SCCMPod-570: The Global Impact of Sepsis

Dr. Gambles Farr: Hello and welcome to the 2026 Congress edition of the Society of Critical Care Medicine podcast. I'm your host, Samantha Gambles Farr. Today, we will be speaking with Dr. Narajan Tex Kissoon about the 2026 Congress William C. Shoemaker Honorary Lecture. This discussion will explore the global epidemiology of sepsis and the disproportionate burden it places on vulnerable populations, including the influence of poverty and social determinants of health. Dr. Kasun is a professor in the Department of Pediatrics, Faculty of Medicine at the University of British Columbia in Vancouver, British Columbia. He is the past president of the World Federation of Pediatric Critical Care and Intensive Care Societies and currently serves as the president of Global Sepsis Alliance Incorporated. He is the co-chair of the Pediatric Surviving Sepsis Campaign and vice president of the Canadian Sepsis Foundation. He also serves on the advisory board of Sepsis Alliance USA and the African Sepsis Alliance, and he is the chair of World Sepsis Day and the International Pediatric Sepsis Initiative. It's important to note he is also the founding member of the Caribbean Sepsis Alliance.

Welcome, Dr. Kissoon.

Dr. Kissoon: Thank you so much.

Dr. Gambles Farr: Thank you very much. Before we get started, are there any disclosures that you wanted to discuss?

Dr. Kissoon: No financial conflict of interest.

Dr. Gambles Farr: Thank you so much. Well, just in your introduction, we know that you are a content expert as it relates to sepsis across the board. And so, on the heels of your revolutionary discussion that we had this morning at Congress, we just wanted to dive a little bit deeper and give our podcast attendees an opportunity to really hear some additional thoughts about your lecture this morning.

Let's just start off by just talking about what your thoughts are on sepsis across the continuum of healthcare.

Dr. Kissoon: Yeah, I think several points I'd like to make with that. One, sepsis does not belong to any one discipline. And the analogy I use, it's similar to pain. Anyone can be afflicted by pain. Anyone can be afflicted by sepsis. And hence, the entire spectrum of medicine, we need to understand sepsis. We need to recognize it and we need to treat it.

I think critical care is a very important part to play for those who are critically ill, who are likely to die. But we should also look beyond the double doors to preventative measures, as well as post-sepsis rehabilitation. I think if we don't do that, we are doing our patients a disservice.

Dr. Gambles Farr: Absolutely. And so, in talking about the things that you feel are very important, why do you think sepsis is so difficult to identify early when we're thinking about outside of that double doors, even for trained clinicians at times?

Dr. Kissoon: Because sepsis is a syndrome. The signs and symptoms of sepsis are protein, which means it can mimic so many other conditions. And there are so many organisms that can incite sepsis or be implicated with sepsis that really presents in different ways.

Moreover, many of the patients that have comorbid conditions, which may mask the signs and symptoms of sepsis also. So someone may come and we think they have a simple cold, but that may evolve into sepsis.

Moreover, the trajectory of sepsis is not linear. So someone may get some, let's say some antibiotics or something, look a little better, but then the trajectory of sepsis is such, then they get worse over time. So I would say that because it's a syndrome, because it has no definite time that you can pinpoint a start time, that this, for instance, like a cardiac arrest or stroke or something, it is very difficult to recognize.

In fact, it was said years ago by Machiavelli in his book, The Prince, he was talking about sepsis. He called it at that time, hectic fever. And he was comparing it to a country in turmoil. He said in the early stages, like hectic fever, it is very difficult to recognize, but easy to suppress. In the late stages, it's very easy to recognize, but it is very difficult to suppress. And I think that analogy holds.

Dr. Gambles Farr: That's a great analogy. And I've never heard it described in that way. And in talking about that description and how early recognition of sepsis is one of the most important things that we know that directly relates to our patient outcomes.

But segueing into how most of the time we identify adult patients who are septic patients, right? And so I know that in your practice and in your journey, as it relates to sepsis, there's a large component of pediatric septic patients that are often when we're having this discussion, we don't always think about. And so nearly half of the sepsis cases occur in children.

And we saw that even in Congress this year, because one of our ICU Heroes was a septic patient, and he was at the age of 14. Would you like to delve into what that looks like for the pediatric population as sepsis is concerned?

Dr. Kissoon: Absolutely. As a pediatrician, I'd love to do that.

Now, when we think about sepsis, as I said, sepsis does not respect borders. We have to think of sepsis globally. And every one of us have lived through the COVID-19 pandemic, which was sepsis. Borders does not matter.

When we look at it in many African countries, more than half the population is under 16 years of age. They're all young kids. Now, sepsis in children, in the older children, may present some easier to diagnose. But remember, we have premature neonates, we have full-term neonates, and at different stages in life, the vital signs are different, their presentations are different.

But the point is that we have to pay attention to these children for the point of view that many of the cases in children can be prevented by recognition of the importance of vaccinations, the importance of nutrition, the importance of hygiene, clean water, et cetera, and the importance of clean deliveries during the perinatal period. If we achieve all that, and exclusive breastfeeding in mothers for the first six months, we can take care of most cases of sepsis by preventing it.

And then we have the other cases that we need to take care of. So children are a unique group, but the point is that while in North America, the population is more tending towards the elderly, and we have a problem that we still have the issue of children, but the issue of children is more germane in sub-Saharan Africa and Asia where large numbers of children are, and where most of the sepsis deaths are.

Dr. Gambles Farr: Absolutely. And in talking about the global health aspect, can you describe, you gave a brief description of how access and equity play a part in how sepsis is treated. What can we do as providers, clinicians, and then even from a healthcare policy standpoint, how do you believe that we can integrate and really affect real change as it relates to moving forward in our fight against sepsis, whether it's here in America or globally?

Dr. Kissoon: Yeah, I think the first thing we have to do is highlight the inequities. In many parts of the world, children die at home without care. When they arrive at the hospital, there are no antibiotics, there is no oxygen, et cetera.

They die in hospital because of poor quality of care and lack of resources. So we need to point that out to policymakers, politicians, et cetera. From the global perspective, advocacy is very important.

And bear in mind too, in our countries, there are areas or pockets where the very same thing happens. So advocacy is very important. And as a society, we need to shout from the rooftops that this is not acceptable.

From the global perspective, we are working with the WHO. We're trying to get to the United Nations World Health Assembly. And we are, in global health, many of us are working in these poor countries to identify the high-risk group.

Because when you have resources, you can follow all patients after discharge. The same number may die within six months from sepsis, and 60% of those never return back for care. So in those sort of situations, if you can pinpoint a high-risk group, then you can concentrate resources there.

And again, in those countries, it is more important that prevention is stressed.

Dr. Gambles Farr: I think the central thing that we are really getting at is prevention. And talking about the 2030 global agenda to reduce sepsis by 25%, what are some additional things that we need to do to get us to that 25% reduction rate that we're looking for?

Dr. Kissoon: So I think the most important thing is trying to get countries to put together national action plans. And that is the basis of the 2030 agenda. So national action plans, which means there will be the government is involved, okay, and there will be money placed directly towards sepsis.

We need to get the whole society involved. So educate patient, families to seek care very early. We educate them about vaccines. We educate them of nutrition and hygiene, breastfeeding, etc. At the same time also, we have to make sure that the system is resilient and ready to take care of these patients. So that's another part of the 2030 agenda.

The other thing that we say is pandemic planning, because there will be another pandemic and we need to prepare for pandemic, again, and incorporate pandemic planning into all health systems, as well as discuss things like the issue of disasters across the world where sepsis is very high, mass migration, wars, etc., where sepsis is also very high.

And finally, I think we need to do more research, innovation and research such that we can get better ways of providing the care in this environment with artificial intelligence now, where we can use, everyone in the world has a cell phone. We have put, for instance, guidelines on cell phone. We have connected the individual with a cell phone to the community health worker, the community health worker back to the hospital. So these are things that we have to continue doing.

But I think the national action plans should incorporate all these things. Some countries are already ahead, but that is what we are trying to do. In other words, with a 2030 agenda, if we can get about 70-80% of rich countries, income countries with action plan, and 50% of the low-income countries, I think that would be a good result.

Dr. Gambles Farr: Absolutely. And talking about things important like nutrition, access, equity, we're seeing a shift in some of the programs in the US in discussions regarding vaccinations and what is needed or not needed as it relates to vaccinations. What thought process do you have as it relates to how that could affect patients who may be suffering with sepsis in the near future?

Dr. Kissoon: I think right now we are seeing outbreaks of measles and other vaccine-preventable disease in the US. And I think it is not for lack of having the vaccines, but I think we have very confusing guidelines from different sectors. I think the American Academy of Pediatrics is very clear that the childhood vaccines are very important to prevent disease.

So I think that is what is happening right now. We have more people who are skeptical of vaccines, and maybe it's part of the medical profession. We have not engaged people in the right way.

I recall reading a few years ago a book, I think the author is Eula Biss talking about her journey with vaccines. Friends did not vaccinate their kids, but she believed in vaccines and went about looking at it. And I recall a quote in the book saying that what we have now is neoliberal mothering. 

So the mother comes with a series of questions. It is not that she is challenging our knowledge, it's asking questions because she wants to get the knowledge to provide best care for her kid. So we have to be prepared to sort of communicate very clearly what the needs are, what should be done.

And granted, there are a lot of information on the web now that are erroneous also. So that makes us, we need to be more vigilant in engaging people and listening to their concerns.

Dr. Gambles Farr: Absolutely. And that ties into the thought process as we're seeing more artificial intelligence being integrated into our society, into medicine, and even talking about disparities and equity regarding at-risk populations, pediatric, geriatric patients, underserved and underrepresented in medicine populations. We're seeing that conversation happen around AI.

And what impact do you think artificial intelligence has on how clinicians could potentially integrate sepsis and sepsis care to certain patient populations?

Dr. Kissoon: I think artificial intelligence as it presently stands is a double-edged sword, because if you have very robust, sound data that is fed into the system for a particular population, it can be very useful. The problem is that the research in the minority and vulnerable groups have not been done to the extent where we have the data. And hence, if we use AI in its broadest sense, we may continue to marginalize these groups because their signs, symptoms, their outcomes, et cetera, response therapy is not represented in the data that is fed into the artificial intelligence systems.

Dr. Gambles Farr: We're seeing more and more discussion around post-sepsis syndrome. What should clinicians and families understand about survivorship?

Dr. Kissoon: Two things. I work a lot in sub-Saharan Africa where the same number of kids who die in hospital within six months, the same number die and they don't return. 60% are unable to return back for care because either they've lost faith in their health system, they do not have transport, they do not have money, et cetera.

So post-discharge mortality have been a lot of our focus. I know in the adult population, even in North America, about 30 or 40% of those elderly afflicted by sepsis may die within a year, but death is only the tip of the iceberg. I think the morbidity is very important because many people may not be able to work. They have pain, they have PTSD, those sort of things. And when you cannot work, you may lose your job. People have lost their houses, now have chronic morbidities like chronic renal failure, et cetera.

It puts a very great stress on their lives and their family also to provide care. And we have really not flashed the bright spotlight on that. Most of us, we take care of them in the ICU or the hospital. When they're discharged, we think that they can go to their general practitioners, but the general practitioners do not have the skill set or as well. We heard a lot about post-COVID syndrome, but COVID is sepsis, very similar sort of thing. But a post-sepsis syndrome is a very important area where a lot of resources are needed and which has great impact in society, especially also with young children because their potential is stultified.

And as Matthew Bourne, I think the Harvard economist said, infections like sepsis and those things steal human resources.

Dr. Gambles Farr: Absolutely. And in thinking about it, just as you were talking just now, understanding medicine is a humanistic science. And so humanistic and science, those two words together is that we focus sometimes so much on the science that we forget the humanistic point sometimes.

And that really happens on discharge and how families are really impacted socioeconomically, psychologically, and then just continued access to care, understanding that whether it's here in the US, we have large pockets of patients who are underinsured, not insured, have low access to care. And then globally, when you think about access as well. And so the things that you just said are so impactful as it relates to what patients have to deal with outside. Because I feel like as clinicians, sometimes we pat ourselves on the back because the patient survived, but what happens after they leave the hospital?

And so wrapping things up today, what are your final last words that you have to say in this conversation that we know will always be a conversation that we will need to have? What are some of your final thoughts on our discussion today? And maybe even one takeaway point that you really want to drive home for people who are listening today.

Dr. Kissoon: I think that individuals should always be optimistic. This is an area that you can get very downcast about the enormity of the issue, but everyone can contribute in different ways. Even helping your neighbors who had sepsis and sort of educating those in the community, participating in World Sepsis Day, joining some sort of organization that helps others.

I think all those things go a long way. In fact, as you rightly pointed out, medicine is a human endeavor and we need to take care of each other. And I think that that's what is very important here.

So as physicians and clinicians, yes, we have a role to play and we take care of the medical part of it. One can say the science, but on the other hand, there are so many other aspects of sepsis that is needed to support each other in the community. And we saw it even during the COVID period with people providing food, support, shelter for others and those things.

And I think that that is what is most important.

Dr. Gambles Farr: Absolutely. Dr. Kissoon, thank you so much for today. Thank you so much for your conversation and for leading the way and being an advocate for sepsis and leading us into the next generation of care, for teaching us as clinicians, providers, and taking a real interdisciplinary approach as it relates to sepsis and survival and what we need to do moving forward.

I really appreciate the conversation today. And saying such, this 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 today, consider rating and leave a review for us.

For the Society of Critical Care Medicine, this is Samantha Gambles Farr signing off. Until next time.

Announcer: Samantha Gambles Farr MSN, NP-C, CCRN, RNFA, is a nurse practitioner intensivist at University of California San Diego Health in the Department of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery. She also serves as adjunct faculty at University of San Diego Hahn School of Nursing and Health Science in its nurse practitioner program.  Join or renew your membership with SCCM, the only multi-professional society dedicated exclusively to the advancement of critical care. Contact a customer service representative at 847-827-6888 or visit sccm.org/membership for more information. The SCCM podcast is the copyrighted material of the Society of Critical Care Medicine, and all rights are reserved.

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