What are the goals and management principles for the treatment of sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

The treatment of patients with septic shock has the following major goals:

  • Start adequate antibiotic therapy (proper dosage and spectrum) as early as possible

  • Identify the source of infection, and treat with antimicrobial therapy, surgery, or both (source control)

  • Resuscitate the patient, using supportive measures to correct hypoxia, hypotension, and impaired tissue oxygenation (hypoperfusion)

  • Maintain adequate organ system function by maintaining blood flow and arterial pressure, guided by cardiovascular monitoring, and interrupt the progression to multiple organ dysfunction syndrome (MODS) by appropriate antibiotics and surgical debridement, as needed

Management principles, based on the current literature, include the following:

  • Early recognition

  • Source control

  • Early and adequate antibiotic therapy

  • Early hemodynamic resuscitation and continued support

  • Proper ventilator management with low tidal volume in patients with acute respiratory distress syndrome (ARDS)

Initial treatment includes support of respiratory and circulatory function, supplemental oxygen, mechanical ventilation, and volume infusion. Treatment beyond these supportive measures includes antimicrobial therapy targeting the most likely pathogen, removal or drainage of the infected foci, treatment of complications, and interventions to prevent and treat effects of harmful host responses. Source control is an essential component of sepsis management.


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