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Semin Respir Crit Care Med 2019; 40(05): 594-603
DOI: 10.1055/s-0039-1696981
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Current Controversies in Sepsis Management

Stephanie R. Moss
1   Department of Hospital Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio
2   Department of Pediatric Hospital Medicine, Pediatrics Institute, Cleveland Clinic Foundation, Cleveland, Ohio
,
Hallie C. Prescott
3   Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
4   VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
› Author Affiliations Funding This work was supported by K08 GM115859 (H.C.P.) from the National Institute of Health. The views expressed in the article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government.
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Publication History

Publication Date:
11 December 2019 (online)

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Abstract

The overarching goals of early sepsis management include early recognition, appropriate antibiotic therapy and source control, maintenance of hemodynamic stability, and supportive care of organ dysfunction. Despite increasing awareness of the global burden of sepsis, and general agreement on the goals of management, there is ongoing controversy regarding the implementation of specific treatment strategies to optimize patient outcomes. This article will address five current points of controversy in the management of sepsis and septic shock. These include optimal timing of antibiotics in patients with potential sepsis, the role of glucocorticoids in septic shock, vitamin C as a novel therapy for sepsis, the ideal intravenous fluid for resuscitation, and the optimal balance of fluid resuscitation and vasopressor administration in septic shock. For each of these topics, we review relevant literature, discuss areas of controversy, and present our current approach to management.

Keywords

septic shock - sepsis - hydrocortisone - critical illness - resuscitation
 

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