Behind the Night, the Surgery Podcast, relevant and engaging content designed to help you dominate the day.

Hello everyone and welcome to Behind the Knife's surgical critical care podcast series.

I'm Brittany Bankett from Texas Tech University in Lubbock, Texas, and I'm here today with Caroline Park and Ryan Dumaw from UT Southwestern in Dallas, Texas.

We are excited to talk to you about sepsis today.

This is especially well timed since an updated surviving sepsis guideline just came out this year.

We'll be going over sepsis, all the newest guidelines, and we'll touch upon some of the major areas to focus on, including antibiotics, vasopressors, and whether or not to be utilizing steroid therapy.

So, Ryan, can you start and provide us with a historical overview of sepsis to get a better idea of where we've come from and how we've ended up at our modern management as it is now?

Sure, thanks, Brittany.

So really, the topic is incredibly important because of the burden of disease.

So sepsis is a bigger killer than cancer worldwide.

One patient dies as sepsis every three seconds.

There's actually a great article in the Lancet that was published last year investigating the global incidence of sepsis, which details this epidemiology.

Fortunately, however, the mortality of sepsis has decreased by more than 50% over the last three decades.

So, how and where did this all get started?

Well, in the early 90s, in 1991, the American College of Chess Physicians, as well as the SCCM, convened a congress in Chicago to emphasize that sepsis was a continuum and an ongoing insult.

They had then defined the systemic inflammatory response syndrome, what we now know as sears.

They defined this continuum of sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome.

Now, of course, we're all very familiar with the shortcomings of the sears definition.

Sears, unfortunately, is very sensitive, but not specific, and really has poor clinical utility in practice.

It can be present in simple, non-complicated infections, and it can be present in response to non-infectious triggers such as trauma or pancreatitis, for example.

So, about a decade later, in 2001, the SCCM and the European Society of Intensive Critical Care Medicine, as well as the American College of Chess Physicians, convened another congress and held a second consensus meeting to update the criteria for sepsis.

This conference continued to attempt to determine the signs and symptoms of sepsis.

...