The first 3 hours of sepsis should be treated with the sense of urgency as the first hours of myocardial infarction, says Angel Coz Yataco, MD, FCCP, a pulmonologist at Lexington Veterans Affairs Medical Center.
The decisions made in the first couple of hours are critical to the patient, but what to do within that timeframe is controversial among the medical community.
Dr. Coz, chair of the session, and his co-presenters will argue for and against some of the controversies in Monday’s session Managing Sepsis: Controversies in the First 3 Hours, which will debate fluid resuscitation levels and when to administer broad spectrum antibiotics. This pro/con debate also will be the topic of a CHEST® journal article this month. The session starts at 11:00 am in room 288 of the convention center. Here’s a look at the session’s debate:
Dr. Coz → Pro: Early Broad-Spectrum Antibiotics are Crucial to Sepsis
Dr. Coz will lead the session arguing for administering broad spectrum antibiotics immediately.
“It’s clear that if antibiotics are not given in a timely fashion for every hour, there is around 8% increase in mortality from sepsis,” he said. “Waiting for information about the diagnosis might be too late. The risk of not giving antibiotics far surpasses the risk of giving them.”
Unfortunately, diagnosing sepsis is difficult. The best way right now is to use clinical judgment, Dr. Coz said.
“Hopefully in the future we will have a more precise way with machine learning algorithms and biomarkers.”
Jayshil J. Patel, MD → Con: Initial Antibiotics Should Be Tailored to the Infection
Dr. Patel will argue that it is important to wait for the diagnosis to administer antibiotics.
“On the flip side, the detractors of this approach (administering immediately) are very worried that giving antibiotics to patients who ultimately may not need them could actually lead to antibiotic resistance, which is a real problem,” Dr. Coz said.
Amit Uppal, MD → Pro: 30 mL/kg for All Patients With Severe Sepsis
Dr. Uppal will support that 30 mL/kg is the right amount of fluid for resuscitation of sepsis. It seems to be a standard, according to different trials—Rivers, ProCESS, ARISE, and PROMISE*.
Heath E. Latham, MD, FCCP → Con: Fluid Boluses Should be Individually Tailored
Dr. Latham will argue that 30 mL/kg may be too much and could harm patients.
“Resuscitation needs to be guided with frequent assessments to make sure that we do not over-resuscitate patients because that is just as harmful as not giving fluid,” Dr. Coz said. “It’s a fine line that the clinician needs to walk as far as being aggressive early but at the same time not being too liberal with fluid resuscitation.”