Current Management of Gram-Negative Septic Shock

Jean-Louis Vincent; Wasineenart Mongkolpun


Curr Opin Infect Dis. 2018;31(6):600-605. 

In This Article


The management of septic shock is challenging, but good and appropriate treatment can make a clear difference in complication rates and survival. The likely outcome can be influenced by many factors including the pathogenicity of the infecting bacteria, the speed of diagnosis, and various host factors, including immune status and comorbidities. Hence, treatment should be individualized and guided by repeated clinical and laboratory review. Importantly, septic shock is always associated with increased blood lactate levels, and blood lactate levels should be measured serially (typically every hour) to be sure they are decreasing with time, which indicates that the resuscitation process is effective. If lactate levels do not decrease then the diagnosis and/or ongoing treatment should be reexamined. As the treatment of septic shock involves multiple diverse interventions all of which need to be performed rapidly without delay, a team approach should be used, not only during working hours but 24 h a day.