![]() Tachycardia, hypotension, warm and flushed skin (vasodilation), poor capillary refill, new murmur In this article, use of the term sepsis includes both sepsis and septic shock unless otherwise specified. Lactate level, an indirect marker of tissue perfusion, has been incorporated in the diagnosis of septic shock in addition to the need for vasopressor therapy required to maintain mean arterial pressure of greater than 65 mm Hg. It is now recognized that hypotension can be a late manifestation, and tissue hypoperfusion precedes hypotension. 8 Previously, septic shock was identified by the presence of hypotension. Septic shock is defined as sepsis with circulatory, cellular, and metabolic dysfunction that is associated with a higher risk of mortality. 8, 9 Sepsis is now defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. 8, 9 The terminology was simplified, and sepsis and septic shock are now the only recognized terms. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were published by the European Society of Intensive Care Medicine and the Society of Critical Care Medicine and incorporated into the Surviving Sepsis Campaign (SSC) International guidelines in 2016. Multiple studies with head-to-head comparisons of norepinephrine and other vasopressors and a meta-analysis showing that norepinephrine reduces sepsis-related mortality Norepinephrine is the first-line vasopressor agent for patients with septic shock if initial fluid resuscitation fails to restore mean arterial pressure to 65 mm Hg or greater. Systematic reviews and retrospective trialsĪs part of fluid resuscitation, patients with sepsis should receive an intravenous crystalloid at 30 mL per kg. Patients with sepsis should complete the sepsis bundle (fluid resuscitation, antibiotics, lactate measurement, and cultures) within three hours of presentation. Sepsis care protocols decrease sepsis-related mortality and should be implemented in all medical facilities. Validation studies and retrospective analysis of observational studies In settings other than the intensive care unit, the quick Sequential Organ Failure Assessment () can help clinicians recognize possible sepsis early in the evaluation. Future trials of sepsis management are focusing on improving long-term rates of readmission and death, physical disability, cognitive impairment, and quality of life. Vasopressor therapy is indicated if hypotension persists despite fluid administration. The latest guidelines recommend starting antimicrobials within one hour, but this is controversial. Most research indicates that antimicrobial therapy should be started within three hours of presentation. Antimicrobial therapy should also be initiated early. Fluid resuscitation is the priority in early management, including administering an intravenous crystalloid at 30 mL per kg within the first three hours. Initial evaluation of patients with suspected sepsis includes basic laboratory tests, cultures, imaging studies as indicated, and sepsis biomarkers such as procalcitonin and lactate levels. Although many patients with sepsis have fever, the clinical manifestation can be subtle, particularly in older patients and those who are immunocompromised. Pneumonia is the most common cause of sepsis. Respiratory, gastrointestinal, genitourinary, and skin and soft tissue infections are the most common sources of sepsis. The guidelines recommend the Sequential Organ Failure Assessment (original and quick versions) as an important tool for early diagnosis. ![]() The measurement of serum lactate has been incorporated into the latest septic shock definition. The guidelines define septic shock as sepsis with circulatory, cellular, and metabolic dysfunction that is associated with a higher risk of mortality. Guidelines published in 2016 provide a revised definition of sepsis: life-threatening organ dysfunction caused by a dysregulated host response to infection.
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