Reducing Mortality in Severe Sepsis and Septic Shock

Andrew T. Levinson, M.D., M.P.H.; Brian P. Casserly, M.D.; Mitchell M. Levy, M.D.

Disclosures

Semin Respir Crit Care Med. 2011;32(2):195-205. 

In This Article

Abstract and Introduction

Abstract

Severe sepsis is one of the most common reasons for critically ill patients to be admitted to an intensive care unit (ICU) and has very high associated morbidity and mortality. The Surviving Sepsis Campaign was initiated with the hope that mortality might be reduced by standardizing care informed by data from an increasing number of clinical trials. Important methods for reducing mortality identified by recent studies include aggressive fluid resuscitation, early goal-directed therapy (EGDT), early administration of antibiotics, and the administration of activated protein C to eligible patients.

Introduction

Patients with severe sepsis requiring intensive care unit (ICU) admission have very high rates of ICU and overall hospital mortality, with estimates ranging from 18 to 50%.[1,2] A large observational cohort study in the United States found an overall hospital mortality rate of 28%.[3] In a multicenter European cohort study, the ICU mortality was 27% and the overall hospital mortality was 36%.[4] Risk factors for death from sepsis include underlying illness, increased age, and multisystem organ failure.[1,3,4] Progression from signs of the inflammatory response to sepsis/severe sepsis and septic shock is associated with an incrementally higher mortality risk.[5,6] The transition to serious illness may occur during the critical "golden hours," when definitive recognition and treatment provide maximal benefit in terms of outcome. Therefore, early recognition of sepsis is of paramount importance in reducing mortality.[7] There is evidence of significant variation in the management of early severe sepsis.[8,9] In contrast, standardization of the management and implementation of evidence-based interventions in diseases such as acute myocardial infarction has significantly improved patient outcome.[10] Education of health care providers about sepsis is critical to enhance the early identification of patients with sepsis. The Surviving Sepsis Campaign guidelines were devised as a means of increasing health care provider awareness throughout the world while simultaneously providing them with a model of optimal sepsis management.

This review summarizes the impetus behind the development of international consensus guidelines for treating patients with severe sepsis and septic shock. It examines the current evidence for specific recommendations and the impact of translating these guidelines into clinical practice on reducing mortality in patients with severe sepsis and septic shock.

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