Sepsis is a hot topic at the moment, receiving a great deal of media attention. Several studies over the last 15 years have revolutionised sepsis management. 2001 saw the publication of the Rivers trial on Early Goal-Directed Therapy (EGDT) in the Treatment of Severe Sepsis and Septic Shock. This had a big impact on sepsis management across the board. Since, several further studies have been conducted looking at the impact (or not) of EGDT, the most recent being the ProMise Trial, published in the NEJM in 2015. 2016 has seen the publication of NICE guidance on the management of sepsis.
What impact does this have on us and our patients? Well, recognition and appropriate early management of sepsis has been highlighted as a must do; recent media coverage of the recently published NICE guideline stated that sepsis must be managed with the same urgency as Acute ST elevation MI. Pre-hospital providers have joined the trend, with many patients now being 'ASHICEd' into the ED with 'code yellow sepsis'.
In our departments we recognise the importance of prompt sepsis recognition and management. Our BUFFALO programme (and stickers) help with this; giving prompts to help us recognise and manage sepsis according to sepsis 6 guidelines.
With all the recent trials and published data, there is potentially the risk of some confusion about what 'is in' and what 'is out' with regards sepsis. To help you clarify some of your thoughts and take a look at the following blogs, links and podcasts.
Sepsis management is I'm sure an area of clinical practice that is going to continue to develop and evolve rapidly. Subscribe to our blog feed to keep up to date - we will endeavour to post relevant articles as they become available.
This podcast and accompanying text runs through some of the key areas in sepsis management as well as discussing some of the recent trials that are influencing current practice.
The Resus Room is a relatively new website run by Simon Laing who is an EM consultant in the UK. The site is a great resource with regular podcast, journal reviews and links to guidelines. This podcast discussed the recent NICE guidance.
This blog post from the St. Emlyns site is a great summary of the ProMise trial and its implications.
Neutropenic Sepsis identification and management is vitally important. Full guidance is available on the Trust Intranet. The flowchart below is a useful guideline.
Remember - Suspect NS in patients who have received oral or IV chemotherapy in the last 4 weeks, and if any suspicion of NS in these patients, treat immediately - do not wait for blood results.
Click on the image below to see the current NS flowchart: