Septicemia (Sepsis) is the second leading cause of death in non-cardiac ICU with more than 750,000 patients developing Sepsis in North America and equal numbers in Europe. More than 162 patients die every day in Germany due to septicemia. In ICU, the death rate is around 50% inspite of active treatment.

Sepsis is usually treated in the intensive care unit with intravenous fluids and antibiotics. If fluid replacement is insufficient to maintain blood pressure, specific vasopressor drugs can be used. Thus, in order to ensure apt diagnosis, a patient suffering from Sepsis is to be constantly monitored. Patient monitors have to adhere to the Sepsis treatment guidelines in order to successfully monitor the patient.

Philips is the only company in the world, which has the Sepsis treatment guidelines at its bedside monitors. Philips also follows the Surviving Sepsis Campaign (SSC) guidelines.

Dr. Mitchell Levy, a world renown expert in Sepsis is also an authority in Surviving Sepsis Campaign. The Surviving Sepsis Campaign (SSC), an initiative of the European Society of Intensive Care Medicine, the International Sepsis Forum, and the Society of Critical Care Medicine, has been developed to improve the management, diagnosis, and treatment of sepsis. The Campaign continues to expand efforts with guidance and support from these three bodies through ongoing collaboration of selected members of each society. The Institute for Healthcare Improvement has worked with campaign leadership to lend expertise in reinforcing the campaign as a quality improvement initiative. Dr. Levy, an active member of the Society of Critical Care, spoke at a conference organised by Philips in New Delhi, on “Reducing Mortality in Sepsis” to spread awareness about the protocols for treating sepsis. During a discussion with eHEALTH, he highlighted the need for proper monitoring.

The SSC aims to reduce mortality from sepsis via a multi-point strategy, primarily:

• Building awareness of sepsis
• Improving diagnosis
• Increasing the use of appropriate treatment
• Educating healthcare professionals
• Improving post-ICU care
• Developing guidelines of care
• Facilitating data collection for the purposes of audit and feedback

Interview with Dr. Mitchell Levy

Q. Kindly share whith us the vision behind the Surviving Sepsis Campaign?

A. I think the reason we are here and the reason what Philips is doing is so important is that the issue of sepsis cuts across all national boundaries. It is one of the most serious illnesses and killers in critical care. In the US alone there are 750,000 new cases of sepsis every year. In the US, more people die from sepsis in the ICU every year than from breast cancer, lung cancer and colon cancer combined. Part of what we’ve tried to do over the past 5 years is just simply raise awareness of sepsis. If you asked patients, ‘Do you know what breast cancer is”, they’d be offended. But if you say, “do you know what sepsis is?”, even if it’s a family member, as likely as not, they would have no idea. And so it shows we just haven’t done a very good job in critical care, of making people aware of the problems we face with sepsis. I think the reason for that is, if you say “pneumonia, abdominal infection, burst appendix, gall bladder disease”, people understand that. But ultimately what that is, is the bodies response to infection and that’s what sepsis is. The body’s response when it gets infected. We just haven’t done a very good job in making the public aware of sepsis, yet it is so common. I think, that is in part because until 5-8 years ago, there really hasn’t been much we could do about it, other than antibiotics. But over the past 5 or 8 years, we have begun to see different interventions published in the literature that have been life-saving. In addition to that, there is more evidence now that it’s not just antibiotics but how quickly you get them. We recently published some data which showed that for every hour of delay in getting appropriate antibiotics, there is an 8% higher chance of dying. It’s not just a matter of going to your physician, getting an antibiotic and then you get better, it’s about your physician being able to diagnose sepsis very quickly and acting on it very quickly. That, I think, is the key to why we’re having this meeting tonight and why we have this ‘Surviving Sepsis Campaign’ running.

It is a global effort, which has involved North America, Europe, Latin America, India and China, over the past 4-5 years. It’s goal has been to increase awareness of sepsis and encourage early diagnosis and treatment of this critical illness.

Q. What initiatives are being taken to create awareness about sepsis?

A. Over the last 5 years, we have done a number of educational programmes globally on defining sepsis. We had a consensus conference in 2001 to address what the definitions of sepsis are. We published that study in 2002. We have done a number of educational initiatives with books and pamphlets on diagnosing sepsis so that clinicians can understand what the definition is and how important it is to diagnose this early. And finally, we have started going directly to the public to try and increase public awareness of sepsis so that people are maybe, a little more cautious than they used to be when they get a cough. In many cultures, India included, people don’t want to go to the doctor. Elders in the family often prescribe home remedies. That’s OK, but at certain times when the fever gets very high and when the patient starts having shaking chills, they actually have to go see a medical doctor. We have a number of initiatives to train physicians how to diagnose the illness early and act on it. Now we have some studies based on the approach I just mentioned, that have been published, that have demonstrated that when you take these educational materials and bring them to hospitals, you save lives.

About 4 months ago we published in the Journal of the American Medical Association the results of the study that we did in Spain, of some 40 hospitals. We were able to show that through just educational materials and heightened awareness, we decreased the mortality by 14% (a relative risk reduction).

Q. Was this because treatment was started earlier or was it because it was the right kind of treatment?

A. I think it is a combination of both. I don’t think you can separate those two. The right kind of treatment is an earlier kind of treatment. The whole point of the Surviving Sepsis Campaign is that there are two bundles or groupings of therapies that are done together. The first bundle is one that’s done immediately after you walk in the door of the hospital and is finished at the end of 6 hours. And the second bundle is finished at the end of 72 hours. So it gives you an idea that it is not just about doing the right thing, it’s about doing the right thing in time. There’s no question, and we have data published that shows that the longer you wait, the less likely you are to help people survive. So the key is 2 things doing it right and doing it quickly.

And that’s honestly where the monitoring comes in. It’s not hard to understand that if the goal of the Surviving Sepsis Campaign is to improve survival, and to take things that you know work, diagnose people quickly, and do them in a timely way, then the challenge is “How do we know?” There are a number of tools where you can imagine that if people are attached to these kind of monitors anyway in the emergency department, that if those monitors that are just monitoring your heart rate, your blood pressure, how fast you breathe, what your temperature is – if they could just become smart monitors and say “hey, your patient has a fever, your patients heart rate is pretty fast, and they’re breathing very quickly, why don’t you think about sepsis?” That is the next step in monitoring. It is to remind clinicians of possible risks. As busy clinicians, sometimes you can’t think of everything all the time and prompts, especially computerised prompts, can really be helpful. We thought that if we could get clinicians to apply the right therapies at the bedside more quickly, we would save lives. That was 4-5 years ago. The gratifying thing for us is that having put forward that hypothesis, we now have data being published in high-level peer reviewed literature that says “yes, it’s true. If you follow these protocols, more people survive.”

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