Sepsis: definitions, prevalence, management and outcomes

Introduction: Sepsis results in life-threatening organ dysfunction, but if recognised and treated promptly, survival chances increase. Current clinical practice uses the systemic inflammatory response syndrome criteria to identify sepsis, and the sepsis six care bundle for management. Changes to the definitions of sepsis internationally and new national sepsis guidelines call into question the most appropriate way to recognise and manage sepsis. Method: This was a two-site audit of healthcare provider’s compliance to the sepsis six care bundle. All patients admitted to two NHS hospitals over 24 hours were screened for sepsis using the modified systemic inflammatory response syndrome criteria and the quick-sequential (sepsis related) organ failure assessment score. Adherence was assessed for each element of the care bundle for all patients identified with sepsis. Results: 249 patients were screened for sepsis; 24 fulfilled the modified systemic inflammatory response syndrome criteria for sepsis, and six fulfilled quick-sequential (sepsis related) organ failure assessment criteria. Compliance was poor; only one patient received all elements of the sepsis six care bundle. Three patients (12%) died within 60 days of admission; all three were receiving palliative cancer care. Conclusion: Current management of sepsis is below recommended standards. The prevalence of sepsis is different depending upon the screening method used. Recommendations for future work include validation of the new sepsis definitions for mortality and morbidity rates

A snapshot of compliance with the sepsis six care bundle in two acute hospitals in the West Midlands, UK

The sepsis six care bundle has been adopted by hospitals in England and Wales for the management of patients with sepsis, with the aim of increasing survival when all elements of the bundle are achieved. To assess compliance with the Sepsis Six Care Bundle in two acute NHS hospitals in the West Midlands. Adults admitted to hospital over a 24-hour period were screened for sepsis. Sepsis was identified using the Systemic Inflammatory Response (SIRS) criteria and the quick sequential organ failure assessment (qSOFA) score. Adherence to the Sepsis Six Care Bundle was assessed. 249 patients were screened and 24 patients were identified as having sepsis (9.6%). One patient received all six elements of the bundle. Compliance was highest for giving intravenous fluids (58.3%) and antibiotics (58.3%), and lowest for measuring urine output (16.7%). Further research is needed to establish the reasons for low compliance. Frankling C, Patel J, Sharif B, Melody T, Yeung J, Gao F, et al. A Snapshot of Compliance with the Sepsis Six Care Bundle in Two Acute Hospitals in the West Midlands, UK. Indian J Crit Care Med 2019;23(7):310-315