Global Health
Post sepsis: Postseptic syndrome explained
Early recognition and intervention improve short-term survival from sepsis, but many individuals experience complications long after the initial infection has resolved and so they are discharged from the hospital. Postseptic syndrome (PSS) occurs in roughly one-sixth of sepsis survivors and includes each long-term physical and psychological effects (Prescott and Costa, 2018).
What are the signs and symptoms of post-septic syndrome?
Sepsis survivors have higher hospital readmission rates and an increased risk of myocardial infarction, stroke, and fatal coronary heart disease (Shankar-Hari and Rubenfeld, 2016). The Sepsis Alliance (2021) identifies the next physical and psychological effects of PSS lasting from months to years:
Physical effects
- Difficulty sleeping; tiredness; lethargy
- Dyspnoea; dyspnoea
- Muscle or joint pain; swelling of the limbs
- Repeated infections
- Poor appetite
- Organ dysfunction
- Hair loss; rash
Psychological effects
- Hallucinations
- Panic attack
- Flashbacks
- Nightmares
- Decreased cognitive functioning
- Depression; lack of self-esteem
- Mood swings
- Difficulty concentrating; memory loss
- Post-traumatic stress disorder (PTSD)
Who is vulnerable to postseptic syndrome?
All patients diagnosed with sepsis are in danger for PSS, and the incidence increases with the severity of sepsis. The increased risk of PSS also applies to older people and patients with pre-existing conditions. Other conditions related to poor long-term outcomes include immobility, visual or hearing impairment, frailty, being in a nursing home, marital status, and the event of delirium during hospitalization (Prescott and Costa, 2018).
How to reduce the chance of post-septic syndrome?
Although essentially the most effective treatment for PSS is to forestall sepsis (using primary prevention techniques reminiscent of handwashing, vaccinations, and nutrition), managing chronic diseases can be key to reducing the chance of sepsis and PSS (Leviner, 2021).
If a patient develops sepsis, treatment with antibiotics is indicated. Stewardship programs are really useful to enhance antibiotic use and reduce the chance of future infections. Procalcitonin levels could be used to assist providers make decisions about increasing the dose or discontinuing antibiotics (Prescott and Costa, 2018).
When prevention of stress ulcers is indicated, H2 receptor agonists are preferred over proton pump inhibitors (PPIs) to reduce the chance of subsequent infections, as PPIs are related to an increased risk of infection and pneumonia (Prescott and Costa, 2018).
Other recommendations, especially for the highest-risk patients within the ICU, include the usage of pain and arousal medications at the bottom possible doses for the shortest possible duration. Strategies reminiscent of pain management first combined with routine pain assessment using a validated pain rating scale; the usage of intermittent reasonably than continuous medications; use of a sedation scale (i.e., Richmond Agitation Sedation Scale, RASS) to find out light levels during continuous sedation; and performing day by day awakening attempts. Additionally, benzodiazepines are related to an increased risk of delirium, which is related to worse long-term outcomes. When continuous sedation is required, propofol and dexmedetomidine, each short-acting, continuous sedatives, are preferred to benzodiazepines. (Prescott and Costa, 2018).
Non-pharmacological strategies reflect those who prevent delirium and include:
- Promoting progressive activity and early mobility, also through the patient’s stay within the ICU
- Visual and hearing aids if the patient uses them normally
- Use of adaptive equipment to facilitate independence
- Promote sleep at night and activity through the day
Rehabilitation is related to reduced 10-year mortality in addition to improved physical functioning and quality of life (Leviner, 2021), so referral for physical and occupational therapy and follow-up are crucial.
These recommendations clearly show that physicians, typically, play a job in mitigating the results of PSS. In the outpatient setting, it is amazingly necessary to coach patients about stopping infections and treating chronic diseases, in addition to recognizing the signs and symptoms of PSS. In intensive care units, cooperation can be necessary to optimize treatment while minimizing risks and complications. PSS awareness and PSS prevention strategies are key to optimizing long-term outcomes after sepsis.
Annane, D. and Sharshar, T. (2015). Cognitive decline after sepsis. , (1), 61–69. https://doi.org/10.1016/S2213-2600(14)70246-2
Levinera S. (2021). Postseptic syndrome. , (2), 182–186. https://doi.org/10.1097/CNQ.0000000000000352
Prescott, H. C. and Costa, Denmark (2018). Improving long-term outcomes after sepsis. Critical Care Clinics, 34(1), 175–188. https://doi.org/10.1016/j.ccc.2017.08.013
Sepsis Alliance (2021, January 21). Postseptic syndrome. https://www.sepsis.org/sepsis-basics/post-sepsis-syndrome/