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Sepsis - What's new in 2019?

Nunnally, Mark E.; Patel, Arpit

Current Opinion in Anesthesiology: April 2019 - Volume 32 - Issue 2 - p 163–168
doi: 10.1097/ACO.0000000000000707
INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski
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Purpose of review Sepsis-3 guidelines have implications in a deeper understanding of the biopathology of the disease. Further, the review focuses on timely topics and new literature on fluid resuscitation, the value of steroids in sepsis, and new therapeutic options such as angiotensin II, vitamin C, and thiamine as well as the emerging role of procalcitonin (PCT) in managing antibiotics.

Recent findings Traditional therapies such as type of crystalloid fluid administration and steroid therapy for sepsis are currently under re-evaluation. Angiotensin II is investigated for reversing vasodilatory shock. The role of capillary endothelium leak and cellular metabolism can be affected by vitamin C and thiamine levels. Biomarker level trends, specifically PCT, can aid clinical suspicion of infection.

Summary Sepsis-3 shifts the focus from a noninfectious inflammatory process and an emphasis on a dysregulated host response to infection. Hyperchloremic crystalloid resuscitation is associated with poor clinical outcomes. Steroid administration can reverse shock physiology; however, mortality benefits remain uncertain. Angiotensin II, vitamin C, and thiamine are novel treatment options that need further validation. PCT assays can help discern between infectious and noninfectious inflammation.

Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, NYU Langone Medical Center, New York, New York, USA

Correspondence to Mark E. Nunnally, MD, Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, NYU Langone Medical Center, 550 1st Ave, New York, NY 10016, USA. Tel: +1 (212) 263 5072; e-mail: Mark.Nunnally@nyulangone.org

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