Sepsis, septic shock and multiple organ failure

Sepsis is one of the most frequent causes of unplanned ICU admission. It is responsible for more than 65,000 admissions annually in the UK and an estimated 750,000 in the USA, with a reported mortality of between 28% and 50%. The pathophysiology of sepsis results from a complex interaction of cellular and inflammatory mediators. Early identification of severe sepsis should improve survival. However, the diagnosis is not always straightforward. The treatment priorities in severe sepsis can be summarized as: prompt recognition and early resuscitation; appropriate antibiotic therapy after obtaining specimens for culture; search for and treatment of focus of infection; adjunctive therapies, including recombinant human activated protein C, steroids and blood glucose control; support for failing organ systems. The Institute for Healthcare Improvement promotes the use of care bundles to encourage change in current practice. Genetic markers that will allow the determination of the host response and provide a key for subsequent treatment may become available in the future.