Recognition and Management of Adult Sepsis in Reduces Premature Death in Acute Care Setting - Term Paper Example

Course Instructor Date ТHЕ ЕFFIСАСY ОF ЕАRLY RЕСОGNITIОN АND MАNАGЕMЕNT ОF АDULT SЕРSIS IN RЕDUСЕS РRЕMАTURЕ DЕАTH IN АСUTЕ САRЕ SЕTTING Introduction Sepsis is an inflammatory response that occurs as a result of infection and often turns lethal and causes death. The clinical syndrome, Sepsis, causes psychological, biochemical, and psychological abnormalities in the patient and is most common among adults aged 65 years and more. Its prevalence is an issue of concern because of the mortality rate that comes with the septic syndrome. The infection is mostly observed in the genitourinary, gastrointestinal, and respiratory systems. There is evident improvement of pharmacotherapy, which has caused a significance increase in the survival rates of the people that are affected by the infection at various levels. It is for that reason that the essay chooses to focus on the strategies to ensure the early detection and intervention. Background This background study describes the pathology, various definitions, the risk factors associated with the pathology, the diagnosis of the septic syndrome, and the presentation of the complication in the healthcare setting. The research narrows down to the impact of the lack of regular check-ups for the timely detection of the adult sepsis and the vulnerability of most adults in the US with regard to the health septic syndrome. There is the subsequent comparison of the various literatures as presented by different authors and the overall findings of the same. The essay focuses on the impact of the early detection of Sepsis and the early commencement of medication in relation to the mortality rate caused by the septic syndrome. Definition of Terms The clinical syndrome, Sepsis, causes psychological, biochemical, and psychological abnormalities in the patient. Sepsis is an inflammatory response that occurs as a result of infection and often turns lethal and causes death. It consists of a continuum of inflammations in response to micro-organisms that is classified as follows: Fig. 1: The sepsis inflammatory response continuum The immune system responds differently to various infections. However, sepsis is severe and progresses quite fast. Its prevalence is an issue of concern because of the mortality rate that comes with the septic syndrome. The first stages are characterized by two or more of the symptoms that include tachycardia, leukocytosis/ leukopenia, fever, and tachypnea. The symptoms can be experienced even in the absence of infections. They may be experienced as a result of burns, surgery, and trauma. Pancreatitis and vasculitis also expose the patient to the autoimmune responses. Some sepsis patients do not also meet all the criteria in terms of symptoms either[Del13]. Dynamics of Sepsis The mortality rate of the severe cases of Sepsis is between 25% and 30%. It is different for septic shock which causes a mortality rate of 70%. The etiology affects the clinical representation of the septic syndrome. The infection is mostly observed in the genitourinary, gastrointestinal, and respiratory systems. The soft tissue and the skin are also affected. Some of the symptoms include pneumonia and fever. Fever tends to manifest itself during the initial stages of the septic syndrome. Pneumonia is also common in manifestation during the later stages of the septic syndrome[Rob131]. The prevalence goes at three people for every 1000 people in the world. That makes it essential to set the importance of the frequent check for the possibility of the occurrence of the septic syndrome a priority. That includes the prioritization of the check for the septic syndrome whenever there are cases with the related symptoms. There is evident improvement of pharmacotherapy, which has caused a significance increase in the survival rates of the people that are affected by the infection at various levels. However, the mortality rates caused by the septic syndrome remain significantly high and the deaths caused by sepsis are almost equal to the number of deaths caused by myocardial infarction. About 750, 000 people are diagnosed with sepsis every year. Neviere, Parsons and Finlay (2017) explain the severity of the coondition vecause septic shock is worse since it accounts for between 40% and 70% death rates among sepsis patients. It is also correct to say that 20% of the causes of deaths recorded in hospitals are attributed to sepsis[Rob131]. The Impact of the Early Management of Adult Sepsis The early detection of sepsis and the implementation of treatment within the first six hours of the septic syndrome is essential for the reduction of the mortality rates caused by the septic syndrome. Since the symptoms progress rapidly and the effects are severe, the stabilization of respiration is essential for the management of the symptoms. The resuscitation of body fluids is another essential immediate response for the management of the septic syndrome before the symptoms progress to irrecoverable stages. Rivers et al (2001) explains the nature of Sepsis by the definition of the various stages of the continuum of the septic syndrome and the risk associated with each. According to Rivers et al, the “golden hours” those in which the septic syndrome is critical but with chances of saving the life of the patient with the timely diagnosis of the septic syndrome and the subsequent timely administration of treatment. The administration of treatment during the golden hours may elapse in the ICU, emergency ward, or the hospital ward. There is the possibility of the self-regulation of the inflammatory response syndrome. There is, however, the risk of the progression of the septic syndrome into severe sepsis. This eventually turns into septic shock. Various circulatory abnormalities are experienced through the continuum where there is increased metabolism, peripheral vasodilation, depletion of the intravascular volume, and the myocardial depression. The imbalance experienced in the delivery of the systemic oxygen and the actual demand of oxygen in the body causes the tissue hypoxia. Rivers et al (2001), however, also explains that the early hemodynamic diagnosis on the basis of physical symptoms is not sufficient in the diagnosis of persistent global tissue hypoxia. Theory gives the rationale of the benefits of the early diagnosis of adult sepsis whereas in reality, the mortality rates do not show any significant change. That is contrary to the increasing rates of cases of adult sepsis in the United States. Incidents of sepsis and septic shock are more common among the elderly than the young. According to the study, the benefits early-goal directed strategies are multi-faceted in their impact and reduction of the death rates. It, for instance, prevents instances of the sudden cardiovascular collapse as opposed to standard care. It is, however, only possible with the early identification of intrinsic factors (insidious illnesses) related to the septic syndrome and not only the external factors [Ema01]. A research related to the incident of sepsis and the trends in the same conducted for 22 years starting 1979 to 2000 indicated a steady rise in the cases of sepsis among Americans, the increase of sepsis-related deaths in the US, and the overall increase in the number of survival cases in relation to sepsis and septic shock. The study period recorded 750 million cases of sepsis-related hospitalizations in the US alone. According to the study, the cases of sepsis showed a steady increase of 8.7 % per year. The average rates of mortality decreased by 17.9% during the last 5 years of the study[Gai13]. The other factor of consideration is the dynamics of the health status of sepsis patients over the last five years of the study. It was noticed that the number of patients that experienced organ failures increased by 19.1% during the first eleven years of the study, only to experience a hike to 30.2% afterwards. The cumulative effect on mortality caused by the cases of organ failure was significant where 70% of such patients died as opposed to the 15% of patients without organ failure. The lungs and kidneys are the organs that fail most often.[Mar03]. According to the research my Martin, et al (2003), the various strategies in place in response to adult sepsis and the increasing rates of the same are only general and do not address the racial and gender disparities experienced in the cases of the septic syndrome. Other factors that require consideration are the hospital procedures and new infections such as the regular use of immunosuppressive drugs, the emergence and prevalence of HIV, and the evolution of microbes which increases their resistance levels. The argument is that for the success of the reduction of the death rates of adult sepsis related deaths amidst the different determinants of the cases of death is more complex than the mere early diagnosis of the adult sepsis. It is also a determiner of the accuracy of the estimates of the adult sepsis epidemiology. According to Kerschen, et al (2007) advocates for the use of Activated Protein C (APC) for the reduction of mortality rates as a result of adult sepsis. According to the research, the effectiveness of APC depends on the cell signaling systems dependent on PAR1 and EPCR. The APC treatment works for adults with severe sepsis. APC is an anti-coagulant as a result of the proteolytic activation of Va, the coagulation factor. The anti-coagulant effect, however, poses the threat of excessive bleeding among the patients. As a result, there is an upper limit to the dosage administered to the patients. The APC treatment is also ineffective among patients with less severe cases of sepsis. Other forms of immediate therapy for the speedy and the management of the same are such as vasopressor therapy, especially when the resuscitation through therapy proves to be ineffective in the restoration of the organ perfusion. The other essential restoration using the emergency management procedures is the achievement of the ideal mean pressure in the patient. The prescription of antibiotics within the first hour of the suspicion of sepsis is essential in saving the life of the patient. Such a prescription helps in the achievement of positive clinical results. There are instances when blood product therapy becomes a priority where there is the need for the correction of cases of anemia and coagulopathy. The therapies also help in the improvement of the central venous oxygen saturation. Since there are instances that are characterized by the hike of the blood glucose levels, the insulin therapy is recommended to restore the blood glucose to healthy and safe levels. It must be maintained at 180mg/ dL. The use of Corticosteroids is also common upon subscriptions. It is commonly administered to people with septic shock when such patients do not improve upon the administration of vasopressor therapy. However, timeliness is the main survival factor. The late diagnosis of the septic syndrome and the late administration of the medication, the more vulnerable the patient is, and the more likely their chances of survival are at stake[Wal13]. Further research focuses on the impact of the combination of various methods of treatment and the variations in the outcomes [Cas10]. The study population was subjected to the proposed Surviving Sepsis Campaign Bundles in a hospital that had adopted the new strategy. There was a significant in-hospital mortality reduction rate was at 37.5% for the intervention group. The study showed proof of the reduction of mortality rates where the extent of the impact is dependent on the number and nature of the interventions[Cas10]. Research conducted in 1987 showed that the use of methylprednisolone sodium succinate (MPSS) on patients with the syndrome showed a negative impact of the use of the treatment of patient with the same [Bon87]. However, the early administration of the MPSS has no impact in the development of Adult Respiratory Distress Syndrome (ARDS). In addition to that, there was the realization that the treatment makes it impossible to reverse the impact of the ARDS. As a result, the treatment of sepsis patients with the MPSS treatment, instead, increases the mortality rate among ARDS patients[Bon87]. The early diagnosis of sepsis was found to have little or no impact on the outcome of the sepsis syndrome and the early administration of various treatments. A 2003 study focused on lactate clearance and its positive impact on severe sepsis and septic shock revealed the impact of the intervention in the Intensive Care Unit (ICU) and the hospital ward. The study was focused on the use of serial lactate concentrations in the treatment of severe sepsis and septic shock. It was based on the hypothesis that the intervention was capable of having an influence on the outcome of the treatment if administered within six hours after diagnosis. However, that is dependent on the timely diagnosis of the sepsis syndrome and the determination of the possible complications based on the overall health of the patient[HBr04]. The research involved the administration of therapy during the emergency treatment of the patient that were then transferred to the intensive care unit. The therapy involved various interventions. There was the additional measurement of various vital signs during the same period. There was a significant reduction in the cases of death as a result of the sepsis syndrome and among the patients that received the lactate clearance at the emergency area. The impact of lactate clearance on global tissue hypoxia is known to have a reduced mortality rate when used in the course of the hospitalization of the patient[HBr04]. Patients that had high lactate clearance 6 hours after the intervention at the emergency unit have evidence in the reduction of the mortality rates as compared to cases without lactate clearance. The reduction was at 11% with an increase in the administration of lactate clearance by 10% increase. Etiology and Risk Factors The treatment of sepsis consists of both inflammatory and pro-inflammatory interventions. The two are experienced as the body responds to the invasion of pathogens. Unfortunately, the defense mechanisms cause damage to the endothelium, the dysfunction of the microvascular system, and the permeability of the vascular system. The oxygenation process is also affected. It is for that reason that a sepsis cascade is experienced. In most instances, bacteria initiate the reactions. It accounts to about 30% to 40% of the instances of the infection[Rod04]. The antibiotic treatment was administered to various patients that had the sepsis syndrome during the emergency situations. The impact was observed to the significant reduction in the crude mortality usually experienced from bacteria-induced inflammations. Other studies show contradictory results in relation to the Early-Goal-Directed Therapy (EGDT) in the intervention strategies towards the treatment of septic syndrome. The therapy consists of the aggressive administration of fluids in the attempt to increase the survival rates from sepsis. Although the cases of fluid overload as a result of EGDT is not yet established, the research found the likelihood of fluid overload among patients that received the intervention and the likelihood of death caused by the same[Dia15]. In addition to that, the study by Gu, et al (2014) indicated that the Goal-Directed Therapy had no direct relationship with the reduction of mortality rates resulting from severe sepsis and septic shock. It is important to consider the nature of the sepsis in the patient and their vulnerability to fluid overload as seen in a Zambian study[Ben14]. An Australian study done between 2000 and 2012 indicated an increased survival rate among sepsis syndrome patients. The medical interventions in relation to severe sepsis among patients in the ICU showed positive results. It did not, however, cover the statistics for the patients of septic shock. The outcomes were seen in the increase in the number of patients discharged into homes, their own homes, or other medical care settings [Kir14]. Adults are at greater risk of the development of the septic syndrome as compared to their younger counterparts. It comes with the change in the responsiveness of the body to various external factors. Adults above the age of 63 face the highest risk of the development of the septic syndrome and the subsequent death from the same. According to research studies conducted by Martin, et al (2003), the dynamics are, however, different among male and female Americans and between white Americans and non-white Americans. Immunosuppression and malnutrition also increase the vulnerability of the adults to the septic syndrome. Recent surgeries and hospital stays also expose the adults to the septic syndrome because of their vulnerability to bacterial infections. Conclusion In conclusion, the severity of the septic syndrome of sepsis is enough motivation to make it a priority to frequently test for the same so that diagnoses are made during the early stages of the septic syndrome for the chance to effectively try the best approaches in treatment. Therefore, just like the pap smear is one of the most important gynecological tests during visits to gynecologists for the sake of the early detection of cervical cancer, the symptoms associated with sepsis should be a priority during regular hospital visits among the adults aged 65 and above for the early detection of the irregularities that may result to the septic syndrome. The various research agree on the relevance of the early diagnosis and intervention against sepsis as a good way to reduce the rates of mortality. As mentioned by some researchers, the critical moment where he patient still has the chance of survival is called the golden hour. During the golden hour, various interventions are capable of significant impact on the outcome of the treatment and the overall survival of the patient. The early detection of the septic syndromes and the timely commencement of the interventions is essential for the reduction of the mortality rates resulting from the same. That is especially so since the mortality rates are indiscriminate of the severity of the sepsis and can equally occur at whichever level of intensity. There are various recommendations on the best intervention strategies and the overall impact of timely intervention. References Del13: , (Dellinger, et al., 2013), Rob131: , (Gauer, 2013), Ema01: , (Rivers, et al., 2001), Gai13: , (Gaieski, et al., 2013), Mar03: , (Martin, et al., 2003), Wal13: , (AJ, et al., 2013), Cas10: , (Castellanos-Orteg, et al., 2010), Cas10: , (Castellanos-Orteg, et al., 2010), Bon87: , (Bone, et al., 1987), Bon87: , (Bone, et al., 1987), HBr04: , (Nguyen, et al., 2004), Rod04: , (MacArthur, et al., 2004), Dia15: , (Kelm, et al., 2015), Ben14: , (Andrews, et al., 2014), Kir14: , (Kaukonen, et al., 2014), Read More