Advances in Sepsis Management

Abstract

For the last two decades, sepsis has been the object of growing attention by the clinical community. Since sepsis has been acknowledged as a time-dependent condition, its initial treatment has moved from the intensive care units to the emergency departments and other medical and surgical wards, in the attempt to treat this syndrome as soon as it is recognized. Considerable controversy exists about which treatments influence prognosis the most and how rapidly and intensively they should be administered. Antibiotics, source control, fluids, and vasopressors are the mainstay of therapy; interesting data has been recently published in each of these fields. Observational studies have confirmed that early antibiotic therapy is the treatment more clearly associated with the lowering of mortality in septic patients. Source control is relevant especially in severe abdominal infections, but its time metrics have still to be elucidated. Fluid administration, which should be performed aggressively in the resuscitative stage of patients in shock, should probably be quickly reduced and tailored to the patient as soon as vital parameters improve. Indeed, a prolonged positive fluid balance has repeatedly been associated with higher mortality. Vasopressors have a role only in patients who remain hypotensive after an adequate initial fluid challenge. Although they are not devoid of adverse effects, vasopressors should not be started too late when patients remain in critical conditions. Good evidence favors noradrenaline over dopamine as the drug with better benefit/risk profile in septic shock patients.