Sepsis: A Review of Advances in Management

Abstract

Infections represent a common health problem in people of all ages. Usually, the response given to them is appropriate and so little treatment is needed. Sometimes, however, the response to the infection is inadequate and may lead to organ dysfunction; this is the condition known as sepsis. Sepsis can be caused by bacteria, fungi or viruses and at present there is no specific treatment; its management basically focuses on containing the infection through source control and antibiotics plus organ function support. This article reviews key elements of sepsis management, focusing on diagnosis, biomarkers and therapy. The main recent advance in therapy is the strategy of personalized medicine, based on a precise approach using biomarkers to identify specific individuals who are likely to benefit from more personalized attention.

Keywords: Bacteremia; Critically ill patients; Pneumonia; Sepsis; Septic shock.

Fig. 1

Hemodynamic monitoring alternatives depending on the evolution and septic patient’s clinical status (in the authors’ practical experience). MAP mean arterial pressure, CVP central venous pressure, SvcO ₂ central venous oxyhemoglobin saturation, ΔpCO ₂ venous to arterial pCO₂ difference, TT transthoracic, PiCOO pulse contour cardiac output

Fig. 2

Scheme of initial treatment of patients in septic shock. MAP mean arterial pressure, CVP central venous pressure, SvcO ₂ central venous oxyhemoglobin saturation, VM mechanical ventilation, IAP intra-abdominal pressure, PiCOO pulse contour cardiac output, IC Immunocompromissed, CO cardiac output, CI cardiac index, PPV pulse pressure variation, SVV systolic volume variation, Ao aorta, Δ dynamics variables (systolic volume or pulse pressure variation)