Controversies in Sepsis Management—What is the Way Forward?

Abstract

Sepsis is life-threatening and might potentially progress from dysregulation to severe organ dysfunction. It is recognised by the World Health Organisation as a global health priority. The mortality rate for sepsis has decreased in many countries, and this is credited to the earlier recognition and treatment of this complex syndrome. In 2002, the Surviving Sepsis Campaign was launched, and there have been several revisions to the sepsis recommendations therefrom. The latest sepsis guidelines focus on viral as well as bacterial infections, and advise that initiating resuscitation and management should take place within one hour from when sepsis is initially suspected. Numerous studies and guidelines pertaining to sepsis management have been published over the past 2 decades. The use of novel therapies and alternative adjunctive therapies has tremendous potential in sepsis management. Debates amongst intensivists exist with the creation of updated sepsis guidelines and advances in treatment. The present review article provides both a summary and recommendations based on the latest clinical evidence and controversies around sepsis management. Key words: Critical Care Medicine, Intensive Care Medicine, Respiratory Medicine, Sepsis, Sepsis Bundles, Sepsis Management

Effect of procalcitonin on the severity and prognostic value of elderly patients with a severe infection of oral and maxillofacial space

“…After bacteria or toxins enter the blood circulation, they cause immune-inflammatory mechanism cascading waterfall-like outbreaks, which release a large number of cytokines and inflammatory mediators, resulting in excessive systemic inflammatory response syndrome. [16] Patients with severe sepsis are prone to distant organ insufficiency and inadequate blood perfusion to the visceral tissues because of immune-inflammatory injury, with an extremely high incidence of multiple organ function injury or failure, they need comprehensive and cluster treatment during the initial stage. [17] The timely identification of the severity of the disease and the accurate judgment of the prognosis is beneficial to the timely adjustment and improvement of the treatment plan.…”

Beneficios de la implementación del código sepsis en pacientes con shock séptico en el área hospitalaria

“…Pruebas sanguíneas: Biometría hemática para descartar leucocitosis, perfil de coagulación, toma de muestra arterial y gasometría, bioquímica, biomarcadores (lactato, procalcitonina, proteína C reactiva) (28).…”

Early fluid bolus in adults with sepsis in the emergency department: a systematic review, meta-analysis and narrative synthesis

“…Implementation of these guidelines over the last decades has resulted in an overall 16.7% decrease in mortality [ 7 ]. However, the Surviving Sepsis Guidelines have been revised periodically with ongoing changes to recommended time of initiation and completion of bundles varying from 6-h in 2005 to 1-h in 2018 [ 8 ] with the latest change to 3-h bundles in 2021 [ 5 ]. These changes have provoked debates among clinicians with some resistance to implementing these guidelines [ 8 ].…”

“…However, the Surviving Sepsis Guidelines have been revised periodically with ongoing changes to recommended time of initiation and completion of bundles varying from 6-h in 2005 to 1-h in 2018 [ 8 ] with the latest change to 3-h bundles in 2021 [ 5 ]. These changes have provoked debates among clinicians with some resistance to implementing these guidelines [ 8 ]. Concerns regarding fluid volume overload associated with injudicious use of intravenous fluids [ 9 ] have also resulted in some advocating for a conservative approach to fluid resuscitation [ 10 ]while others show benefit from early administration of fluid bolus [ 11 ].…”