Transcription:

Melanie Cole (Host): Sepsis is a complication caused by the body’s overwhelming and life-threatening response to an infection which can lead to tissue damage, organ failure, and even death. My guest today is Dr. Robert Alexander Brevetta. He’s a Pulmonary Critical Care Medicine Physician at Greenville Health System. Welcome to the show, Dr. Brevetta. Tell the listeners, what is sepsis?

Dr. Robert Alexander Brevetta (Guest): Well, sepsis, as you’ve explained in the introduction, is your body’s overwhelming response to an infection. It can be an infection in any organ system -- it can be in the lungs, it can be in the bladder, but basically it’s how the body – occasionally, depending who you are – inappropriately responds to that infection. You can think about it as just as you get loose when you would have the flu, you get fatigued, you feel down, you feel loose – when your body experiences sepsis, it releases certain chemicals, and your organs and your vessels can become loose and leaky, thus leading to some organ dysfunction and low blood pressure and a vicious cycle if not dealt with early on.

Melanie: What causes it, and are certain people with an infection more likely to get sepsis?

Dr. Brevetta: It’s an interesting, what causes it? There’s a lot of studies out now – it appears that certain people just have the immune system that’s genetically predisposed to sepsis. What causes it and brings people to the hospital is an infection. When you get that infection, if you’re prone to sepsis, your body releases certain – what we call cytokines, or signaling molecules, or chemicals – and it produces too much of them. As the body responds, as I’ve said, the vessels get loose, and the blood pressure goes down, and you can have end organ dysfunction.

It turns out if you look at everyone that’s getting sepsis, the more comorbidities that you have – if you’re a completely healthy person , you don’t take a lot of medications, you don’t have a lot of organ dysfunction at baseline, you’re probably at less risk for sepsis. If you have, let’s say heart failure, or COPD, or lung disease, or diabetes, and a lot of other comorbidities, you’re likely at a higher risk to develop sepsis or a more severe type of sepsis.

Melanie: So this can happen with any kind of infection, correct? So what do you want people to look for, Dr. Bravetta, if they do get an infection -- whether it’s a cut, or they’ve got pneumonia or one of those kinds of things -- what is it you want them to be aware of?

Dr. Brevetta: Sure, I would be aware for anything that – besides the infection itself, if you’re not progressing, if you’re not getting better, if you start to notice, let’s say dizziness, or a family member notices that you’re not thinking clearly, that your mental status has changed, certainly if you notice a blood pressure that’s low – if you’re at a physician’s office, and your blood pressure is lower than what your normal blood pressure would be, and if you’re starting to feel loose, and down, and dizzy, and very weak, that is the time when even if it’s just a small infection – someone told you-you had a cut or a urinary tract infection, that’s the time to potentially call your physician immediately or present to an Emergency Department immediately.

Melanie: So would you recommend that if someone gets some of these symptoms or if they get shivering, or fevers, or any of these things, that they all 9-1-1, or they get themselves – because can the EMS start any sort of treatment if they suspect it’s sepsis?

Dr. Brevetta: The first thing I would do if you’re initially experiencing these – it’s pretty severe symptoms if you’re starting to have fever, chills, rigors, you really don’t feel well, you’re maybe not thinking clearly -- I would try to get ahold of your primary physician immediately who would likely tell you to call EMS. In today’s day-in-age, if you were to call EMS – and I would say if you can’t get ahold of your primary care physician, call EMS because, in this day-in-age, physicians and EMS can get fluids started, can get the type of resuscitative treatment, including antibiotics, started, more quickly than if you decided to just go to the Emergency Department yourself. And it may not be safe for you if you don’t have someone to take you to the Emergency Department, for you to drive or to get yourself to the Emergency Department.

Melanie: And how is it diagnosed, and what happens in the Emergency Room if somebody comes in that you suspect has sepsis?

Dr. Brevetta: What happens right away is the diagnosis might not be concretely made – we’re looking for signs in your hemodynamics as in your blood pressure, your respiratory rate, your temperature and some of your initial labs. We’re looking for an indication of sepsis because the mortality for the people who can end up dying with sepsis is high enough and severe enough that you need to have antibiotics very soon, within an hour of presentation with sepsis and the earlier, the better. You likely will need -- if your blood pressure is low, you’ll need immediate fluid resuscitation to restore you to a normal so that you don’t end up with these organ dysfunctions because your blood pressure was too low, so there’s certain things that can be done right off the bat. Then the doctors will search for that indication of where the infection is, whether it be the lungs or anywhere else. That’s secondary to immediately treating it with big, broad spectrum antibiotics that will cover everything and then the job of the physician is to titrate down those medications once you are stabilized.

Melanie: Are there any long-term effects of sepsis?

Dr. Brevetta: It could be – if you have a severe sepsis and depending what kind of medications you have and what kind of end organ failure you have. If you were to have respiratory failure, or you were on a ventilator, or lung inflammation secondary to sepsis, people can be debilitated afterward. They can be on oxygen, they can have tracheostomies, and you can deal with end-stage, or significant kidney disease after – or any other organs. It’s very important to catch it early to present early, to let a physician know early so that we can try to mitigate the end-organ dysfunction and mitigate the debility that someone will have after they’re discharged from the hospital.

Melanie: And is there anything that people can do to prevent sepsis and Dr. Bravetta, wrap it up for us, with your best advice about prevention and recognizing these emergent signs?

Dr. Brevetta: Sure, and the best thing you can do is keep up with your doctor’s appointments, healthy diet, exercise, try to keep yourself at a decent, healthy weight. Try to keep yourself out and moving around and if you have anything like diabetes, or lung disease, or heart disease, make sure you’re following your doctor’s instructions, taking your medications, and following up with those appointments. The best thing you can do is to be as healthy as you possibly can be to give your immune system a chance, so you’re not a set up for a type of severe sepsis.

Melanie: And what does the future hold for sepsis at Greenville Health System?

Dr. Brevetta: Well, we’re trying to adhere to the cutting edge data that’s coming out now, and a lot of that has to do with how we resuscitate people, the best way to give people the most optimum amount of fluid resuscitation, the optimum antibiotics, how to recognize it earlier and earlier and how to treat it very early in the beginning with the appropriate type of medications – not too much, not too little, so that someone doesn’t deal with the debility that we’re talking about afterwards. We’re doing a good job comparing to the best literature and the best data that’s being produced in the country right now.

Melanie: Thank you, so much, for being with us today, Dr. Brevetta. That’s very important information for listeners to hear. You’re listening to Inside Health with Greenville Health System, and for more information, you can go to GHS.org, that’s GHS.org. This is Melanie Cole. Thanks, so much, for listening.