Treating Sepsis: A Clinician’s Perspective

An interview with Doug Hansell, MD, MPH, vice president of medical affairs

Around the world, September is recognized as Sepsis Awareness Month – an opportunity to educate the public about the critical condition and engage the healthcare community in conversations to address it. Amid a global pandemic, the need to do so has never been more urgent. 

Q: What is sepsis, and why is it critical that the healthcare community address it? 

Dr. Hansell: Sepsis is defined by the Global Sepsis Alliance as "a life-threatening organ dysfunction caused by a dysregulated host response to infection." Sepsis occurs when the body damages its own organs while trying to fight an infection; basically, it’s an infection response out of control and its impact is vast. Nearly 50 million people globally are affected by the condition every year.ⁱ  In the U.S., one in three patients who pass away in the hospital have sepsisⁱⁱ. Unfortunately, there are few proven effective options for treatment because there is still a lot we don’t know about how or why sepsis occurs – but the size of this condition's impact deserves attention and we must continue to investigate it. 

Q: If sepsis has such a grave impact, why does treating it continue to be such a challenge?

Dr. Hansell: One of the challenges with sepsis is that it can occur across so many different specialties – you see it in surgical patients, pulmonary patients, patients with congestive health failure – and sometimes I think it's difficult to step back and connect the dots to see the whole picture. Another challenge is that it can be hard to recognize in real time. Sepsis is slow and insidious in its onset, and so it can take time to recognize it. In the last 20 years, there's been a big push to focus on recognizing sepsis sooner and treating it faster. We've seen an improvement in mortality rate because of this emphasis, but there's still a lot of work to be done. 

Q: What do you make of the relationship between sepsis and COVID-19? 

Dr. Hansell: There are clear parallels as well as differences between the two, and we're continuing to learn about how COVID-19 impacts the body. What we do know is that the COVID-19 virus can trigger the same massive inflammatory response in the body that bacterial sepsis does. When you look at the original definition of sepsis -- the body's response to a disease overwhelming the body -- that is clearly happening in severe cases of COVID-19. When COVID-19 patients experience lung damage, kidney damage, etc., that organ damage is, by definition, sepsis. In order to make the biggest impact from a treatment perspective, the medical community should be extremely thoughtful as we continue to learn more about both conditions. 

Q: As a practicing physician with a background in critical care, based on what we know about sepsis today, what peaks your interest most? Where do you think science needs to delve deeper? 

Dr. Hansell: Intravenous (IV) fluid therapy is a cornerstone of sepsis treatment and has been for a long time – just as it is a standard component of care for most patients in the hospital. As a member of the medical and scientific community, I've always known that we could do better with fluid management but never had the right tools to work with... until now. Today, we finally have the tools that we've been looking for my entire career to help gauge the effectiveness of fluid, and we're seeing the ability to make an impactful change. We're also seeing more and more research on the kinds of fluid used in different clinical settings, and the difference that makes for patients. I think this is an area with great potential to help improve outcomes for sepsis patients, and I'm proud that we're exploring this at Baxter. It's very exciting and motivating to potentially make a big impact in a massive disease that affects so many people.

Q: You were an investigator in a recently-published randomized clinical trial, the Fluid Response Evaluation in Sepsis Hypotension and Shock (FRESH) study. What did the study find, and why do you think the results are significant? 

Dr. Hansell: As I mentioned, standard practice for treating patients with sepsis has revolved around IV fluid therapy, but there's traditionally been little evaluation on how much fluid is given, when it's administered, to which kind of patients, etc. In a nutshell, the FRESH study looked at how patients with septic shock were impacted when their clinician performed a dynamic assessment of responsiveness to fluid before administering any, and the study demonstrated benefits of doing so. This was the first randomized controlled clinical trial of its kind, and I believe points us in a direction of making sepsis treatments more effective.

Q: What do you hope the healthcare community accomplishes as it relates to sepsis in the next 5 years?

Dr. Hansell: I hope we can continue to get better at recognizing and treating sepsis earlier. I also hope that as we at Baxter continue to learn more about fluid-based physiology, that we’re able to broadly communicate findings to the healthcare community and help with adoption worldwide. 

ⁱ https://www.global-sepsis-alliance.org/sepsis 
ⁱⁱ https://www.cdc.gov/sepsis/datareports/index.html