Sepsis is a potentially fatal or life-changing condition that arises when the body’s immune system reacts to an infection, which results in organ dysfunction. The response causes harm to the body’s tissues and organs, which leads to shock, multiple organ failure, and in severe cases, death if not treated.

Sepsis can affect individuals of any age and include pregnant women or those with underlying health conditions who are at high risk. Symptoms of sepsis include fever, rapid heart rate, breathing difficulties, confusion, and body pain, progressing to septic shock or multiple organ failure if left untreated.

Sepsis is primarily caused by bacterial infections, which can also result from viral, parasitic, or fungal infections.

Sepsis can be differentiated in three stages:

Stage one: Identifying sepsis can be challenging for clinicians, but it often manifests with notable symptoms such as high body temperature, rapid heart rate, elevated respiratory rate, abnormal WBC count, and evidence of infection.

These signs indicate Systematic Inflammatory Response Syndrome, which is considered a broader category encompassing various conditions, including sepsis. Sepsis is diagnosed when two or more SIRS criteria are met in conjunction with confirmed or suspected infection.

Stage two: Second stage also known as severe sepsis, is identified when acute organ dysfunction emerges. This stage may also be recognized when sepsis coexists with hypotension (low blood pressure) or hypoperfusion (reduced blood flow to an organ).

Organ dysfunction presents with symptoms like decreased urine output, abrupt alterations in mental status, low blood platelet count, respiratory distress, impaired cardiac function, and abdominal pain.

Stage three: The third stage represents septic shock, the most critical phase of sepsis. It occurs when there is persistent hypotension, triggered by sepsis, even after fluid resuscitation.

Septic shock is characterized by perfusion abnormalities such as elevated lactate levels. This stage carries the highest risk of mortality, with estimates ranging from 30% to 50%.

What is the first line of treatment for sepsis?

The primary treatment for sepsis involves a rapid and systematic approach aimed at resuscitating the patient. This includes identifying and addressing the underlying infection through empirical administration of broad-spectrum antibiotics, fluid resuscitation to restore the perfusion, and control of the septic source if feasible.

The initial resuscitation phase, particularly the first six hours, is critical for reducing mortality rates, and standardized protocols like Early Goal-Directed Therapy (EGDT) have shown efficacy in improving outcomes.

Vital parameters such as central venous pressure, mean arterial pressure, urine output, and oxygen saturation are closely monitored and managed within specific target ranges to ensure adequate tissue perfusion and oxygenation.

What is the best management of sepsis?

The guidelines recommend the completion of specific bundles of care within the first three and six hours of recognizing severe sepsis or septic shock. Early initiation of appropriate antibiotics within the first hour of recognition, along with aggressive fluid resuscitation and vasopressor support, if necessary, forms the cornerstone of therapy.

Source control procedure should be initiated promptly, and continuous reassessment of the patient’s response to treatment guide further interventions.

Multidisciplinary coordination, including input from infectious disease specialists, intensivists, and surgeons, is essential for delivering optimal care to septic patients and improving clinical outcomes.

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