Current Controversies in Sepsis Management

Stephanie R. Moss, MD; Hallie C. Prescott, MD, MSc


Semin Respir Crit Care Med. 2019;40(5):594-603. 

In This Article


In summary, sepsis is a heterogeneous response to infection that requires a multifaceted approach to management. There remains uncertainty in how to optimize multiple aspects of sepsis management to improve patient outcomes. Antibiotics should be given promptly when there is clinical suspicion of sepsis, and as soon as possible in the cohort of patients with the greatest illness severity. Glucocorticoids are effective in reducing time to shock reversal, but their role in reducing mortality is less certain. We favor their use in patients with high or persistent vasopressor requirements. There are ongoing RCTs to better evaluate the potential role for vitamin C in sepsis. We are awaiting the results of these trials before incorporating vitamin C supplementation into our practice. Content and quantity of fluid resuscitation are undergoing rigorous evaluation after longstanding historical rather than evidence-based practice. While additional data accrue, we favor balanced fluids, an initial 30 mL/kg bolus for sepsis-induced hypotension or lactic acidosis, and prompt initiation of vasopressors for patients who remain hypotensive. We look forward to learning the results of multiple ongoing and planned RCTs to help refine our early sepsis management.