President's Message - Spotlight on Sepsis

2015 - 5 October – 45th Critical Care Congress Advance Program
Craig M. Coopersmith, MD, FCCM
SCCM President Craig M. Coopersmith, MD, FCCM, discusses the Society’s efforts to combat sepsis.

Sepsis is a devastating disease. Between 230,000 and 370,000 people die of sepsis annually in the United States, making it the third most common cause of death in the country. Unfortunately, the incidence of sepsis worldwide is even higher, leaving a trail of destruction across the globe.

And yet, if you mentioned sepsis to the average lay person even a few years ago, you would likely have been met with a blank stare. Sadly, the low public profile of sepsis has been remarkably disproportionate to the misery it causes, both to patients and families alike. In many places, sepsis has been all but invisible. For instance, the World Health Organization website lists the top 10 causes of death across a host of parameters throughout the world. The word “sepsis” literally does not show up on any list a single time because syndromes are not considered to be a cause of death.

This has historically been frustrating to many of my colleagues who tirelessly work on behalf of the millions of septic patients worldwide. While other diseases have had visible spokespeople (Michael J. Fox), successful campaigns (Race for the Cure) or YouTube videos gone viral (the Ice Bucket Challenge), sepsis has had…well…none of these. I mention these other disease states not to compare the burden of sepsis to Parkinson’s disease or breast cancer or ALS—obviously a counterproductive exercise as each is horrific in its own right. Rather, I bring these examples up because the sepsis community aspires to match the success seen in raising the public profile of these other diseases—success that assuredly could accelerate our fight against this deadly disease.

Despite this challenging history, over the last few years, the tide is quickly turning. We are currently witnessing before our eyes a “tipping point” in the worldwide fight against sepsis and the raising of public consciousness required to make sepsis the public health priority it deserves to be. And at every step of the way, the Society of Critical Care Medicine (SCCM) is taking the lead in this fight.

There are so many exciting initiatives ongoing that I could fill an entire issue of Critical Connections with the great work being done by my colleagues at SCCM. But I will instead highlight just a few with apologies to those who I deeply respect but don’t have room to mention. The cornerstone of our anti-sepsis efforts has been the Surviving Sepsis Campaign. With three iterations of our guidelines out and a fourth on the way, there are tens of thousands of patients (if not more) who are participating in the campaign worldwide. The evidence is clear: mortality from sepsis is decreasing, and higher compliance with the Surviving Sepsis Campaign bundles is associated with decreased mortality. The National Quality Forum took the Surviving Sepsis bundles and directly incorporated them into the first national quality metric on sepsis (and one of the first on critical care). Around the time you read this, public reporting of compliance with elements of the bundles will become required by the Centers for Medicare & Medicaid Services. While there will be some effort associated with this reporting, it is incredibly exciting that sepsis is moving front and center on the national stage in the United States, since there is every reason to believe that reporting will lead to better compliance, which, in turn, will lead to better care and better outcomes for septic patients.

And now the Surviving Sepsis Campaign is expanding. In collaboration with the Hellman Foundation, a pilot project is underway on combatting sepsis in resource-limited countries. The approach that needs to be taken will be drastically different, but a project in the Ruhango District in the Southern Province of Rwanda on early recognition and treatment of sepsis has the potential to not only impact people in the local community but also to be scalable and have far reaching benefits in other resource-limited environments.

Yet, that’s not all. In February at our annual meeting (spoiler alert!), a new definition of sepsis and septic shock will be unveiled. This effort—the  result of a joint SCCM and European Society of Intensive Care Medicine effort that will be endorsed by societies throughout the world—will be an evidence-based definition informed by a “big data” analysis of multiple databases combined with expertise from around the globe. This dovetails perfectly with a new SCCM partnership with the experts in the Centers for Disease Control and Prevention to help come up with a nationwide surveillance program for sepsis. In addition, key leaders at SCCM were recently invited to a consensus conference at the National Institute of Child Health and Human Development at the National Institutes of Health on pediatric multiple organ dysfunction, with an emphasis on sepsis that seems likely to spur exciting new discoveries in the fight against pediatric sepsis.

If you told me a few years ago that all of this could possibly occur in a one-year span, I would have thought you were crazy. And yet, here we are. Sometimes, when one is in the middle of making history, it is difficult to take a step back to appreciate everything that is going on. So, I urge each of you to take some time to savor the progress we have made on so many fronts in combatting sepsis. And then, let’s dive in together to recognize, treat and fight this horrific disease so more and more patients will successfully survive sepsis and thrive long-term!