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Current controversies in the support of sepsis

Chawla, Shalinee; DeMuro, Jonas P.

Current Opinion in Critical Care: December 2014 - Volume 20 - Issue 6 - p 681–684
doi: 10.1097/MCC.0000000000000154
SPECIAL COMMENTARY: Edited by Michael S. Niederman

Purpose of review Sepsis has a high morbidity, with a mortality rate of over 50% in the septic shock patient. This review provides a comprehensive summary of the latest Surviving Sepsis Campaign and the recent evidence since its publication. The guidelines reflect literature from the past 5 years to optimize outcomes in patients with severe sepsis and septic shock.

Recent findings The most relevant changes in the latest Surviving Sepsis Campaign include the use of a protocolized resuscitation with specific physiologic targets, preference of crystalloids for volume resuscitation, preferential use of norepinephrine as the initial vasopressor, addition of lactate and its clearance as a marker of tissue hypoperfusion, reduced emphasis on corticosteroids, and removal of activated protein C therapy. Since these latest guidelines, there have been many trials published to address the various measures that are advocated. We review the recent data on fluid resuscitation, targets of resuscitation, vasopressors, and trials of protocolized care versus usual care.

Summary Severe sepsis remains a significant cause of morbidity and mortality in hospitalized patients. The International Surviving Sepsis Guidelines provide a framework for early recognition and treatment of this condition, with the goal of an improved outcome and mortality in severe sepsis. The recent evidence suggests that early identification, adequate volume resuscitation, and assessment of adequate circulation may be the key elements to decrease morbidity from severe sepsis and septic shock.

Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, and Division of Pulmonary Critical Care Medicine, Department of Medicine, Winthrop-University Hospital, Mineola, New York, USA

Correspondence to Shalinee Chawla, MD, Division of Pulmonary Critical Care Medicine, Department of Medicine, Winthrop-University Hospital, Mineola, New York, USA. Tel: +1 516 663 2004; fax: +1 516 663 4888; e-mail: schawla@winthrop.org

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins