Improving Diagnosis of Sepsis After Burn Injury Using a Portable Sepsis Alert System.

摘要

Background: Sepsis is the leading cause of death after significant burn injury. Severely burned patients (TBSA less than 20%) have sepsis rates less than 40%. Early initiation of antibiotics within 1 hour of recognition of sepsis is the only factor associated with better survival. Diagnosis of sepsis after burn injury is not amenable to standard sepsis criteria. To address this problem, the American Burn Association developed specific criteria to prompt sepsis workup. Despite these guidelines, these findings can be subtle leading to delays in recognition of sepsis. Hypothesis: Best practice guidelines using "new vital signs" of heart rate variability, regional tissue oxygenation, and noninvasive cardiac output can diagnose burn sepsis earlier, reducing morbidity and mortality. Rationale: Heart Rate Variability (HRV), regional Tissue Oxygenation, and non-invasive Cardiac Output (CO), have shown promise in detecting sepsis in other patient populations. These modalities have not been evaluated for sepsis detection after burn injury. Specific Aims/Study Design: 1. Prospectively collect traditional and"new vital signs"and compare the diagnostic accuracy, time to diagnosis, and prediction of outcome. 2. Develop a best practice guideline for the early diagnosis and treatment of sepsis in the burn patient, integrating current and new vital signs, and incorporating these into a bedside decision-support tool. 3. Design and conduct a prospective, multicenter, randomized study to test the efficacy of the newly developed bedside tool in detecting sepsis. Relevance: The use of "new vital signs" will provide an improved assessment of burn sepsis, enabling earlier detection of sepsis. The results of the study may change the standard of burn care if it is found that "new non-invasive vital signs" can detect sepsis earlier, leading to earlier initiation of antibiotics and improved morbidity and mortality.