Treatment of severe sepsis
Dashiell Gantner2012, Anaesthesia & Intensive Care Medicine
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Abstract
Severe sepsis is a heterogeneous condition affecting multiple organ systems, and is commonly encountered in the hospital setting due to both community and nosocomial infections. The incidence of severe sepsis has increased over the past decades, and mortality remains alarmingly high. Management of the septic patient involves rapid evaluation and prompt initiation of both supportive and specific therapies. Such patients commonly require admission to the intensive care unit (ICU) for invasive monitoring and haemodynamic support. Resuscitation, early initiation of broad-spectrum antimicrobial therapy and source control remain the cornerstones of therapy. Controversy persists about the roles and benefits of early goal-directed therapy (EGDT), corticosteroids and the advantage of albumin over saline as resuscitation fluid. This review summarizes the contemporary evidence regarding diagnostic and treatment strategies of severe sepsis, with emphasis on patients in critical care settings.
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Key takeaways
- Early, aggressive management of the patient with severe sepsis reduces mortality and organ dysfunction.
- In the case of suspected H1N1 influenza causing severe sepsis, antiviral therapy is generally commenced empirically while awaiting diagnostic results.
- Several laboratory tests have been investigated for specificity in identifying bacterial sepsis:
- Despite this, several large randomized trials have failed to find consistent survival benefit of exogenous glucocorticoids in sepsis.
- The multicentre PROWESS (Protein C Worldwide Evaluation in Severe Sepsis) study found rhAPC lead to a 6.1% absolute reduction in 28-day all-cause mortality (24.7% vs 30.8%) in a heterogeneous group of adult patients with severe sepsis.
