The Long Tail of Sepsis

September 9, 2015 by CDC's Safe Healthcare Blog

Hallie C. Prescott, MD, MSc

Guest Author: Hallie C. Prescott, MD, MSc
Pulmonary and Critical Care
University of Michigan
Ann Arbor VA Hospital

I am an intensive care unit (ICU) doctor. Ever since I began medical training, I was drawn to the ICU. I love the challenge of caring for the sickest patients. I love being part of a large team of physicians, nurses, and therapists all working together to provide the highest level of care to critically ill patients. And, I love getting to know families during this stressful time, and being able to help them through this.

When I meet with families of sepsis patients, I talk about how their loved one is doing and answer their questions. Is she getting better or worse? Will she survive the hospital stay? Often too: What exactly is “sepsis?”

But, beyond answering these common questions, I also feel an obligation to answer a question that most families don’t ask: How will mom be doing in 6 months?

Unfortunately, the answer to this question is not straightforward.

Many patients develop new health problems as a result of surviving sepsis, which are collectively known as “Post-Intensive Care Syndrome” (PICS). The common symptoms of PICS include difficulty concentrating, memory loss, weakness, anxiety, and depression.

While we know many patients develop PICS, knowing what will happen for any individual patient is less clear. Each patient experiences life after sepsis differently. Some have more problems with concentration, while others have more problems with weakness. Unfortunately, we don’t yet have a tool to predict which problems an individual patient will develop.

This conversation leads families to ask me another tough question: What should we do to help mom recover?

We do not yet have good enough answers. In addition to being an ICU doctor, I am also a medical researcher. My research focuses on improving the long-term quality of life of the sepsis survivors. So I know, unfortunately, there are still big gaps in our evidence about how to best promote recovery after sepsis.

While there are big gaps, there are also some things we definitely do know. We know it’s important for patients to stay active as they recover, seek medical attention for new symptoms, and clarify prescriptions that are stopped or started during the hospital stay. It can also be helpful for families to keep a diary of what happens in the hospital so they can fill in the blanks for their loved one if they can’t remember.

Beyond this, there are a growing number of online resources to help patients understand and cope with the long-term consequences of sepsis, including the following:

A description of PICS that can be added to a hospital discharge summary: http://www.med.umich.edu/1libr/CriticalCare/PICs.pdf
A non-profit organization that focuses on raising awareness of sepsis: http://www.sepsis.org/faces/
A non-profit organization that is building a support network for survivors of critical illness and their families: http://www.myicucare.org/thrive/

So I tell families to be aware of possible new symptoms, which may or may not occur over the coming year. I tell them to realize that many clinicians don’t know about PICS, and may need to be educated. I tell them to seek out other survivors who may be able to help. And I promise to continue my research so that, in the future, we’ll be able to give better answers.

September 9, 2015 by CDC's Safe Healthcare Blog