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Sepsis

Sepsis or septicemia is the body’s overwhelming or extreme response to an infection.

Sepsis or septicemia is the body’s overwhelming or extreme response to an infection. In some cases, it may become life-threatening, causing multiple organ failure and eventually death. Normally, the body’s immune system fights the infection.

However, if you already have an infection, your body may release a large number of chemicals called as cytokines into the bloodstream which triggers hyperinflammation, blood clotting, and may reduce blood flow to your internal organs and limbs which deprives your body of oxygen and nutrients. Due to the risk of multiple organ failure, you need to seek immediate medical treatment. If delayed, it may become life-threatening, causing death or disability.

Death/disability toll of sepsis

• It is difficult to calculate the prevalence of sepsis across the globe. The estimated prevalence is 30 million cases hospitalized every year due to sepsis, and around 6 million deaths occur each year due to septic shock. It is more common in low- and middle-income countries.

What you need to know about the staging of sepsis:

The staging of the sepsis is also necessary for your doctor to understand the pathology of the disease and the proper treatment protocol to be followed.

Guidelines for staging the progression of sepsis are as follows:

The common signs and symptoms of sepsis include very high fever, cold skin, high heart and respiratory rate, raised white blood cells and a known or suspected infection are indications of SIRS.

It is the second stage of sepsis. It indicates the beginning of acute organ dysfunction. The signs of organ dysfunction include hypotension, and hypoperfusion of organs. Other signs include no/low urine output, changing mental state, decreased blood platelet count, difficult breathing, abnormal heart pumping function and abdominal pain.

The most severe stage of sepsis is septic shock. It is indicated by hypotension despite fluid resuscitation. It is associated with increased levels of lactic acid in the blood.

Sepsis can occur in all kinds of populations. The chances of developing sepsis is higher in infants, children, pregnant women, older adults patients with serious infections and blood infections, patients with other diseases like diabetes, AIDS, cancer, etc., which increases the risk of worsening the infection.

Additionally, if you are falling into any of the category mentioned below, you are at a risk of developing sepsis:
• Older patients with chronic diseases
• Patients with an antibiotic-resistant infection
• Organ transplanted patients on immunosuppressant medications
• Patients with compromised immunity

In India approximately 35% of intensive care unit deaths occur due to sepsis.
“According to the studies published in 2017, the sepsis-related mortality in the ICU, hospital and 1-month was 56%, 63% and 63% respectively.”

Treating sepsis: All you need to know about the treatment of sepsis

The essentials of the treatment of sepsis according to the guidelines are:

• Controlling the source of the infection;
• Antimicrobial therapy;
• Resuscitation and hemodynamic support;
• Organ support, including mechanical ventilation and renal replacement therapy;
• Sedation/analgesia as needed; and
• Adequate nutrition.

Patients with sepsis are treated in the intensive care unit. Doctors try to protect vital organs and control the falling blood pressure by giving antibiotics and fluids through an intravenous route. In case of severe sepsis, physicians may use a breathing tube, dialysis, or surgery to remove the infection.

For hemodynamic support, fluid volume resuscitation is provided. If hypotension and hypoperfusion persists, vasopressor agents/ catecholamines are initiated. The end goal of hemodynamic support is to regulate blood pressure, microcirculation and microperfusion across the body. The treatment success after severe sepsis depends on the choice of antibiotics.

As per your doctor’s advice, get vaccinated against the infections like pneumonia, flu.
Keep any small injury clean. Good hygiene practices must be followed when applying medicines/handling a wound site. Good hygiene practices also include washing your hands.

Hemoadsorption Device like Cytosorb:

new extracorporeal organ support therapies including hemoadsorption and hemoperfusion, with new sorbent cartridges designed to remove cytokines and other circulating mediators help patients with sepsis regaining control and prevent multiorgan dysfunction/failure.

Life after sepsis

After proper treatment patients return to normal and regain their ability to perform daily activities. However, patients with long-standing infection may have permanent organ damage, and patients with kidney impairment prior to sepsis may suffer from kidney failure and will require dialysis lifelong.

In case of an infection, one must be aware of and look out for the symptoms of sepsis. You must call an ambulance for immediate medical help if any of the following symptoms are observed:

• Dizziness, a feeling of faint-headedness
• Confusion, a drop in consciousness,
• Diarrhea, nausea, vomiting,
• Difficulty in breathing or shortness of breath,
• High fever, muscle pain, a feeling of general discomfort,
• Loss of consciousness,
• Cold and pale skin at the extremities

Useful links:
• https://www.who.int/news-room/fact-sheets/detail/sepsis
• https://www.webmd.com/a-to-z-guides/sepsis-septicemia-blood-infection#2
• https://www.cdc.gov/sepsis/what-is-sepsis.html
• https://www.sepsis.org/sepsis-basics/what-is-sepsis/
• https://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214

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