Recovering from Sepsis

Sepsis is an extreme immune reaction of the human body toward serious bacterial infection circulating in the bloodstream. It becomes life-threatening or lethal when it manifests in the extreme stages of severe sepsis and septic shock.

The time taken for full recovery from sepsis for each individual differs, and it depends on several factors such as the severity of infection, the overall health condition of the patient, and the type of treatment provided.

Mild Sepsis Recovery

In mild sepsis, complete recovery is possible at a quicker rate. On an average, the recovery period from this condition takes from about three to ten days depending on the response to the appropriate treatment including medication.

Severe Sepsis Recovery

Severe sepsis requires immediate treatment in the critical care area for a period of one month or more. Recovery is achievable, but it takes a longer time. Many individuals are known to have regained normal health after severe sepsis without residual dysfunctions. In severe sepsis, the recovery period duration varies from patient to patient, as it depends on the number of organs impacted by the infection and the extent of organ dysfunction.

Post-Sepsis Syndrome (PSS)

About 50% of severe sepsis survivors experience either short- or long-term cognitive and physical problems, which are collectively termed as post-sepsis syndrome, during their recovery period. The difficulties may include physical (excessive fatigue, weaker muscle strength, bloated limbs, and chest pain), psychological (anxiety, memory loss), and mental (inability to do simple arithmetical calculations) issues.

Recovery from Post-Sepsis Syndrome:

It is necessary to provide rehabilitation facilities to the patient so that they can return to normal life. The duration of recovery from PSS is about two years or more.

Recovery at hospital: Recovery from post-sepsis syndrome is initiated in the hospital by the physiotherapist, who helps the patients to carry out simple everyday activities on their own, such as:

• bathing, getting dressed, and walking
• doing physical exercises, as advised by the physiotherapist, in order to regain muscle strength

Recovery at home: After discharge from hospital, the sepsis survivor needs detailed care at home along with regular reviews with the healthcare provider.

• They need to have complete rest and build up their strength with slowly increasing activities, as they are likely to feel weak and tired.
• A balanced diet is essential. Small meals and supplemental nutrition drinks are suggested for those with a lack of appetite.
• To avoid depression and anxiety, interaction with family and friends is necessary.
• Small targets are fixed to achieve daily tasks.

Septic Shock Recovery

Septic shock is a life-threatening stage of generalized infection, where the chance of patient survival is only about 50%, owing to multiple organ dysfunction associated with low blood pressure. Complete recovery from septic shock would imply the termination of any auxiliary therapies, which is not usually possible. In most cases, a patient with pre-existing chronic disease who survives septic shock is likely to need lifelong supportive treatment because of permanent organ dysfunction.

Rehabilitation for Patients with Amputated Limbs

Amputation of a part of the body, such as one or more fingers or toes, or of a limb, either in part or completely, is sometimes done to increase the rate of survival in patients who develop gangrene during septic shock. Amputation leads to scarring and changes in the structure of normal tissue, which is termed as contractures, as a result of the normal wound healing process. To prevent contracture, the physiotherapist will recommend

• exercises to make the joint muscles mobile
• scar massage once it is healed;
• application of appropriate splints to hold the scar area in a stretched position
• appropriate medication to avoid pain
• in case of amputation of lower limbs, use of prosthetic (artificial) limbs is helpful for the independent movement of young patients, while crutches or wheel chairs may be useful for elders

Rehabilitation of Patients with Kidney Damage

Even after surviving septic shock, some patients require lifelong dialysis due to kidney failure.

• The patient should perform physical activities like walking and moderate exercises
• Perform small tasks with a goal-oriented approach to achieve eventual independence to as large an extent as possible
• Go for dialysis therapy as scheduled by the doctor
• Since dialysis is not a cure, the patients may be registered for renal transplantation to ensure partial or complete recovery

New Findings in Recovery of Sepsis

Patients with late stages of sepsis need more time to recover when there is post-sepsis or sepsis-induced organ dysfunction. More research or studies are needed to find the best way of overcoming these complications.

Neutralization of HMGB1 Protein

A recent report by the Journal of Leukocyte Biology states that if a protein called high mobility group box 1(HMGB1), which is elevated in the late stages of sepsis, is increased or neutralized, white blood cell (neutrophil) dysfunction can be corrected. This promotes the ability of the body to destroy bacteria during the recovery period.

Mesenchymal Stem Cell Therapy

The world’s first trial of stem cell therapy for sepsis was performed in Ottawa. A septic shock patient in Ottawa hospital was administered 30 million mesenchymal cells along with the specific treatment for sepsis, which resulted in complete recovery.

References

• http://www.medindia.net/news/a-new-approach-to-septic-shock-recovery-170575-1.htm
• http://www.nhs.uk/Conditions/Blood-poisoning/Pages/Introduction.aspx
• http://www.australiansepsisnetwork.net.au/community-awareness/life-sepsis
• https://www.cdc.gov/sepsis/pdfs/life-after-sepsis-fact-sheet.pdf
• https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/blood-poisoning-sepsis
• http://sepsistrust.org/public/recovering-from-sepsis/
• https://rorystauntonfoundationforsepsis.org/surviving-sepsis/
• https://www.kingstonhospital.nhs.uk/patients-visitors/sepsis/recovering-from-sepsis.aspx
• http://stemcellfoundation.ca/en/2016/03/31/man-makes-remarkable-recovery-from-septic-shock-after-stem-cell-transplant/