Sepsis therapy in the next decade: seamless care from emergency to the ICU

Letters

CJEM 2005;7(4):227

To the Editor: Severe sepsis: defined by inflammation (aberrant temperature and white blood cell count, tachypnea and tachycardia); suspicion of infection; and evolving organ dysfunction, is associated with an incidence, mortality and cost similar to acute coronary syndromes.¹ However, sepsis has not received similar recognition or funding. Evidence suggests "golden hours" during which early and aggressive therapy can prevent progression to intractable organ failure.² Guidelines now provide evidence-based strategies to expedite a continuum of care from the emergency department, to the ward, to the ICU.³ As such, the next decade holds great potential. Conceptually this is similar to the "chain-of-survival" recommended for cardiac disease.⁴ Early goal-directed therapy, early antibiotic administration, tight glycemic control, low-dose corticosteroids, consideration of recombinant protein C, and consideration of early transfer to ICU are all likely to improve mortality.³

To promote seamless multidisciplinary care, representatives from 5 Canadian sites met to exchange ideas and learn from the world authority.³ Emergency, intensive care and internal medicine physicians along with nurses, educators and administrators discussed strategies. They agreed that the use of established protocols will help to provide optimal care delivery, germinate education and stimulate research..

We welcome correspondence, both to share our nascent protocols and to stimulate nationwide involvement. We encourage others to address their own continuum of sepsis care and learn how to facilitate early sepsis therapy while the greatest chance for recovery exists.

We thank Dr. Emanuel Rivers and the other staff members at Detroit's Henry Ford Hospital who provided the impetus to tackle this disease. It is now time for Canadian physicians to show leadership and for funding to follow.

Peter G. Brindley
Assistant Professor
Critical Care Medicine
4H1.22, University of Alberta Hospital
8440-112th St.
Edmonton AB T6G 2B7
peterbrindley@cha.ab.ca

Dennis Djogovic
Emergency Medicine
University of Alberta Hospital
Edmonton, Alta.

References

1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-10.
2. Rivers E, Nyugen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early-goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.
3. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-72.
4. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (70-2041). Part 1: Introduction to the International Guidelines 2000 for CPR and ECC: a consensus on science. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Circulation 2000;102(suppl 1):I1-11.