Treatment

Sepsis is a medical emergency, and should be treated as such. In other words, sepsis should be treated as quickly and efficiently as possible as soon as it has been identified. This means rapid administration of antibiotics and fluids. A 2006 study showed that the risk of death from sepsis increases by and average of up to 7.6% with every hour that passes before treatment begins. (Critical Care Medicine)

Treatment

Antibiotics

Antibiotics (usually more than one type) are prescribed by the physician based on the type of infection that is causing the illness. The first antibiotics are usually broad-spectrum, which means the antibiotic is effective against several of the more common bacteria. The antibiotics are given intravenously in order to ensure they get into the blood system quickly and efficiently.

IV Fluids

Antibiotics alone won’t treat sepsis; fluids are also needed. The body needs extra fluids to help keep the blood pressure from dropping dangerously low, causing the patient to go into shock. Giving the fluids by IV allows the health care staff to track how much fluid is being administered and to control the type of fluid the patient is getting.

Ensuring the body has enough fluids helps the organs to function and may reduce damage from sepsis.

While there are several types of IV fluids, some are standard in treating sepsis. Normal saline is one commonly given fluid. It is a crystalloid fluid. These are fluids that contain minerals, such as sodium, and are water soluble, or dissolve in water. These add fluid to the blood system.

Colloids, another type of fluid that is used, are thicker. For example, blood is a colloid. Colloids that may be given by IV include albumin and dextran. Colloids do not dissolve as quickly as crystalloids. More crystalloid fluid is needed than colloid fluid to achieve the same goal of boosting body fluid volume, but crystalloids are less expensive.

Additional Possible Treatments and Equipment

Since all patients are different and there are many causes of sepsis, not every available treatment is right for each patient. To find out what treatment is being given to you or your loved one and why, speak with your health care provider.

Here are treatments, medications, and types of equipment that may be used on a patient with sepsis or septic shock:

Arterial lines – Arterial lines look like IV lines but they go directly into an artery, usually the wrist or groin. These lines allow nurses to monitor blood pressure and to take frequent samples of blood without inserting a needle in a vein each time one is needed. The line is protected with a special cap that allows for the blood to be drawn and it must be monitored closely because the pressure of the blood pumping from the heart can cause serious bleeding if the line becomes undone. 

Central lines – Central lines are large IV catheters most often inserted into a large vein near the shoulder, although they can be inserted in any large vein, such as the neck or groin. Central lines have larger catheters than IVs and are used to give fluids more quickly and easily. They also don’t need to be changed as often as an IV, which may be more comfortable for the patient. 

Corticosteroids – Although doctors don’t know why corticosteroids work for some patients who have sepsis and not others, they can be helpful. Corticosteroids can help reduce inflammation in the body and depress the immune system, making it less active.

Endotracheal Tube – An endotracheal tube, or ET tube, is inserted through the mouth into the trachea (windpipe) and is attached to a ventilator. When a patient has an ET tube, he or she is intubated. When the tube comes out, this is called extubation. Patients with ET tubes cannot speak as the tube passes through the vocal cords. If there is damage in the mouth but intubation is necessary, a nasotracheal tube is inserted through the nose. Patients who are intubated may be restrained, their hands fastened down, if there is a danger of them unknowingly pulling the tube out. If a patient must be on a ventilator for an extended time or there is too much damage to the mouth or throat to allow for intubation, the physicians may opt to perform a tracheostomy. This procedure makes an opening in the throat for direct access to the trachea. A tube is then inserted through the opening and fastened down, and connected to the ventilator. 

Intracranial Pressure Monitor – An intracranial pressure (ICP) monitor measures the fluid pressure in the brain. A sensor that has been placed directly below the skull is attached to the monitor. 

Kidney dialysis – also called renal replacement therapy, dialysis may be necessary if the kidneys cannot filter the blood as they should. A portable dialysis machine allows patients to undergo dialysis in the ICU if their kidneys fail. A special catheter is inserted into a large vein and attached to the dialysis machine. Blood flows through the machine, which filters out toxins in the blood, which is what the kidneys normally do. Once the blood has been filtered, it flows back into the body.

Mechanical ventilation – Ventilators, sometimes called respirators, help patients to breathe. The machines can either do all the work for the patient by pushing the air into the lungs at a preprogrammed speed, or they may only help when needed. The machine is programmed to record how often the patient breathes and if there are not enough breaths within a certain period, the machine will assist by taking over as needed.

Nasogastric Tube – A nasogastric (NG) tube is inserted through the nose and goes down into the stomach. If it is inserted through the mouth, it is called an oral-gastric tube, but through the nose is the most common approach. This tube may be connected to a suction bottle, which draws out stomach contents to help reduce nausea and vomiting. 

Oxygen – Patients are generally given oxygen, by mechanical ventilator, mask or nasal cannula, to ensure the body has enough oxygen in its system. A pulse oximetry monitor, often called a pulse ox, is a small piece of equipment that is fit over the tip of a finger or toe, or on the ear lobe. It measures the amount of oxygen in the blood. 

PreSep(tm) catheter –  this type of catheter was developed to help intensive care unit staff by monitoring the oxygen levels in blood that is returning to the heart.

Pulmonary artery catheter – this type of catheter is inserted into the pulmonary artery – the blood vessel that carries blood from the heart to the lungs where the blood can be supplied with oxygen. “Pulmonary” means something is related to the lungs.

Urinary Catheter  – Often referred to as a Foley catheter or indwelling catheter, a urinary catheter is a tube that is inserted through the urethra to the bladder to help drain urine into a bag attached to the side of the bed. Patients may need a urinary catheter for a few hours or indefinitely, depending on the situation. If the catheter is to remain in for an extended period, it needs to be changed according to the facility’s protocol. 

Vasopressors – Physicians prescribe vasopressors to patients who are in shock and whose blood pressures have dropped dangerously low. The vasopressors act by constricting or tightening up the blood vessels, forcing the blood pressure to go up.