Sepsis has always been a threatening condition for the patient leading to a high risk of mortality and complications. Modern medicine has developed advanced technology and broad knowledge to prevent patients’ critical conditions and doctors’ fatal errors whilst diagnosing. However, sepsis remains one of the central issues in healthcare, and medical professionals are still struggling to treat complicated occasions such as a combination of comorbidity and sepsis. The main purpose of this project is to decrease the mortality rate from sepsis by evaluating the key risk factors leading to it and developing sepsis-related guidelines and strategies for nursing personnel.
Nursing professionals play a significant role in taking after patients in such conditions, and designing protocols for them will help lower the mortality rate. In this literature review, eight research will be assessed from the point of their theoretical framework and interconnections with the main project’s aim. The frameworks of the studies are both theoretical and conceptual. Review research estimates a vast amount of data that is useful for understanding the issue’s details. Cohort studies provide clinical information and evidence, helping to form goals for further research. The evidence provided in the research will be evaluated for persuasiveness and usefulness of the data, study’s limitations, and gaps in the research. At the end of the review, the studies will be summarized with provided information that can be used in the project.
One of the major risk factors influencing on initiating and spreading of sepsis is elder age. The review by Rowe and McKoy (2017) observes the causing factors leading to the disproportional effect of sepsis among the old generation. The article unites several epidemiological estimations from 2000 to 2012, according to which patients aged more than 65 years had a higher rate of sepsis and were more frequently treated in an intensive care unit (ICU) (Rowe &McKoy, 2017).
Researchers distinguish such causes leading to the condition as a reduced immune response within age, immobility, inadequate oral sanitation, poor skin integrity, malnutrition, cognitive insufficiency, frailty, specific medical condition, and comorbidities. The research also estimated nursing home inhabitants were diagnosed with severe sepsis more often compared to non-nursing home residents (14% vs. 1.9%) (Rowe &McKoy, 2017). Diagnostic complications connected with older patients are major in examining them as fever can be absent or lower in numbers, atypical syndrome specific signs, and comorbid pathology covering sepsis symptoms and biomarkers (Rowe &McKoy, 2017).
The research is essential for the project as it evaluates data from the previous years and highlights the risk stratum of the population. Nursing professionals with appropriate knowledge of infection development among the elderly and its hidden clinic picture can enhance diagnosis and medical care of the patients, and prevent complications of sepsis and mortality.
The medical approach toward septic conditions is also important in the way of reducing the mortality rate. Surgical tactic plays an essential role in patients’ recovery and the postoperative state. A review by Boldingh et al. (2017) observes several studies providing data about abdominal sepsis outcomes. The authors claim that primary abdomen closure is beneficial in patients with sepsis unless other conditions such as visceral edema are limiting it. Moreover, it was estimated that planned relaparotomy with negative results, open abdomen, temporary abdomen closure, damage control surgery, peritoneal lavage, and rapid source control laparotomy showed negative results compared to relaparotomy on-demand (Boldingh et al., 2017).
The preferred strategy, according to the authors, is an immediate closure of the abdomen and further operative tactics only in case of consequent worsening of the patient’s condition. The study is relevant for the project as it raises the issue of treatment planning and reducing postoperative stress in patients with abdominal sepsis. Reducing the number of interventions, according to the data provided, will lower the mortality rate and improve recovery. The limitation of the research is the data of proposal tactics and statistical assessment, which could have raised the reliability of the research and improved its trustworthiness. Nurses should also be aware of the surgical strategy and the specifics of preparation for the invasive treatment, and care in the postoperative period.
The importance of sepsis’s causative agents and the frequent location of infection initiating the condition is a central topic of modern medicine. Studying the main reasons and places of the infection can help prevent the development of threatening conditions. A prospective observational study by Van Vught et al. (2016) assessed patients hospitalized for more than 48 hours in ICUs of 2 teaching hospitals in the Netherlands between January 2011 and January 2014.
Estimating 5920 cases, the research calculates the admission for sepsis to the first ICU-acquired infection to be 9 days (interquartile range 6-13 days) (Van Vught et al., 2016). The study also assessed the most common causes of sepsis which were catheter-related bloodstream infections (n=88, 26.3%), pneumonia (n=85, 25.4%), and abdominal infections (n=53, 15.9%) ((Van Vught et al., 2016). The spectrum of causative pathogens was presented as: gram-positive bacteria (n=151, 45.2%), gram-negative bacteria (n=89, 26.6%), fungi (n=32, 9.6%), and viruses (n=33, 9.9%). The results provided will be used in the project as the main causes and triggers of sepsis. Being cognizant of the pathological agents can help plan the treatment facilities better.
Long-term outcomes are essential for modern medicine to assess the risks patients meet after medical aid. A cohort study by Shankar-Hari et al. (2019) evaluated 94748 adult sepsis survivors from 192 hospitals in England in terms of long-term mortality after sepsis treatment. The research estimated age, male sex, several comorbidities, surgical or nonsurgical status, organ dysfunction, acute severity of disease, and prehospitalization dependency was impartially connected with longstanding death (Shankar-Hari et al., 2019). Moreover, the average age of survivors, according to the study, was 61.3 years, 46.0% were female, and 90.8% were white (Shankar-Hari et al., 2019).
After 1 year after signing out, 15% had died, and 6% to 8% were dying per year over the next 5 years (Shankar et al., 2019). The research gives comprehensive information on long-term mortality from sepsis, and this data can be used for the elaboration of targeted strategies pointing to decreasing deferred death outcomes.
Medical professionals must also be aware of complications of sepsis that can oftentimes cause acute conditions and threaten life. Sepsis-induced cardiomyopathy (SICM) is a reversible state of a heart muscle caused by sepsis or sepsis shock manifesting by depressed ejection fraction (EF), left ventricular dilatation, and changes in hemodynamics. A retrospective cohort study by Sato et al. (2016) evaluated 210 adult patients with sepsis and septic shock in Japanese hospitals from January 1, 2013, to December 31, 2015.
Transthoracic electrocardiography showed that 13.8% of the patients had SICM, the prevalence rate of which was higher between male sex, young age, higher lactate level on admission, and anamnesis of heart failure (Sato et al., 2016). Despite a limited number of estimated patients and not a very persuasive confidence interval (95%), the study’s facts are persuasive enough to continue research and monitor relevant sepsis complications and monitor the patient condition. Nursing professionals are a major part of patient monitoring and examination, and having a wider spectrum of knowledge can be useful at all stages of treatment.
Furthermore, sepsis can be a predisposal factor for stroke, and statistical data can help identify a contingent of sepsis patients that can be targeted to reduce stroke risks and complications. A study by Shao et al. (2019) assessed 121947 patients with sepsis or bloodstream infection using the 2007-2009 California State Inpatient Database from the Healthcare Utilization Project. According to the research, 0.5% (n=613) have been primarily diagnosed with stroke after a year of their sepsis hospitalization (Shao et al., 2019).
The study has strength as it identified risk factors based on regression coefficients for stroke among post-sepsis patients, which were: valvular heart diseases, renal failure, congestive heart insufficiency, lymphoma, peripheral vascular disorders, coagulopathy, and pulmonary circulation diseases (Shao et al., 2019). Thus, such risk factors can be used for primary stroke prevention among sepsis patients. Monitoring their condition and prescription of anticoagulants at the right time can reduce stroke statistics as an early outcome of sepsis condition.
Along with anticoagulants in the previous study, further research shows positive effects of antihypertensive therapy on sepsis-connected outcomes. A population-based cohort study of the National Health Insurance Service from 2003 to 2013 in South Korea by Kim et al. (2019) involved 4549 patients. The study concluded that prior intake of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for at least 1 month was associated with a lower mortality rate from sepsis (Kim et al., 2019).
However, such interconnection was not attaching calcium channel blockers and thiazides. Several studies claim inhibitors of the renin-angiotensin-aldosterone system (RAAS) have positive supplementary effects on the cardiovascular system and tend to prolong life and prevent early complications of high blood pressure. Despite the fact of limitations of the research, such as the disability to evaluate sepsis severity by using accessible scoring systems, the data provided is reliable and can be used for further studies and treatment protocols.
In the historical cohort study by Dhondup et al. (2019), 633 sepsis patients in ICU at Mayo Clinic were estimated according to negative fluid balance from January 2007 through December 2009. The authors used regression modeling after amendments for age, comorbidities, and disease severity (Dhondup et al., 2019).
According to the results of the research, patients reaching negative fluid balance had more severe signs of the disease, however, they recovered faster and survived within 90 days compared to those who did not achieve a negative fluid level. The study estimates an unexpected criterion during sepsis condition that can be used as one of the estimated factors when examining sepsis patients. Even though the cohort involved in the research is relatively old, the guideline for crystalloid treatments has not significantly changed within these years. The data can be used to enhance clinical protocols for sepsis patient treatment.
This literature evaluation involves eight cohort and review studies that are essential for the project and can help enhance the outcomes of sepsis mortality rates. Studying the possible impact of comorbidity, medication intake, and preventing risk factors causing post-sepsis complications will lead to better research of the issue and prevent the negative long-term results. It is also significant to monitor patients with the predisposition of sepsis-related cardiomyopathies in the short term and strokes in the long-term perspective.
Considering the most frequent spectrum of pathogens and common causes of the condition, the safer tactics of surgical invasion can enhance the treatment of sepsis from various sides. Both physicians and nursing personnel must be involved in the optimization and improvement of the issue. Sepsis is a condition that should be recognized and treated rapidly; otherwise, it will remain a cause of a high rate of deaths.
References
Boldingh, Q. J. J., de Vries, F. E. E., & Boermeester, M. A. (2017). Abdominal sepsis. Current Opinion in Critical Care, 23(2), 159–166. Web.
Dhondup, T., Claudia Tien, J.-C., Marquez, A., Kennedy, C. C., Gajic, O., & Kashani, K. B. (2019). Association of negative fluid balance during the de-escalation phase of sepsis management on mortality: A cohort study. Journal of Critical Care, 55, 16-21. Web.
Kim, J., Kim, Y. A., Hwangbo, B., Kim, M. J., Cho, H., Hwangbo, Y., & Lee, E. S. (2019). Effect of antihypertensive medications on sepsis-related outcomes. Critical Care Medicine, 47(5), e386–e393. Web.
Rowe, T. A., & McKoy, J. M. (2017). Sepsis in older adults. Infectious Disease Clinics of North America, 31(4), 731–742. Web.
Sato, R., Kuriyama, A., Takada, T., Nasu, M., & Luthe, S. K. (2016). Prevalence and risk factors of sepsis-induced cardiomyopathy. Medicine, 95(39), e5031. Web.
Shankar-Hari, M., Harrison, D. A., Ferrando-Vivas, P., Rubenfeld, G. D., & Rowan, K. (2019). Risk factors at index hospitalization associated with longer-term mortality in adult sepsis survivors. JAMA Network Open, 2(5), e194900. Web.
Shao, I. Y., Elkind, M. S. V., & Boehme, A. K. (2019). Risk factors for stroke in patients with sepsis and bloodstream infections. Stroke, 50(5), 1046-1051. Web.
Van Vught, L. A., Klein Klouwenberg, P. M. C., Spitoni, C., Scicluna, B. P., Wiewel, M. A., Wiewel, M. A., Horn, J., Schultz, M. J., Nurnberg, P., Bonten, M. J. M., Cremer, O. L., & Poll, T. (2016). Incidence, risk factors, and attributable mortality of secondary infections in the intensive care unit after admission for sepsis. JAMA, 315(14), 1469-1479. Web.