Advertisement

Severe Sepsis

  • Suhel Al-Soufi
  • Vineet Nayyar
Chapter

Abstract

  • The cornerstones of sepsis management are prompt haemodynamic optimisation, early and appropriate antibiotic therapy, organ-specific support and adjuvant therapy.

  • Fluid management of septic patients is time sensitive.

  • Mean arterial pressure (MAP) of at least 65 mmHg should be targeted in patients with septic shock.

  • Timely administration of antibiotic therapy, within 1 h of recognition of severe sepsis, is associated with improved outcome in life-threatening infections.

Keywords

Septic Shock Severe Sepsis Mean Arterial Pressure Acute Kidney Injury Septic Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    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;345:1368–77.CrossRefPubMedGoogle Scholar
  2. 2.
    Dellinger P, Levy M, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637.CrossRefPubMedGoogle Scholar
  3. 3.
    The ARISE Investigators, ANZICS Clinical Trials Group. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371:1496–506.CrossRefGoogle Scholar
  4. 4.
    The ProCESS Study Investigators. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370:1683–93.CrossRefGoogle Scholar
  5. 5.
    Annane D, Siami S, Jaber S, et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock. JAMA. 2013;310:1809–17.CrossRefPubMedGoogle Scholar
  6. 6.
    The SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350:2247–56.CrossRefGoogle Scholar
  7. 7.
    Caironi P, Tognoni G, Masson S, ALBIOS Study Investigators, et al. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014;370:1412–21.CrossRefPubMedGoogle Scholar
  8. 8.
    Myburgh J, Finfer S, Bellomo R, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012;367:1901–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Boyd JH, Forbes J, Nakada TA, 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.CrossRefPubMedGoogle Scholar
  10. 10.
    Wiedemann HP, Wheeler AP, Bernard GR, National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564–75.CrossRefPubMedGoogle Scholar
  11. 11.
    Asfar P, Meziani F, Hamel JF, et al. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014;370:1583–93.CrossRefPubMedGoogle Scholar
  12. 12.
    Myburgh JA, Higgins A, Jovanovska A, CAT Study investigators, et al. A comparison of epinephrine and norepinephrine in critically ill patients. Intensive Care Med. 2008;34:2226–34.CrossRefPubMedGoogle Scholar
  13. 13.
    Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358:877–87.CrossRefPubMedGoogle Scholar
  14. 14.
    Polito A, Parisini E, Ricci Z, et al. Vasopressin for treatment of vasodilatory shock: an ESICM systematic review and meta-analysis. Intensive Care Med. 2012;38:9–19.CrossRefPubMedGoogle Scholar
  15. 15.
    Holst LB, Haase N, Wetterslev J, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med. 2014;371:1381–91.CrossRefPubMedGoogle Scholar
  16. 16.
    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;34:1589–96.CrossRefPubMedGoogle Scholar
  17. 17.
    Ferrer R, Martin-Loeches I, Phillips G. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med. 2014;42:1749–55.CrossRefPubMedGoogle Scholar
  18. 18.
    The ARDS Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.CrossRefGoogle Scholar
  19. 19.
    Palevsky PM, Zhang JH, O’Connor TZ, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359:7–20.CrossRefPubMedGoogle Scholar
  20. 20.
    Bellomo R, Cass A, Cole L, et al. Intensity of continuous renal replacement therapy in critically ill patients. N Engl J Med. 2009;361:1627–38.CrossRefPubMedGoogle Scholar
  21. 21.
    Annane D, Bellissant E, Bollaert PE, et al. Corticosteroids in the treatment of severe sepsis and septic shock in adults: a systematic review. JAMA. 2009;301:2362–75.CrossRefPubMedGoogle Scholar
  22. 22.
    Venkatesh B, Myburgh J, Finfer S, et al. The ADRENAL study protocol: adjunctive corticosteroid treatment in critically Ill patients with septic shock. Crit Care Resusc. 2013;15:83–8.PubMedGoogle Scholar
  23. 23.
    Stevenson EK, Rubenstein AR, Radin GT, et al. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis. Crit Care Med. 2014;42:625–31.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    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;311:1308–16.CrossRefPubMedGoogle Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Intensive Care UnitSt Vincent’s HospitalDarlinghurstAustralia
  2. 2.Intensive Care UnitWestmead HospitalWestmeadAustralia

Personalised recommendations