Management of Sepsis

Abstract

Sepsis is a life-threatening organ dysfunction due to dysregulated response infection. Septic shock occurs when underlying circulatory, metabolic, and cellular abnormalities occur with refractory hypotension despite sufficient intravenous (IV) fluid resuscitation and vasopressor requirement to maintain mean arterial pressure (MAP) >65 mmHg. When approaching a patient with sepsis or septic shock, establish IV access and start fluid resuscitation, obtain cultures, and then start empiric broad-spectrum intravenous antibiotics as soon as possible. While monitoring these patients, trend labs including lactate and ScVO₂, and frequently reassess fluid responsiveness while providing fluid resuscitation. Patients requiring surgical exploration or intervention for emergent source control should be identified with management as soon as medically possible after diagnosis. The major tenets of managing patients with sepsis include fluid resuscitation for sepsis-induced hypoperfusion and elevated lactate, vasopressors for refractory hypotension, antimicrobial therapy and source control, supplemental oxygen or lung protective mechanical ventilation for sepsis-induced acute respiratory distress syndrome (ARDS), and other supportive therapies.