News in Sepsis with Implications in Clinical Practice
DOI:
https://doi.org/10.24950/rspmi.786Keywords:
Intensive Care Units, Sepsis, Systemic Inflammatory Response SyndromeAbstract
Sepsis is the body response to infection. In case of severe sepsis there
are three proven interventions that can save lives: 1. Early recognition
and severity stratification; 2. Optimize O2 delivery (DO2) to prevent and
support organ dysfunction; 3. Focus control with proper antibiotics and
surgery/drainage (when indicated). After 2012 SSC recommendations
several papers have been published changing state of the art for clinical
practice.The initial manifestations depend on the immune status and
the presence of comorbidities. The number of SIRS criteria clinically
recognized correlates with prognosis and demand the research for
severity criteria that, when installed, establish urgent intervention procedure.
Disoxia manifestations (hyperlactatemia) of hypotension that
do not respond to proper volume infusion and/or are associated to
organ dysfunction, once again, are the most serious. Fluid’s prescription
in sepsis should not include starches, gelatins or hyperosmotic
fluids. It has been recognized that albumin has no deleterious effects
on sepsis but is not recommended for hemodynamic stabilization.
Balanced crystalloid are preferred as fluids for resuscitation because
of the risk hyperchloremicacidosis with 0.9% saline. Presently no fluid
is recommended as the ideal one. Ultrasounds, along with the patient
itself, have an important role in the differential diagnosis and severity
stratification, evaluating treatment response and identifying the cause
of sepsis. Severity stratification and treatment monitoring should follow
the “2O+2C” strategy, resumed in 4 questions: How is oxygenation?
How is circulation? How are organs? How is the cell? Severe sepsis is
an emergency requiring immediate treatment.
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