their families and our intuition. Rory’s family knew something was wrong and they voiced it to several doctors, but were they heard? Have you ever “felt” something was not quite right with your patient, but you could not pinpoint why? That is your nursing 0147-9563/$ e see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hrtlng.2013.04.001 intuition (experience and expertise) telling you to delve deeper and critically examine the situation. Rapid response teams are a new concept built upon an oldschool model of bringing the practitioner to the patient who is in need (remember when doctors did house calls?). We should also invest in outreach or after care programs that “check up” on patients transferred from the ICU or are discharged from the hospital or emergency department (remember when neighbors checked up on each other?). They can provide follow up assessments, including reviewing the EMR to ensure nothing important was missed. Rory’s doctors did not know he had a significant bandemia because he was discharged from the emergency room before the labs were resulted. Technologies are there for us to use, but if we do not go back to our old-school ways of skills training, listening, and following updhow will our patients survive sepsis? References 1. Martin CS, Mannino DM, Easton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546e1554. 2. Funk DJ, Parrillo JE, Kumar A. Sepsis and septic shock: a history. Crit Care Clin. 2009;25:83e101. 3. Manjo G. The ancient riddle of sepsis. J Infect Dis. 1991;163:937e945. 4. American College of Chest Physicians (ACCP)/Society of Critical Care Medicine (SCCM). AACP/SCCM consensus conference: definitions of sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864e874. 5. Dellinger RP, Carlet JM, Masur H, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med. 2004;30: 536e555. 6. Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296e327. 7. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580e637. 8. Dwyer J. An infection, unnoticed turns unstoppable. The New York Times. July 12, 2012;59:A15. 9. Giuliano KK. Physiological monitoring for critically ill patients: testing a predictive model for the early detection of sepsis. Am J Crit Care. 2007;16: 122e131. 10. Giuliano KK, Lecardo M, Staul L. Impact of protocol watch on compliance with the surviving sepsis campaign. Am J Crit Care. 2011;20:313e321. Laura Kierol Andrews, PhD, APRN, ACNP-BC Assistant Professor, Yale School of Nursing, New Haven, CT, USA Senior Acute Care Nurse Practitioner, Department of Critical Care Medicine, Hospital of Central Connecticut, New Britain, CT, USA E-mail address: Laura.andrews@yale.edu