Article Data

  • Views 2001
  • Dowloads 196

Review

Open Access

Current management of sepsis and septic shock

  • JEAN-LOUIS VINCENT1

1Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium

DOI: 10.22514/SV112.062016.1 Vol.11,Issue S2,June 2016 pp.14-16

Published: 14 June 2016

*Corresponding Author(s): JEAN-LOUIS VINCENT E-mail: jlvincent@intensive.org

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 diag-nosis enabling early initiation of appropri-ate therapy is essential to maximize sur-vival rates. Effective antimicrobial therapy should be started as soon as possible after diagnosis, with empirical choices based on likely pathogens, local microbiologi-cal patterns, and any recent antimicrobial therapy. At the same time, fluids and va-sopressor agents should be commenced to restore and maintain hemodynamic stability and adequate tissue perfusion. No effective immunomodulatory therapies are available, but some candidates are un-dergoing clinical trials. Better techniques for characterization of the degree of sepsis response in individual patients are needed to help target such agents more appropri-ately as some patients may benefit from immunosuppressive agents while others may require an immune stimulating in-tervention. The management of patients with septic shock is often complex and the development of sepsis teams should be encouraged so that the multiple compo-nents of treatment, e.g., insertion of intra-vascular lines, blood sampling for culture and biochemistry, positioning of required monitoring devices, fluid, antibiotic and vasoactive drug administration, etc, can be carried out simultaneously.  

Keywords

infection, fluid resuscitation, immunomodulation, organ dysfunction, sepsis team, vasopressors

Cite and Share

JEAN-LOUIS VINCENT. Current management of sepsis and septic shock. Signa Vitae. 2016. 11(S2);14-16.

References

1. Singer M, Deutschman CS, Seymour CW et al: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315:801-810

2. Vincent JL, Marshall JC, Namendys-Silva SA et al: Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit. Lancet Respir Med 2014; 2:380-386

3. Rivers E, Nguyen B, Havstad S et al: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345:1368-1377

4. Gaieski DF, Mikkelsen ME, Band RA et al: Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med 2010; 38:1045-1053

5. Vincent JL: The clinical challenge of sepsis identification and monitoring. PLoS Med 2016; 13: e1002022

6. Vincent JL, Rello J, Marshall J et al: International study of the prevalence and outcomes of infection in intensive care units. J A M A 2009; 302:2323-2329

7. Heenen S, Jacobs F, Vincent JL: Antibiotic strategies in severe nosocomial sepsis: why do we not de-escalate more often? Crit Care Med 2012; 40:1404-1409

8. Dellinger RP, Levy MM, Rhodes A et al: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013; 39:165-228

9. Vincent JL, Bassetti M, François B et al: Advances in antibiotic therapy in the critically ill. Crit Care 2016; 20:133

10. de Jong E, van Oers JA, Beishuizen A et al: Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treat-ment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis 2016; in press

11. Vincent JL, De Backer D: Circulatory shock. N Engl J Med 2014; 370:583

12. Vincent JL, Weil MH: Fluid challenge revisited. Crit Care Med 2006; 34:1333-1337

13. Vincent JL: “Let’s give some fluid and see what happens” versus the “mini-fluid challenge”. Anesthesiology 2011; 115:455-456

14. Vincent JL, Rhodes A, Perel A et al: Clinical review: Update on hemodynamic monitoring--a consensus of 16. Crit Care 2011; 15:229

15. Acheampong A, Vincent JL: A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care 2015; 19:251

16. Bai X, Yu W, Ji W et al: Early versus delayed administration of norepinephrine in patients with septic shock. Crit Care 2014; 18:532

17. Beck V, Chateau D, Bryson GL et al: Timing of vasopressor initiation and mortality in septic shock: a cohort study. Crit Care 2014; 18:R97

18. De Backer D, Biston P, Devriendt J et al: Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 2010; 362:779-789

19. De Backer D, Aldecoa C, Njimi H et al: Dopamine versus norepinephrine in the treatment of septic shock: A metaanalysis. Crit Care Med 2012; 40:725-730

20. Volbeda M, Wetterslev J, Gluud C et al: Glucocorticosteroids for sepsis: systematic review with meta-analysis and trial sequential analysis. Intensive Care Med 2015; 41:1220-1234

21. Shiramizo SC, Marra AR, Durao MS et al: Decreasing mortality in severe sepsis and septic shock patients by implementing a sepsis bundle in a hospital setting. PLoS One 2011; 6:e26790

22. Vincent JL: Give your patient a fast hug (at least) once a day. Crit Care Med 2005; 33:1225-1229

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top