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Sepsis Response Team

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Textbook of Rapid Response Systems

Abstract

The transition from sepsis to severe life-threatening disease frequently develops well before admission to an intensive care unit (ICU), often in the pre-hospital setting, the emergency department (ED), general medical-surgical floors, operating room or the outpatient clinic setting. One would hope that as soon as possible after the sepsis syndrome occurs, treatment with resuscitation fluids, restoration of adequate oxygen delivery to the tissues, and antimicrobial therapy would begin. However, optimal care may be delayed for many reasons, including lack of recognition, ED overcrowding and long wait times for ICU beds. Delays to medical emergency teams (MET) and rapid response team involvement may further hinder the availability of expert care to prevent morbidity and mortality. For years we have recognized that delay in care negatively impacts outcome for trauma, myocardial infarction, and stroke.1–3 There is now robust evidence that treatment delay can also negatively impact outcome in sepsis.4–7 This chapter will review the evidence for early intervention in sepsis, models of delivery, and potential obstacles. While a specific team response is not required, a Rapid Response System with a trained efferent limb may provide one mechanism for providing a rapid, coordinated team response to patients presenting to the hospital with signs of sepsis.

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References

  1. Nathens AB, Jurkovich GJ, Maier RV, et al. Relationship between trauma center volume and outcomes. JAMA. 2001;285:1164–1171.

    Article  CAS  PubMed  Google Scholar 

  2. Anderson HV, Willerson JT. Thrombolysis in acute myocardial infarction. N Engl J Med. 1993;329:703–709.

    Article  CAS  PubMed  Google Scholar 

  3. Marler JR, Brott T, Broderick J, Kothari R, Odonoghue M, Barson W. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995;333:1581–1587.

    Article  CAS  Google Scholar 

  4. Han YY, Carcillo JA, Dragotta MA, et al. Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics. 2003;112:793–799.

    Article  PubMed  Google Scholar 

  5. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–1377.

    Article  CAS  PubMed  Google Scholar 

  6. Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med. 2007;35:1477–1483.

    Article  PubMed  Google Scholar 

  7. Lundberg JS, Perl TM, Wiblin T, et al. Septic shock: an analysis of outcomes for patients with onset on hospital wards versus intensive care units. Crit Care Med. 1998;26:1020–1024.

    Article  CAS  PubMed  Google Scholar 

  8. Pearse RM. Extending the role of lactate measurement into the pre-hospital environment. Crit Care. 2009;13:115.

    Article  PubMed  Google Scholar 

  9. Mikkelsen ME, Miltiades AN, Gaieski DF, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009;37:1670–1677.

    Article  CAS  PubMed  Google Scholar 

  10. Trzeciak S, Dellinger RP, Chansky ME, et al. Serum lactate as a predictor of mortality in patients with infection. Intensive Care Med. 2007;33:970–977.

    Article  CAS  PubMed  Google Scholar 

  11. Shapiro NI, Howell MD, Talmor D, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45:524–528.

    Article  PubMed  Google Scholar 

  12. Rivers EP, Kruse JA, Jacobsen G, et al. The influence of early hemodynamic optimization on biomarker patterns of severe sepsis and septic shock. Crit Care Med. 2007;35:2016–2024.

    Article  PubMed  Google Scholar 

  13. Gao F, Melody T, Daniels DF, Giles S, Fox S. The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study. Crit Care. 2005;9:R764–R770.

    Article  PubMed  Google Scholar 

  14. Kortgen A, Niederprum P, Bauer M. Implementation of an evidence-based “standard operating procedure” and outcome in septic shock. Crit Care Med. 2006;34:943–949.

    Article  PubMed  Google Scholar 

  15. Sebat F, Johnson D, Musthafa AA, et al. A multidisciplinary community hospital program for early and rapid resuscitation of shock in non-trauma patients. Chest. 2005;127:1729–1743.

    Article  PubMed  Google Scholar 

  16. Shapiro NI, Howell MD, Talmor D, et al. Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Crit Care Med. 2006;34:1025–1032.

    Article  PubMed  Google Scholar 

  17. Trzeciak S, Dellinger RP, Abate NL, et al. Translating research to clinical practice: a 1-year experience with implementing early goal-directed therapy for septic shock in the emergency department. Chest. 2006;129:225–232.

    Article  PubMed  Google Scholar 

  18. Lin SM, Huang CD, Lin HC, Liu CY, Wang CH, Kuo HP. A modified goal-directed protocol improves clinical outcomes in intensive care unit patients with septic shock: a randomized controlled trial. Shock. 2006;26:551–557.

    Article  PubMed  Google Scholar 

  19. Micek ST, Roubinian N, Heuring T, et al. Before-after study of a standardized hospital order set for the management of septic shock. Crit Care Med. 2006;34:2707–2713.

    Article  PubMed  Google Scholar 

  20. Nguyen HB, Corbett SW, Steele R, et al. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med. 2007;35:1105–1112.

    Article  PubMed  Google Scholar 

  21. Sebat F, Musthafa AA, Johnson D, et al. Effect of a rapid response system for patients in shock on time to treatment and mortality during 5 years. Crit Care Med. 2007;35:2568–2575.

    Article  PubMed  Google Scholar 

  22. Chen ZQ, Jin YH, Chen H, Fu WJ, Yang H, Wang RT. Early goal-directed therapy lowers the incidence, severity and mortality of multiple organ dysfunction syndrome. Nan Fang Yi Ke Da Xue Xue Bao. 2007;27:1892–1895.

    CAS  PubMed  Google Scholar 

  23. He ZY, Gao Y, Wang XR, Hang YN. Clinical evaluation of execution of early goal directed therapy in septic shock. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007;19:14–16.

    PubMed  Google Scholar 

  24. Qu HP, Qin S, Min D, Tang YQ. The effects of earlier resuscitation on following therapeutic response in sepsis with hypoperfusion. Zhonghua Wai Ke Za Zhi. 2006;44:1193–1196.

    PubMed  Google Scholar 

  25. Castro R, Regueira T, Aguirre ML, et al. An evidence-based resuscitation algorithm applied from the emergency room to the ICU improves survival of severe septic shock. Minerva Anestesiol. 2008;74:223–231.

    CAS  PubMed  Google Scholar 

  26. Akinnusi ME, Alsawalha L, Pineda LA, El Solh AA. Outcome of septic shock in the elderly following the implementation of the sepsis bundle: a propensity-adjusted analysis. Chest. 2007;132:494.

    Google Scholar 

  27. Jones AE, Focht A, Horton JM, Kline JA. Prospective external validation of the clinical effectiveness of an emergency department-based early goal-directed therapy protocol for severe sepsis and septic shock. Chest. 2007;132:425–432.

    Article  PubMed  Google Scholar 

  28. Ferrer R, Artigas A, Levy MM, et al. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA. 2008;299:2294–2303.

    Article  CAS  PubMed  Google Scholar 

  29. Zubrow MT, Sweeney TA, Fulda GJ, et al. Improving care of the sepsis patient. Jt Comm J Qual Patient Saf. 2008;34:187–191.

    PubMed  Google Scholar 

  30. Zambon M, Ceola M, Almeida-de-Castro R, Gullo A, Vincent JL. Implementation of the Surviving Sepsis Campaign guidelines for severe sepsis and septic shock: we could go faster. J Crit Care. 2008;23:455–460.

    Article  PubMed  Google Scholar 

  31. Thiel SW, Asghar MF, Micek ST, Reichley RM, Doherty JA, Kollef MH. Hospital-wide impact of a standardized order set for the management of bacteremic severe sepsis. Crit Care Med. 2009;37:819–824.

    Article  PubMed  Google Scholar 

  32. Focht A, Jones AE, Lowe TJ. Early goal-directed therapy: improving mortality and morbidity of sepsis in the emergency department. Jt Comm J Qual Patient Saf. 2009;35:186–191.

    PubMed  Google Scholar 

  33. Moore LJ, Jones SL, Kreiner LA, et al. Validation of a screening tool for the early identification of sepsis. J Trauma. 2009;66:1539-1546. Discussion 1546–1547.

    Article  PubMed  Google Scholar 

  34. de Oliveira CF, de Oliveira DS, Gottschald AF, et al. ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation. Intensive Care Med. 2008;34:1065.

    Article  PubMed  Google Scholar 

  35. Shorr AF, Micek ST, Jackson WL Jr, Kollef MH. Economic implications of an evidence-based sepsis protocol: can we improve outcomes and lower costs? Crit Care Med. 2007;35:1257–1262.

    Article  PubMed  Google Scholar 

  36. Huang DT, Clermont G, Dremsizov TT, Angus DC. Implementation of early goal-directed therapy for severe sepsis and septic shock: a decision analysis. Crit Care Med. 2007;35:2090–2100.

    Article  PubMed  Google Scholar 

  37. Talmor D, Greenberg D, Howell MD, Lisbon A, Novack V, Shapiro N. The costs and cost-effectiveness of an integrated sepsis treatment protocol. Crit Care Med. 2008;36:1168–1174.

    Article  PubMed  Google Scholar 

  38. Pope JV, Jones AE, Gaieski DF, Arnold RC, Trzeciak S, Shapiro NI. Multicenter study of central venous oxygen saturation (ScvO(2)) as a predictor of mortality in patients with sepsis. Ann Emerg Med. 2009;55(1):40–46.

    Article  PubMed  Google Scholar 

  39. Varpula M, Tallgren M, Saukkonen K, Voipio-Pulkki LM, Pettila V. Hemodynamic variables related to outcome in septic shock. Intensive Care Med. 2005;31:1066–1071.

    Article  PubMed  Google Scholar 

  40. Grissom CK, Morris AH, Lanken PN, et al. Association of physical examination with pulmonary artery catheter parameters in acute lung injury. Crit Care Med. 2009;37:2720–2726.

    Article  PubMed  Google Scholar 

  41. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296–327.

    Article  PubMed  Google Scholar 

  42. Berwick DM. Disseminating innovations in health care. JAMA. 2003;289:1969–1975.

    Article  PubMed  Google Scholar 

  43. De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004;109:1223–1225.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Emergency Medicine and Surgery, Wayne State University, Henry Ford Hospital, Detroit, MI, USA

    Emanuel P. Rivers

Authors
  1. Emanuel P. Rivers
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  2. David Amponsah
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  3. Victor Coba
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Corresponding author

Correspondence to Emanuel P. Rivers .

Editor information

Editors and Affiliations

  1. , Department of Critical Care Medicine, University of Pittsburgh Medical Center, Dewey Street 125, Edgewood, 15218-1407, Pennsylvania, USA

    Michael A. DeVita

  2. Liverpool Hospital, Dept. Intensive Care, University of New South Wales, Locked Bag 7103, Liverpool, 1871, New South Wales, Australia

    Ken Hillman

  3. Dept. Intensive Care, Austin and Repatriation Medical Centre, Studley Road, Heidelberg, 3084, Victoria, Australia

    Rinaldo Bellomo

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© 2011 Springer Science+Business Media, LLC

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Rivers, E.P., Amponsah, D., Coba, V. (2011). Sepsis Response Team. In: DeVita, M., Hillman, K., Bellomo, R. (eds) Textbook of Rapid Response Systems. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92853-1_22

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  • DOI: https://doi.org/10.1007/978-0-387-92853-1_22

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-92852-4

  • Online ISBN: 978-0-387-92853-1

  • eBook Packages: MedicineMedicine (R0)

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