Current management of sepsis and septic shock

Sepsis remains a leading cause of death in the intensive care unit. With no specific sepsis therapies available, management currently relies on infection control and hemodynamic stabilization. Rapid diag-nosis enabling early initiation of appropri-ate therapy is essential to maximize sur-vival rates. Effective antimicrobial therapy should be started as soon as possible after diagnosis, with empirical choices based on likely pathogens, local microbiologi-cal patterns, and any recent antimicrobial therapy. At the same time, fluids and va-sopressor agents should be commenced to restore and maintain hemodynamic stability and adequate tissue perfusion. No effective immunomodulatory therapies are available, but some candidates are un-dergoing clinical trials. Better techniques for characterization of the degree of sepsis response in individual patients are needed to help target such agents more appropri-ately as some patients may benefit from immunosuppressive agents while others may require an immune stimulating in-tervention. The management of patients with septic shock is often complex and the development of sepsis teams should be encouraged so that the multiple compo-nents of treatment, e.g., insertion of intra-vascular lines, blood sampling for culture and biochemistry, positioning of required monitoring devices, fluid, antibiotic and vasoactive drug administration, etc, can be carried out simultaneously.