SCCM Pod-486: Strategies for Preventing Sepsis and Septic Shock in the Hospital Setting

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Maureen A. Madden, DNP, RN, CPNP-AC, CCRN, FCCM, is joined by Craig M. Coopersmith, MD, FACS, MCCM, to discuss optimal strategies for preventing sepsis and septic shock in the hospital setting. Explore the challenges faced in integrating these strategies into hospital workflows and gain insights into the significant contributions made by multiple team members. This podcast is funded by the Gordon and Betty Moore Foundation through a grant program administered by the Council of Medical Specialty Societies. 0.25 hours of accredited continuing education credit is available for this podcast through July 30, 2024. Visit sccm.org/store for details.

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Transcript:

This podcast is funded by the Gordon and Betty Moore Foundation through a grant program administered by the Council of Medical Specialty Societies.

Dr. Madden: Hello and welcome to the Society of Critical Care Medicine Podcast. I’m your host, Maureen Madden. Today I’m joined by Dr. Craig Coopersmith to discuss strategies for preventing sepsis and septic shock in hospital settings. Dr. Coopersmith is director of the Emory Critical Care Center and professor of surgery for Emory University School of Medicine in Atlanta, Georgia. Welcome, Dr. Coopersmith. Before we start, do you have any disclosures to report?

Dr. Coopersmith: I will mention that I am the cochair of the Steering Committee of the Surviving Sepsis Campaign. And at least for a few more months, I’m the chair of the Research Committee for the Surviving Sepsis Campaign, and I’m an author on the Sepsis-3 definition, which are maybe intellectual conflicts to disclose.

Dr. Madden: I think it makes you the perfect person to get to chat about this concept and provide us some insight. I really appreciate the fact that you have the time today. I also want to mention that you’re a former president of the Society of Critical Care Medicine, so you know from so many different perspectives how important it is to discuss sepsis and be aware of it and talk about the prevention strategies and how to mitigate it. I’m really excited to get your insight on all of this today.

Dr. Coopersmith: I’m excited to be here. This will be fun.

Dr. Madden: Tell me a little bit more about your background or interest in sepsis.

Dr. Coopersmith: I’d actually say it’s been the sort of driving thing of my entire profession. Although I am a professor of surgery, I don’t operate. I have not operated since the day I finished my chief residency in 1999, so I’m full-time critical care. Everybody has something that gets them excited about their job, and sepsis has always been what’s got me excited about my job. I’m a little bit unusual, I guess, in that I believe very, very strongly in implementation science, because if we just do what we know is correct, we can make a fundamental difference for tens of thousands or hundreds of thousands or even maybe millions of people worldwide.

At the same time, I also have a lab because if we do everything perfectly, there are still going to be an awful lot of people who die or have post-intensive care syndrome because we don’t actually understand what’s causing everything. So on the one hand, I literally do podcasts like this to say, What can we change today in the hospital? And the other part of me is saying, How can we lead to new fundamental molecular understandings that might change things 20 years downrange?

Dr. Madden: That’s really quite diverse. I would think that your life is very interesting on any given day. You mentioned something, though, about how to prevent sepsis. I want to touch on that now. We know that there are an awful lot of people who come in to the hospital setting and they then meet criteria for sepsis. Therefore, we then implement all the strategies to try and treat it and have them recover from it. But let’s focus a little bit more about our population. Once they’re in the hospital, what are the barriers that prevent these best strategies that we’ve identified? We’ve put it into the Surviving Sepsis Campaign, we’ve put it into the definitions. I know so many places have integrated processes for the identification and the activation to then treat somebody who appears to have sepsis. What are the barriers that are preventing all of those things getting integrated into the hospital workflow?

Dr. Coopersmith: The first thing I want to mention, just to reiterate what you said, that 80% to 85% of patients with sepsis in the hospital present with sepsis. Having said that, we can prevent sepsis, period, by preventing infection from progressing to sepsis. We can prevent sepsis from progressing to septic shock. And there are many things we can do at the bedside to actually just prevent sepsis from happening in the first place, depending upon the location.

I guess before we talk about barriers, maybe I’ll talk about things that we can do to prevent sepsis. Once we talk about that, then we can talk about barriers. Let’s start with, according to the Sepsis-3 definition, sepsis requires an infection and organ dysfunction and a dysregulated host response to the infection, as well as it being life-threatening. The key thing of that is, while it starts with an infection, not every infection has to lead to sepsis. If one treats an infection before there’s a dysregulated host response and before there’s organ dysfunction, one can entirely prevent sepsis.

It’s a little bit of a paradigm shift to think that sepsis is preventable, other than some of the things I’ll talk about a little bit later. But if somebody has an infection, it doesn’t matter what it is. I know you’re a pediatrician. If somebody comes in with strep throat, morbid disease of children, or if somebody comes in with a urinary tract infection, or if somebody has a postoperative wound infection, all of those are infections, and infections are important. They make the patient feel lousy, they have a cost involved, they have a morbidity attached, but none of them have actually progressed to organ dysfunction.

So if we recognize and treat infection early, we can prevent sepsis from ever happening. That’s either somebody in the emergency room or somebody on the floor or even in the ICU. If somebody has sepsis, we can, in many cases, prevent it from progressing to septic shock. There is a progression as people get sicker, and the single best thing we can do for that is early recognition and early treatment. The data are abundantly clear that the longer we delay treatment of sepsis, the worse the outcomes are. So having a process in place to recognize somebody who’s septic early clearly can change patient outcomes.

Then there are things that we can do at the bedside to prevent things like device-related sepsis. Patients have central lines in place, patients have Foley catheters in place, patients have arterial lines in place. Both from a humanitarian standpoint, but also from an infection control standpoint and a sepsis prevention standpoint, we should be asking every single day, Does my patient need this catheter? Not only is it uncomfortable for the patient, but it’s a potential source of infection. A lot of times, if you forget to ask the question, you’re not going to take out the line. You put the patient at discomfort and you put the patient at risk. This needs to be part of the daily checklist.

There are also things that happen at the bedside that nurses are doing, oral hygiene, head of the bed up to prevent ventilator-associated pneumonia. There’s a wide variety of things that we can do to prevent sepsis. I think your question was about barriers?

Dr. Madden: Yes, but let’s not go there yet because actually I’m intrigued by some of the things that you started to talk about for strategies to prevent in the hospital setting. Let’s talk about recognition. Before the onset, we just have an infection or presenting with signs and symptoms of sepsis, so that recognition and the process. I know what’s in my institution and I know how we struggle with some of that as well. But I wanted to hear your take on what types of processes have you seen be implemented that are successful. Give me a sense of what you’ve been working on or what you’ve seen in the past.

Dr. Coopersmith: I think one thing that’s critical, or more than one thing that’s critical, is having some type of alert system, some type of electronic sniffer. I understand that not every hospital and not everybody listening to me is going to have an electronic medical record. We’ll talk about that in a minute. But if you have an electronic medical record, there can be some type of, again, for lack of a better term, sniffer, something that looks for something going wrong in the patient. There are multiple different ways and none of them are perfect. You could talk about SIRS or NEWS or MEWS or TREWS, a lot of acronyms that rhyme, or qSOFA.

There are lots of different ways of looking at it. I know there’s a sniffer within Epic, not to mention one specific electronic medical record but that’s the one that’s most commonly used. But clearly having something that tells you when you don’t always have eyes on the patient, or even if you do have eyes on the patient, that something is going awry. They all are variations on this single theme of: The patient was doing okay, and now something is either changed and gotten worse, or it’s the first sign of something we’re getting and things are wrong. The heart rate is wrong. The temperature is wrong. The oxygen saturation is wrong. Certain laboratory values are wrong.

Very simple things that each of us can identify at the bedside if all of us have eyes on the same patient at the same time, but we don’t. No matter where we are, whether we’re in the ICU, whether we’re on the floor, whether in the emergency department, we can’t all have eyes on the same patient at the same time. An electronic sniffer takes us out of the equation. It says, Here’s something that objectively suggests that the patient is at risk. It doesn’t tell you that the patient is septic. It tells you that the patient needs to be paid attention to. That makes a huge difference.

Dr. Madden: From the pediatric perspective, we have our acronym too. We have PEWS. They’re early warning signs and they’re used. And as you said, not everybody will have the means of an electronic medical record. But even if you do, talking about the human factor, because you have to have either the data inputted and accepted or you have to have that AI that’s integrated into the electronic medical record that’s sophisticated enough to recognize it, and this is where I’ve struggled in the past because I’ve worked with creating that system in our facility.

It’s one thing in the emergency department. It’s another thing on the regular floors, but then you have our ICU settings, and we have all sorts of variability in our laboratory findings, in our hemodynamics, and we’ve struggled with how to create something that is sensitive enough to really acknowledge the ICU patient is at risk, particularly for sepsis. But the other thing is, the alarm triggers and the alarm fatigues that come with all of that. Would you mind talking about that a little bit?

Dr. Coopersmith: That is clearly not different from pediatrics to adults; it’s the exact same concern. Balancing sensitivity and specificity, I wouldn’t say it’s impossible but, by definition, there’s going to be a tradeoff. The more people that you pick up, the more alarms are going to go off. The more alarms that go off, you’re going to have alarm fatigue, and a certain number of them are going to be negative, which leads people to want to ignore the alarms.

Then if you say, okay, you know what? I want to make sure that 98% of them are positive. Well, you can make sure that 98% of them are positive or 100% of them are positive if you make the dysregulation strong enough. If you say, I want to only have somebody with an oxygen saturation with a good pleth of 70% and a heart rate of over 150, well, you’re going to pick up only really sick patients, but then you’re going to miss a lot of patients who are sick, but less sick, that you can intervene on.

There is no ideal balance because people have different concepts of, okay, the alarm is driving me crazy, I’m not going to pay attention. For some people, it’s after three alarms. For some people, it’s after 20 alarms. But what counts as a false alarm? What percentage of truly sick patients do you want to pick up? Most people would say you want to pick up everybody. But if you’re going to pick up everybody, you’re going to also pick up an awful lot of people who really don’t have the issue. So saying, what’s your sensitivity, what’s your specificity, what I think and what you might think might be different.

What our listeners are hearing right now, they all might have an absolute, This is what I think, and it might be different from the person next to them, so it is a tremendously difficult thing. You really have to go to a place that institutionally or, even better than institutionally, nationally or internationally, we come to accepted standards and you come to an accepted standard that you say, okay, I understand I’m losing a little bit on this side. I understand I’m losing a little bit on this side, but I’m trying to find the Goldilocks place, not that I’m getting 10,000 alerts per hour and not that I’m missing half my patients.

Dr. Madden: So the struggle’s real.

Dr. Coopersmith: For sure. A lot of it does require institutional commitment. We’re talking about this, and putting an electronic sniffer actually requires a huge electronic institutional commitment. But then we have to go a step beyond that, which is education. Education makes a difference independent of whether or not you have an electronic medical record, whether or not you actually have a sniffer. If you don’t know what sepsis is, if you don’t know what infection is, and I know that might sound silly because we’re all healthcare professionals, if you don’t think of it, you can never make the diagnosis.

You take what you might say to somebody in the community. You say you have pain radiating down your left arm and chest pain, and 99% of people are going to say, Oh, that could be a heart attack, I need to immediately get to the emergency room, or I need to get my family member to the emergency room, this is potentially life-threatening. If you say sepsis, 35% of people have never heard of it. And there are variations from countries. But even within the medical community, where hopefully we’ve all heard of sepsis, if you say, tell me the definition, a lot of people can’t tell you what it is. It’s more like, I know it when I see it, or it’s like infection in the bloodstream, or it’s like the body’s failing because of infection.

Really educating people that the mortality, I’m not trying to compare, I’m not saying that one disease is worse than the other, but sepsis is the third most common cause of death in the United States and probably the most common cause of death worldwide. On a per-patient basis, sepsis has a higher mortality than a heart attack or than a stroke or than a gunshot or a car accident. Again, I’m not making a value judgment, I’m not saying one is more important than the other because obviously they’re all important.

But I don’t think anybody has difficulty recognizing a gunshot. I don’t think many people have difficulty recognizing a stroke or recognizing we have to get an emergent ECG, I need to see whether somebody’s having a STEMI. A lot of people still, in the year 2023, struggle to recognize sepsis because it’s relatively more nonspecific. Education can make a humongous difference in actually seeing, Is my patient septic? Are there concerns of sepsis? I need to be on it now because if I wait x number of hours, I will literally worsen my patient’s mortality.

Dr. Madden: You’re absolutely correct, and you touched on so many things. One, I wanted to briefly talk about the economics too of when we fail to recognize sepsis and it proceeds to septic shock. These are our patients who are in the ICU setting. They have a disproportionate resource burden at that point in time, not to minimize, as you said, any other diagnoses, but at the same time, they’re in the ICU setting and it is affecting end-organ function. We ideally hope that we can then minimize the morbidity and mortality, but that’s not always the piece. The education, as you’re talking about, to try and, as people say, I know it when I see it, but to also understand that some people are more at risk as well because of other preexisting conditions or medications that they’re exposed to, to recognize that piece when you’re evaluating them, to not disregard that.

Dr. Coopersmith: I think one of the most important things, and I’m going to go through a couple of facts and figures about the finances since you brought that up, because I’m going to again reiterate, sepsis is the third most common cause of death in the United States. Prior to COVID, it killed 11 million people, and 49 billion people in the world had sepsis, making it probably the most common cause of death in the United States. It is by far the most expensive hospital condition. These are all coming from federal databases. It has by far the highest level of readmission to the hospital after discharge. One in five people with sepsis will get readmitted within 30 days. So the implications, outside of human suffering, financially are enormous.

In the Sepsis-3 definition, there are six components to it. There’s the intellectual definition of sepsis, the bedside definition, the intellectual definition of septic shock, the bedside definition, as well as qSOFA, which is looking for either death or prolonged ICU stay. There’s another box in the Sepsis-3 definition that I think is incredibly important. On the one hand it’s self-evident. On the other hand, I think not enough people talk about. It simply says, If you have infection, look for organ dysfunction, and if you have organ dysfunction, look for infection. Again, I know that sounds pretty straightforward, but if you have infection and you look for organ dysfunction, that’s going to tell you whether your patient is infected or whether they’re septic.

That is tremendously different for the prognosis, for their treatment, for everything, for how much of an emergency it is. But on the other hand, if you have organ dysfunction, to always look for infection is incredibly important. If you have a differential of one, you have a differential of one. If somebody has acute shortness of breath five days into the hospital when they’re walking around, everybody’s going to say it’s a PE. And it might be. And it might not be. And if you don’t put infection on your list, if you don’t think that the presentation could be infection, you’re never going to think about it. You’re never going to treat it.

You’re going to miss a certain number of septic patients who, again, if we miss them, or if we delay treatment, their outcomes are significantly worse. So I actually really like that box, which nobody talks about, as a good way of, every time you see a sick patient in either direction, think about the other one.

Dr. Madden: I agree with your comments about that box because I think sometimes when we think more simply and with common sense to look at something and to think about it, it allows us then to build more complex concepts and not miss or be siloed in that perspective, so I really like that. You had already started talking about in the hospital setting and device-related sepsis and how we need to talk about it every day. I’m aligning it with something that we have in our ICU, where we have an interdisciplinary rounding tool. What that means is, every day the multidisciplinary team who’s rounding on an individual patient is all integrated into that process because we have things in there about asking those questions every day. Do they need that ET tube? Do they need that line? Do they need that Foley? It’s really looking at, as you said, how we can prevent sepsis before it even starts? Have you had experience or thoughts about a process like that?

Dr. Coopersmith: I could not possibly agree any stronger. We published on a checklist maybe 15 years ago or so right now. We religiously do this, and this is more our personal anecdote, although I strongly agree that this is something that you can do anywhere because the resources involved in an interdisciplinary checklist are human capital only. You need somebody to be there to say, Do they have this? Have you done this? Do they need this? Again, taking apart the fact that the obvious suffering involved in having tubes and lines in place that I think a lot of us, because we do this day after day, tend to forget. It’s incredibly uncomfortable to have a central line or an A line or an endotracheal tube in place. Patients are miserable and we certainly can’t forget the humanitarian person behind that.

But while it’s maybe self-evident whether somebody has an ET tube, and I would hope that our listeners ask each day, does the patient still need the endotracheal tube, it’s really easy to forget a lot of times that your patient has a central line. It’s under the gown. You might not even see it. It might be there for days and days. It’s easy to think, well, they’ve got a Foley, they’re in an ICU, they’re sick, so of course they need the Foley, and they don’t.

The default is where we are. Most of us walking around do not have a central line, do not have an arterial line, do not have a Foley catheter, do not have an NG tube, do not have an endotracheal tube, etc. Most of us are unencumbered by any exogenous lines or catheters, and that’s the normal state. For every patient every day, the question should be, how can we get them as close as they can get to a normal state? Do they need this? Because it’s not exciting, we forget about it. That’s why I’m in such agreement with you and with Atul Gawande about the concept of checklists.

Nobody ever forgets, I’m putting somebody on ECMO. Nobody ever forgets, I ran a code today. Nobody forgets, oh, I’m starting my patient on CRRT. Those are all major events. It’s very easy to say we placed a central line five days ago when the patient was in shock and now they’re not on pressors, they’ve got good peripheral access, they’re not on TPN, do they need the central line? You have x number of patients in your ICU and on each patient you have x number of decisions. When you multiply the first x by the second x, it’s an awful lot of patients and an awful lot of decisions. The things that are not exciting are the things that get dropped. But at the end of the day, the things that are not exciting are the things that make some of the biggest differences.

Dr. Madden: I’m going to take that and make a statement that you agree with me that talking about a rounding tool or a checklist is one of the best strategies that can be implemented to try and prevent sepsis and septic shock. But let’s talk about the barriers to integrating it into the hospital workflow and if there’s other things that you also think about that are barriers.

Dr. Coopersmith: The first barrier is simply human capital. I said before, there’s no cost except for human capital, as if that’s not a cost. That means that everybody needs to be there and talk about it. I’m not talking about a one-person checklist. It’s an interdisciplinary team. I see rounds, I’m multiprofessional. That means that everybody needs to be there. And when you’re at point A, it means that you can’t be at point B. You need a commitment from an institutional level on all these things, on checklists, on early warning systems, on education.

We went through the finances before to say how important sepsis is. But for something that a lot of people haven’t heard of, they might still not recognize that there really needs to be an institutional commitment at the level of the unit, at the level of the hospital, at the level of the C-suite, to really say, this is important. This is important for financial purposes. This is important for human suffering. By the way, I’m not putting them in that order. Those are huge barriers. There are clearly right now shortages of staffing all over the place, and certainly it’s hitting some professions more than other professions. But I would be shocked if anybody listening to us right now hasn’t been affected by staffing shortages that have occurred and have worsened since COVID.

With that, you have x number of people, but there are y number of tasks, and every time they do task A, it means they can’t do task B. So there are a number of barriers that really need to be overcome, as well as intellectual barriers like standardization. Somebody’s saying, you know what, I know the right way, don’t tell me how to practice. Your guidelines and your bundles or whatever else, that’s for like the norm, for the mean and not for me because I’m so great at what I do, don’t talk to me about the mean, I’m better than the mean.

Really changing the culture to the concept of a combination of precision personalized medicine as well as standardized care with buy-in at all levels from the bedside provider up to the unit director, up to the CEO of the hospital. All of that needs to happen, and any one of those not happening is a barrier to everything we’ve talked about for the last 25 minutes.

Dr. Madden: All right, let’s get to the nitty-gritty then. How can we get that buy-in? How can we get those individuals that you’ve mentioned from all the different categories to acknowledge that this is a best strategy and we have to do this? It matters to our patients.

Dr. Coopersmith: Well, first I’m going to give a little plug to a webcast that we’re going to be doing on July 26 with Judy Jacobi, our former president of SCCM, and Christa Schorr, a legend within SCCM, and myself, where we’re going to be talking a lot about that, I think for about 45 minutes, but within a couple of minutes, how do we get to buy-in? First, we really have to—

Dr. Madden: Before you go there, Craig, tell me the title of the webcast, because some individuals, when they’re listening, it may have already passed, so I want them to know what it is.

Dr. Coopersmith: It is Engaging Healthcare Leaders in Sepsis Prevention and Progression.

Dr. Madden: Thank you.

Dr. Coopersmith: We will be talking about this for 45 minutes. We have three different talks on this. But if we want to have a couple of things in terms of how we get the buy-in, it really depends on who we’re talking to because the buy-in locally within the unit is very different from the buy-in from the C-suite. Understanding that we all care about human suffering and we all care about finances, the nuances might be different in your audience, as well as what argument really wins the day because somebody might see this as an economic imperative, and somebody might say, I have x number of people who can do things. What can we actually do?

Starting not from importance, but starting at the C-suite, really the important thing is to make the financial case. The financial case, wherever you are, sepsis is not only a top killer where you are, but it is literally by far the most expensive hospital condition and associated by far with the highest amount of readmission within 30 days. So, purely from a financial standpoint, sepsis is disproportionate to the fact that it already is a big burden within the hospital, a hugely disproportionate burden, both in current hospitalization, as well as future hospitalization, as well as death.

Those kind of numbers are what get the attention of people who say, I have only x amount of dollars to spend, I have only x amount of quality initiatives that I can get to, what gives me the biggest bang for the buck? Sepsis gives you the biggest bang for the buck because it’s so devastating, not only in death, but in terms of cost and in terms of continuing cost, not one-time cost. On a more local level, it really gets down to culture. You have to get buy-in at the leadership level, and it’s multiprofessional.

We are talking the unit nursing director, the unit medical director, leaders of respiratory therapy, leaders of pharmacy, your lead APP, all professions who have something to do with sepsis prevention really need to get together and agree, this is something that we care about in our local environment. Once you have that, then you can have the bidirectional conversation with the 50, 70, 100 people who work in your ICU. It’s difficult to get everybody upfront until everybody’s together at the leadership level saying, this is something that matters, we all agree to it, now let’s talk about why, and now let’s implement it.

Dr. Madden: Are you familiar with Rory Staunton?

Dr. Coopersmith: I am very familiar with him.

Dr. Madden: I’m sure most people are, but this was from 2012, and it’s a 12-year-old boy in New York City who had a misdiagnosis and wasn’t properly treated and ultimately died from septic shock. But it prompted a local, meaning the hospital facility, then statewide for New York State and then a national recognition about how we can improve our components to try and do those items of preventing sepsis or recognizing sepsis and promptly treating it. This came in already in the time frame that the Surviving Sepsis Campaign was already in place and starting to grow, but it also brought in, at the same time, some of the federal level in regards to maybe a little bit more of that punitive piece, because if you’re not having the processes in place, you might be disciplined or fined, depending upon how individual states looked at this. Do you have any comments about that?

Dr. Coopersmith: Yeah, I’m perfectly fine with mandates. I actually am supportive of them, very supportive of them. I understand that there is a lot of nuance and that when there is a mandate, it is difficult to talk about the nuance. I do understand that there are the occasional patients who I wouldn’t want to treat exactly like everybody else. It’s the 90-10 rule. That’s why each of us went to school and we’re each medical professionals. But in general, just saying do whatever you want didn’t work. And understanding that association can never prove causation.

You mentioned New York State. When Rory’s Rules went into account and New York State mandated that every hospital had to have a sepsis protocol, that they could do whatever they wanted but it had to comply with the three-hour and six-hour Surviving Sepsis bundles, what they found is, first, in a study published in the New England Journal of Medicine by Chris Seymour of 50,000 patients and then a follow-up in the Blue Journal in a study of 105,000 patients published by Mitchell Levy, one of the godfathers of the Surviving Sepsis Campaign and a past president of SCCM, showing a significant decrease in mortality: a) with being involved in doing this mandatorily and b) with every hour delay. Sean Townsend, also one of the godfathers of the Surviving Sepsis Campaign, has also published literature, along with Christa Schorr, who I mentioned before, has mentioned that the longer one’s involved in the Surviving Sepsis Campaign, the better outcomes are.

Again, understanding that association cannot prove causation scientifically, there are, in my mind, a tremendous amount of data that suggest that the more we pay attention to this, and actually mandating it really does change outcomes, and I do understand the concept of unintended consequences, and they’re real, and we should unequivocally pay attention to making everything as good as we can to minimize the unintended consequences, to minimize unnecessary antibiotic treatment, to minimize unnecessary fluids when they’re truly not needed. But globally, sepsis is a killer, a big killer, and if we have people paying attention to it, and we make people pay attention to it, just like we do for ST elevation MIs, outcomes are better. So I’m actually very supportive.

Dr. Madden: We’re about at our time limit. I’ve really enjoyed having the opportunity to chat with you about this. You have so much knowledge and enthusiasm for this topic. Before we close out, I just wanted to ask if you had anything further you wanted to make sure that we talked about.

Dr. Coopersmith: Yeah, the final thing I’ll say, other than thanking you for having me, is that actually we all have so much knowledge on this. There are some things that we do that are incredibly complicated. If I were to talk about my lab now and put everybody to sleep, there are some things that are really, really complicated. This is not. This is actually really straightforward.

Infection, if untreated, leads to the body’s inappropriate response, which leads to organ dysfunction, which leads to tremendous morbidity and death. We can intervene there. We can intervene when somebody has a fever and a white count and we think they’re infected. We can intervene if somebody already has sepsis, but we can intervene early. The things we’re talking about doing are not tremendously complicated. Give fluids, give antibiotics, give pressors when necessary. Do a daily checklist. Take out lines that don’t need to be there. Make sure the head of the bed is elevated.

This is something that I think there’s actually a tremendous amount of equality in all of our knowledge that every one of us on some level really fundamentally understands this and fundamentally can make a difference because it is so straightforward, which leaves the opportunity to be even greater across the world for us to minimize, prevent, and treat sepsis.

Dr. Madden: That’s wonderful. I really want to thank you, Dr. Craig Coopersmith. This now concludes another episode of the Society of Critical Care Medicine Podcast. If you’re listening on your favorite podcast app and you liked what you heard, consider rating and leaving a review. For the Society of Critical Care Medicine Podcast, I’m Maureen Madden. Thank you.

This podcast is funded by the Gordon and Betty Moore Foundation through a grant program administered by the Council of Medical Specialty Societies.

Maureen A. Madden, DNP, RN, CPNC, AC, CCRN, FCCM, is a professor of pediatrics at Rutgers Robert Wood Johnson Medical School and a pediatric critical care nurse practitioner in the pediatric intensive care unit at Bristol Myers Squibb Children’s Hospital in New Brunswick, New Jersey.

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