Update in sepsis guidelines: what is really new?

Abstract

Sepsis remains a highly lethal entity resulting in more than 200 000 deaths in the USA each year. The in-hospital mortality approaches 30% despite advances in critical care during the last several decades. The direct health care costs in the USA exceed $24 billion dollars annually and continue to escalate each year especially as the population ages. The Surviving Sepsis Campaign published their initial clinical practice guidelines for the management of severe sepsis and septic shock in 2004. Updated versions were published in 2008, 2012 and most recently in 2016 following the convening of the Third International Consensus Definitions Task Force. This task force was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine to address prior criticisms of the multiple definitions used clinically for sepsis-related illnesses. In the 2016 guidelines, sepsis is redefined by the taskforce as a life-threatening organ dysfunction caused by a dysregulated host response to infection. In addition to using the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score to more rapidly identify patients with sepsis, the task force also proposed a novel scoring system to rapidly screen for patients outside the ICU who are at risk of developing sepsis: the ‘quickSOFA’ (qSOFA) score. To date, the largest reductions in mortality have been associated with early identification of sepsis, initiation of a 3-hour care bundle and rapid administration of broad-spectrum antibiotics. The lack of progress in mortality reduction in sepsis treatment despite extraordinary investment of research resources underscores the variability in patients with sepsis. No single solution is likely to be universally beneficial, and sepsis continues to be an entity that should receive high priority for the development of precision health approaches for treatment.

Luteolin attenuates sepsis‑induced myocardial�injury by enhancing autophagy in mice

“…Sepsis is a condition that is often caused by a dysregulated host response to infection and can lead to life-threatening organ dysfunction (1). despite abundant investigative attention towards advances in intensive care and supportive technology, sepsis remains in the top 10 leading causes of death and is a substantial cause of death among critically ill patients in non-coronary intensive care units (2,3). Sepsis is estimated to affect at least 19 million patients worldwide, reminding scientists and clinicians that it remains a serious global health burden and a major clinical challenge (4)(5)(6).…”

Update on diagnosis and management of sepsis in cirrhosis: Current advances

“…In patients with dysregulated immune functions, such as those with cirrhosis, this initial phase goes unchecked, progressing to sepsis - induced immunosuppression and a stage of immune-paralysis with subsequent organ failure development. In the following sections of this review, we aim to discuss current and future aspects in the diagnosis and treatment of sepsis and extrapolate recent advances in the management of sepsis concerning critically ill patients with cirrhosis with sepsis[ 4 , 5 ].…”

Synergistic cytoprotection by co-treatment with dexamethasone and rapamycin against proinflammatory cytokine-induced alveolar epithelial cell injury

“…During the course of evaluating the clinical applicability of these agents, we noted that combining the drugs could improve their cytoprotective effects. In the current management for patients with severe sepsis or septic ALI, most of the recommended strategies are just supportive and very few agents possessing direct anti-inflammatory properties have been established as therapeutic drugs [9]. In this study, we evaluated the combination of dexamethasone [10] and rapamycin [11, 12] as clinically applicable candidates with favorable synergistic effects in vitro.…”