Article Abstract

Diagnosis and therapy of sepsis

Authors: Frank Bloos

Abstract

Sepsis is a condition, which arises when the host response to infection causes organ dysfunction. The sepsis definition has been reworked with fundamental changes in basic terminology of this condition. The Sepsis-3 task force derived diagnostic criteria for sepsis from a large database consisting of 148,907 patients with suspected infection. The definition of septic shock has been derived from a metaanalysis to define a subgroup of sepsis patient with an increased risk of death more than sepsis alone. The Surviving Sepsis Campaign (SSC) has updated their recommendations for sepsis diagnosis and therapy. Early and adequate antimicrobial therapy, fluid resuscitation using crystalloids, and maintaining arterial blood pressure with norepinephrine remain the cornerstones of initial sepsis therapy. The concept of early goal directed therapy (EGDT) has been abandoned. In addition, the SSC-guidelines make comprehensive recommendations regarding the management of sepsis patients on the intensive care unit (ICU). Several treatment strategies tried to address the systemic inflammation as one of the underlying mechanism for the development of the multiorgan dysfunction syndrome. This inflammatory host response in sepsis may be addressed by treatment with hydrocortisone, immunoglobulins, and cytokine removal techniques. Of these, only low-dose hydrocortisone is recommended in patients with septic shock unresponsive to resuscitation.