Sepsis in the critically ill patient: current and emerging management strategies

ABSTRACT

Introduction: Sepsis, a dysregulated host response to infection, is a major cause of morbidity and mortality worldwide. Early identification and evidence-based treatment of sepsis are associated with improved outcomes.

Areas covered: This narrative review was undertaken following a PubMed search for English language reports published before July 2020 using the terms ‘sepsis,’ ‘septic shock,’ ‘fluids,’ ‘fluid therapy,’ ‘albumin,’ ‘corticosteroids,’ ‘vasopressor.’ Emerging management strategies were identified following a search of the ClinicalTrails.gov database using the term ‘sepsis.’ Additional reports were identified by examining the reference lists of selected articles and based on personnel knowledge of the field of sepsis.

Expert opinion: The core treatment of sepsis relies on source control, early antibiotics, and organ support. The main emerging strategies focus on immunomodulation, artificial intelligence, and on multi-omics approaches for a personalized therapy.

KEYWORDS:

• Septic shock
• intensive care unit
• corticosteroids
• vasopressors
• resuscitation fluids

Article highlights

• Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.

• Sepsis is a major cause of morbidity and mortality worldwide.

• First line treatments include early administration of appropriate antimicrobial therapy and source control, associated with organ support.

• The basics of hemodynamic management of sepsis rely on administration of fluids and vasopressors, guided by dynamic assessment of cardiovascular indices and of lactate levels.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.