From the Guidelines
Sepsis and septic shock are distinct entities with different management strategies, and the primary goal is to reduce morbidity, mortality, and improve quality of life by promptly recognizing and treating these conditions with evidence-based practices, as recommended by the Surviving Sepsis Campaign guidelines 1.
Key Differences and Management Strategies
- Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, identified clinically using the Sequential Organ Failure Assessment (SOFA) score or the quick SOFA criteria (altered mental status, respiratory rate ≥22/min, systolic blood pressure ≤100 mmHg) 1.
- Septic shock is a subset of sepsis characterized by profound circulatory, cellular, and metabolic abnormalities associated with higher mortality, clinically identified by persistent hypotension requiring vasopressors to maintain mean arterial pressure ≥65 mmHg and serum lactate >2 mmol/L despite adequate fluid resuscitation 1.
- Management of both conditions requires:
- Prompt recognition and early antibiotic administration within 1 hour (broad-spectrum initially, then narrowed based on cultures) 1.
- Source control.
- Fluid resuscitation with 30 mL/kg crystalloids 1.
- For septic shock, norepinephrine is the first-line vasopressor (starting at 0.05-0.1 mcg/kg/min, titrated to effect), with vasopressin (0.03 units/min) or epinephrine added if needed 1.
- Hydrocortisone 200 mg/day may be considered if shock persists despite adequate fluid resuscitation and vasopressor therapy 1.
Importance of Early Recognition and Treatment
- Early identification and prompt administration of intravenous fluids are crucial in patients with sepsis and septic shock, with the goal of improving microvascular blood flow and increasing cardiac output 1.
- Initial resuscitation should be titrated to clinical response, rather than a predetermined protocol, and should include monitoring of clinical endpoints such as mean arterial pressure, skin color and capillary refill, mental status, and urinary output 1.
- The distinction between sepsis and septic shock matters, as septic shock carries a substantially higher mortality rate (>40%) compared to sepsis without shock (10-20%) and requires more aggressive hemodynamic support 1.
From the Research
Sepsis vs Septic Shock: Key Differences
- Sepsis is a life-threatening condition that occurs when the body's response to an infection damages its own tissues and organs [ 2 ].
- Septic shock is the most severe form of sepsis, characterized by persistent hypotension despite fluid resuscitation and the presence of tissue hypoperfusion [ 3 ].
Diagnosis and Treatment
- Early recognition of sepsis and septic shock is crucial, and treatment should include antibiotics, fluids, and vasopressors [ 2 ].
- The choice of antibiotic therapy is important, with studies suggesting that meropenem may have a lower mortality rate compared to piperacillin-tazobactam in critically ill patients with sepsis and septic shock [ 4 ].
- Fluid resuscitation and vasopressor administration play a crucial role in maintaining tissue perfusion in septic shock patients [ 3 ].
Clinical Decision Making
- Clinicians should be aware of the importance of timely and appropriate treatment, as delays in diagnosis and initiation of treatment can increase the risk of mortality [ 3 ].
- The use of real-world evidence can inform clinical decision making, such as the impact of piperacillin-tazobactam dosing on clinical outcomes in septic shock patients [ 5 ].
- A standardized approach to diagnosis and treatment is essential, including the use of diagnostic tools and treatment strategies [ 6 ].