Description
Sepsis is a life-threatening condition that demands early recognition and prompt management. It typically arises as the body's extreme response to an infection, and its progression can be rapid. Early recognition involves identifying signs such as fever, rapid heart rate, and altered mental state. Once suspected, immediate medical attention is crucial. Management often requires antibiotics, intravenous fluids, and, in severe cases, admission to an intensive care unit for close monitoring and supportive care. Early intervention is vital in sepsis to prevent it from advancing to severe septic shock, which has a higher mortality rate. Hence, sepsis demands swift recognition and timely medical intervention for the best possible outcomes.
Résumé
- Sepsis is a global health problem with high mortality, requiring early identification and treatment. Three definitions have been developed, but none are fully satisfactory. The Sepsis-3 definition defines it as life-threatening organ dysfunction caused by a dysregulated host response to infection. Screening tools, including SIRS, MEWS, and qSOFA, play a crucial role in identifying sepsis patients for prompt treatment and transfer to the ICU.
- The pathophysiology of sepsis involves a complex interplay of cytokines, with interleuking-mediated reactions and compensatory anti-inflammatory responses. Imbalance between these leads to immunoparalysis, increasing the risk of secondary infections and organ failure. Early intervention is vital to improve outcomes by addressing this imbalance before it progresses.
- The Surviving Sepsis Campaign emphasizes the "first hour bundle," including measuring lactate, obtaining blood cultures before antibiotics, administering broad-spectrum antibiotics, and initiating IV fluids and vasopressors. Crystalloid solutions are the preferred initial fluid choice (30 ml/kg), and vasopressor support (norepinephrine) is initiated to maintain a mean arterial pressure (MAP) above 65 mmHg.
- Fluid management strategies have evolved from liberal to restrictive approaches. Crystalloids, particularly normal saline initially (up to 2 liters), are favored, switching to balanced crystalloid solutions beyond that. Albumin may be considered in certain cases, while colloids like hydroxyethyl starch and gelatin are generally avoided. Restrictive fluid strategies are now preferred over liberal strategies.
- Norepinephrine is the first-line vasopressor, without a ceiling dose, although higher doses (>1 mcg/kg/min) are associated with poorer outcomes. Adjunctive therapies such as hydrocortisone, levosimendan, and methylene blue may be considered in refractory shock. Extracorporeal blood purification methods may offer some benefit in select cases.
- Effective resuscitation involves considering both macro and microcirculatory parameters. Early Goal-Directed Therapy (EGDT) has become less emphasized, while capillary refill time and lactate levels serve as indicators. Broad-spectrum antibiotics should be initiated based on the suspected source of infection and local antibiograms.
- Improving sepsis outcomes requires increasing public awareness, establishing sepsis registries, and implementing performance improvement programs adhering to established bundles. Early recognition, prevention, and adherence to evidence-based practices are key.
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