BMJ  2007;335:929-932 (3 November), doi:10.1136/bmj.39346.696620.AE

Clinical Review

Management of sepsis

Iain Mackenzie, consultant in intensive care medicine and anaesthesia1, Andrew Lever, professor of infectious diseases and honorary consultant physician2

1 John Farman Intensive Care Unit, Box 17, Addenbrooke's Hospital, Cambridge CB2 2QQ, 2 Department of Medicine, University of Cambridge, Cambridge

Correspondence to: I Mackenzie  iain@number2.demon.co.uk

The first 150 words of the full text of this article appear below.

This is the second of two reviews—the first discussed the definition, epidemiology, and diagnosis of sepsis, whereas this one focuses on management and outcome. Management of sepsis can conveniently be divided into general supportive measures and specific treatment.


A favourable outcome depends on early, aggressive, treatment
Antimicrobial treatment must take into account both patient susceptibilities and local resistance patterns; advice from infectious disease or microbiology colleagues is often helpful
Volume resuscitation and cardiovascular support should be titrated to simple clinical end points
Subtle signs of organ hypoperfusion should be sought in physically robust patients
The role of activated protein C and low dose steroids remains to be clarified


Circulatory compromise arises from the combination of vasodilatation, capillary leak, and reduced myocardial contractility, and needs early correction. Whether crystalloids or colloids are better for volume resuscitation remains unresolved. Few people now use human albumin after a controversial meta-analysis concluded that albumin . . . [Full text of this article]


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This article has been cited by other articles:

  • Lee, S., Hinz, A., Bauerle, E., Angermeyer, A., Juhaszova, K., Kaneko, Y., Singh, P. K., Manoil, C. (2009). Targeting a bacterial stress response to enhance antibiotic action. Proc. Natl. Acad. Sci. USA 106: 14570-14575 [Abstract] [Full text]  
  • Reid, L. E M (2007). Surviving sepsis campaign's recommendations. BMJ 335: 1007-1007 [Full text]  

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