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Management of Sepsis and Septic Shock

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Evidence-Based Critical Care

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Abstract

Despite advances in modern medicine, sepsis and septic shock continue to be a leading cause of death worldwide. The United States alone has over 750,000 reported cases per year. It is estimated that severe sepsis is diagnosed in 2% of all hospital admissions resulting in 10% of all ICU admissions. The diagnosis and management of sepsis have greatly evolved with the creation of care “bundles” such as Early Goal Directed Therapy incorporated into the Surviving Sepsis Campaign. Research results continue to refine the proposed guidelines in the treatment of this disease.

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References

  1. Surviving Sepsis Campaign. Society of Critical Care Medicine. [Revised 4/2015 by the SSC Executive Committee]. http://www.survivingsepsis.org/Bundles/Pages/default.aspx.

  2. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med. 2004;30(4):536–55.

    PubMed  Google Scholar 

  3. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.

    CAS  PubMed  Google Scholar 

  4. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165–228.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. http://www.survivingsepsis.org/Bundles/Pages/default.aspx

  6. Finfer S, Bellomo R, Boyce N, et al. SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350(22):2247–56.

    CAS  PubMed  Google Scholar 

  7. Caironi P, Togoni G, Masson S, et al. ALBIOS Study Investigators. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014;370(15):1412–21.

    CAS  PubMed  Google Scholar 

  8. Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013;369(13):1243–51.

    CAS  PubMed  Google Scholar 

  9. Yunos NM, Bellomo R, Hegarty C, et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012;308:1566–72.

    CAS  PubMed  Google Scholar 

  10. Young P, Bailey M, Beasley R, et al. Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: the SPLIT randomized clinical trial. JAMA. 2015;314:1701–10.

    CAS  PubMed  Google Scholar 

  11. Semler MW, Self WH, Rice TW, et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med. 2018;378(20):1951. https://doi.org/10.1056/NEJMc1804294.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Self WH, Semler MW, Wanderer JP, et al. Balanced crystalloids versus saline in noncritically ill adults. N Engl J Med. 2018;378(9):819–28. https://doi.org/10.1056/NEJMoa1711586. Epub 2018 Feb 27

    Article  PubMed  PubMed Central  Google Scholar 

  13. Myburgh JA, Finfer S, Bellomo R, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012;367(20):1901–11.

    CAS  PubMed  Google Scholar 

  14. Holst LB, Haase N, Wetterslev J, et al. Transfusion requirements in septic shock (TRISS) trial – comparing the effects and safety of liberal versus restrictive red blood cell transfusion in septic shock patients in the ICU: protocol for a randomized controlled trial. Trials. 2013;14:150.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Park DW, Chun BC, Kwon SS, et al. Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock: a propensity-matched analysis. Crit Care Med. 2012;40(12):3140–5.

    PubMed  Google Scholar 

  16. Ebert RV, Stead EA. Circulatory failure in acute infections. J Clin Invest. 1941;20:671–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Ait-Oufella H, Lemionne S, Boelle P, et al. Mottling score predicts survival in septic shock. Intensive Care Med. 2011;37(5):801–7.

    CAS  PubMed  Google Scholar 

  18. Cawcutt K, Peters S. Severe sepsis and septic shock: clinical overview and update on management. Mayo Clin Proc. 2014;89(11):1572–8.

    PubMed  Google Scholar 

  19. Monnet X, Rienzo M, Osman D, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006;34:1402–7.

    PubMed  Google Scholar 

  20. Marik P, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642–7.

    PubMed  Google Scholar 

  21. Michard F, Warltier DC. Changes in arterial pressure during mechanical ventilation. Anesthesiology. 2005;103(2):419–28.

    PubMed  Google Scholar 

  22. Stawicki SP, Ej A, Eiferman ES, et al. Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure? J Trauma Acute Care Surg. 2014;76(4):956–64.

    PubMed  Google Scholar 

  23. Seymour C, Rosengart M. Septic shock: advances in diagnosis and treatment. JAMA. 2015;314(7):708–17.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739–46.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779–89.

    PubMed  Google Scholar 

  26. Investigators VASST. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358(9):877–87.

    Google Scholar 

  27. Khanna A, English SW, Wang XS, et al. Angiotensin II for the treatment of vasodilatory shock. N Engl J Med. 2017;377(5):419–30. https://doi.org/10.1056/NEJMoa1704154.

    Article  CAS  PubMed  Google Scholar 

  28. Schein M, Marshall J. Source control. A guide to the management of surgical infections. Heidelberg: Springer; 2002.

    Google Scholar 

  29. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–96.

    PubMed  Google Scholar 

  30. Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence. 2014;5(1):4–11.

    PubMed  Google Scholar 

  31. Gamacho-Montero J, Gutierrez-Pizarraya A, Escoresca-Ortega A, et al. De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock. Intensive Care Med. 2014;40(1):32–40.

    Google Scholar 

  32. Kollef MH. What can be expected from antimicrobial de-escalation in the critically ill? Intensive Care Med. 2014;40(1):92–5.

    PubMed  Google Scholar 

  33. Ginde AA, Moss M. Lung-protective ventilation in emergency department patients with severe sepsis. Acad Emerg Med. 2014;21(1):96–7.

    PubMed  Google Scholar 

  34. Russell JA. Management of sepsis. N Engl J Med. 2006;355(16):1699–713.

    CAS  PubMed  Google Scholar 

  35. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;354(19):1359–67.

    Google Scholar 

  36. Study Investigators NICE-SUGAR, Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.

    Google Scholar 

  37. Arabi YM, Tamim HM, Dhar GS, et al. Permissive underfeeding and intensive insulin therapy in critically ill patients: a randomized controlled trial. Am J Clin Nutr. 2011;93(3):569–77.

    CAS  PubMed  Google Scholar 

  38. Investigators PCESS, Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370(18):1683–93.

    Google Scholar 

  39. ARISE Investigators, ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371(16):1496–506.

    Google Scholar 

  40. ProMISe Investigators, Mouncey P, Osborn T, Power S, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372:1301–11.

    Google Scholar 

  41. Angus DC, Barnato AE, Bell D, et al. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators. Intensive Care Med. 2015;41(9):1549–60.

    CAS  PubMed  Google Scholar 

  42. Kaukonen KM, Bailey M, Suzuki S, et al. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311(13):1308–16.

    CAS  PubMed  Google Scholar 

  43. Dellinger RP, Levy MM, Rhodes A, Annane D, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637.

    PubMed  Google Scholar 

  44. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369(9):840–51.

    CAS  PubMed  Google Scholar 

  45. Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288(7):862–71.

    CAS  PubMed  Google Scholar 

  46. Moreno R, Sprung C, Annane D, et al. Time course of organ failure in patients with septic shock treated with hydrocortisone: results of the Corticus study. In: Applied physiology in intensive care medicine, vol. 1. Heidelberg: Springer; 2012. p. 423–30.

    Google Scholar 

  47. Venkatesh B, Finfer S, Cohen J, et al. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med. 2018;378(9):797–808. https://doi.org/10.1056/NEJMoa1705835.

    Article  CAS  PubMed  Google Scholar 

  48. Annane D, Renault A, Brun-Buisson C. Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med. 2018;378(9):809–18. https://doi.org/10.1056/NEJMoa1705716.

    Article  CAS  PubMed  Google Scholar 

  49. Kaukonen KM, Bailey M, Pilcher D, et al. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372:1629–38.

    CAS  PubMed  Google Scholar 

  50. Investigators SEPSISPAM. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014;370:1583–93.

    Google Scholar 

  51. Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34:344–53.

    PubMed  Google Scholar 

  52. Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564–75.

    CAS  PubMed  Google Scholar 

  53. Boyd J, Forbes J, Nakada T, et al. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39:259–65.

    PubMed  Google Scholar 

  54. Hospital Quality Initiative, Outcome Measures. Centers for Medicare and Medicaid Services. [Last Modified: 09/29/2015]. https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/hospitalqualityinits/outcomemeasures.html.

  55. Cooper J, Walley K, Wiggs B, et al. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. Ann Intern Med. 1990;112:492–8.

    CAS  PubMed  Google Scholar 

  56. Jaber S, Paugam C, Furier E, et al. Sodium bicarbonate for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomized controlled, phase 3 trial. Lancet. 2018;392:31–40.

    CAS  PubMed  Google Scholar 

  57. Morelli A, Ertmer C, Westphal M, et al. Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock. JAMA. 2013;310:1683–91.

    PubMed  Google Scholar 

  58. Marik PE, Khangoora V, Rivera R, et al. Hydrocortisone, vitamin C, and thiamine for the treatment of severe Sepsis and septic shock: a retrospective before-after Study. Chest. 2017;151(6):1229–38. https://doi.org/10.1016/j.chest.2016.11.036.

    Article  PubMed  Google Scholar 

  59. Iwashyna TJ, Ely EW, Smith DM, et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304(16):1787–94.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Regazzoni CJ, Zamora RJ, Petrucci E, et al. Hospital and 1-year outcomes of septic syndromes in older people: a cohort study. J Gerontol A Biol Sci Med Sci. 2008;63(2):210–2.

    PubMed  Google Scholar 

  61. Balas MC, Vasilevskis EE, Olsen KM, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024–36.

    PubMed  PubMed Central  Google Scholar 

  62. Barr J, Fraser G, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Critical Care Medicine Unit, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA

    Rommel Sagana & Robert C. Hyzy

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  1. Rommel Sagana
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  2. Robert C. Hyzy
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Correspondence to Rommel Sagana .

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Editors and Affiliations

  1. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Robert C. Hyzy

  2. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Jakob McSparron

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Sagana, R., Hyzy, R.C. (2020). Management of Sepsis and Septic Shock. In: Hyzy, R.C., McSparron, J. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-26710-0_60

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  • DOI: https://doi.org/10.1007/978-3-030-26710-0_60

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