title: Roundtable debate: Controversies in the management of the septic patient--desperately seeking consensus.
abstract: Despite continuous advances in technologic and pharmacologic management, the mortality rate from septic shock remains high. Care of patients with sepsis includes measures to support the circulatory system and treat the underlying infection. There is a substantial body of knowledge indicating that fluid resuscitation, vasopressors, and antibiotics accomplish these goals. Recent clinical trials have provided new information on the addition of individual adjuvant therapies. Consensus on how current therapies should be prescribed is lacking. We present the reasoning and preferences of a group of intensivists who met to discuss the management of an actual case. The focus is on management, with emphasis on the criteria by which treatment decisions are made. It is clear from the discussion that there are areas where there is agreement and areas where opinions diverge. This presentation is intended to show how experienced intensivists apply clinical science to their practice of critical care medicine.
authors.affiliation: Pulmonary Critical Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. ABWaxman@partners.org
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Waxman
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ward
authors.forename: Taylor
authors.initials: T
authors.lastname: Thompson
authors.forename: Craig M
authors.initials: CM
authors.lastname: Lilly
authors.forename: Alan
authors.initials: A
authors.lastname: Lisbon
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hill
authors.forename: Stanley A
authors.initials: SA
authors.lastname: Nasraway
authors.forename: Stephen
authors.initials: S
authors.lastname: Heard
authors.forename: Howard
authors.initials: H
authors.lastname: Corwin
authors.forename: Mitchell
authors.initials: M
authors.lastname: Levy
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D032921:Consensus; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D011486:Protein C / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012151:Resuscitation / Q000379:methods; D012772:Shock, Septic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated