Post-Sepsis Care

1/1/20 8:00 AM

While sepsis survival rates have improved over the years, sepsis guidelines regarding post-hospital care or recovery remain bare, neglecting the physical, mental, and cognitive impairments suffered by many sepsis survivors.  

Globally, more than 19 million individuals develop sepsis each year, and approximately 14 million survive and are discharged from the hospital.  According to one review by Prescott & colleagues, of the 14 million survivors only half recover, one-third will die during the following year, and one-sixth will have severe persistent impairments. These impairments may cause chronic pain and limit daily functions such as the ability to bathe or dress independently in addition to mental health issues such as decreased cognitive functioning, anxiety, depression, and/or post-traumatic stress disorder. 

The Sepsis Alliance refers to these physical and/or psychological long-term effects as post-sepsis syndrome (PSS), a condition that affects up to 50% of sepsis survivors. The risk of PSS increases for lengthier hospital stays and for those admitted to an intensive care unit (ICU), and while PSS can affect people of all ages, the older population are at a higher risk of developing long-term cognitive and physical impairments.  The cause of PSS may be obvious for some. Amputations due to blood clots and poor blood circulation while patients were hospitalized and long term effects due to organ damage can be clearly explained. However, other impairments, such as chronic fatigue and pain, memory loss, or hair loss, are not quite as clear cut.

PSS demonstrates that sepsis care does not end once a patient is discharged.  While there is currently a lack of clinical trial evidence on specific post-discharge rehabilitation treatments, an observational study involving 30,000 sepsis survivors found that referral to rehabilitation within 90 days was associated with a lower risk of 10-year mortality. Since physical therapy can help improve a patient’s strength and stamina, it can help alleviate some of the physical impairments associated with PSS, enabling survivors to continue daily functions independently.  Cognitive impairments and mental health issues should also be addressed and receive appropriate treatment. 

Overall, as recommended by Prescott and colleagues, “In the months after hospital discharge for sepsis, management should focus on (1) identifying new physical, mental, and cognitive problems and referring for appropriate treatment, (2) reviewing and adjusting long-term medications, and (3) evaluating for treatable conditions that commonly result in hospitalization, such as infection, heart failure, renal failure, and aspiration.”

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