One of the major challenges is to recognize sepsis when it starts. That's because in its early stages, it is often mistaken for a milder infection or other problems, said Angus. "A person may arrive with what looks like a simple case of pneumonia, and the emergency department team starts antibiotics and believes things will go well. Only when the blood pressure drops or is no longer responsive to intravenous fluids does the team realize it is suddenly behind the eight ball. By then, the patient is quickly spiraling into multisystem organ failure. Starting resuscitation at this point may already be too late."
To test ways of managing the disease during the first six hours after diagnosis, the consortium will train teams of doctors, nurses, and other emergency department workers at more than a dozen institutions. Like dedicated trauma teams, the sepsis teams will focus all their attention on one patient at a time and will follow a scripted protocol to stabilize, diagnose, and treat sepsis.
The protocol includes a sequence of resuscitation methods to deliver fluids, restore blood pressure, and monitor cardiovascular function and other organ activity. It was developed several years ago by Emanuel Rivers, M.D., M.P.H., a researcher and physician at Henry Ford Hospital in Detroit, where it dramatically increased survival rates.
To implement this approach across the entire country is a daunting task. As a first step, the consortium aims to find out whether the protocol will have similar success at multiple hospitals across the nation.
Following a year-long period of establishing and training sepsis teams, the consortium plans to treat early severe sepsis in nearly 2,000 patients, enrolling patients over a two- to three-year period. It will randomly assign patients to Rivers' protocol or to the existing "usual care" approach, which does not include such aggressive
Source:NIH/National Institute of General Medical Sciences