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Sepsis

Sepsis is a whole-body inflammatory response to an infection.[1] Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.[2] There may also be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection. In the very young, old, and people with a weakened immune system, there may be no symptoms of a specific infection and the body temperature may be low or normal rather than high.[3] 

Sepsis is caused by an immune response triggered by an infection.[3][4] The infection is most commonly by bacteria, but can also be by fungi, viruses, or parasites.[3] Common locations for the primary infection include: lungs, brain, urinary tract, skin, and abdominal organs. Risk factors include young or old age, a weakened immune system from conditions such as cancer or diabetes, and major trauma or burns.[2]


ESICM & Sepsis

Surviving Sepsis Campaign

The European Society of Intensive Care Medicine (ESICM) alongside the Society of Critical Care Medicine (SCCM) spearheaded the Surviving Sepsis Campaign (SSC) in 2002 with several aims including the development of guidelines for diagnosis, treatment and post-ICU care of sepsis and a reduction of mortality from sepsis.

The updated guidelines are now available in Intensive Care Medicine:

Rhodes A. et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

For more information on the SSC Campaign, please visit the Surviving Sepsis Campaign webpage.

The Sepsis Definitions Task Force

Definitions for sepsis and septic shock were last revised in 2001. In order to evaluate and, as needed, update definitions for sepsis and septic shock, ESICM and SCCM convened a Task Force of 19 members with expertise in sepsis pathophysiology, clinical trials and epidemiology. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases and voting, followed by circulation to international professional societies requesting peer review and endorsement. The resulting publications can be found below.

Singer M, Deutschman CS, Seymour CW, et al: The Sepsis Definitions Task Force The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, February 23, 2016, Vol 315, No. 8).

Shankar-Hari M, Phillips G, Levy ML, et al. Assessment of definition and clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, February 23, 2016, Vol 315, No. 8).

Seymour CW, Liu V, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, February 23, 2016, Vol 315, No. 8).


References

1. Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup; Dellinger, RP; Levy, MM; Rhodes, A; et al. (2013). “Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2012” (PDF). Critical Care Medicine 41 (2): 580–637. doi:10.1097/CCM.0b013e31827e83af. PMID 23353941 – via Surviving Sepsis Campaign.
2. “Sepsis Questions and Answers”. cdc.gov. Centers for Disease Control and Prevention (CDC). May 22, 2014. Retrieved 28 November 2014.
3. Jui, Jonathan (2011). “Ch. 146: Septic Shock”. In Tintinalli, Judith E.; Stapczynski, J. Stephan; Ma, O. John; Cline, David M.; et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide (7th ed.). New York: McGraw-Hill. pp. 1003–14. Retrieved December 11, 2012 – via AccessMedicine. (subscription required (help)).
4. Deutschman, CS; Tracey, KJ (April 2014). “Sepsis: Current dogma and new perspectives”. Immunity 40 (4): 463–75. doi:10.1016/j.immuni.2014.04.001. PMID 24745331.


Sepsis Publications

Ben Andrews, Matthew W. Semler, Levy Muchemwa, et al. Effect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension Randomised Clinical Trial. JAMA. 2017;318(13):1233-1240. doi:10.1001/jama.2017.10913

Bloos F, Rüddel H, Thomas-Rüddel D, et al (2017) Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomised trial. Intensive Care Med 43:1602–1612. doi: 10.1007/s00134-017-4782-4

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Intensive Care Medicine – Jan 2017

Paul E. Marik, Vikramjit Khangoora, Racquel Rivera, Michael H. Hooper, John Catravas. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock – A Retrospective Before-After Study. CHEST. DOI: http://dx.doi.org/10.1016/j.chest.2016.11.036

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock, 2012 Intensive Care Medicine – Jan 2013

Singer M, Deutschman CS, Seymour CW, et al: The Sepsis Definitions Task Force The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, February 23, 2016, Vol 315, No. 8).

Shankar-Hari M, Phillips G, Levy ML, et al. Assessment of definition and clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, February 23, 2016, Vol 315, No. 8).

Seymour CW, Liu V, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, February 23, 2016, Vol 315, No. 8).

Werner C. Albrich, Stephan Harbarth. Pros and cons of using biomarkers versus clinical decisions in start and stop decisions for antibiotics in the critical care setting. Intensive Care Medicine, Review; Volume 41, Issue 10 / October, 2015; Pages 1739 – 1751, ICME-D-15-00400

Ranzani. Implementation of a multifaceted sepsis education program in an emerging country setting: clinical outcomes and cost-effectiveness in a long-term follow-up study. Intensive Care Medicine, Original; Volume 40, Issue 2 / February, 2014; Pages 182 – 19, 1ICME-D-13-00671.3

Grimaldi. Specific MAIT cell behaviour among innate-like T lymphocytes in critically ill patients with severe infections. Intensive Care Medicine, Original; Volume 40, Issue 2 / February, 2014; Pages 192 – 201, ICME-D-13-00847.2

Hinds. Patients with faecal peritonitis admitted to European intensive care units: an epidemiological survey of the GenOSept cohort. Intensive Care Medicine, Original; Volume 40, Issue 2 / February, 2014; Pages 202 – 210, ICME-D-13-00593.3

Douglas. Sepsis and the innate-like response. Intensive Care Medicine, What’s New in Intensive Care; Volume 40, Issue 2 / February, 2014; Pages 249 – 251, ICME-D-13-01122.1

Mallat. Time course of central venous-to-arterial carbon dioxide tension difference in septic shock patients receiving incremental doses of dobutamine. Intensive Care Medicine, Original; Volume 40, Issue 3 / March, 2014; Pages 404 – 411, ICME-D-13-01106.1

Selvapatt. Understanding infection susceptibility in patients with acute-on-chronic liver failure. Intensive Care Medicine, Understanding the Disease; Volume 40, Issue 9 / September, 2014; Pages 1363 – 1366, ICME-D-14-00397.1

Shih. Effect of the use of low and high potency statins and sepsis outcomes. Intensive Care Medicine, Original; Volume 40, Issue 10 / October, 2014; Pages 1509 – 1517, ICME-D-14-00442.3

Hélène Nougué, Anne-Laure Le Maho, Mourad Boudiaf, Jean-Philippe Blancal, Etienne Gayat, Mathieu Le Dorze, Fabrice Vallée, Benjamin Verillaud, Joaquim Mateo, Hakim Kechiche, Claudia Pignataro, Philippe Herman, Alexandre Mebazaa. Clinical and imaging factors associated with severe complications of cervical necrotising fasciitis. Intensive Care Medicine, Original; Volume 41, Issue 7 / July, 2015; Pages 1256 – 1263, ICME-D-15-00001

Jason P. Burnham, Marin H. Kollef. Understanding toxic shock syndrome. Intensive Care Medicine, Understanding the Disease; Volume 41, Issue 9 / September, 2015; Pages 1707 – 1710, ICME-D-15-00477

Paul Dark, Bronagh Blackwood, Simon Gates, Danny McAuley, Gavin D. Perkins, Ronan McMullan, Claire Wilson, Daniel Graham, Kate Timms, Geoffrey Warhurst. Accuracy of LightCycler® SeptiFast for the detection and identification of pathogens in the blood of patients with suspected sepsis: a systematic review and meta-analysis. Intensive Care Medicine, Systematic Review; Volume 41, Issue 1 / January, 2015; Pages 21 – 33, ICME-D-14-01054

Geoffrey Warhurst, Satanayarana Maddi, Graham Dunn, Murad Ghrew, Paul Chadwick, Peter Alexander, Andrew Bentley, John Moore, Michael Sharman, Gordon L. Carlson, Duncan Young, Paul Dark. Diagnostic accuracy of SeptiFast multi-pathogen real-time PCR in the setting of suspected healthcare-associated bloodstream infection. Intensive Care Medicine, Understanding the Disease. Original; Volume 41, Issue 1 / January, 2015; Pages 86 – 93, ICME-D-14-01058

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 Intensive Care Medicine Vol 34:17-60

The Surviving Sepsis Campaign guidelines for the management of severe sepsis and septic shock:   Background, recommendations, and discussion from an evidence-based review. A supplement to Critical Care Medicine Vol 32 (11): S445-S597, 2004

Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock  Vol 30(5): 536-555, 2004 – 273 KB

2001 SCCM/ESICM/ACCP/ATS/SIS: International Sepsis Definitions Conference (ESICM Section on Sepsis) Vol 29(4): 530-538, 2003 – 175 KB

A European survey of the use of inhaled nitric oxide in the ICU (ESICM Working group on Inhaled NO) Vol 24(8): 864-877, 1998 – 487 KB

The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure (ESICM Working group on Sepsis-related problems) Vol 22(7): 707-710, 1996 – 224 KB


Sepsis Videos

Sepsis: Effect of a multifaceted educational intervention for anti-infectious measures on mortality (Frank Bloos, Nov 2017)

COMMENTARY – THE WHO SEPSIS RESOLUTION: Making an impact on global sepsis awareness (Ruth Kleinpell, Oct 2017)

EGDT for Sepsis care in Zambia: an RCT (Todd Rice, Sept 2017)

SURVIVING SEPSIS GUIDELINES: Comparison of recommendations from 2012 to 2016 (from SSC: Intl Guidelines for Management of Sepsis and Septic Shock: 2016, ICM Jan 2017, Appendix 2)

Sepsis Series (icTV): Impact of the Surviving Sepsis Campaign (Ricard Ferrer Roca, Jan 2015)

Sepsis Series (icTV): Performance metrics and outcomes – Results from a 7.5-year study published in ICM (Mitchell Levy, Oct 2014)

IMPRESS: Spring Update 2014 (icTV) (Mitchell Levy, March 2014)

Sepsis Series (icTV): The Next Phase of SSC (Richard Beale, 2013)

Sepsis Series (icTV): Future Outlook (Derek Angus, July 2013)

Sepsis Series (icTV): Expanding a Winning SSC Strategy (Jean-Daniel Chiche, July 2013)

Sepsis Series (icTV): What to do if you Suspect Sepsis (Rupert Pearse, 2013)

Sepsis Series (icTV): How to Implement SSC Guidelines in Your Hospital (Ricard Ferrer Roca, 2013)

Sepsis Series (icTV): SSC affects 25% reduction in mortality rates – Future Expansion & Implementation (Jean-Daniel Chiche, 2013)

Sepsis Series (icTV): Antimicrobial Therapy – The 3 Key Factors (Ricard Ferrer Roca, 2013)

Sepsis Series (icTV): How the Updated SSC Guidelines will Impact MY Practice… (Djillali Annane, 2013)

Sepsis Series (icTV): Lactates, Fluids, Antibiotics & Biomarkers (Ricard Ferrer Roca, 2013)

Sepsis Series (icTV): Prevalence & Impact (Rupert Pearse, 2013)

Sepsis Series (icTV): Utilising SSC Bundles (Richard Beale, 2013)

icTV interview with Richard Beale: SSC progress (2012)

icTV interview with Mitchell Levy: SSC updated guidelines (2012)


Sepsis Webinars

ESICM hosts webinars focused on the definition, diagnosis, treatment and management of sepsis.

 

“Surviving Sepsis Guidelines 2016: What do you need to know?”

 

> Watch Replay


“The New Sepsis Definitions: What’s new with Sepsis-3?”

> Watch Replay