Running head: Critical Care Nursing: Patients with Severe Sepsis 1

Critical Care Nursing: Patients with Severe Sepsis or Septic Shock

Angela M. Facer, WCSN

Westminster College
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Complications from infections can lead to medical emergencies such as sepsis and septic

shock Sepsis occurs with a hypersensitive reaction to fight infection within the blood stream.

This response can generate a chain reaction that could potentially lead to damage with multiple

organ systems and possibly death. This chain reaction makes it vital that healthcare providers

understand the recommended treatment in order to provide the best evidence-based practice.

“Severe sepsis is one of the most significant concerns in the treatment of critical care patients,

with more than 750,000 cases occurring annually. The condition spreads quickly, is often

difficult to recognize, and has a mortality rate of 28% to 50%” (Tuggle & Ahrens, 2004).

Early recognition and intervention are essential for the survival of patients with severe

sepsis or septic shock. The Society of Critical Care Medicine (SCCM) has launched the

Surviving Sepsis Campaign (SSC), which is changing the way healthcare providers identify and

treat sepsis (Society of Critical Care Medicine, 2018). The goal of this campaign is to reduce the

overall patient morbidity and mortality from sepsis and septic shock by implementing initiatives

based on current evidenced-based practice (Society of Critical Care Medicine, 2018). These new

guidelines have improved early identification of infections, risks for sepsis and septic shock,

rapid antibiotic administration, and aggressive fluid resuscitation to restore tissue perfusion.

These guidelines and tools are facilitating healthcare providers to improve patient outcomes in a

timely proficient manner (Tuggle & Ahrens, 2004).

Patients with sepsis or septic shock require early identification and prompt intervention in

order to restore tissue perfusion. These interventions are essential to the survival of current and

future patients (Cecconni, Evans, Levy, & Rhodes, 2018). Without prompt intervention, patients

will have progression of this syndrome, which could lead to tissue necrosis, multiple organ
CRITICAL CARE NURSING: PATIENTS WITH SEVERE SEPSIS 3

dysfunction (MODs), and potentially death. “50% of people who survive sepsis develop post-

sepsis syndrome” (Sepsis Alliance, 2016). This can be caused by a range of factors, which

includes permanent disability from the sepsis and the psychological effects of both the illness

and their extended hospitalization (Davis & Howell, 2017). Continuing our advancement and

education with this multilevel-system syndrome is how patient outcomes improve. Severe sepsis

and septic shock remain not only the deadliest syndrome managed in the critical care setting, but

it is also one of the most complex (Mayo Clinic, 2018).

The negative effects on many body systems, including pulmonary, renal, central nervous,

hepatic, and cardiovascular, if not promptly and competently identified and intervened, will

cause permanent damage, which could lead to patient mortality.

This syndrome doesn’t have a one-size-fits-all approach to care for a patient with severe

sepsis or septic shock, which is why it is imperative to use critical thinking skills along with

current evidence-based practice to treat this complex syndrome (Davis & Howell, 2017; Tuggle

& Ahrens, 2004).

Early identification of sepsis and septic shock improve patient outcomes and decrease the

mortality rate but also saves the hospital significant cost related to length of stay and readmission

rate (Maclay & Rephann, 2017). One way to reduce mortality from sepsis or septic shock is to

implement early goal-direct therapy (EGDT). However, there are several barriers that EGDT

faces which include cost, and logistic difficulties (Maclay & Rephann, 2017). There are also

regulations put in place that require the hospital to submit data that relates to sepsis and septic

shock. These regulations also partially determine compensation from Centers for Medicare &

Medicaid Services. Early recognition and treatment of potential sepsis patients decreases
CRITICAL CARE NURSING: PATIENTS WITH SEVERE SEPSIS 4

mortality, length of stay, readmission rates, and hospitals potential cost (Maclay & Rephann,

2017).

The Society of Critical Care Medicine (SCCM) has guidelines that follow current

evidence-based practice in treating severe sepsis and septic shock. Broad-spectrum antibiotics

are recommended within the first hours of diagnosis of sepsis and septic shock for treatment and

prevention of further damage to the body’s organs. Initial fluid (crystalloids) resuscitation is

guided by frequent reassessment of hemodynamic status (Society of Critical Care Medicine,

2018). Norepinephrine is recommended as the first-choice vasopressor to hit a target mean

arterial pressure (MAP) of 65 mmHg (Society of Critical Care Medicine, 2018). If shock is not

resolving quickly, it is recommended to do a further hemodynamic assessment such as assessing

cardiac function. Normalizing lactate in patients with elevated lactate levels is a marker of tissue

hypoperfusion. Lactic acidosis caused by increased lactate levels, typically resulting from tissue

hypoxia in common clinical situations. (Society of Critical Care Medicine, 2018)

Healthcare providers can improve patient outcomes by having a performance

improvement program for sepsis and septic shock, which include screening for acutely ill, high-

risk patients (Society of Critical Care Medicine, 2018).

There is new research that has been released by the Surviving Sepsis Campaign “Sepsis

1-hour bundle” (Cecconni, Evans, Levy, & Rhodes, 2018). This new bundle provides enhanced

delivery of care by combining fluid resuscitation and management. Below are the

recommendations for the “sepsis 1-hour bundle. Which was retrieved from the (SSC) website

(Cecconni, Evans, Levy, & Rhodes, 2018).

CRITICAL CARE NURSING: PATIENTS WITH SEVERE SEPSIS 5

Fig. 1
Hour-1 Surviving Sepsis Campaign Bundle of Care

Since this research is new there is currently no supportive evidence that accelerating

sepsis interventions is beneficial to the patient. Some healthcare providers say the “1-hour

bundle” (Cecconni, Evans, Levy, & Rhodes, 2018) eliminates thoughtful decision-making with

could lead to overtreatment of patients. There is also no accurate reliable test for sepsis. Further

discussion and evidence related to each intervention should be explored when dealing with

“Sepsis 1-hour bundle” (Society of Critical Care Medicine, 2018).

Severe sepsis and septic shock have such elevated mortality rates and, for patients that

are fortunate enough to survive, are left with a long-term morbidity (Society of Critical Care

Medicine, 2018). The increased awareness and on-going campaigns, healthcare providers are

starting to understand evidence-based approaches to manage the increasing problems (Society of

Critical Care Medicine, 2018). New research is the key to unlocking the mystery that surrounded

this complex syndrome. Nothing should be ruled out until evidence shows that it doesn’t

improve patient outcomes. However, early identification does improve patient outcomes and

while working on the solution, all healthcare providers should be aware of the risk and benefit of

treatment relating to severe sepsis and septic shock. Meanwhile, the search continues for
CRITICAL CARE NURSING: PATIENTS WITH SEVERE SEPSIS 6

improved diagnostic techniques that can facilitate individualized management strategies, and for

a pharmacological agent that can modify the disease process and improved basic care driven by

education and quality-improvement programmed offers the best hope of improving outcomes

(Society of Critical Care Medicine, 2018).

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References

Cecconni, M., Evans, L., Levy, M., & Rhodes, A. (2018). Sepsis & septic shock. The Lancet,

392(10141), 75-87.

Cheung, W. K., & Chau, L. S. (2016). Clinical management for patients admitted to critical care

unit with severe sepsis or septic shock. Intensive Critical Care Nursing, 31(6), 359-365.

Clinic, M. (2018). Retrieved from https://www.mayoclinic.org/diseases-

conditions/sepsis/symptoms-causes/syc-20351214

Davis, A., & Howell, M. (2017). Management of sepsis and septic shock. Jama, 317(8), 783-880.

Maclay, T., & Rephann, A. (2017). The impact of early identification and a critical care-based

sepsis response team on sepsis outcomes. Critical Care Nurse, 37(6), 88-92.

Park, S.-K., & Shin, S. (2017). The effects of early goal-directed therapy for treatment of severe

sepsis or septic shock. Journal of critical care, 38, 115-122.

Society of Critical Care Medicine. (2018). Retrieved from http://www.sccm.org/Home

Tuggle, D., & Ahrens, T. (2004). Surviving severe sepsis: early recognition and treatment.

Critical care nurse, 1-15.