Spreading the knowledge on the epidemiology of sepsis

Abstract

Notwithstanding the definition we choose, sepsis-associated short-term and long-term mortality and morbidity remain a major public health concern. From a high-income country perspective, the half-full glass (as shown by a sustained decline in mortality 1,2 ) is counterbalanced by the half-empty glass in which the high burden of long-term cognitive and functional decline seen in survivors of long-term sepsis 3 is increasingly recognised. However, in low-income and middle-income countries, the growing evidence base obtained from recent epidemiological studies of sepsis leaves us far from optimistic. At a quick glance, the well-designed study by Flavia R Machado and colleagues 4 shows that sepsis still has an ominous prognosis in patients admitted to a national-representative cohort of Brazilian intensive-care units (ICUs), with hospital mortality rates of 55%. Even for basic therapies such as antimicrobials, there remains a large variation in availability, with many hospitals having suboptimal provision. In Brazilian ICU settings where good standards of care are provided, recent data show that sustained efforts to implement best practices with increased sepsis awareness are associated with decreased mortality rates and costs. 5,6

Facility readiness in low and middle-income countries to address care of high risk/ small and sick newborns

“…WHO with partners has highlighted the importance of compassionate and good QoC at facility level [39]. In many LMIC, there is often a significant variation in the existing quality of care, with some hospitals providing excellent care but with many others having neither the required skills, supplies nor the motivation, resulting in poorer quality care including inadequate pain management [40].…”

Mortality in mechanically ventilated patients in middle-income countries: a call for action

“…Interestingly, the authors found that the use of low tidal volumes (<8mL/kg predicted weight) was similar in MICs and HICs (42•4% vs 44•2%; absolute difference -1•69% [95% CI -9•58 to 6•11]; p=0•67), as were most ventilatory parameters (except for a small decrease in positive end expiratory pressure in the ICUs in MICs than in HICs (5 [IQR 5-8] vs 6 [5][6][7][8] cm H2O; p=0•0011). However, ICU mortality was much greater in MICs than in HICs (30•5% vs 19•9%; p=0•0004; adjusted effect 16•41% [95% CI 9•52-23•52]; p<0•0001).…”

“…Some of these factors have already been shown in previous analyses in MIC hospitals: worse outpatient health care, fewer (and perhaps lesser qualified) health professionals (particularly nursing), greater number of comorbidities, and lower availability of hospital and ICU beds (thus selecting patients with more severe conditions and more advanced clinical conditions). 6 , 7 , 8 All of these factors are probably related to socioeconomic conditions per se, perhaps more than to the ventilatory strategy.…”

“…Some of these factors have already been shown in previous analyses in MIC hospitals: worse outpatient health care, fewer (and perhaps lesser qualified) health professionals (particularly nursing), greater number of comorbidities, and lower availability of hospital and ICU beds (thus selecting patients with more severe conditions and more advanced clinical conditions). [6][7][8] All of these factors are probably related to socioeconomic conditions per se, perhaps more than to the ventilatory strategy. Finally, it should be noted that, despite the fact that this study did not find differences in outcomes (mortality) between MICs and HICs directly related (or attributed) to mechanical ventilation, it should not be forgotten that the careful strategy of mechanical ventilation, minimising stress and strain of the alveolar parenchyma, in addition to allowing adequate patient and machine interaction and reducing diaphragmatic injury and dys-synchrony, are among the most revolutionary advances in the care of critically ill patients.…”

Challenges for the care delivery for critically ill COVID-19 patients in developing countries: the Brazilian perspective

“…Jorge I. F. Salluh 1,2* , Thiago Lisboa 3,4 and Fernando A. Bozza 1,5 Background The delivery of critical care is a major challenge for developing countries [1]. The inequity of access to an ICU bed, heterogeneous triage policies, a low staff/patient ratio and suboptimal adherence to evidence-based practices contribute to disproportionally high mortality of sepsis and acute respiratory distress syndrome in these countries [2][3][4][5]. In addition, limited step-down and specialized ward beds' availability further widens the gap between critical and non-critical care inside hospitals.…”