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CATES: Sepsis in children can be treated - Odessa American: Health

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CATES: Sepsis in children can be treated

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Posted: Monday, February 17, 2020 4:00 am

When I was a young nurse, when someone said a patient was “septic” or had sepsis that meant, very specifically, bacteria had been found growing in a patient’s blood stream. In order to make that diagnosis, it was several days of waiting for a sample of the patient’s blood to grow bacteria in the lab. Because it was several days before such a diagnosis was made, generally, the diagnosis of sepsis meant a very poor prognosis for the patient. A prognosis is the prediction of how well a person will recover. A good prognosis means the patient is likely to recover with no complications, a poor prognosis means they can have life-long complications or even die from that illness. Back then, the doctor’s started antibiotics and treatment to the best of their abilities, but because there weren’t strong guidelines, prognosis remained poor for patients who received treatment, if they survived long enough for us to figure out they were septic in the first place.

Fortunately, in 2020, a diagnosis of sepsis does not necessarily mean a poor prognosis. During the 1990s and early 2000’s, doctors and medical scientists did a huge amount of research on sepsis. They wanted to figure out how to recognize it earlier—before they get positive blood culture results (blood has grown bacteria in the lab), and how best to treat once they diagnose sepsis. The researchers were very successful in finding solutions. Because of their work, now we don’t wait for days to find out there is blood growing bacteria in the lab, we now define sepsis as a group of symptoms with a source of infection; we look for the body’s response to an infection in the blood rather than looking at the blood itself—and we start treatment based on the symptoms and source of infection. It’s made a huge difference for patients. In 1990, there were an estimated 60.2 million sepsis cases world-wide with 15.7 million deaths, in 2017, there were 48.9 million cases, and deaths had dropped to 11 million. This is as the population increased from 5.3 billion people to 7.5 billion people world-wide. Our challenge to keep decreasing this number is to continue to educate both health care providers and the public on how to recognize sepsis early, and then to seek and start treatment as soon as possible. Sepsis, like so many things in health care, responds better with fewer life-long problems and less chance of death when people seek treatment quickly.

Until now, however, the recognition and treatment guidelines for sepsis have mainly centered on adults. This is largely because adults are more susceptible to sepsis than kids. In the US 1.7 million adults develop sepsis every year, and 270,000 of those people die. 1 in 3 adults who die in a hospital, die because of sepsis. In contrast about 72,000 kids are diagnosed with sepsis each year, and 18,000 of those little ones die. Even though it is less prevalent, there are still kids dying from this illness. So, I was very excited to read this week that the Saving Sepsis Campaign, the organization who puts out the recommendations for diagnosing and treating sepsis here in the US, has issued guidelines for recognizing and treating sepsis in kids as well.

In adults we look for several symptoms, a high heart rate, fever or low body temperature, confusion or other types of altered mental status (unconsciousness for instance), shortness of breath and rapid breathing rate, pain, clammy or sweaty skin or low blood pressure. People don’t have to have all of those, but more than just one. We then add some lab testing, and look for some sort of infection, like an open wound or signs of urinary tract infection or a respiratory infection. If all those come out positive, doctors can then diagnose a person with sepsis and begin treatment. That means quickly starting antibiotics and giving lots of IV fluids as well as a few other medications, depending on the type of infection source. In kids diagnosis is harder because kids normally get scared in strange environments and around strange people, and so things like high heart rates and high breathing rates can be from being anxious and afraid, not from sepsis, so doctors have to be a little more careful in making the diagnosis in kids—which is why the new guidelines are so exciting, it makes the sepsis diagnosis in kids simpler for doctors. After that, treatment is very similar to adults, starting antibiotics quickly and giving lots of IV fluids as well as a few other medications. These guidelines will make a difference for our kiddos suffering from sepsis, just like they did in adults. It is very exciting news.

If you or a loved one are having symptoms that you think might be sepsis, please speak to your health care provider as soon as possible or go to an urgent care clinic or emergency room. That way, if it is sepsis, you can be treated quickly and have the good prognosis that so often happens now when sepsis is diagnosed.

Odessa, TX

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