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Review
. 2023 Sep 4;11(9):2231.
doi: 10.3390/microorganisms11092231.

Management of Sepsis and Septic Shock: What Have We Learned in the Last Two Decades?

Shiwani Kamath  1 , Hiba Hammad Altaq  1 , Tony Abdo  1
Affiliations
Review

Management of Sepsis and Septic Shock: What Have We Learned in the Last Two Decades?

Shiwani Kamath et al. Microorganisms. .

Abstract

Sepsis is a clinical syndrome encompassing physiologic and biological abnormalities caused by a dysregulated host response to infection. Sepsis progression into septic shock is associated with a dramatic increase in mortality, hence the importance of early identification and treatment. Over the last two decades, the definition of sepsis has evolved to improve early sepsis recognition and screening, standardize the terms used to describe sepsis and highlight its association with organ dysfunction and higher mortality. The early 2000s witnessed the birth of early goal-directed therapy (EGDT), which showed a dramatic reduction in mortality leading to its wide adoption, and the surviving sepsis campaign (SSC), which has been instrumental in developing and updating sepsis guidelines over the last 20 years. Outside of early fluid resuscitation and antibiotic therapy, sepsis management has transitioned to a less aggressive approach over the last few years, shying away from routine mixed venous oxygen saturation and central venous pressure monitoring and excessive fluids resuscitation, inotropes use, and red blood cell transfusions. Peripheral vasopressor use was deemed safe and is rising, and resuscitation with balanced crystalloids and a restrictive fluid strategy was explored. This review will address some of sepsis management's most important yet controversial components and summarize the available evidence from the last two decades.

Keywords: colloids; corticosteroids; crystalloids; early goal-directed therapy; sepsis; septic shock; surviving sepsis campaign; vasopressors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Key randomized controlled trials investigating resuscitation with different colloids and crystalloids in critically ill patients, including patients with sepsis and septic shock. HES: hydroxyethyl starch, ARF: acute renal failure, RRT: renal replacement therapy, ICU: intensive care unit.
Figure 2
Figure 2
Key randomized controlled trials comparing balanced crystalloids to normal saline in critically ill patients, including patients with sepsis and septic shock. AKI: acute kidney injury. MAKE 30: Major Adverse Kidney Events within 30 days, a composite endpoint of mortality, treatment with kidney replacement therapy, and/or doubling creatinine, PL-148: Plasma-Lyte 148, RRT: renal replacement therapy, TBI: traumatic brain injury.
Figure 3
Figure 3
Key randomized controlled trials of corticosteroids in sepsis and septic shock. RRT: renal replacement therapy.
See this image and copyright information in PMC

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