The management of sepsis
Sepsis is a disease continuum that ranges from simple infections to severe sepsis with Multiple Organ Dysfunction Syndrome (MODS.) Patients at the more severe end of the sepsis continuum require a significant input from critical care resources and the development of MODS has a major impact on length of stay (intensive care and hospital) and patients' level of function in the long-term if they survive their illness. Sepsis carries a mortality rate of 30%. Good immediate management therefore has the potential to influence long-term resources. Regardless of aetiology the basic management remains constant with severity determining the degree of intervention. The basics are assessment and goal-directed resuscitation, diagnosis, investigation, appropriate antimicrobial therapy, source control and ongoing supportive care including invasive ventilation, cardiovascular support with vasoactive medications and renal replacement therapies. The search for specific therapies has focused on the inflammatory cascade, endocrine dysfunction and the microcirculation. The influence of genetic markers on survival may also be significant. With such information in mind the Surviving Sepsis Campaign was launched in October 2002. It aims to reduce the relative mortality from sepsis to 25% over 5 years through evidence based guidelines, clinical and educational support.