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

Clinical Review

Management of sepsis

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

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.

Summary points 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

What are the general supportive measures?

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]

Box 1 Clinical and functional end points for titration of fluid resuscitation
Box 2 Resuscitation end points in the study by Rivers and colleagues⁶

What specific treatments are available?

Antimicrobials
Corticosteroids
Immunoglobulins and statins
HMGB-1

Multiple system organ failure and outcome

Box 3 Common sequence of organ failure
Primary involvement
Secondary involvement
Tertiary involvement

Conclusion

Sources and selection criteria
Tips for non-specialists
Additional educational resources
Information resources for patients

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