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respiratory
clinical skills
literature review

Can pre-hospital recognition and intervention improve outcome for patients with severe sepsis?

02 April 2015
Features
02 April 2015
Volume 7 · Issue 4

Abstract

Pre-hospital provision of care for patients with severe sepsis and septic shock varies significantly throughout the UK. Timely recognition of this complex and highly morbid syndrome is known to be challenging, and significant evidence exists to support the clear association between advancing pre-hospital care and improving patient outcomes. The aim of this literature review is to analyse the opportunities for pre-hospital clinicians to transform the increasing burden of sepsis care. There is evidently a lack of research in this area, reflected in the relative scarcity of relevant research papers. Following a comprehensive literature search, 10 quantitative studies were selected for critical appraisal. Results would suggest that pre-hospital clinicians could effectively contribute to improving outcomes for this patient group. The clinical importance of immediate identification of sepsis is highlighted, recognising the need for sepsis screening aids, standardised pre-hospital evidence-based guidelines and diagnostic tools. Improved communication between pre-hospital clinicians and receiving hospitals was advocated. Further research was proposed to evaluate the effect of pre-hospital therapeutic interventions.

Sepsis is a life-threatening condition, a common cause of shock and is a major killer in the UK, with mortality rates quoted at 37 000 deaths annually (Daniels, 2012). The UK Sepsis Group (2011) estimated that patients with sepsis are six times more likely to die than patients with acute myocardial infarction (AMI) or acute stroke—two conditions with high mortality that are managed using ratified pre-hospital protocols. Sepsis embodies a range of clinical conditions; it is a systemic inflammatory response to infection in which clinical deterioration can progress rapidly. It is defined by Dellinger et al (2013) as the presence of infection that stimulates a systemic response; severe sepsis is sepsis-induced tissue hypoperfusion, and the most critical end of this spectrum is septic shock, resulting in profound hypotension despite adequate fluid resuscitation. This inflammatory response results in multiple immunological and circulatory effects, which can rapidly progress to multi-organ failure and death, (Baudouin, 2008; 1–4), therefore presenting a considerable and complex challenge to all clinicians.

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Early goal-directed therapy
Emergency medical services
Paramedic
Pre-hospital
Sepsis
Severe sepsis