Many infections that patients get do not result in severe illness requiring the ICU. Pneumonias, urinary tract infections, and GI bugs pass through clinics across the world each day without a thought. A few unfortunate patients develop a clinical syndrome that is much more severe called sepsis. This is the term that physicians use to describe an overwhelming infection that has made a patient very ill. Treating these patients can be a complex process. Here is some insight into what physicians are considering when they see a patient with sepsis.
Sepsis and the Infectious Continuum
Doctors are very detail oriented by nature. To that end, we classify everything in order to better understand things. For severe infections, there is a continuum of disease ranging in severity from your basic infection like a urinary tract infection all the way to the most severe, septic shock. This spectrum may seem a bit like voodoo, so here is a simple breakdown:
SIRS (Systemic Inflammatory Response Syndrome)-patient has two or more of abnormal temperature, heart rate, respiratory rate, or white blood cell count (blood test)
Sepsis-Has SIRS plus a known site of infection
Severe Sepsis-Has sepsis plus dysfunction of at least one organ
Septic Shock-Has severe sepsis plus low blood pressure
Antibiotics and Other Medications
The mainstay of therapy for anyone with a severe infection is antibiotics. Common sense would tell you that giving antibiotics quickly probably makes a difference. As a matter of fact, it does. There was a study published in Critical Care Medicine that showed giving antibiotics more quickly saves more lives.
In addition to giving antibiotics quickly, there is a protocol known commonly amongst physicians as Rivers Protocol. This is named for the lead author on the article appearing in The New England Journal of Medicine that first outlined this approach. The general idea is that antibiotics are given quickly as well as other interventions (fluids, medicines to sustain blood pressure, and blood) to sustain the patient while they are in the acute phase of their illness. This is why things seems to happen quickly at first when someone goes to the ICU. There is usually a well planned out protocol for the first few hours.
Ventilator
It is not uncommon for a patient with sepsis to require the ventilator for a period of time, especially if the patient's infection started as a pneumonia. Putting a patient on the ventilator relieves the patient from the work of breathing and ensures that their respirations continue in a controlled manner. By taking control of this essential function, doctors can use other medications and interventions described above to get the patient on the road to recovery while ensuring that the patient's lungs continue to work. As a side effect, patients must be sedated while on the ventilator because of the invasive nature of having a tube in your throat, which means they won't remember much of being on the ventilator. Once they begin to improve, they can be weaned off the ventilator and have the breathing tube removed.
Long Term Health Effects
Because of the debilitating nature of having sepsis, many patients find it takes them weeks or even months to recover their strength. This is especially true for elderly folks or those already weak from chronic illness. Many ICUs will get physical therapy to see patients even while they are still in the ICU. After getting appropriately treated, some patients require time at a rehab facility to regain their strength before going home. While most want to get home quickly, patients often find that they are eventually appreciative of going to rehab as they would not have had the strength to function at home without it. There's nothing like getting out of bed to make a person feel better!