History of Colors - 5nd year
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ABOUT THE FIFTH POSTGRADUATE COURSE OF SEPSIS AND MODS
"Mecca of sepsis" - that's what someone called the postgraduate course in Ostrava dedicated to sepsis and multi-organ failure. I don't know if he meant it, but in any case it pleased me as a co-organizer of the course. Finally, there is a certain connection - for the fifth time in Ostrava, doctors dealing with the problem of the disease, which has the epithet "rapid killer", met. The statistics are truly relentless. They talk about a 30% mortality rate within one month and a 50% mortality rate within six months of diagnosis. In Europe and the USA, almost 350 patients die from sepsis every year! These alarming data are underlined by the high incidence of the disease. Worldwide, there are an estimated 000 million cases per year (for example, the entire population of Finland, Denmark, Norway and Ireland combined), with forecasters predicting an increase in incidence at a rate of 18% per year. This means, for example, that in the US alone there will be one million patients diagnosed with "severe sepsis" by 1,5. In any case, today the incidence of this disease is higher than the incidence of cardiovascular or oncological diseases. The social and economic impact of this disease is no less serious. The management of sepsis places an enormous burden on both the nursing staff and the patient himself and his relatives. We all know this very well and there is nothing to add. I prefer to mention the economy only in a few figures cited in the literature. Almost €2020 billion is spent annually on the treatment of severe sepsis in Europe and €8 billion in the USA! The cost of treating patients with sepsis accounts for almost 18% of the total costs of intensive care units and is six times higher compared to the treatment of other patients.
The text of the Founding Charter of the Czech-Slovak Sepsis Forum was read by Mrs. Helena Hlaváčová
The logical question now is, "How are we doing with the level of sepsis management? Have we made any progress?" I sure do! We master ways to replace the functions of failing organs, we know how to implement complex diagnostic and therapeutic procedures, and we even make excellent use of the vocabulary and knowledge of several clinical fields. The standard of sepsis management today is certainly at a higher level than it was thirty years ago. But what is important - we must also note the improvement of the therapeutic results! Why this is not the case is a matter of debate at various levels. And these are - if we follow the literature - sometimes so complex that it is not possible to implement these conclusions in real time into regular clinical practice. Paradoxically, today records the effectiveness of simple therapeutic procedures. For example, early recognition and aggressive elimination of shock are able to reduce mortality in the protocol groups of various studies by almost 70%, strict normoglycemic control by almost 45%, protective ventilation in ALI/ARDS by almost 25%. The common denominator of these undeniably gratifying reports is the relatively simple "timing" for the use of the mentioned procedures. Unfortunately, this is not the case with others. And so it can happen that even a well-mastered therapeutic technology is applied late and the results do not bring - compared to the experiment - the expected improvement. In general, the issue of correct "timing" (among other things) is tied to timely and accurate diagnosis. However, are we able to accurately diagnose sepsis today so that we can start the right therapeutic technology in time? Unfortunately, we have to answer this question in the negative. The diagnostic criteria used today are based on symptoms that can be the result of a whole spectrum of non-infectious agents. In one of the surveys, this fact was confirmed by almost 90% of the interviewed doctors. Moreover, 81% of them are convinced that the absence of an exact definition of sepsis is a potential source for delayed initiation of appropriate treatment intervention with fatal consequences. These views are very important because they reflect the reality of daily work at the bedside of a critically ill patient. Moreover, they can be a source of uncertainty, doubt or frustration if the excellently established therapeutic technology did not bring the expected effect.
Helena Hlaváčová
Roman Kula