Malpractice in treating sepsis: Early aggressive care saves lives

There are no simple diagnostic tests for sepsis – an out-of-control reaction to infection that can start shutting down organs in mere hours – but there are warning signs if healthcare providers pay close enough attention, according to Dr. James O’Brien, a critical care specialist at Ohio State University Medical Center.

“Minutes matter,” O’Brien says, noting that delays are too often simply a case of “not treating this like a medical emergency.” Millions of people around the world die from sepsis each year, and 30% of sepsis cases in the U.S. result in death.

The early symptoms of sepsis can be vague: confusion, shortness of breath, an increase in the heart rate, falling blood pressure and weakness, all of which could be caused for many other reasons. But the combination of symptoms without a clear benign cause is reason for aggressive care.

Sepsis occurs when the body overreacts while fighting an infection and damages its own tissues, which in turn can lead to shock and organ failure. Complex interactions between the microbe and the immune system cause the immune system to overreact to the point that even if the bacteria is eradicated, the damage continues to spread due to the toxic reaction of the immune system.

To better combat this deadly reaction, international sepsis experts recently formed a Global Sepsis Alliance to urge more aggressive care. The alliance wants hospitals to start antibiotics and intravenous fluids within an hour of suspicion of sepsis, as every hour of delay lowers survival by nearly 8 percent. Currently, many hospitals don’t begin appropriate care for four or even six hours, O’Brien says.

Scientists in Portugal, meanwhile, may have found an important clue as to what fuels sepsis, which is estimated to kill more than 200,000 Americans annually. During sepsis, red blood cells can become injured and leak an iron-based substance called heme that’s normally part of the hemoglobin that carries oxygen.

But when it leaks into the bloodstream at the same time the body is experiencing lots of inflammation – a given during sepsis – the heme becomes toxic to organs. In a series of experiments with infected mice, the researchers showed that extrame heme leads to more deaths.

Although the body manufactures a molecule called hemopexin to clean up leaky heme, the level of hemopexin dropped as heme levels rose. When the researchers injected more hemopexin, more mice survived.

More research is needed to confirm the findings, the study authors say.

Source: Associated Press

To learn more about the global sepsis alliance, go here:

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