From the Research
Introduction to Sepsis Management
Sepsis, also known as Systemic Inflammatory Response Syndrome due to infection, is a clinical syndrome that results from the dysregulated inflammatory response to infection, leading to organ dysfunction 1. The management of sepsis has evolved significantly over the years, driven by advances in understanding its pathophysiology.
Definition and Pathophysiology
The definition of sepsis has undergone significant changes, from the 1991 American College of Chest Physicians/Society of Critical Care Medicine definition based on the criteria of systemic inflammatory response syndrome, to the 2016 Sepsis-3 definition that incorporates the Sequential Organ Failure Assessment score 2. Sepsis is characterized by a dysregulated inflammatory response to infection, leading to organ dysfunction.
Management of Sepsis
The management of sepsis involves early goal-directed therapy, which includes early identification of at-risk patients and prompt treatment with:
- Antibiotics to target the underlying infection
- Hemodynamic optimization to improve stroke volume
- Vasopressors to counteract vasoplegic shock
- High-quality supportive care, including aggressive fluid resuscitation and shock reversal 3, 1, 2
- Source control, which is critical in preventing the spread of infection and reducing morbidity and mortality 4
Treatment Strategies
Treatment strategies for sepsis include:
- Early administration of antibiotics, with a focus on appropriate dosing and duration of therapy
- Fluid resuscitation to optimize intravascular volume and improve stroke volume
- Vasopressors to counteract vasoplegic shock
- Supportive care, including lung protective ventilation, judicious use of blood products, and strategies to reduce nosocomial infections 1, 5
- Novel therapies, such as vitamin C, which are still investigational but show promise in refractory septic shock 4
Dosing and Duration of Therapy
The dosing and duration of antibiotic therapy should be individualized based on the patient's condition and the severity of the infection. The Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial has challenged the previous paradigm of length of antibiotic treatment, and biomarkers such as procalcitonin are playing a prominent role in individualizing therapy 4.
Caveats and Considerations
The management of sepsis requires a multidisciplinary approach, with collaboration between healthcare providers, surgeons, and other specialists. The public health role of the surgeon is key, including collaboration and multi-disciplinary antibiotic stewardship at a hospital level, as well as controlling pharmaceutical sales and the unregulated dispensing of antibiotic agents globally through policy initiatives to control emerging resistance through prevention 4. Artificial intelligence, machine learning, and bedside scoring systems can assist the clinician in predicting post-operative sepsis, and care bundles continue to be updated by the Surviving Sepsis Campaign, although their global adoption remains controversial 4.