Sepsis in 2018: a review

Abstract

Abstract Sepsis is responsible for tremendous morbidity, mortality and healthcare expenditure worldwide. Recently, the conceptualization of sepsis has shifted away from one based upon the inflammatory response to infection to one based upon a dysregulated immune response and resulting organ dysfunction. Revised definitions of sepsis and septic shock have been proposed in order to improve the specificity of the diagnostic criteria and to provide tools to facilitate accurate and timely (i.e. early) diagnoses at the bedside. The crux of sepsis management remains early identification and diagnostic testing, early antimicrobial therapy, and early haemodynamic resuscitation. The most recent guidelines recommend that first steps in this process should take place within 1 hour from when sepsis is suspected. Additional important new elements in the most recent sepsis management guidelines include the use of dynamic parameters to assess fluid responsiveness, a conservative fluid strategy following initial resuscitation (with ‘de-resuscitation’ when possible), serial re-assessments of haemodynamic status, and adaptable treatment plans. This article provides a summary of the most recent clinical evidence and professional guidelines for the diagnosis and treatment of the sepsis in the critical care setting.