Septic shock: Clinical indicators and implications to critical patient care

Abstract

Aims and Objective To identify clinical indicators of septic shock in critical care patients. Background The identification of clinical indicators of septic shock is relevant to avoid clinical deterioration of patients with sepsis. However, the recognition of these factors, especially by the nursing team, is still deficient and reinforces the need for studies that investigate the subject in different realities such as that of Brazil. Design The study had a cross‐sectional design based on STROBE guidelines (see Appendix S1). Methods A sample of 392 patients with sepsis or septic shock was admitted to the Intensive Care Unit of a Brazilian university hospital. Data were collected from medical records of the Intrahospital Sepsis Combat Program referring to patients admitted between January 2018–January 2019. Sociodemographic and clinical data were collected, as well as information on the time from diagnosis of sepsis or septic shock to initiation of antibiotic therapy, length of stay, and discharge or death outcomes. Data were statically analysed. Results Out of the total sample, 190 (49%) patients were admitted with septic shock. Clinical indicators of septic shock were hypotension, mechanical ventilation, lactate levels between 2.0–3.9 or >4, hypothermia <36°C, radiotherapy‐associated chemotherapy, Sequential Organ Failure Assessment score >3 and admittance through the emergency unit. Among patients with septic shock, 85 (44.7%) were discharged and 105 (55.2%) died in the intensive care unit. Conclusions Patients with septic shock presented hyperlactataemia and greater organic dysfunction as clinical indicators when compared to patients with sepsis. Mechanical ventilation, chemotherapy and radiotherapy increased the risk of developing septic shock. Relevance to clinical practice Our results can support the nursing team by providing the main clinical indicators of septic shock and contributing to the interprofessional team in the prevention of septic shock.

<br/> INTERVENÇÕES ESPECIALIZADAS À PESSOA EM SITUAÇÃO CRÍTICA EM CHOQUE SÉPTICO: REVISÃO SISTEMÁTICA DA LITERATURA <br/>

“…Pinto et al (9) observaram que existe maior risco de desenvolvimento de choque séptico nos doentes provenientes do SU do que daqueles transferidos de outras unidades hospitalares, sendo que os sinais e sintomas mais regularmente apresentados nas primeiras 6 horas foram: taquicardia > 90 bpm; taquipneia > 20 cpm; leucopenia < 4000/mm 3 ; leucocitose > 12 000/mm 3 ; SpO 2 < 90%; hipertermia > 38,3ºC; e hipotermia < 36ºC. Como indicadores de choque séptico, foram também identificados: hipotensão; suporte por VMI; hipotermia; lactatos > 2 mmol/L; radioterapia associada a quimioterapia; score SOFA > 3; e admissão pelo SU.…”

“…Associado ao choque séptico, o órgão mais afetado é o cardiovascular, motivo pela qual a hipotensão se apresentar como um dos sintomas mais usuais (9) . Este é também verificado por Jeganathan et al (15) que, no seu estudo, referem que 52% dos seus doentes em choque séptico, teve presente disfunção cardiovascular.…”

Recent nanoengineered diagnostic and therapeutic advancements in management of Sepsis

“…Apart from diagnosis, sepsis management guidelines majorly concentrated on three windows i.e. , hemodynamic steadiness, contagion control and intonation of the septic responses [ 8 ]. Some of the other intrusions include fewer specific parameters of organ support like ventilation on a mechanical basis, oxygen therapy, renal replacement therapy, corticosteroids, and hemodynamic support [ 9 ].…”

Intensive care nurses’ awareness of identification of early sepsis findings

“…In the ‘Surviving Sepsis Campaign’ (SSC) guidelines, the importance of hospitals and hospital systems for sepsis screening for acute and high‐risk patients was emphasised (Levy et al, 2018; Rhodes et al, 2017). Intensive care nurses serving high‐risk critical patients for sepsis should also have a more advanced level of sepsis awareness and screening and management skills compared with nurses working in other units of hospitals (Bleakley & Cole, 2020; Pinto et al, 2021).…”

“…Some studies conducted in Turkey indicated that mortality in sepsis was 31.2% in ICU, it was 75.9% in septic shock (Baykara et al, 2018), and the cost of sepsis treatment constituted 39.2% of the total treatment costs (Azap et al, 2019). It was found that 49% of the patients followed up in ICUs in Brazil over a one‐year period were admitted to the unit due to septic shock and that 44.7% of these patients were discharged and 55.2% died (Pinto et al, 2021). While sepsis increases mortality rates and costs, physical and cognitive functions in patients after sepsis are significantly reduced, and it causes repeated hospitalisations (Gauger et al, 2020).…”