WSC Spotlight: Session on Neonatal Sepsis Now Available
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The session on 'Neonatal Sepsis' from the WSC Spotlight: Maternal and Neonatal Sepsis is now available on demand on YouTube (embedded below) and as a Podcast on Apple Podcasts (iTunes Link). The next session will be 'Updates on Sepsis', released on Thursday, November 2nd, 2017. A full release schedule is available here (PDF). If you enjoyed this free online congress, please donate to make the 2nd World Sepsis Congress possible in 2018.

 
Marvin Zick
The Catastrophic Consequences of Sepsis: The Traumatic Story of a Sepsis Survivor
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In April 2016, I had a life threatening and life changing experience as a result of an infection in my index finger. One week previously I had seen a physician who diagnosed a Cellulitis infection on my finger and prescribed an antibiotic to treat it. Unfortunately for me this physician did not give me any information about what I should do if the antibiotic he prescribed was not successful in treating this infection. To make a long story short a week later I collapsed at home and was rushed to the hospital with a ruptured abdominal aneurysm and in septic shock. I survived an event with a higher than 90% fatality rate.

What had happened was that the infection I had, had seeded itself in my blood stream, creating and causing an aneurysm to rupture. When I was taken to the hospital I was essentially bleeding to death. Emergency vascular surgery, blood transfusions,  a week in a coma and 3 weeks in the ICU saved my life. I feel fortunate to be alive.

As part of my recovery and to help prevent problems of this type occurring for other people I have taken to writing about my experience. In particular I have written two articles which were published in the Toronto Globe and Mail Facts and Arguments Column.  These articles can be accessed by Googling my name and the Globe and Mail. As well I have complained to the College of Physicians and Surgeons of Manitoba about the medical care I received from the aforementioned physician and two other physicians I saw in the week previous to my near death experience.

Unfortunately my story is all too typical of Sepsis survivors who have received deficient medical care leading up to a traumatic medical experience which in many cases could have been prevented with better patient/physician communication and medical care. Recently as a result of my complaint about the first physician I saw the College published the following note in its newsletter:

"The investigation Committee recently reviewed a case which highlighted the importance of providing good instruction for follow up. A patient with cellulitis of the hand was seen on a walk-in basis and provided with antibiotics. The next day he was seen by another physician who drained the abscess. Unfortunately the patient went on to develop sepsis and seeded a mycotic psuedoaneurysm resulting in an extended ICU admission. While this specific complication is rare, sepsis is a life threatening complication which requires rapid intervention, so physicians must be vigilant in providing follow-up instructions.
As with any acute illness, patients with infections should be informed of the anticipated course of recovery and what to do if their clinical course does not follow this trajectory. Patients who understand the anticipated time lines and the specific signs of deterioration are better able to seek appropriate reassessment in a timely fashion."

I went through a hell of an experience. But what I went through pales in comparison to what my family had to deal with. We are all still recovering from the PTSD symptons of this terrible experience. We need to do more to educate not only doctors but also the general public about Sepsis. The catastrophic consequences of infections can and often do kill people.

Mac Horsburgh, Sepsis Survivor
 

To prevent further stories like this, please help us raising awareness for sepsis by donating.

Helen Reinke
Reminder: Submit Your Pictures for 2017 WSD Event Poster Now
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What did you do for World Sepsis Day? We want to know and feature you and your event on the 2017 WSD Event Poster. 
Please fill out the form here and include a picture of your event to be featured on the poster. 
Please note you can only upload one picture per event. 

The poster will be completed by November, and we will make it available for download, as well as sent out printed copies.

Please let your colleagues and friends know, especially if you know they did an event for WSD.

 

Helen Reinke
WSC Spotlight: Session on Maternal Sepsis Now Available
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The session on 'Maternal Sepsis' from the WSC Spotlight: Maternal and Neonatal Sepsis is now available on demand on YouTube (embedded below) and as a Podcast on Apple Podcasts (iTunes Link). The next session will be 'Neonatal Sepsis', released on Thursday, October 19th, 2017. A full release schedule is available here (PDF). If you enjoyed this free online congress, please donate to make the 2nd World Sepsis Congress possible in 2018.

 
Marvin Zick
The Hidden Faces of Sepsis, What do They Tell Us? Focal Points for Improving Patient Outcome.
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Idelette Nutma published by: ICU Management & Practice. 2017;17(3):182-4. 

Based on the patients’ perspective Nutma sheds light on the hidden faces of sepsis, calling for more expertise on sepsis sequelae. She also offers recommendations to improve recovery and outcome.

It wasn’t until 2007, after my illness that: “I came to understand the extensive process of recovery after critical illness. Moreover, I came to realise that the need for explanation, support and advice, as well as the importance of providing the patient with a good start of the recovery process, was seriously underestimated. Having been a former nurse, I considered this an important eye opener” (Nutma 2016).

Obviously, I was enormously grateful for having been given a second chance. When my recovery came to a standstill at a certain point, I learned that survival ‘in itself’ wasn’t sufficient to measure ‘outcome’. I’m very happy that the patient’s perspective of quality of life is being taken into account more and more.

Sepsis: a critical illness in disguise

In 2007 I experienced the thin line between life and death caused by sepsis. I fell ill due to a septic shock, and spent 5 days in ICU. I was in critical condition and my family was informed that “it could go either way”, leaving them between hope and fear. Fortunately, thank God, I turned the corner after having been ventilated for a few days. Sepsis is incredibly sneaky. Without warning and seeming to resemble the flu, sepsis strikes like lightning, devastating both you and your loved ones. In a few hours’ time I went into shock and developed acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC), the meaning of which comes close to Death Is Coming.

Earlier that morning, just before ICU admission, antibiotic IV treatment because of pneumonia had already started. I tried to make sense of it all: how did my body lose control? It felt like some supernatural force was pushing me over the edge…. It started with dizziness when walking to the toilet, and soon it felt like my legs went wobbly. I made it back to bed just in time and called for the nurse. It became clear that I was very hypotensive. Shortly after that my feet and hands had turned ice-cold and I felt my heart beating very fast. I realised that I was going into shock. In less than 15 minutes my shortness of breath worsened and as I coughed, my mouth filled with bloody mucus and fluid. For a moment I was caught by the very fear of dying, and I thank God there was an ICU to turn to: it saved my life.

Being a nurse at the time, I tried to get a hold on things. The first few hours after my transfer to ICU I stayed very alert, and every now and again I looked over my shoulder on the monitor to see if my blood pressure was rising. It wasn’t…. Sepsis, however, never crossed my mind! During my nursing education the word sepsis had been mentioned with regard to a complication of a wound infection or a peritonitis. Never ever had it been referred to as the systemic, dysregulated host response or organ dysfunction that was making my body react in this life-threatening way. Eventually I had to let go, due to exhaustion. Breathing was hardly possible, and after a moment of saying goodbye—‘for better or for worse’—I was given ventilatory support. Sepsis nearly killed me, but no one ever mentioned the word…. A few months after my discharge I noticed the word sepsis in my medical record.

As said earlier, sepsis really caught me by surprise. Many patients don’t realise what’s going on, because the brain has already lost control. As a matter of fact, when patients do stay alert and experience life slipping through their fingers, they often don’t get the chance to fully realise the impact either, because intubation makes sedation necessary. On top of all this, lots of patients don’t realise ‘what hit them’, because, just like me, they hadn’t been informed. Hence it became my mission to communicate about sepsis and to literally spread the word. Fact is, that even when patients are not admitted to the ICU (with treatment sometimes carried out under the supervision of an ICU physician) sepsis remains a critical illness. Actually, it seems to be the most common critical illness outside the ICU, for one main reason: sepsis is not often promptly diagnosed at the general ward. There’s one more important aspect of disguise: when things go wrong in terms of prompt diagnosis and consistent implementation of protocols, sepsis is generally referred to as ‘a complication’, whereas it should actually be regarded as a calamity. The report on ‘collateral damage in Dutch hospitals’, published in 2007 (de Bruijne et al. 2007), led to the Security Management System implementation in hospitals, including protocols of the Surviving Sepsis Campaign. The importance of compliance was illustrated by van Zanten et al. showing a decline in the mortality rate of 16.7% (van Zanten et al. 2014). When it comes to consistent compliance and alertness, a lot of work still has to be done in hospitals and other settings, in the Netherlands, but in the rest of the world as well.

You might also like: From Independent Attorney to Critically Ill Patient

Recovery after sepsis and critical illness: from no man’s land to a mission

  • Given the fact that sepsis is a critical illness in disguise, extra effort is also needed to spot it proactively, including concentrating funds and scientific research to develop biomarkers.
  • Raising the red flag on sepsis remains very important, just as important as communicating the word ‘sepsis’.
  • The same applies to creating more awareness of long term sequelae, although significant progress is being made by the Global Sepsis Alliance and many others.

My recovery took a long time and there was no aftercare whatsoever, nor information about what to expect and how to cope. It was also hard for my husband and children. My energy level was terribly low. I was readmitted three times because of an infection during the first few years, and I had problems with ‘ordinary’ things like planning, multitasking, remembering appointments, etc. Mentally I suffered from mood swings, a short fuse, and the quest for the explanation of the ‘void’; I had no factual memories of the crisis I’d gone through. Actually, the struggle for life had turned into the struggle with life. Nowadays we know that critically ill sepsis patients are more likely to develop PTSD (Johns Hopkins Medicine 2013). Fortunately, the definition of postintensive care syndrome (PICS) has highlighted the impact of critical illness in general (Needham et al. 2012). At the time, however, I blamed myself for having these feelings. Finally, after 8 months I found some fellow-sufferers. They also felt like they had been dropped in no man’s land: deserted and facing rehabilitation all alone.

Eventually, having gained strength from complementary medicine, I decided to assemble all the information on sepsis and recovery after critical illness I could find, and write a book about it. Moreover, it triggered me to turn my mission into a new job: teaching, giving lectures, information and guidance, from the patient’s perspective.

I sincerely hope Sepsis and Afterwards provides former patients, relatives and professionals from all over the world with a better understanding of the impact of sepsis and all that may be helpful during recovery. Information about the book: https://www.sepsis-en-daarna.nl/english

The hidden faces of sepsis – some focal points

Sepsis leaves a trail of devastation to many survivors and/or relatives. A few months ago I received a phone call from a woman whose sister had just passed away in ICU, due to sepsis. She told me that in a few days’ time her sisters’ legs had turned purple and black, and how she had witnessed her sister literally leave this life bit by bit. It’s terrifying and one of the horrible physical faces of sepsis, causing death or great visible impact due to disseminated intravascular coagulation (DIC). However, I’d like to shed some light on the more invisible, let’s say hidden physical faces of sepsis: neuropathic disorders, neurocognitive sequelae and the effects on the immune system.

An important aspect of my job is to provide guidance to former patients (and/ or their relatives), and it strikes me how often they report some form of neuropathy. This also applies to those who were not admitted to the ICU (meaning they were not ventilated and sedated), emphasising how sepsis itself can affect the peripheral nerve system. They may suffer from tingling, pain or even numbness. When these symptoms occur during and after ICU admission they are described as ICU-acquired weakness, but actually this expression doesn’t cover the sensory aspects mentioned above. Critical illness neuropathy is a comprehensive expression for various disruptions of the nerves. This may also include autonomic dysregulation (as reported by some clients), combined with hypersensitivity to all kinds of stimuli, together with an auto-immune disease or a hyperactive immune system in general. This suggests a possible (complex) link and interaction between the brain/the central nerve system and the immune system. Many of these patients are confronted with the knowledge gap with regard to these after effects, because the expertise about sepsis among physicians is often limited to the acute phase of the illness.

A (research) centre specialised in sepsis sequelae would really be a major step forward.

As to the neurocognitive sequelae, it is important to realise that sepsis is an independent risk factor for delirium, making patients vulnerable to neurocognitive disorder: they are facing problems with their short-term memory, mental processing speed and multitasking, and returning to work. Smith and Meyfroidt stated that “the brain is always in the line of fire” and that:

“a brain-oriented approach should be a unifying concept in the management of all critically ill patients” (Smith and Meyfroidt 2017).

More focus on neurocognitive rehabilitation(facilities) is needed.

Protecting the brain is reducing neurocognitive sequelae and the effect on the immune system as well. What applies to the brain applies to PICS in general: you don’t have to repair what can be protected and secured. Furthermore, especially after sepsis, the immune system is totally out of balance, giving way to all kinds of ‘intruders’, among other things, due to a heavily disturbed intestinal flora.

“According to a study published in the Journal of Hospital Medicine, about onethird of the survivors of sepsis or septic shock were readmitted within 30 days (Zilberberg et al. 2015). This all lays a heavy burden on the lives of the survivors and their family members, but on society and healthcare as well” (Nutma 2016).

And who shows those concerned the way to build up their immune competence again?

Patients should be provided with recovery tools to build up their immune competence.

In organising the workshop ‘Recovery after sepsis’ I try to make a contribution and give tips about good nutrition and dietary supplements which I found to be very helpful myself.

Conclusion

Serious attention to rehabilitation right from the start can make the difference between the downward spiral and climbing up. Fortunately the general focus on the impact of critical illness and ICU admission (which concerns many sepsis patients) has improved. Quoting Sepsis and afterwards:

“Investing in getting the ex-patient in better shape and teaching how to deal with impairments can mean a lot in terms of prevention. The so-called Balance Training for adult former ICU-patients was started up in the Netherlands in 2016, initiated by Hanneke Oonk, “Gezondheidszorgcoach” (health care coach),” together with the author of this article. “It supports survivors in dealing with longterm sequelae, by means of mindfulness, peer support and psycho education, aiming at (re)gaining the balance in body and life. [….] 'Family and Patient Centred Intensive Care' (FCIC) was founded in the Netherlands in 2015, aiming at reducing the impact of ICU care. This foundation seeks to combine expertise and experience of (health care) professionals, researchers and former patients and relatives” (Nutma 2016).

Still, aftercare tailor made for the needs of sepsis patients, like the workshop mentioned above, and reducing long term sepsis sequelae require more attention.

Therefore I’d like to call for more expertise and education on the hidden impairments of sepsis and to provide patients with more specific recovery tools, thus preventing readmissions and help them to improve their quality of life; the life that was so hard-won.

References:

de Bruijne MC, Zegers M, Hoonhout LHF et al (2007) Onbedoelde schade in Nederlandse ziekenhuizen: dossier-onderzoek van ziekenhuisopnames in 2004. Amsterdam: Netherlands Instituut voor Onderzoek van de Gezondheidszorg.

Johns Hopkins Medicine (2013) PTSD symptoms common among ICU survivors [press release]. [Accessed: 22 June 2017] Available from hopkinsmedicine.org/news/media/releases/ptsd_symptoms_common_among_icu_survivors

Needham DM, Davidson J, Cohen H et al. (2012) Improving long-term outcomes after discharge from intensive care-unit: Report from a stakeholders’ conference. Crit Care Med, 40(2): 502-9. 

Nutma I (2016) Sepsis en daarna [Sepsis and afterwards]. Soest: Boekscout.

Smith M, Meyfroidt G (2017) Critical illness: the brain is always in the line of fire. Intensive Care Med, 43(6): 870-3.

van Zanten AR, Brinkman S, Arbous MS et al. (2014). Guidelines bundles adherence and mortality in severe sepsis and septic shock. Crit Care Med, 42(8): 1890-8.

Zilberberg MD, Shorr AF, Micek ST et al. (2015) Risk factors for 30-day readmission among patients with culture-positive severe sepsis and septic shock: a retrospective cohort study. J Hosp Med, 10(10): 678–85. 

Helen Reinke
Results from the WSD Supporter Meeting at ESICM in Vienna (incl. Presentations)
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On Tuesday, September 26th 2017, the GSA held its biannual Supporter Meeting at the ESICM Lives Congress in Vienna. Representatives from over 15 countries joined Flavia Machado, Konrad Reinhart, Imrana Malik, and Marvin Zick from the GSA, who gave updates on the progress of the World Sepsis Day Movement, the WSC Spotlight, the WHO Resolution on Sepsis, and GSA Advance. Supporters shared their stories and experiences from World Sepsis Day this year.

Download all presentations here (Zip-Folder, 15 MB).

 

Marvin Zick
Hurricanes, Flooding Bring an Increased Risk of Infection That Can Lead to Sepsis
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By Imrana Malik, MD
Assistant Professor and Associate Medical Director, Department of Critical Care
The University of Texas MD Anderson Cancer Center


With this year’s hurricane season on track to be one of the most active and destructive on record, it’s vital to remember that as flood waters rise so does the risk of infection and sepsis. It’s especially important to bear in mind now with Texas and Florida recovering from major storms, multiple storms strengthening in the Atlantic and Pacific and three more months remaining in the hurricane season.

As a critical care physician and pulmonologist at MD Anderson Cancer Center in Houston, I’ve had a unique vantage point to witness recent storms, particularly Hurricane Harvey which dumped more than 50 inches of rain on our region Aug. 26 - 29. Today, millions of residents along the Texas Gulf Coast continue to clean out their homes devastated by flooding, ripping up soaked carpets and hardwood floors, pitching out moldy furniture and removing sopped dry wall. It’s sobering to see neighborhood streets piled high with furniture, toys, appliances, books and mattresses all ruined and contaminated by the floodwaters.

MD Anderson’s clinical and research facilities were spared major damage and more than 1,000 of our employees provided extraordinary care to more than 500 inpatients and 300 family members throughout the storm. But since reopening and resuming all clinical operations and appointments, we’re keeping an especially close eye on patients, caregivers and health providers for any signs of infection and sepsis. This year, it was especially important – and poignant – for MD Anderson to once again observe World Sepsis Day Sept. 13, as it has since 2012.

Floodwaters, standing water and post-flood cleanup can increase the risk of infection and sepsis, but there are ways to reduce the chances. Here are some tips to consider:

  • Keep your hands clean.  Wash frequently with soap and clean water.
  • Clean and cover wounds.
  • Limit exposure to mold and water-damaged spaces.  Wear an appropriate surgical mast when exposed to environments where mold growth is possible.
  • Get a flu vaccination if your doctor recommends it. 
  • Talk to your doctor about a tetanus shot.
  • Prevent mosquito bites by wearing long-sleeved shirts, long pants and using an Environmental Protection Agency (EPA)-registered insect repellent.

As volunteers and residents work to restore Houston, the Texas Gulf Coast, Florida and the Caribbean islands, keep in mind the many dangers after the storms. None of us can control Mother Nature, but we can be proactive about infection control after the storms pass and recovery begins.

 

Helen Reinke