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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2008 Maggio;74(5):181-95
Management of sepsis
Schuerholz T., Marx G.
Clinic of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University, Jena, Germany
An early diagnosis of sepsis prior to the onset of clinical decline is of particular interest to health practitioners because this information increases the possibilities for early and specific treatment of this life threatening condition. In comparison to acute myocardial infarction or ischemic stroke, the time to initiate therapy is thought to be crucial and the major determining factor for surviving sepsis. The treatment of severe sepsis and septic shock consists of source control, early antimicrobial therapy, and supportive and adjunctive therapies. For supportive therapy, an adequate volume loading is the most important step in the treatment of patients with sepsis. This step is performed in order to restore and maintain oxygen transport and tissue oxygenation. Therefore, the supportive treatment should focus on adequate volume resuscitation and appropriate use of inotropes and vasopressors. Within the first 24 h after the initial sepsis-induced organ failure, adjunctive therapies can help to decrease mortality in patients suffering from severe sepsis and septic shock. Ongoing research continues to provide new information on the management of sepsis. However, implementing new medical advances in the management of sepsis into daily clinical intensive care remains a major hurdle. High quality management tools are necessary to bring evidence-based therapy to the bedside. With respect to recently published studies, the importance of the time taken to improve the outcome of sepsis can not be overemphasized.