Abstract

Sepsis remains a leading cause of death in the intensive care unit. With no specific sepsis therapies available, management currently relies on infection control and hemodynamic stabilization. Rapid diagnosis enabling early initiation of appropriate therapy is essential to maximize survival rates. Effective antimicrobial therapy should be started as soon as possible after diagnosis, with empirical choices based on likely pathogens, local microbiological patterns, and any recent antimicrobial therapy. At the same time, fluids and vasopressor agents should be commenced to restore and maintain hemodynamic stability and adequate tissue perfusion. No effective immunomodulatory therapies are available, but some candidates are undergoing clinical trials. Better techniques for characterization of the degree of sepsis response in individual patients are needed to help target such agents more appropriately as some patients may benefit from immunosuppressive agents while others may require an immune stimulating intervention. The management of patients with septic shock is often complex and the development of sepsis teams should be encouraged so that the multiple components of treatment, e.g., insertion of intravascular lines, blood sampling for culture and biochemistry, positioning of required monitoring devices, fluid, antibiotic and vasoactive drug administration, etc, can be carried out simultaneously.

Key words: infection, fluid resuscitation, immunomodulation, organ dysfunction, sepsis team, vasopressors

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