Sepsis involves life-threatening organ dysfunction due to an autoimmune response to infection. It can result in multi-organ failure and is a major healthcare problem. Septic shock describes the dysfunction using certain parameters, such as low blood pressure (hypotension), along with evidence of poor blood flow to vital tissues (perfusion abnormalities) - manifested by increased lactate, reduced urine output, or acute mental status change. Sepsis is sometimes described as Systemic Inflammatory Response Syndrome (SIRS). The American College of Chest Physicians (ACCP) recommends using this umbrella term to encompass similar organ responses from various causes. The ACCP criteria for SIRS include an elevated or low body temperature (above 38°C or below 36°C), increased heart rate (tachycardia), increased respiratory rate (tachypnea), and an abnormal white blood cell count (either elevated or decreased).
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International guidelines for surviving sepsis and septic shock estimate that millions of people develop these conditions each year, resulting in death for between one in three and one in six affected patients. Medical professionals are well aware that early diagnosis and prompt treatment during the initial hours are critical for saving lives and improving outcomes. Sepsis is a medical emergency that requires immediate intervention and resuscitation. A 2018 study emphasized that early recognition and effective treatment are "highly time sensitive." In the United States, more than one million people are hospitalized with sepsis annually, and sepsis accounts for nearly half of all hospital deaths.
The cornerstones of effective sepsis treatment include timely administration of antibiotics, resuscitation with intravenous fluids, and, when necessary, vital organ support such as vasopressors and mechanical ventilation. Early administration of appropriate antibiotics is one of the most effective measures to reduce mortality. A 2006 study found that administering antibiotics within the first hour of documented hypotension was associated with a 79.9% survival rate, identifying this as the "single strongest predictor of outcome." Indeed, that study calculated there was a 7.6% reduction in survival for each hour of delay after hypotension in administering antibiotics over the ensuing six hours.
International guidelines recommend initiating antibiotics in patients with possible sepsis as soon as it becomes the most likely diagnosis, and no later than three hours after recognition. Given the high risk of death associated with septic shock and the strong link between antimicrobial timing and mortality, the guidelines advise immediate antibiotic administration—ideally within one hour—for all patients with potential septic shock or confirmed or likely sepsis.
A study involving 49,311 patients in 149 New York hospitals demonstrated that each additional hour from emergency room arrival to antibiotic administration increased the risk of in-hospital death. Similar findings were reported in a study of 35,000 patients treated at Kaiser Permanente Northern California and in a study of 10,811 patients in Utah hospitals.
Fluid resuscitation is also a critical aspect of managing sepsis and septic shock. One study reported that adults presenting to the emergency department with sepsis or septic shock who did not receive adequate fluid resuscitation within three hours of onset had higher odds of in-hospital death, prolonged hypotension, and longer ICU stays. Intravenous fluids support cardiac function and tissue perfusion and may reduce the risk of kidney dysfunction caused by hypotension and poor perfusion. Guidelines recommend starting fluid resuscitation immediately upon recognition of sepsis or septic shock and maintaining a low threshold for initiating fluids in patients suspected of having sepsis. Patients must be closely monitored for signs of fluid accumulation and the risks associated with fluid overload. Effective management of sepsis requires a thorough initial assessment and ongoing, close re-evaluation of the patient’s response to treatment.
Because sepsis can cause failure of multiple organ systems, some patients may require additional support beyond antibiotics and fluids. This may include medications to maintain blood pressure (vasopressors) and ensure adequate organ perfusion, as well as respiratory support such as mechanical ventilation for those experiencing respiratory distress.
The New York medical malpractice attorneys at Queller Fisher Washor Fuchs & Kool have unfortunately handled many cases involving patients who died or suffered severe injury due to sepsis. Despite clear mandates and widespread recognition within the medical community, too many patients with sepsis or septic shock continue to receive delayed, inadequate, or missed diagnoses and treatment—often with tragic consequences for them and their families.