Current Controversies in Sepsis Management

Abstract

The overarching goals of early sepsis management include early recognition, appropriate antibiotic therapy and source control, maintenance of hemodynamic stability, and supportive care of organ dysfunction. Despite increasing awareness of the global burden of sepsis, and general agreement on the goals of management, there is ongoing controversy regarding the implementation of specific treatment strategies to optimize patient outcomes. This article will address five current points of controversy in the management of sepsis and septic shock. These include optimal timing of antibiotics in patients with potential sepsis, the role of glucocorticoids in septic shock, vitamin C as a novel therapy for sepsis, the ideal intravenous fluid for resuscitation, and the optimal balance of fluid resuscitation and vasopressor administration in septic shock. For each of these topics, we review relevant literature, discuss areas of controversy, and present our current approach to management.

Diagnostic Value of sIL-2R, TNF-α and PCT for Sepsis Infection in Patients With Closed Abdominal Injury Complicated With Severe Multiple Abdominal Injuries

“…What plays an essential role in the treatment of sepsis is the early removal of infected lesions and the use of antibiotics as quickly and accurately as possible (22). Mortality is significantly increased for each hour of delay in antibiotic administration (23,24), and the delay in antibiotic administration was associated with prolonged length of hospital stay, severity of organ dysfunction, and adverse clinical outcomes (25). However, for all patients with suspected sepsis, antibiotics given within 1 h will lead to its unreasonable use and to increased bacterial resistance (26)(27)(28).…”

Diagnostic Value of sIL-2R, TNF-α and PCT for Sepsis Infection in Patients with Closed Abdominal Injury Complicated with Severe Multiple Abdominal Injuries

“…What plays an essential role in the treatment of sepsis is the early removal of infected lesions and the use of antibiotics as quickly and accurately as possible [23]. Mortality was signi cantly increased for each hour of delay in antibiotic administration [24,25], and the delay in antibiotic administration was associated with prolonged length of hospital stay, severity of organ dysfunction and adverse clinical outcomes [26]. However, for all patients with suspected sepsis, antibiotics given within one hour will lead to unreasonable use of antibiotics and increase of bacterial resistance [27][28][29].…”

The effect of continuous intravenous norepinephrine infusion on systemic hemodynamics in a telemetrically-monitored mouse model of sepsis

“…All mice were monitored at 6, 18, and 24 hours, and from 24-72 hours, at least every 4 hours during the day and at least every 6 hours at night, and then every 8 hours until 7 days, when the study was concluded. Mice were given a euthanasia score based on their respiratory pattern (depressed respiratory rate: 2, or apneustic respiration: 5), activity (spontaneous activity without stimulus: 0, activity in response to tactile stimuli: 1, delayed activity in response to tactile stimuli: 2, or unresponsive to tactile stimuli: 5) and general appearance (piloerection: 1, lack of eye grooming: 1) Animals with a score > 5 are humanely euthanized (8). Clinical activity score was scored separately, from 0 (no activity after stimuli) to 6 (active as normal) according to mice activity [18] based on a more extensive scoring system [19].…”

“…Hypotension is a critical harbinger of sepsic shock. Although administration of vasopressors to treat hypotension is standard of care and included in clinical guidelines [3], the benefits of vasopressors are not universally accepted [5][6][7][8]. Thus, decision-making criteria for individual patient are highly individualized, and pressor use varies greatly in practice [5].…”