Sepsis in the intensive care unit

Sepsis remains a major cause of mortality in intensive care. The past 10 years has seen a more uniform, worldwide approach to the management of sepsis, severe sepsis and septic shock. This has resulted in improved survival. It is important to recognize the early symptoms and signs of sepsis; the confused, hypoxic, hypotensive patient with pyrexia, tachycardia, tachypnoea and leucocytosis. Examination must include finding a source for infection and early drainage or debridement. Next take appropriate cultures, and give fluids and broad-spectrum antibiotics. If the picture does not improve over the next 6 hours step-up the treatment to include urine output, blood gases for base excess, lactate, haemoglobin, and glucose. These will guide the management of vasopressors, insulin, fluids, transfusion and bicarbonate. If the hypotension persists (septic shock) the patient should be moved to intensive care. Steroids should be added and additional inotropes. This should be instituted with 24 hours of the start of sepsis. Further advanced care may include mechanical ventilation which requires special consideration. Prevention by screening, stopping cross-infection and appropriate use of antibiotics remains the first priority.